What is the optimal anthropometric index/ratio associated with two key measures of cardio-metabolic risk associated with hypertension and diabetes?

Abstract

Background Few studies have investigated the optimal anthropometric index associated with potential cardio-metabolic risk. Using direct measures of standing height, body mass, and waist circumference, we sought to identify the optimal index for detecting cardio-metabolic risk associated with diabetes and hypertension in a nationally representative sample of US adults.

Methods Complete (non-missing) cross-sectional data from 8375 US adults aged 18–80+ years were obtained from the 2015–16 and 2017–March 2020 (pre-pandemic) cycles of the National Health and Nutrition Examination Survey. The cardio-metabolic risk was identified using blood pressure and glycohemoglobin (A1c). Allometric models were used to identify the optimal anthropometric indices associated with cardio-metabolic risk. Receiver operating characteristics curves were used to verify the discriminatory ability of the identified index in comparison with other anthropometric measures.

Results The optimal anthropometric index associated with cardio-metabolic risk was waist circumference divided by body mass to the power of 0.333 (WC/M0.333). The ability for this new index to discriminate those with diabetes (area under the ROC curve: 0.73 [95%CI: 0.71–0.74]) and hypertension (area under the curve: 0.70 [95%CI: 0.69–0.72]) was superior to all other anthropometric measure/indices investigated in this study (body mass index, waist circumference, waist-to-height ratio, and waist/height0.5).

Conclusions We identified WC/M0.333 as the optimal anthropometric index for identifying US adults with hypertension and diabetes. Instead of using body mass index (kg/m2), we recommend using WC/M0.333 in clinical and public health practice to better identify US adults at potential cardio-metabolic risk associated with hypertension and diabetes.