The present study simultaneously compared the ability of several popular anthropometric measurements to predict total body fat, CT-measured abdominal fat, and CVD risk factors in a large biracial sample of men and women. Each anthropometric measure exhibited moderate to high correlations with adiposity and CVD risk factors, and all variables were significant predictors of elevated cardiometabolic risk. Prior studies have suggested the use of one anthropometric measure over another. For example, BMI predicts fat mass14
; WC predicts abdominal visceral adiposity,15
CVD risk factors,16
; and BAI predicts percentage of fat.1
The present findings suggest that all anthropometric measurements performed similarly and consistently in estimating adiposity and CVD risk and the slight differences in correlations observed may not have clinical relevance or implications for health.
Because DXA and other imaging methods are not readily available in most epidemiological studies, finding a clinical measurement that captures general adiposity is important. It has been previously shown that BMI and BAI perform similarly when estimating percentage of fat.17
The present analyses indicate that weight, HC, WC, waist-height ratio, weight-height ratio, BAI, and BMI may be interchangeable measures for fat mass and percentage of fat because each was highly correlated with both fat mass (0.75-0.96) and percentage of fat (0.72-0.87) over all of the sex-by-race groups. Waist-hip ratio, however, was only moderately correlated with fat mass (0.38-0.65) and percentage of fat (0.30-0.65). Because waist-hip ratio is a measure of fat distribution, reflecting whether fat is deposited as an android (at trunk) or a gynoid (at the gluteofemoral region) pattern, it does not appear to adequately capture total fat mass.
Estimating depot-specific adipose tissue is also important because VAT and SAT may convey unique health risks.18
In the present study, each anthropometric measure was highly correlated with SAT, with the exception of waist-hip ratio. Most anthropometric measurements were only moderately or weakly correlated with VAT, with the strongest associations emerging for WC (0.61-0.71) and waist-height ratio (0.59-0.74). Waist-height ratio has previously shown the highest correlation (0.83) with intra-abdominal fat compared with WC, waist-hip ratio, or BMI.19
The present findings align with those in a prior study by Rankinen and colleagues,15
who compared the correlations between BMI, waist, and waist-hip ratio and visceral adiposity. In their study, all anthropometric measures performed moderately well in men (0.74-0.82), whereas the waist-hip ratio (0.39-0.49) was lower in women compared with BMI and WC (0.69-0.81). A robust anthropometric measure that reflects the deleterious effects of fat stored in the abdomen is needed. Although WC is often proposed as this measure because it has the strongest correlation with VAT, WC is actually a better indicator of total body fat mass (0.87-0.93). Future research is warranted to find a clinical measure that is highly correlated with VAT and SAT in a manner that takes into account the potential confounding effect of total adiposity.
Total and depot-specific fat, especially at excess levels, is used to predict health risk. Nearly all anthropometric measurements in the present study demonstrated low to moderate correlations with each CVD risk factor, but HC and BAI demonstrated no association with some risk factors. Of importance, differences among anthropometric measurements in associations with cardiometabolic risk were small. A previous study also found small differences among adiposity measures in relation to metabolic risk factors, indicating that although WC and waist-height ratio had higher associations, the abdominal and general adiposity measures can be considered equivalent.6
There were noticeably lower correlations between height and the measures of adiposity ( and ) compared with the other anthropometric measurements when separated by sex. When stratified by sex, controlling for height is unnecessary because there is little or no correlation between height and adiposity. However, when the group is taken as a whole, height exhibits a negative correlation with percentage of fat (−0.54 in our data), which is not surprising because men tend to be taller with less body fat and women tend to be shorter with more body fat, as confirmed in the present study. The newly proposed BAI used height in the equation due to the moderate correlation (−0.52) between height and percentage of fat, which was the second highest correlation from a single measure when both sexes were analyzed together.1
It is unknown what the sex-specific correlations with height were in that study and how strong the confounding effect resulting from pooling both sexes was.
An underlying principle of using anthropometric measurements in a clinical setting is that they aim to reflect body fat, which in turn can be used to assess health risk. Yet for women, the present data indicated slightly lower and less consistent correlations between DXA-measured percentage of fat and CVD risk factors than between VAT or WC, for example, and CVD risk factors. In men, VAT was correlated with CVD risk factors, including glucose in both African American and white men and HDL-C level, triglyceride level, and blood pressure in white men. A prior investigation of body composition and health risk found that percentage of fat did not perform better than BMI or WC in predicting metabolic risk.6
The lack of relationship between BAI and the risk factors is particularly novel because the BAI has only recently been proposed as a new index of adiposity. Our current results, combined with previous results,17
show that the BAI is not a better indicator of body fat or health risk than established anthropometric measures. The overarching goal of anthropometric research is to identify the optimal measure that can be used for accurate identification and surveillance of adverse health outcomes. For this reason, the value of having an anthropometric measure or index that is related to percentage of fat alone must be questioned unless it can also be related to health outcomes or mortality. A circumspect approach may be to use BMI due to the large accumulation of data, which can be used for comparison and reference purposes, or to use WC as a single measure to assess the relationship between adiposity and cardiovascular health.
A strength of this study is the large biracial sample that allowed for any sex and race differences to be highlighted. A limitation when comparing anthropometric measurements with image-based adiposity measures is the site of measurement. Although standard clinical procedures were used in the present study, the site of measurement for WC, for example, and the location of an imaging section can affect the association between anthropometry and VAT or SAT.20
However, a systematic review of 120 studies revealed that measurement site of WC does not appear to affect its association with CVD, diabetes, or mortality risk.21
A further limitation of the present study was that information on participants' medications, such as those used to treat hyperlipidemia, was not available. Another weakness of this study is the temporal dispersion of the baseline visits of 15 years because population health changes have occurred during this period. For instance, the use of lipid-lowering medications has increased during this period, and thus this cohort's use of medications might alter the associations between anthropometry and biochemical CVD risk factors. This study relied on volunteers at a research clinic, and these results should be replicated using representative population samples to determine the generalizability of the results to the wider population.