Comparison of multiple obesity indices for cardiovascular disease risk classification in South Asian adults: The CARRS Study

• Type of Material: Article
• Authors: Shivani Patel, Emory University; Mohan Deepa, Madras Diabetes Research Foundation; Roopa Shivashankar, Centre for Chronic Conditions and Injuries; Mohammed Ali, Emory University; Deksha Kapoor, All India Institute of Medical Sciences; Ruby Gupta, Centre for Chronic Conditions and Injuries; Dorothy Lall, Institute of Public Health Bengaluru; Nikhil Tandon, Centre for Chronic Conditions and Injuries; Viswanathan Mohan, Madras Diabetes Research Foundation; M. Masood Kadir, The Aga Khan University; Zafar Fatmi, The Aga Khan University; Dorairaj Prabhakaran, Centre for Chronic Conditions and Injuries; Kabayam Venkat Narayan, Emory University
• Language: English
• Date: 2017-04-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2017 Patel et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0174251
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 12
• Issue: 4
• Start Page: e0174251
• End Page: e0174251
• Grant/Funding Information: The CARRS Study was funded in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health, Department of Health and Human Services (contract no. HHSN268200900026C) and the United Health Group (Minneapolis, MN, USA).; RS is supported by a Wellcome Trust Capacity Strengthening Strategic Award Extension phase to the Public Health Foundation of India and a consortium of UK universities (WT084754/Z/08/A).
• Keywords: INDIANS; COUNTRIES; IDENTIFICATION; POINTS; SKINFOLD THICKNESS; WAIST CIRCUMFERENCE; Multidisciplinary Sciences, Science & Technology; Science & Technology; BODY-MASS INDEX; ACCURATE,; ABDOMINAL OBESITY; FAT
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Background: We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population. Methods: 8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol and report associations (prevalence ratios, PRs), discrimination (area-under-the-curve, AUCs), and calibration (index χ2). We also examined a composite unhealthy cardiovascular profile score summarizing glucose, lipids, and blood pressure. Results: No single obesity index consistently performed statistically significantly better than the others across the outcome models. Based on point estimates, WHtR trended towards best performance in classifying diabetes (PR = 1.58 [1.45-1.72], AUC = 0.77, men; PR = 1.59 [1.47-1.71], AUC = 0.80, women) and hypertension (PR = 1.34 [1.26,1.42], AUC = 0.70, men; PR = 1.41 [1.33,1.50], AUC = 0.78, women). WC (mean difference = 0.24 SD [0.21-0.27]) and WHtR (mean difference = 0.24 SD [0.21,0.28]) had the strongest associations with the composite unhealthy cardiovascular profile score in women but not in men. Conclusions: WC and WHtR were the most useful indices for identifying South Asian adults with prevalent diabetes and hypertension. Collection of waist circumference data in South Asian health surveys will be informative for population-based CVD surveillance efforts.