Body mass index, waist girth, and waist-to-hip ratio as indexes of total and regional adiposity in women: evaluation using receiver operating characteristic curves

Abstract

Receiver operating characteristic (ROC) curves were constructed to assess the value of body mass index (BMI) as a screening measure for total adiposity and to examine waist-to-hip ratio (WHR) and waist circumference as measures of central fat distribution. Body fat reference measurements were determined by dual-energy X-ray absorptiometry (DXA). The study population comprised 96 healthy white women aged 16-80 y. A positive reference test was defined as a result at or above the 75th percentile for our study population for all DXA measurements. Sensitivity and specificity were calculated at several percentile cutoffs for BMI, WHR, and waist girth. The areas under the ROC curves were calculated to compare the relative ability of each anthropometric technique to correctly classify subjects according to the reference measurement for that technique. BMI (our 75th percentile = 27.3) performed well as a screening measure of total adiposity, correctly identifying 83% of subjects with a high body fat mass while misclassifying only eight subjects [four false-negatives (subjects with high fat mass who were in the low BMI category) and four false-positives (subjects with a low fat mass who were in the high BMI category)]. The screening performance of WHR (our 75th percentile = 0.81) was lower, accurately categorizing 58% of subjects while misclassifying 28 subjects. By contrast, waist circumference (our 75th percentile = 86.9 cm) was significantly better than WHR at screening for regional fat distribution, accurately classifying 83% of subjects and misclassifying eight subjects (P < 0.05). We conclude that BMI and waist circumference provide simple yet sensitive methods for the estimation of total and central adiposity in groups of adult women.

Body composition and physical fitness of undernourished South African rural primary school children

“…One reason for these differences may be that in Western countries BMI and SSF are indicators of overnourishment (Viteri, 1971;Barac Nieto et al, 1978;Malina & Little, 1985;Martorell et al, 1992;Malina et al, 1998), while in this South African population, there is no overnourishment. A second reason for the opposite findings between the present study and Western studies may be that BMI is an indicator of fatness in Western countries, whereas in a population like ours, a high BMI may indicate higher muscle mass (Malina & Little, 1985;Malina et al, 1998;Taylor et al, 1998). This is supported by the fact that BMI was highly correlated with FFM and that the relationships between physical fitness and BMI were more or less the same as the relationships between physical fitness and FFM.…”

Waist circumference values in Spanish children—Gender related differences

“…However, in adults, waist girth is likely to be a more convenient anthropometric correlate of visceral adipose tissue than the waist-to-hip ratio because threshold values of waist girth corresponding to critical amounts of visceral adipose tissue do not appear to be in¯uenced by sex or by the degree of obesity (Lemieux et al, 1996). In adult women, waist circumference was also signi®cantly better than waist-to-hip ratio at screening for regional fat distribution, accurately classifying 83% of subjects (Taylor et al, 1998). In male and female 11 y old children, waist circumference and some skinfolds alone or skinfolds ratios were the best indicators of intraabdominal fat, as measured by magnetic resonance imaging (Fox et al, 1993).…”

Abdominal obesity and the prevalence of diabetes and intermediate hyperglycaemia in Chinese adults

“…Anthropometric indices such as BMI and waist circumference (WC) remain the most commonly used tools for assessing body composition because of their simplicity and low cost, and provide sensitive methods for the estimation of total and central adiposity in different population groups (4) .…”