Dual Metrics of Obesity: Evaluating BMI and Central Obesity as Indicators of Cardiometabolic Risk in Rural India

Abstract

PurposeIndians face a higher risk of cardiometabolic diseases (CMDs) at the same BMI compared to Caucasians. This study explored the use of the Dual Metric Obesity Criteria (DMOC), combining central obesity (CO) indices with BMI, to assess sex-specific associations with CMDs in rural Indians.MethodsBaseline cross-sectional data from 3,397 participants aged ≥45 from the Centre for Brain Research-Srinivaspura Aging, Neuro Senescence and COGnition (CBR-SANSCOG) study were analysed. Five obesity indices were examined: BMI, Waist Circumference, Waist-Hip Ratio (WHR), Waist-Height Ratio (WHtR), and Visceral Fat Percentage. Cohen’s Kappa assessed the agreement between BMI and CO indices. Participants were classified based on BMI and CO status: NWNC (Normal Weight No CO), AWNC (Abnormal Weight No CO), NWCO (Normal Weight CO), and AWCO (Abnormal Weight CO). Multinomial logistic regression models evaluated associations between DMOC groups and CMDs. Interaction analyses explored CO and CMD relationships across sex, BMI categories, and age groups. The mediation effect of CO indices on the relationship between BMI and cardiometabolic risk factors was investigated.ResultsBMI showed a slight to fair agreement with WHR and moderate agreement with WHtR. Individuals with AWCO had the highest odds for all CMDs (p<0.001). Males with NWCO had a 3.51 (2.14,6.04) times increased odds times for diabetes and 2.04 (1.22,3.37) times odds for dyslipidemia. Individuals < 58 years and males had stronger associations with CMDs.ConclusionCombining CO indices with BMI effectively identifies high-risk CMD groups in rural Indians, including those with NWCO a previously overlooked group.