Diabetes & Metabolic Syndrome: Clinical Research & Reviews
Original ArticleBody adiposity index as a risk factor for the metabolic syndrome in postmenopausal Caucasian, African American, and Filipina women
Introduction
Obesity or accumulated adiposity is an important etiological factor in the clustering of clinical conditions that comprise the metabolic syndrome (MetS) [1]. These conditions include central obesity, hypertension, hyperglycemia, and dyslipidemia [2], [3]. Having the MetS in turn, predisposes individuals for more serious chronic clinical outcomes, such as cardiovascular disease (CVD), type 2 diabetes, and possibly some cancers [2], [4].
Although, high precision imaging techniques, including computed tomography (CT) or dual-energy X-ray absorptiometry (DXA) imaging, are considered to be the gold standard for measuring fat distribution, their clinical value is often undermined by the cost and time burden associated with CT or DXA. Therefore, other markers including weight, waist circumference, skinfold patterns, BMI and waist–hip ratio are used as convenient and economical clinical proxies to evaluate adiposity [5], [6]. While anthropometric thresholds provide a general assessment of risk, they may not provide a valid basis for comparisons between ethnic groups, and ethnic specific thresholds must be considered [7], [8], [9].
Previous reports have shown the importance of considering ethnic differences in fat distribution when assessing adiposity using BMI [10], [11]. Persons from different ethnic groups with similar BMIs can be at dissimilar risks for poor health outcomes attributable to increased adiposity. For example, several studies suggest that despite similar BMI, Indians, Asians, and Filipina women living in the US have higher visceral adipose tissue compared to Caucasians. while African American women have less visceral adipose tissue despite significantly larger BMI [12], [13]. Also, variations of body fat do not correlate with BMI variations in Mexican American, non-Hispanic White, and non-Hispanic Black adolescents [14].
A recent analysis by Bergman and colleagues, reported that the body adiposity index (BAI) based on hip circumference and height, was highly correlated with DXA measures of body fat in relatively young African American and Mexican American men and women (average age 35 years) [15]. The applicability of this index has been studied in various populations such as middle-aged and elderly Caucasian adults, post-menopausal Caucasian women, multi-ethnic cohorts predominantly Caucasian or African American, and Chinese adults, however the conclusions drawn have been inconsistent [16], [17], [18], [19], [20], [21]. However, there have been no studies comparing BAI and its association with the MetS in older women of Caucasian, African American, and Filipino ethnicities.
The purpose of this study is to examine the association of BAI with other adiposity markers in Caucasian, African American, and Filipina women aged 50–70 years and to investigate the utility of BAI as a risk factor for the MetS in community dwelling women of these ethnicities.
Section snippets
Study population
Caucasian women in this study were members of the Rancho Bernardo Cohort who were initially enrolled in a community-based longitudinal study between 1972 and 1974 [22]. In 1997–1999, all surviving members of the original cohort were invited to participate in a research clinic visit focused on diabetes and its risk factors; approximately 70% of the locally residing, non-institutionalized cohort attended this visit. African American and Filipina women were enrolled as ethnic comparison groups to
Results
After adjustment for age, there were significant weight, waist circumference, and hip girth differences across all three ethnicities (see Table 1). Mean %BF, BAI and BMI were similar across Caucasian and Filipina women. However, African American women had significantly higher levels of truncal fat, leg fat, %BF, BAI and BMI but significantly lower triglycerides and total cholesterol than women in the other two ethnic groups. African American and Filipina women had similar mean systolic blood
Discussion
This study shows that BAI was more similar to DXA measured %BF than BMI when estimating the association with MetS. There were ethnic differences in the relation between adiposity and prevalent clinical conditions. In this analysis, African American women had significantly higher mean values for adiposity, including weight, BMI, BAI, %BF, and waist circumference than Caucasian and Filipina women. However, they had lower MetS prevalence compared to Filipina women.
To our knowledge, this is the
Acknowledgements
The data analyzed in this article were collected with support from the American Heart Association Grant 0070088Y, NIH/National Institute of Diabetes and Digestive and Kidney Diseases Grant R03 DK60575, NIH/National Institute on Aging Grant 5R01AG07181, and NIH/National Institute of Diabetes and Digestive and Kidney Diseases Grant 5R01DK31801.
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this article.
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