Anthropometric indicators of obesity. Are the new indicators a better predictor of body fat content than BMI?
DOI:
https://doi.org/10.12775/JEHS.2021.11.08.001Keywords
Relative Fat Mass (RFM), A Body Shape Index (ABSI), Body Adiposity Index (BAI), Body Roundness Index (BRI), Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), obesityAbstract
Anthropometric measurements are widely used in medicine, scientific research, but also in specialist medical care. Their proper use provides valuable information about the nutritional status, the adipose tissue and even the risk of comorbidities. Numerous scientific works question the usefulness of the BMI (body mass index), which is only an indirect measure of obesity. It does not take into account information on gender and age, and does not provide an answer on the distribution of body fat. Misclassification can result in serious deviations in the estimation of obesity-related effects. Therefore, the aim of this study is to present five new anthropometric obesity indicators as an alternative to BMI.
In response to the dramatically growing problem of overweight and obesity, further exacerbated by the necessary restrictions related to the COVID-19 pandemic, it is necessary to search for precise, yet simple tools for assessing body composition that can be routinely used by individuals but also for population studies. Based on the literature review, five frequently described indicators were selected: Relative Fat Mass (RFM), A Body Shape Index (ABSI), Body Adiposity Index (BAI), Body Roundness Index (BRI) and CUN-BAE. Application possibilities and their effectiveness for the estimation of adipose tissue content and the risk of coexisting diseases are presented.
Growing number of authors confirm the validity of using indicators such as RFM, BRI, CUN-BAE and ABSI. At the same time, researchers point to the need for further verification of their usefulness in clinical practice and public health.
References
Stefaniak A, Janion K, Ostręga W, Walkiewicz K, Nowakowska-Zajdel E. Nowe wskaźniki antropometryczne w aspekcie zwiększonej masy ciała osób dorosłych. Nowe trendy w dietetyce. Warszawa, Wydawnictwo Wyższej Szkoły Inżynierii i Zdrowia w Warszawie; 2019: 90-98.
Malik VS, Willet WC, Hu FB. Nearly a decade on — trends, risk factors and policy implications in global obesity. Nat Rev Endocrinol. 2000;16:615–616. doi:10.1038/s41574-020-00411-y
Abdelaal M, le Roux CW, Docherty NG. Morbidity and mortality associated with obesity. Ann Transl Med. 2017;5(7):161. doi:10.21037/atm.2017.03.107
Meisinger C, Doring A, Thorand B, et al. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study. Am J Clin Nutr. 2006;84:483-9. doi: 10.1093/ajcn/84.3.483
Klop B, Elte JW, Cabezas MC. Dyslipidemia in obesity: mechanisms and potential targets. Nutrients. 2013;5(4):1218-1240. doi:10.3390/nu5041218
Carbone S, Canada JM, Billingsley HE, Siddiqui MS, Elagizi A, Lavie CJ. Obesity paradox in cardiovascular disease: where do we stand?. Vasc Health Risk Manag. 2019;15:89-100. doi:10.2147/VHRM.S168946
Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, Jean-Louis G, McFarlane SI. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord. 2017;1(4):00019.
Pischon T, Nimptsch K. Obesity and Risk of Cancer: An Introductory Overview. Recent Results Cancer Res. 2016;208:1-15. doi: 10.1007/978-3-319-42542-9_1
Ortega FB, Sui X, Lavie CJ, Blair SN. Body Mass Index, the Most Widely Used But Also Widely Criticized Index: Would a Criterion Standard Measure of Total Body Fat Be a Better Predictor of Cardiovascular Disease Mortality? Mayo Clin Proc. 2016;91(4):443-455. doi: 10.1016/j.mayocp.2016.01.008
Mahadevan S, Ali I. Is body mass index a good indicator of obesity?. Int J Diabetes Dev Ctries. 2016;36:140–142. doi:10.1007/s13410-016-0506-5
World Health Organization (WHO). Obesity and overweight factsheet from the WHO.2021 Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Rothman K. BMI-related errors in the measurement of obesity. Int J Obes. 2008;32:56–59. doi:10.1038/ijo.2008.87
Nuttall FQ. Body Mass Index: Obesity, BMI, and Health: A Critical Review. Nutrition Today. 2015;50(3):117–128.
Banerji MA, Faridi N, Atluri R, Lebovitz HE, Chaiken RL. Body composition, visceral fat, leptin and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84:137–44. doi: 10.1210/jcem.84.1.5371
Shuster A, Patlas M, Pinthus JH, Mourtzakis M. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85(1009):1-10. doi:10.1259/bjr/38447238
Głuszek S, Cieśla E, Głuszek-Osuch M, Kozieł D, Kiebzak W, Wypchło Ł, Suliga E. Anthropometric indices and cut-off points in the diagnosis of metabolic disorders. PLoS One. 2020;15(6):e0235121. doi: 10.1371/journal.pone.0235121
Adab P, Pallan M, Whincup P H. Is BMI the best measure of obesity? BMJ. 2018; 360:k1274. doi:10.1136/bmj.k1274
Arroyo-Johnson C, Mincey KD. Obesity Epidemiology Worldwide. Gastroenterol Clin North Am. 2016;45:571-579. doi: 10.1016/j.gtc.2016.07.012
Zachary Z, Brianna F, Brianna L, Garrett P, Jade W, Alyssa D, Mikayla K. Self-quarantine and weight gain related risk factors during the COVID-19 pandemic. Obes Res Clin Pract. 2020;14(3):210-216. doi: 10.1016/j.orcp.2020.05.004
Bhutani S, Cooper JA. COVID-19–Related Home Confinement in Adults: Weight Gain Risks and Opportunities. Obesity. 2020;28:1576–1577. doi: 10.1002/oby.22904
Đogaš Z, Lušić Kalcina L, Pavlinac Dodig I, Demirović S, Madirazza K, Valić M, Pecotić R. The effect of COVID-19 lockdown on lifestyle and mood in Croatian general population: a cross-sectional study. Croat Med J. 2020;61(4):309-318. doi: 10.3325/cmj.2020.61.309
Chew HSJ, Lopez V. Global Impact of COVID-19 on Weight and Weight-Related Behaviors in the Adult Population: A Scoping Review. Int J Environ Res Public Health. 2021;18(4):1876. doi:10.3390/ijerph18041876
Choi HS, Cho YH, Lee SY, Park EJ, Kim YJ, Lee JG, Yi YH, Tak YJ, Hwang HR, Lee SH. Association between new anthropometric parameters and arterial stiffness based on brachial-ankle pulse wave velocity. Diabetes Metab Syndr Obes. 2019;12:1727-1733. doi: 10.2147/DMSO.S211542
Ehrampoush E, Arasteh P, Homayounfar R, Cheraghpour M, Alipour M, Naghizadeh MM, Hadibarhaghtalab M, Davoodi SH, Askari A, Razaz JM. New anthropometric indices or old ones: Which is the better predictor of body fat? Diabetes Metab Syndr. 2017;11(4):257-263. doi: 10.1016/j.dsx.2016.08.027
Wang F, Chen Y, Chang Y, Sun G, Sun Y. New anthropometric indices or old ones: which perform better in estimating cardiovascular risks in Chinese adults. BMC Cardiovasc Disord. 2018;18(1):14. doi: 10.1186/s12872-018-0754-z
Woolcott OO, Bergman RN. Relative fat mass (RFM) as a new estimator of whole-body fat percentage ─ A cross-sectional study in American adult individuals. Sci Rep. 2018;8:10980. doi:10.1038/s41598-018-29362-1
Shepherd JA, Ng BK, Sommer MJ, Heymsfield SB. Body composition by DXA. Bone. 2017;104:101-105. doi:10.1016/j.bone.2017.06.010
Lee SY, Gallagher D. Assessment methods in human body composition. Curr Opin Clin Nutr Metab Care. 2008;11:566–572. doi: 10.1097/MCO.0b013e32830b5f23
Andreasson A, Carlsson AC, Önnerhag K, Hagström H. Predictive Capacity for Mortality and Severe Liver Disease of the Relative Fat Mass Algorithm. Clin Gastroenterol Hepatol. 2019;17(12):2619-2620. doi: 10.1016/j.cgh.2018.11.026
Efe SÇ, Karagoz A, Dogan C, Bayram Z, Kalkan S, Altıntas MS, Yuksel Y, Karabag T, Ayca B, Ozdemir N. Relative Fat Mass Index can be solution for obesity paradox in coronary artery disease severity prediction calculated by SYNTAX Score. Postgrad Med J. 2021;97(1149):434-441. doi: 10.1136/postgradmedj-2020-138926
Kobo O, Leiba R, Avizohar O, Karban A. Relative fat mass is a better predictor of dyslipidemia and metabolic syndrome than body mass index. Cardiovasc Endocrinol Metab. 2019; 10;8(3):77-81. doi: 10.1097/XCE.0000000000000176
Zhang Y, Li B, Liu N, Wang P, He J. Evaluation of Different Anthropometric Indicators for Screening for Nonalcoholic Fatty Liver Disease in Elderly Individuals. Int J Endocrinol. 2021;2021:6678755. doi: 10.1155/2021/6678755
Corrêa CR, Formolo NPS, Dezanetti T, Speretta GFF, Nunes EA. Relative fat mass is a better tool to diagnose high adiposity when compared to body mass index in young male adults: A cross-section study. Clin Nutr ESPEN. 2021;41:225-233. doi: 10.1016/j.clnesp.2020.12.009
Guzmán-León AE, Velarde AG, Vidal-Salas M, Urquijo-Ruiz LG, Caraveo-Gutiérrez LA, Valencia ME. External validation of the relative fat mass (RFM) index in adults from north-west Mexico using different reference methods. PLoS One. 2019;14(12):e0226767. doi: 10.1371/journal.pone.0226767
Fedewa MV, Russell AR, Nickerson BS, Fedewa MP, Myrick JW, Esco MR. Relative accuracy of body adiposity index and relative fat mass in participants with and without down syndrome. Eur J Clin Nutr. 2019;73(8):1117-1121. doi: 10.1038/s41430-018-0351-3
Nickerson BS, McLester CN, McLester JR, Kliszczewicz BM. Relative accuracy of anthropometric-based body fat equations in males and females with varying BMI classifications. Clin Nutr ESPEN. 2020;35:136-140. doi: 10.1016/j.clnesp.2019.10.014
Paek JK, Kim J, Kim K, Lee SY. Usefulness of relative fat mass in estimating body adiposity in Korean adult population. Endocr J. 2019;66(8):723-729. doi: 10.1507/endocrj.EJ19-0064
Ripka WL, Orsso CE, Haqq AM, Prado CM, Ulbricht L, Leite N. Validity and accuracy of body fat prediction equations using anthropometrics measurements in adolescents. Eat Weight Disord. 2021;26(3):879-886. doi: 10.1007/s40519-020-00918-3
Woolcott OO, Bergman RN. Defining cutoffs to diagnose obesity using the relative fat mass (RFM): Association with mortality in NHANES 1999-2014. Int J Obes (Lond). 2020;44(6):1301-1310. doi: 10.1038/s41366-019-0516-8
Krakauer NY, Krakauer JC. A new body shape index predicts mortality hazard independently of body mass index. PLoS One. 2012;7(7):e39504. doi: 10.1371/journal.pone.0039504
Krakauer NY, Krakauer JC. Expansion of waist circumference in medical literature: potential clinical application of a body shape index. J Obes Weight Loss Ther. 2014;4:216.
Krakauer NY, Krakauer JC. An Anthropometric Risk Index Based on Combining Height, Weight, Waist, and Hip Measurements. J Obes. 2016;2016: 8094275. doi: 10.1155/2016/8094275
Christakoudi S, Tsilidis KK, Muller DC. et al. A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort. Sci Rep. 2020;10:14541. doi:10.1038/s41598-020-71302-5
Soltanifar M, Karunanayake C, Khadka D, Henderson R, Konehnck N, et al. Is A Body Shape Index (ABSI) Predictive of Lung Function?. Int J Respir Pulm Med. 2019;6(1):101. doi.org/10.23937/2378- 3516/1410101
Bozorgmanesh M, Sardarinia M, Hajsheikholeslami F, Azizi F, Hadaegh F. CVD-predictive performances of "a body shape index" versus simple anthropometric measures: Tehran lipid and glucose study. Eur J Nutr. 2016;55(1):147-157. doi:10.1007/s00394-015-0833-1
Biolo G, Di Girolamo FG, Breglia A, Chiuc M, Baglio V, Vinci P, Toigo G, Lucchin L, Jurdana M, Pražnikar ZJ, Petelin A, Mazzucco S, Situlin R. Inverse relationship between "a body shape index" (ABSI) and fat-free mass in women and men: Insights into mechanisms of sarcopenic obesity. Clin Nutr. 2015;34(2):323-327. doi: 10.1016/j.clnu.2014.03.015
Gomez-Peralta F, Abreu C, Cruz-Bravo M, Alcarria E, Gutierrez-Buey G, Krakauer NY, Krakauer JC. Relationship between "a body shape index (ABSI)" and body composition in obese patients with type 2 diabetes. Diabetol Metab Syndr. 2018;10:21. doi: 10.1186/s13098-018-0323-8.
Bouchi R, Asakawa M, Ohara N, Nakano Y, Takeuchi T, Murakami M, Sasahara Y, Numasawa M, Minami I, Izumiyama H, Hashimoto K, Yoshimoto T, Ogawa Y. Indirect measure of visceral adiposity 'A Body Shape Index' (ABSI) is associated with arterial stiffness in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2016;4(1):e000188. doi: 10.1136/bmjdrc-2015-000188
Gažarová M, Galšneiderová M, Mečiarová L. Obesity diagnosis and mortality risk based on a body shape index (ABSI) and other indices and anthropometric parameters in university students. Rocz Panstw Zakl Hig. 2019;70(3):267-275. doi: 10.32394/rpzh.2019.0077
Bertoli S, Leone A, Krakauer NY, Bedogni G, Vanzulli A, Redaelli VI, De Amicis R, Vignati L, Krakauer JC, Battezzati A. Association of Body Shape Index (ABSI) with cardio-metabolic risk factors: A cross-sectional study of 6081 Caucasian adults. PLoS One. 2017;12(9):e0185013. doi:10.1371/journal.pone.01850
Wu K, He S, Zheng Y, Chen X. ABSI is a poor predictor of insulin resistance in Chinese adults and elderly without diabetes. Arch Endocrinol Metab. 2018;62(5):523-529. doi: 10.20945/2359-3997000000072
Baveicy K, Mostafaei S, Darbandi M, Hamzeh B, Najafi F, Pasdar Y. Predicting Metabolic Syndrome by Visceral Adiposity Index, Body Roundness Index and a Body Shape Index in Adults: A Cross-Sectional Study from the Iranian RaNCD Cohort Data. Diabetes Metab Syndr Obes. 2020;13:879-887. doi: 10.2147/DMSO.S238153
Ji M, Zhang S, An R. Effectiveness of A Body Shape Index (ABSI) in predicting chronic diseases and mortality: a systematic review and meta-analysis. Obes Rev. 2018;19(5):737-759. doi: 10.1111/obr.12666
Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A better index of body adiposity. Obesity (Silver Spring). 2011;19(5):1083-1089. doi: 10.1038/oby.2011.38
Zwierzchowska A, Celebańska D, Rosołek B, Gawlik K, Żebrowska A. Is body mass index (BMI) or body adiposity index (BAI) a better indicator to estimate body fat and selected cardiometabolic risk factors in adults with intellectual disabilities? BMC Cardiovasc Disord. 2021;21(1):119. doi:10.1186/s12872-021-01931-9
Silva MI, Vale BS, Lemos CC, Torres MR, Bregman R. Body adiposity index assess body fat with high accuracy in nondialyzed chronic kidney disease patients. Obesity (Silver Spring) 2013;21:546–52. doi: 10.1002/oby.20261
Almeida RT, Pereira ADC, Fonseca MJMD, Matos SMA, Aquino EML. Association between body adiposity index and coronary risk in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clin Nutr. 2020;39(5):1423-1431. doi: 10.1016/j.clnu.2019.06.001
Garcíaa AI, Niño-Silvaa LA, González-Ruízb K, Ramírez-Vélezc R. Body adiposity index as marker of obesity and cardiovascular risk in adults from Bogotá, Colombia. Endocrinología y Nutrición. 2015; 62(3):130-137. doi: 10.1016/j.endonu.2014.11.007
Cerqueira MS, Santos CAD, Silva DAS, Amorim PRDS, Marins JCB, Franceschini SDCC. Validity of the Body Adiposity Index in Predicting Body Fat in Adults: A Systematic Review. Adv Nutr. 2018;9(5):617-624. doi: 10.1093/advances/nmy043
Bennasar-Veny M, Lopez-Gonzalez AA, Tauler P, Cespedes ML, Vicente-Herrero T, Yañez A, Tomas-Salva M, Aguilo A. Body adiposity index and cardiovascular health risk factors in Caucasians: a comparison with the body mass index and others. PLoS One. 2013;8(5):e63999. doi: 10.1371/journal.pone.0063999
Alkhalaqi A, Al-Naimi F, Qassmi R, Shi Z, Ganji V, Salih R, Bawadi H. Visceral adiposity index is a better predictor of type 2 diabetes than body mass index in Qatari population. Medicine (Baltimore). 2020;99(35):e21327. doi: 10.1097/MD.0000000000021327
Zara A. Ioannides, Frederik J. Steyn, Robert D. Henderson, Pamela A. Mccombe, Shyuan T. Ngo. Anthropometric measures are not accurate predictors of fat mass in ALS, Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. 2017;18(7-8):486-491. doi: 10.1080/21678421.2017.1317811
Jabłonowska-Lietz B, Wrzosek M, Włodarczyk M, Nowicka G. New indexes of body fat distribution, visceral adiposity index, body adiposity index, waist-to-height ratio, and metabolic disturbances in the obese. Kardiol Pol. 2017;75(11):1185-1191. doi: 10.5603/KP.a2017.0149
Thomas DM, Bredlau C, Bosy-Westphal A, Mueller M, Shen W, Gallagher D, Maeda Y, McDougall A, Peterson CM, Ravussin E, Heymsfield SB. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obesity (Silver Spring). 2013;21(11):2264-2271. doi: 10.1002/oby.20408
Chang Y, Guo X, Li T, Li S, Guo J, Sun Y. A Body Shape Index and Body Roundness Index: Two New Body Indices to Identify left Ventricular Hypertrophy among Rural Populations in Northeast China. Heart Lung Circ. 2016;25(4):358-364. doi: 10.1016/j.hlc.2015.08.009.
Maessen MF, Eijsvogels TM, Verheggen RJ, Hopman MT, Verbeek AL, de Vegt F. Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status. PLoS One. 2014;9(9):e107212. doi: 10.1371/journal.pone.0107212
Gawrys W, Zyska A, Ślęzak A. Anthropometric indicators and their applications for assessing population’s health condition. Hygeia Public Health. 2017;52(1):41-47
Solak I, Guney I, Cihan FG, Mercan S, Eryilmaz MA. Evaluation of a body shape index and body roundness index, two new anthropometric indices, in obese individuals. Acta Medica Mediterranea. 2018;34:1545-1550.
Liu B, Liu B, Wu G, Yin F. Relationship between body-roundness index and metabolic syndrome in type 2 diabetes. Diabetes Metab Syndr Obes. 2019;12:931-935. doi: 10.2147/DMSO.S209964
Stefanescu A, Revilla L, Lopez T, Sanchez SE, Williams MA, Gelaye B. Using A Body Shape Index (ABSI) and Body Roundness Index (BRI) to predict risk of metabolic syndrome in Peruvian adults. J Int Med Res. 2020;48(1):300060519848854. doi: 10.1177/0300060519848854
Rico-Martín S, Calderón-García JF, Sánchez-Rey P, Franco-Antonio C, Martínez Alvarez M, Sánchez Muñoz-Torrero JF. Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis. Obes Rev. 2020;21(7):e13023. doi: 10.1111/obr.13023
Ozler S, Kozanhan B, Bardak O, Arıkan MN. Are body roundness index and a body shape index in the first trimester related to foetal macrosomia? J Obstet Gynaecol. 2021,24:1-7. doi: 10.1080/01443615.2021.1907565
Gómez-Ambrosi J, Silva C, Catalán V, Rodríguez A, Galofré JC, Escalada J, Valentí V, Rotellar F, Romero S, Ramírez B, Salvador J, Frühbeck G. Clinical usefulness of a new equation for estimating body fat. Diabetes Care. 2012;35(2):383-388. doi: 10.2337/dc11-1334.
Davila-Batista V, Molina AJ, Vilorio-Marqués L, Lujan-Barroso L, de Souza-Teixeira F, Olmedo-Requena R, Arias de la Torre J, García-Martínez L, Álvarez-Álvarez L, Freisling H, Llorca J, Delgado-Rodríguez M, Martin V. Net contribution and predictive ability of the CUN-BAE body fatness index in relation to cardiometabolic conditions. Eur J Nutr. 2019;58(5):1853-1861. doi: 10.1007/s00394-018-1743-9
Vinknes KJ, Nurk E, Tell GS, Sulo G, Refsum H, Elshorbagy AK. The relation of CUN-BAE index and BMI with body fat, cardiovascular events and diabetes during a 6-year follow-up: the Hordaland Health Study. Clin Epidemiol. 2017;9:555-566. doi: 10.2147/CLEP.S145130
Fuster-Parra P, Bennasar-Veny M, Tauler P, Yañez A, López-González AA, Aguiló A. A comparison between multiple regression models and CUN-BAE equation to predict body fat in adults. PLoS One. 2015;10(3):e0122291. doi: 10.1371/journal.pone.0122291
Costa A, Konieczna J, Reynés B, Martín M, Fiol M, Palou A, Romaguera D, Oliver P. CUN-BAE Index as a Screening Tool to Identify Increased Metabolic Risk in Apparently Healthy Normal-Weight Adults and Those with Obesity. J Nutr. 2021 May 12:nxab117. doi: 10.1093/jn/nxab117
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