Identifying the Optimal Waist Circumference-Based Body Adiposity Index for Detecting Metabolically Obese but Normal-Weight Older Koreans: A Cross-Sectional Study
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Background: The concept of being metabolically obese but normal weight (MONW) has emerged as a significant public health concern. Individuals with MONW exhibit insulin resistance and are at elevated risk for chronic diseases, despite having a body mass index (BMI) <25 kg/m2. Given the high prevalence of MONW among older Asian adults and the role of abdominal visceral fat in metabolic abnormalities in individuals with MONW, identifying an accurate waist circumference (WC)-based body adiposity index for older Asian adults is essential. Thus, this study aimed to determine the most accurate WC-based body adiposity index for identifying MONW in older Korean adults that are not underweight or obese.Methods: This cross-sectional study included 7,846 participants (3,536 males and 4,310 females) aged ≥60 years with a BMI of 18.5–24.9 kg/m2 from the Korea National Health and Nutrition Examination Survey. MONW was defined using metabolic syndrome criteria and sex-specific triglyceride–glucose Index cutoff points. Associations were analyzed using logistic regression, and discriminative ability was assessed using receiver operating characteristic curves. The analysis included BMI, WC and various WC-based adiposity indices, including the visceral adiposity index (VAI), body roundness index, waist-to-height ratio, conicity index, weight-adjusted waist index, and a body shape index.Results: While all WC-based indices were associated with MONW, only the VAI showed a stronger association (odds ratios [ORs], 26.542 in males and 21.495 in females) and superior discriminative ability (area under the curves [AUCs], 0.826 in males and 0.802 in females) in both sexes compared with WC (ORs, 4.538 and 4.060; AUCs, 0.679 and 0.676). Other indices showed weaker associations and lower areas under the curves than did the VAI and WC, regardless of sex.Conclusions: The VAI may serve as the most effective indicator for identifying MONW among older Korean adults that are not underweight or obese.
Abstract
Background: The concept of being metabolically obese but normal weight (MONW) has emerged as a significant public health concern. Individuals with MONW exhibit insulin resistance and are at elevated risk for chronic diseases, despite having a body mass index (BMI) <25 kg/m2. Given the high prevalence of MONW among older Asian adults and the role of abdominal visceral fat in metabolic abnormalities in individuals with MONW, identifying an accurate waist circumference (WC)-based body adiposity index for older Asian adults is essential. Thus, this study aimed to determine the most accurate WC-based body adiposity index for identifying MONW in older Korean adults that are not underweight or obese.Methods: This cross-sectional study included 7,846 participants (3,536 males and 4,310 females) aged ≥60 years with a BMI of 18.5–24.9 kg/m2 from the Korea National Health and Nutrition Examination Survey. MONW was defined using metabolic syndrome criteria and sex-specific triglyceride–glucose Index cutoff points. Associations were analyzed using logistic regression, and discriminative ability was assessed using receiver operating characteristic curves. The analysis included BMI, WC and various WC-based adiposity indices, including the visceral adiposity index (VAI), body roundness index, waist-to-height ratio, conicity index, weight-adjusted waist index, and a body shape index.Results: While all WC-based indices were associated with MONW, only the VAI showed a stronger association (odds ratios [ORs], 26.542 in males and 21.495 in females) and superior discriminative ability (area under the curves [AUCs], 0.826 in males and 0.802 in females) in both sexes compared with WC (ORs, 4.538 and 4.060; AUCs, 0.679 and 0.676). Other indices showed weaker associations and lower areas under the curves than did the VAI and WC, regardless of sex.Conclusions: The VAI may serve as the most effective indicator for identifying MONW among older Korean adults that are not underweight or obese.