Significance and agreement between obesity anthropometric measurements and indices in adults: a population-based study from the United Arab Emirates

Mahmoud and Sulaiman BMC Public Health https://doi.org/10.1186/s12889-021-11650-7 (2021) 21:1605 RESEARCH Open Access Significance and agreement between obesity anthropometric measurements and indices in adults: a population-based study from the United Arab Emirates Ibrahim Mahmoud1 and Nabil Sulaiman1,2* Abstract Background: The rates of overweight and obese adults in the United Arab Emirates (UAE) have increased dramatically in recent decades. Several anthropometric measurements are used to assess body weight status. Some anthropometric measurements might not be convenient to use in certain communities and settings. The objective of this study was to assess the agreement of four anthropometric measurements and indices of weight status and to investigate their associations with cardiometabolic risks. Methods: The study design was a cross-section population-based study. Adults living in the Northern Emirates were surveyed. Fasting blood samples, blood pressure readings and anthropometric measurements were also collected. Results: A total of 3531 subjects were included in this study. The prevalence of obesity/overweight was 66.4% based on body mass index (BMI), 61.7% based on waist circumference (WC), 64.6% based on waist–hip ratio (WHR) and 71% based on neck circumference (NC). There were moderate agreements between BMI and WC and between WC and WHR, with kappa (k) ranging from 0.41 to 0.60. NC showed poor agreement with BMI, WC and WHR, with k ranging from 0 to 0.2. Overweight and obesity based on BMI, WC and WHR were significantly associated with cardiometabolic risks. Conclusion: Overall, there was a moderate to a poor agreement between BMI, WC, WHR and NC. Particularly, NC showed poor agreement with BMI, WC and WHR. BMI and WC showed better performance for identifying cardiometabolic risks than WHR and NC. Keywords: Agreement, Anthropometric measurements, Cardiometabolic, Obesity, Overweight Introduction Overweight and obesity pandemics are increasing worldwide. According to the World Health Organisation (WHO), approximately two billion adults worldwide were overweight or obese in 2016, with more than 2.8 million people dying every year due to being overweight * Correspondence: 1 College of Medicine, University of Sharjah, Sharjah, United Arab Emirates 2 Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia or obese [1]. In the United Arab Emirates (UAE), the rates of overweight and obesity are among the highest in the world due to tough weather conditions and rapid urbanisation leading to sedentary lifestyles and consumption of unhealthy fast-food [2]. Anthropometric measurements and indices are quantitative non-invasive tools used to measure the composition of the body. The significance of these measurements and indices is identifying individuals at increased risk of © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Mahmoud and Sulaiman BMC Public Health (2021) 21:1605 overweight or obesity. A number of epidemiological studies reported a substantial positive association between an increased body weight or obesity and cardiometabolic risks including raised blood cholesterol, high blood pressure and elevated blood glucose [3, 4]. There are several anthropometric measurements and indices, such as body mass index (BMI), waist circumference (WC), waist–hip ratio (WHR) and NC. BMI was developed in the nineteenth century and is the method most commonly used by health professionals worldwide to assess weight status [5]. Nevertheless, BMI is limited in that it does not consider differences in age, sex, bone structure or muscle mass [6]. In the late1990s, the WHO recognised central obesity evaluated by WC or WHR as an important measure for weight status [7]. Moreover, several studies have identified central obesity as a strong predictor of overweight- and obesity-related health problems [8–10]. However, methods to measure central obesity are limited by certain factors, such as lack of ability to differentiate subcutaneous from visceral fat deposition [7]. Recently, NC was identified as a reliable, simple and culturally acceptable measure to assess weight status [11–13]. However, very few population-based studies have attempted to examine whether those anthropometric measurements and indices can be used interchangeably in the clinical and research settings. This study aimed to assess the agreement of BMI, WC, WHR and NC and whether they can be used interchangeably. An additional objective was to examine the performance of those anthropometric measurements and indices, for identifying cardiometabolic risks in the UAE adult populations. Methods This is a population-based cross-sectional study using secondary data from the UAE National Diabetes and Lifestyle (UAEDIAB) Study. The UAEDIAB Study was a cross-sectional survey designed to investigate the prevalence of diabetes and associated risk factors among Emirati citizens and expatriates. Anthropometric measurements of obesity and blood samples were also collected as part of the UAEDIAB Study. Settings The UAEDIAB Study recruited adults living in the UAE’s Northern Emirates (Sharjah, Ajman, Ras al-Khaimah, Fujairah and Umm al-Quwain). Participants Participants for the UAEDIAB Study were recruited in two phases. In the first phase, adults who lived in the UAE for at least 4 years but were not citizens were approached while applying for their second or subsequent visa renewal. In the second phase, UAE citizens Page 2 of 10 18 years of age and older were recruited through a household survey following a random selection of regions and were stratified by emirate using a cluster sampling method. In both phases, participants were excluded if they had serious physical disabilities, learning disorders, severe communication barriers or were pregnant. None of the participants was involved in the development of any stage of this study. The methods for the UAEDIAB Study are described in detail e (...truncated)