Alternative waist-to-height ratios associated with risk biomarkers in youth with diabetes: comparative models in the SEARCH for Diabetes in Youth Study.

BACKGROUND/OBJECTIVES: The waist-to-height ratio (WHtR) estimates cardiometabolic risk in youth without need for growth charts by sex and age. Questions remain about whether waist circumference measured per protocol of the National Health and Nutrition Examination Survey (WNHAHtR) or World Health Organization (WWHOHtR) can better predict blood pressures and lipid parameters in youth. PARTICIPANTS/METHODS: WHtR was measured under both anthropometric protocols among participants in the SEARCH Study, who were recently diagnosed with diabetes (ages 5-19 years; N = 2 773). Biomarkers were documented concurrently with baseline anthropometry and again ~7 years later (ages 10-30 years; N = 1 712). For prediction of continuous biomarker outcomes, baseline WNHAHtR or WWHOHtR entered semiparametric regression models employing restricted cubic splines. To predict binary biomarkers (high-risk group defined as the most adverse quartile) linear WNHAHtR or WWHOHtR terms entered logistic models. Model covariates included demographic characteristics, pertinent medication use, and (for prospective predictions) the follow-up time since baseline. We used measures of model fit, including the adjusted-R2 and the area under the receiver operator curves (AUC) to compare WNHAHtR and WWHOHtR. RESULTS: For the concurrent biomarkers, the proportion of variation in each outcome explained by full regression models ranged from 23 to 46%; for the prospective biomarkers, the proportions varied from 11 to 30%. Nonlinear relationships were recognized with the lipid outcomes, both at baseline and at follow-up. In full logistic models, the AUCs ranged from 0.75 (diastolic pressure) to 0.85 (systolic pressure) at baseline, and from 0.69 (triglycerides) to 0.78 (systolic pressure) at the prospective follow-up. To predict baseline elevations of the triglycerides/HDL cholesterol ratio, the AUC was 0.816 for WWHOHtR compared with 0.810 for WNHAHtR (p = 0.003), but otherwise comparisons between alternative WHtR protocols were not significantly different. CONCLUSIONS: Among youth with recently diagnosed diabetes, measurements of WHtR by either waist circumference protocol similarly helped estimate current and prospective cardiometabolic risk biomarkers.

Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016.

Importance: The prevalence of diabetes among Hispanic and Asian American subpopulations in the United States is unknown. Objective: To estimate racial/ethnic differences in the prevalence of diabetes among US adults 20 years or older by major race/ethnicity groups and selected Hispanic and non-Hispanic Asian subpopulations. Design, Setting, and Participants: National Health and Nutrition Examination Surveys, 2011-2016, cross-sectional samples representing the noninstitutionalized, civilian, US population. The sample included adults 20 years or older who had self-reported diagnosed diabetes during the interview or measurements of hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2hPG). Exposures: Race/ethnicity groups: non-Hispanic white, non-Hispanic black, Hispanic and Hispanic subgroups (Mexican, Puerto Rican, Cuban/Dominican, Central American, and South American), non-Hispanic Asian and non-Hispanic Asian subgroups (East, South, and Southeast Asian), and non-Hispanic other. Main Outcomes and Measures: Diagnosed diabetes was based on self-reported prior diagnosis. Undiagnosed diabetes was defined as HbA1c 6.5% or greater, FPG 126 mg/dL or greater, or 2hPG 200 mg/dL or greater in participants without diagnosed diabetes. Total diabetes was defined as diagnosed or undiagnosed diabetes. Results: The study sample included 7575 US adults (mean age, 47.5 years; 52% women; 2866 [65%] non-Hispanic white, 1636 [11%] non-Hispanic black, 1952 [15%] Hispanic, 909 [6%] non-Hispanic Asian, and 212 [3%] non-Hispanic other). A total of 2266 individuals had diagnosed diabetes; 377 had undiagnosed diabetes. Weighted age- and sex-adjusted prevalence of total diabetes was 12.1% (95% CI, 11.0%-13.4%) for non-Hispanic white, 20.4% (95% CI, 18.8%-22.1%) for non-Hispanic black, 22.1% (95% CI, 19.6%-24.7%) for Hispanic, and 19.1% (95% CI, 16.0%-22.1%) for non-Hispanic Asian adults (overall P < .001). Among Hispanic adults, the prevalence of total diabetes was 24.6% (95% CI, 21.6%-27.6%) for Mexican, 21.7% (95% CI, 14.6%-28.8%) for Puerto Rican, 20.5% (95% CI, 13.7%-27.3%) for Cuban/Dominican, 19.3% (95% CI, 12.4%-26.1%) for Central American, and 12.3% (95% CI, 8.5%-16.2%) for South American subgroups (overall P < .001). Among non-Hispanic Asian adults, the prevalence of total diabetes was 14.0% (95% CI, 9.5%-18.4%) for East Asian, 23.3% (95% CI, 15.6%-30.9%) for South Asian, and 22.4% (95% CI, 15.9%-28.9%) for Southeast Asian subgroups (overall P = .02). The prevalence of undiagnosed diabetes was 3.9% (95% CI, 3.0%-4.8%) for non-Hispanic white, 5.2% (95% CI, 3.9%-6.4%) for non-Hispanic black, 7.5% (95% CI, 5.9%-9.1%) for Hispanic, and 7.5% (95% CI, 4.9%-10.0%) for non-Hispanic Asian adults (overall P < .001). Conclusions and Relevance: In this nationally representative survey of US adults from 2011 to 2016, the prevalence of diabetes and undiagnosed diabetes varied by race/ethnicity and among subgroups identified within the Hispanic and non-Hispanic Asian populations.

Diabetes-Related Emergency Medical Service Activations in 23 States, United States 2015.

OBJECTIVE: The use of emergency medical services (EMS) for diabetes-related events is believed to be substantial but has not been quantified nationally despite the diverse acute complications associated with diabetes. We describe diabetes-related EMS activations in 2015 among people of all ages from 23 U.S. states. METHODS: We used data from 23 states that reported ≥95% of their EMS activations to the U.S. National Emergency Medical Services Information System (NEMSIS) in 2015. A diabetes-related EMS activation was defined using coded EMS provider impressions of "diabetes symptoms" and coded complaints recorded by dispatch of "diabetic problem." We described activations by type of location, urbanicity, U.S. Census Division, season, and time of day; and patient-events by age category, race/ethnicity, disposition, and treatment with glucose. Crude and age-adjusted diabetes-related EMS patient-level event rates were calculated for adults ≥18 years of age with diagnosed diabetes using the Behavioral Risk Factor Surveillance System to estimate the population denominator. RESULTS: Of 10,324,031 relevant EMS records, 241,495 (2.3%) were diabetes-related activations, which involved over 235,000 hours of service. Most activations occurred in urban or suburban environ- ments (86.4%), in the home setting (73.5%), and were slightly more frequent in the summer months. Most patients (72.6%) were ≥45 years of age and over one-half (55.4%) were transported to the emergency department. The overall age-adjusted diabetes-related EMS event rate was 33.9 per 1,000 persons with diagnosed diabetes; rates were highest in patients 18-44 years of age, males, and non-Hispanic blacks and varied by U.S. Census Division. CONCLUSIONS: Diabetes results in a substantial burden on EMS resources. Collection of more detailed diabetes complication information in NEMSIS may help facilitate EMS resource planning and prevention strategies.

The contribution of subsidized food commodities to total energy intake among US adults.

OBJECTIVE: The contribution of subsidized food commodities to total food consumption is unknown. We estimated the proportion of individual energy intake from food commodities receiving the largest subsidies from 1995 to 2010 (corn, soyabeans, wheat, rice, sorghum, dairy and livestock). DESIGN: Integrating information from three federal databases (MyPyramid Equivalents, Food Intakes Converted to Retail Commodities, and What We Eat in America) with data from the 2001-2006 National Health and Nutrition Examination Surveys, we computed a Subsidy Score representing the percentage of total energy intake from subsidized commodities. We examined the score's distribution and the probability of having a 'high' (≥70th percentile) v. 'low' (≤30th percentile) score, across the population and subgroups, using multivariate logistic regression. SETTING: Community-dwelling adults in the USA. SUBJECTS: Participants (n 11 811) aged 18-64 years. RESULTS: Median Subsidy Score was 56·7 % (interquartile range 47·2-65·4 %). Younger, less educated, poorer, and Mexican Americans had higher scores. After controlling for covariates, age, education and income remained independently associated with the score: compared with individuals aged 55-64 years, individuals aged 18-24 years had a 50 % higher probability of having a high score (P<0·0001). Individuals reporting less than high-school education had 21 % higher probability of having a high score than individuals reporting college completion or higher (P=0·003); individuals in the lowest tertile of income had an 11 % higher probability of having a high score compared with individuals in the highest tertile (P=0·02). CONCLUSIONS: Over 50 % of energy in US diets is derived from federally subsidized commodities.

Replacing the body mass index with the sagittal abdominal diameter (abdominal height).

The body mass index (BMI; weight/height2 ), providing no information about the relative size of any adipose tissue depots, may accordingly misclassify degrees of cardiometabolic risk. However, in supine persons the abdominal height above the exam table (the sagittal abdominal diameter, SAD) is associated preferentially with the accumulation of visceral fat. Since visceral fat is a marker of insulin resistance, type 2 diabetes, coronary heart disease, and hypertension, SAD could contribute to the estimation of generalized cardiometabolic risk. The SAD has been measured inexpensively by a sliding-beam caliper in small studies and in the US National Health and Nutrition Examination Survey (NHANES). Cross-sectional models found that the SAD/height ratio (SADHtR) is more strongly associated than the waist circumference/height ratio or BMI with intermediary predictors of cardiometabolic disease. Prospective studies are needed, however, to demonstrate how well SAD or SADHtR might predict major disease outcomes or all-cause mortality.

Associations between ultra- or minimally processed food intake and three adiposity indicators among US adults: NHANES 2011 to 2016.

OBJECTIVE: Ultraprocessed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally processed food (MPF) intake are unknown. METHODS: Data included 12,297 adults in the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. This study analyzed associations between usual percentage of kilocalories from UPFs and MPFs and three adiposity indicators: supine sagittal abdominal diameter to height ratio (SADHtR, estimates visceral adiposity); waist circumference to height ratio (WHtR, estimates abdominal adiposity); and BMI, using linear and multinomial logistic regression. RESULTS: Standardized ß coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI, respectively (all p < 0.001; p > 0.26 for pairwise differences). For MPF intake, the ß coefficients were -0.0901, -0.0806, and -0.0688 (all p < 0.001; p > 0.18 pairwise). Adjusted odds ratios (95% CI) for adiposity tertile 3 versus tertile 1 (comparing UPF intake quartiles 2, 3, and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78), respectively, for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51), respectively, for BMI. MPF intake showed inverse associations with similar trends in association strength. CONCLUSIONS: Among US adults, abdominal and visceral adiposity indictors were positively associated with UPFs and inversely associated with MPFs.

Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study.

OBJECTIVE: Obesity's association with type 2 diabetes (T2DM) is well established, but is less clear with type 1 diabetes (T1DM). We calculated the prevalence of overweight and obesity among diabetic youth in the USA from a six-center, population-based study of racially and ethnically diverse youth with diabetes, and we compared these rates with estimates among nondiabetic youth. DESIGN/SETTING: Diabetic participants were examined in 2001-2004 for the SEARCH for Diabetes in Youth study (SEARCH) and nondiabetic participants were examined during the same years of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: 3953 diabetic youth and 7666 nondiabetic youth aged 3-19 yr. MAIN OUTCOME MEASURES: Overweight was defined as body mass index (BMI) from the 85th to <95th percentile for age and sex and obesity defined as > or = 95th percentile. Diabetes type was categorized as T1DM or T2DM based on physician diagnosis. RESULTS: Among youth with T2DM, the prevalence of overweight was 10.4% and obesity was 79.4%. Among youth with T1DM, 22.1% were overweight. The prevalence of overweight among youth with T1DM was higher than among those without diabetes overall (22.1% vs. 16.1%) (P <.05). The obesity rate for T1DM was 12.6% overall (range Non-Hispanic White 10.7%-African-American 20.1%). CONCLUSIONS: As expected, most of the youth with T2DM were obese. Youth with T1DM had a higher prevalence of overweight, but not of obesity, than nondiabetic youth. Future studies of obesity among youth with diabetes of all types will further our understanding of the impact of obesity on diabetes both as a risk factor and a comorbidity.

A simple index of lipid overaccumulation is a good marker of liver steatosis.

BACKGROUND: Liver steatosis is often found in association with common cardiometabolic disorders, conditions that may all occur in a shared context of abdominal obesity and dyslipidemia. An algorithm for identifying liver steatosis is the fatty liver index (FLI). The lipid accumulation product (LAP) is an index formulated in a representative sample of the US population to identify cardiometabolic disorders. Because FLI and LAP share two components, namely waist circumference and fasting triglycerides, we evaluated the ability of LAP to identify liver steatosis in the same study population from the Northern Italian town where FLI was initially developed. METHODS: We studied 588 individuals (59% males) aged 21 to 79 years. Liver steatosis was detected by ultrasonography and coded ordinally as none, intermediate and severe. 44% of the individuals had liver steatosis. Using proportional-odds ordinal logistic regression, we evaluated the ability of log-transformed LAP (lnLAP) to identify liver steatosis. We considered the benefits to our model of including terms for sex, age, suspected liver disease and ethanol intake. We calculated the 3-level probability of liver steatosis according to lnLAP and sex, providing tables and nomograms for risk assessment. RESULTS: An ordinal proportional-odds model consisting of lnLAP and sex offered a reasonably accurate identification of liver steatosis. The odds of more severe vs. less severe steatosis increased for increasing values of lnLAP (odds ratio [OR] = 4.28, 95%CI 3.28 to 5.58 for each log-unit increment) and was more likely among males (OR = 1.88, 95%CI 1.31 to 2.69). CONCLUSION: In a study sample of adults from Northern Italy, the simple calculation of LAP was a reasonably accurate approach to recognizing individuals with ultrasonographic liver steatosis. LAP may help primary care physicians to select subjects for liver ultrasonography and intensified lifestyle counseling, and researchers to select patients for epidemiologic studies. A more thorough assessment of LAP's potential for identifying liver steatosis will require its cross-evaluation in external populations.

The 2D:4D digit ratio is not a useful marker for prenatal famine exposure: Evidence from the Dutch hunger winter families study.

OBJECTIVES: Digit lengths, and in particular the ratio of the 2nd (2D) to 4th (4D) digit (2D:4D), are stable in adulthood and have been linked to characteristics thought to have developmental origins, but little research has focused on early life determinants of these measures. We examined whether exposure to acute famine during specific periods of gestation was associated with 2D, 4D or the 2D:4D ratio. METHODS: We studied men and women (1) born in one of three hospitals in western Netherlands whose mothers were exposed to a limited period of famine immediately prior to or during the pregnancy (n = 337); (2) born in the same hospitals to mothers not exposed to famine during the pregnancy (n = 271) or same-sex siblings of individuals in Groups 1 and 2 (n = 295). We measured 2D and 4D on both hands using calipers and computed the 2D:4D ratio. RESULTS: Mean 2D and 4D lengths were 73.5 (SD 5.1) and 75.0 (5.4) mm, respectively. The 2D:4D ratio was 0.981 (SD 0.030). Both 2D and 4D were associated with male gender and height (all P < 0.001), and weakly with BMI. The 2D:4D ratio was 0.0070 (95% confidence interval 0.0017, 0.0123) lower among males as compared with females, and was not significantly associated with height (0.0002 per cm; 95% -0.0001, 0.0005). The 2D:4D ratio was not significantly associated with exposure to famine, overall (-0.0010, 95% CI 0.0030, 0.0050) or within any period of gestation. CONCLUSIONS: The 2D:4D ratio is not significantly affected by prenatal exposure to famine and therefore is not a useful marker for generalized prenatal undernutrition.

Two risk-scoring systems for predicting incident diabetes mellitus in U.S. adults age 45 to 64 years.

BACKGROUND: Simple prediction scores could help identify adults at high risk for diabetes. OBJECTIVE: To derive and validate scoring systems by using longitudinal data from a study that repeatedly tested for incident diabetes. DESIGN: Prospective cohort, divided into derivation and validation samples. SETTING: The ARIC (Atherosclerosis Risk in Communities) study, which followed participants for 14.9 years beginning in 1987 to 1989. PARTICIPANTS: 12 729 U.S. adults (baseline age, 45 to 64 years; 22.8% black). Follow-up was 96.1% at 5 years and 72.2% at 10 years. MEASUREMENTS: Anthropometry, blood pressure, and pulse (basic system) plus a fasting blood specimen assayed for common analytes (enhanced system). Diabetes was identified in 18.9% of participants. Risk score integer points were derived from proportional hazard coefficients associated with baseline categorical variables and quintiles of continuous variables. RESULTS: The basic scoring system included waist circumference (10 to 35 points); maternal diabetes (13 points); hypertension (11 points); and paternal diabetes, short stature, black race, age 55 years or older, increased weight, rapid pulse, and smoking history (< or =8 points each). The enhanced system included glucose (6 to 28 points); waist circumference (5 to 21 points); maternal diabetes (8 points); and triglycerides, black race, paternal diabetes, low high-density lipoprotein cholesterol concentration, short stature, high uric acid, age 55 years or older, hypertension, rapid pulse, and nonuse of alcohol (< or =7 points each). When applied to the validation sample, ascending quintiles of the basic system were associated with a 10-year incidence of diabetes of 5.3%, 8.7%, 15.5%, 24.5%, and 33.0%, respectively. Quintiles of the enhanced system were associated with a 10-year incidence of 3.5%, 6.4%, 11.5%, 19.3%, and 46.1%. LIMITATIONS: The risk scoring systems had no question regarding previous gestational diabetes, and knowledge of parental diabetes may be uncertain. The analyzed cohort was restricted by age and race; the systems may be less effective in other samples. CONCLUSION: Basic information identified adults at high risk for diabetes. Additional data from fasting blood tests better identified those at extreme risk.

Comparison of adiposity indicators associated with fasting-state insulinemia, triglyceridemia, and related risk biomarkers in a nationally representative, adult population.

AIMS: We hypothesized that height-corrected abdominal size (supine sagittal abdominal diameter/height ratio [SADHtR] or waist circumference/height ratio [WHtR]) would associate more strongly than body mass index (BMI, weight/height2) with levels of fasting insulin, triglycerides, and three derived biomarkers of insulin resistance. METHODS: Anthropometry, including SAD by caliper, was collected on 4398 adults in the 2011-2014 National Health and Nutrition Examination Survey. For comparison purposes, each adiposity indicator was scaled to its population-based, sex-specific, interquartile range (IQR). For each biomarker we created four outcome groups based on equal-sized populations with ascending values. Multivariable polytomous logistic regression modeled the relationships between the adiposity indicators and each biomarker. RESULTS: Highest-group insulin was associated with a one-IQR increment of BMI (RR 4.3 [95% CI 3.9-4.9]), but more strongly with a one-IQR increment of SADHtR (RR 5.7 [5.0-6.6]). For highest-group HOMA-IR the RR for BMI (4.2 [3.7-4.6]) was less than that of SADHtR (6.0 [5.1-7.0]). Similarly, RRs for BMI were smaller than those for SADHtR applying to highest-group triglycerides (RR 1.6 vs 2.1), triglycerides/HDL-cholesterol (RR 1.9 vs 2.4) and TyG index (RR 1.7 vs 2.2) (all p < .001). The RRs for WHtR were consistently between those for SADHtR and BMI. The top 25% of insulin resistance among US adults was estimated to lie above adiposity thresholds of 0.140 for SADHtR, 0.606 for WHtR, or 29.6 kg/m2 for BMI. CONCLUSIONS: Relative abdominal size rather than relative weight may better define adiposity associated with homeostatic insulin resistance. These population-based, cross-sectional findings could improve anthropometric prediction of cardiometabolic risk.

Mortality associated with less intense risk-factor control among adults with diabetes in the United States.

AIMS: Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol. METHODS: National Health and Nutrition Examination Survey 1999-2010 participants with self-report of diagnosed diabetes (N=3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c<9% and BP<160/110, and non-HDL cholesterol<190mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol. RESULTS: Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR=0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals. CONCLUSIONS: Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year.

Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study.

BACKGROUND: Several investigators have concluded that the waist-to-height ratio is more strongly associated with cardiovascular disease risk factors than is the body mass index (BMI; in kg/m(2)). OBJECTIVES: We examined the relation of the BMI-for-age z score and waist-to-height ratio to risk factors (lipids, fasting insulin, and blood pressures). We also compared the abilities of these 2 indexes to identify children with adverse risk factors. DESIGN: Children aged 5-17 y (n=2498) in the Bogalusa Heart Study were evaluated. RESULTS: As assessed by the ability of the 2 indexes to 1) account for the variability in each risk factor and 2) correctly identify children with adverse values, the predictive abilities of the BMI-for-age z score and waist-to-height ratio were similar. Waist-to-height ratio was slightly better (0.01-0.02 higher R(2) values, P<0.05) in predicting concentrations of total-to-HDL cholesterol ratio and LDL cholesterol, but BMI was slightly better in identifying children with high systolic blood pressure (0.03 higher R(2), P<0.05) in predicting measures of fasting insulin and systolic and diastolic blood pressures. On the basis of an overall index of the 6 risk factors, no difference was observed in the predictive abilities of BMI-for-age and waist-to-height ratio, with areas under the curves of 0.85 and 0.86 (P=0.30) and multiple R(2) values of 0.320 and 0.318 (P=0.79). This similarity likely results from the high intercorrelation (R(2)=0.78) between the 2 indexes. CONCLUSIONS: BMI-for-age and waist-to-height ratio do not differ in their abilities to identify children with adverse risk factors. Although waist-to-height ratio may be preferred because of its simplicity, additional longitudinal data are needed to examine its relation to disease.

Anthropometric measures in middle age after exposure to famine during gestation: evidence from the Dutch famine.

BACKGROUND: Few studies in humans have related maternal undernutrition to the size of the adult offspring. OBJECTIVE: The objective was to assess whether reductions in food intake by pregnant women during the Dutch famine of 1944-1945 were related to offspring length, weight, and indexes of adiposity in middle age. DESIGN: We recruited 1) exposed persons born in western Netherlands between January 1945 and March 1946 whose mothers experienced famine during or immediately preceding pregnancy, 2) unexposed persons born in the same 3 institutions during 1943 or 1947 whose mothers did not experience famine during this pregnancy, and 3) unexposed same-sex siblings of persons in series 1 or 2. Anthropometric measurements (n = 427 males and 529 females) were obtained between 2003 and 2005. We defined 4 windows of gestational exposure (by ordinal weeks 1-10, 11-20, 21-30, and 31 through delivery) on the basis of exposure to a ration of <900 kcal/d during the whole 10-wk interval. RESULTS: Exposure to reduced rations was associated with increased weight and greater indexes of fat deposition at several tissue sites in women but not in men (P for interaction <0.01). Measures of length and linear proportion were not associated with exposure to famine. CONCLUSION: Reduced food availability may lead to increased adiposity later in life in female offspring.

Indicators of abdominal size relative to height associated with sex, age, socioeconomic position and ancestry among US adults.

BACKGROUND/OBJECTIVES: The supine sagittal abdominal diameter (SAD) and standing waist circumference (WC) describe abdominal size. The SAD/height ratio (SADHtR) or WC/height ratio (WHtR) may better identify cardiometabolic disorders than BMI (weight/height2), but population-based distributions of SADHtR and WHtR are not widely available. Abdominal adiposity may differ by sociodemographic characteristics. SUBJECTS/METHODS: Anthropometry, including SAD by sliding-beam caliper, was performed on 9894 non-pregnant adults ≥20 years in the US National Health and Nutrition Examination Surveys of 2011-2014. Applying survey design factors and sampling weights, we estimated nationally representative SADHtR and WHtR distributions by sex, age, educational attainment, and four ancestral groups. RESULTS: The median (10th percentile, 90th percentile) for men's SADHtR was 0.130 (0.103, 0.165) and WHtR 0.569 (0.467, 0.690). For women, median SADHtR was 0.132 (0.102, 0.175) and WHtR 0.586 (0.473, 0.738). Medians for SADHtR and WHtR increased steadily through age 79. The median BMI, however, reached maximum values at ages 40-49 (men) or 60-69 (women) and then declined. Low educational attainment, adjusted for age and ancestry, was associated with elevated SADHtR more strongly than elevated BMI. While non-Hispanic Asians had substantially lower BMI compared to all other ancestral groups (adjusted for sex, age and education), their relative reductions in SADHtR and WHtR, were less marked. CONCLUSIONS: These cross-sectional data are consistent with monotonically increasing abdominal adipose tissue through the years of adulthood but decreasing mass in non-abdominal regions beyond middle age. They suggest also that visceral adipose tissue, estimated by SADHtR, expands differentially in association with low socioeconomic position. Insofar as Asians have lower BMIs than other populations, employing abdominal indicators may attenuate the adiposity differences reported between ancestral groups. Documenting the distribution and sociodemographic features of SADHtR and WHtR supports the clinical and epidemiologic adoption of these adiposity indicators.