Jesse C. Krakauer

Objective: A Body Shape Index (ABSI) is a validated anthropometric measure describing body shape independently of BMI and height. This study aimed to evaluate the association between ABSI and dietary quality and eating behaviours in a Mediterranean clinical population. Design: We conducted a cross-sectional study analysing associations between ABSI and diet/behaviour using Pearson correlations and multivariable linear regressions adjusted for age, sex and BMI. Setting: The study took place at a Mediterranean diet-based nutrition clinic in Rome, Italy. Participants: The sample included 1640 adult patients attending follow-up visits at the clinic. ABSI z -scores were calculated and standardised by age and sex. Weekly food intake was assessed using 7-day food diaries, and behavioural preferences were collected via structured questionnaires. Results: The Pearson correlation between BMI and internal z -scored ABSI (zABSI) was weak but statistically significant ( r = 0·113, P < 0·0001), confirming that ABSI captures body shape independently from BMI. As expected, ABSI strongly correlated with WC ( r = 0·78, P < 0·001). Playing a sport was inversely associated with zABSI ( β = –0·365, P < 0·001). Nighttime eating ( β = 0·237, P = 0·001), snacking between meals ( β = 0·133, P = 0·014) and preference for sweet over salty foods ( β = 0·025, P = 0·010) were positively associated with higher ABSI values. Conclusions: In this Mediterranean clinical sample, ABSI identified behavioural and dietary correlates of body shape-related risk. Promoting physical activity and addressing nighttime eating may help improve anthropometric profiles linked to abdominal fat distribution.

Background/Objectives: Anthropometric indices based on height (H), weight (W), waist circumference (WC) and hip circumference (HC) can identify incident and future health risks. While BMI provides a standard for relative W (adjusted for H), there is no standard for indices using WC and HC. A body shape index (ABSI) and hip index (HI) have been proposed to extend to respectively WC and HC the same allometric power-law approach used to derive BMI to be independent of H. Here, we compared the mutually independent allometric set H, BMI, ABSI, HI with other proposed indices. Methods: We examined the formulas and rationales of published indices, and used Third National Health and Nutrition Examination Survey (NHANES III) cohort data to investigate their inter-correlations and association with mortality. Results: Many of the proposed indices are based on geometric (isometric) similarity, which does not match human body variability patterns. Unlike ABSI and HI, most proposed indices showed large correlations with BMI, complicating interpretation when considered together with BMI. Indices’ association with mortality risk were generally consistent with their correlations with BMI and ABSI. Combining the separable mortality risks associated with BMI and ABSI, even in a simplified way, outperformed any single index. Conclusions: With calls for incorporating additional indices incorporating WC and HC to supplement BMI in defining obesity, only ABSI and HI are independent of BMI. Additionally, separate risk estimates from these allometric indices can be readily combined to optimize overall risk assessment.

Background: Gender differences in dietary patterns and lifestyle behaviours may influence abdominal adiposity and cardiometabolic risk, but comprehensive analyses integrating these factors remain limited. Methods: We conducted a cross-sectional study including 1631 adults recruited from a centre specialising in nutrition and metabolic health. Food intake was assessed by 7-day food diaries and lifestyle behaviours were assessed by structured questionnaires. Z scores of a body shape index (zABSI) were calculated as a marker of abdominal adiposity. zABSI represents the standardised value of ABSI, an index specifically designed to assess abdominal adiposity independently of BMI Multivariable linear regression models, stratified by sex and adjusted for age, examined associations between dietary patterns, physical activity and zABSI. Results: Higher intake of plant-based protein was significantly associated with lower zABSI values in women (β = −0.052, p = 0.0053) but not in men (β = −0.015, p = 0.2675). Stratified analyses revealed that women in the middle tertile of plant-based protein intake showed significantly lower zABSI values than men. Combined analyses showed that women classified as physically active and high consumers of plant-based protein had the most favourable abdominal adiposity profiles (p = 0.0036). Participation in endurance and strength sports was associated with lower zABSI values in both sexes, whereas women engaged in team sports had the lowest zABSI values. No significant interaction terms between sex and lifestyle were identified; however, male sex remained an independent predictor of higher zABSI values. Conclusions: In this cross-sectional study, plant-based dietary patterns and physical activity were associated with lower abdominal adiposity, especially among women. These findings suggest the importance of gender-specific strategies to address cardiometabolic risk and emphasise the need for prospective studies to confirm these associations and clarify the underlying mechanisms.

Aim: To examine the association between body mass index (BMI)‐independent allometric body shape indices and kidney function. Materials and methods: We performed a two‐sample Mendelian randomization (MR) analysis, using summary statistics from UK Biobank, CKDGen and DIAGRAM. BMI‐independent allometric body shape indices were: A Body Shape Index (ABSI), Waist‐Hip Index (WHI) and Hip Index (HI). Kidney function outcomes were: urinary albumin‐to‐creatinine ratio (UACR), estimated glomerular filtration rate and blood urea nitrogen. Furthermore, we investigated type 2 diabetes (T2D) as a potential mediator on the pathway to albuminuria. The main analysis was inverse variance‐weighted random‐effects MR in participants of European ancestry. We also performed several sensitivity MR analyses. Results: A 1‐standard deviation (SD) increase in genetically predicted ABSI and WHI levels was associated with higher UACR ( β = 0.039 [95% confidence interval: 0.016, 0.063] log [UACR], P = 0.001 for ABSI, and β = 0.028 [0.012, 0.044] log [UACR], P = 6 x 10 ⁻⁴ for WHI) in women, but not in men. Meanwhile, a 1‐SD increase in genetically predicted HI was associated with lower UACR in women ( β = −0.021 [−0.041, 0.000] log [UACR], P = 0.05) and in men ( β = −0.026 [−0.058, 0.005] log [UACR], P = 0.10). Corresponding estimates in individuals with diabetes were substantially augmented. Risk of T2D increased for genetically high ABSI and WHI in women ( P < 6 x 10 ⁻¹⁹ ) only, but decreased for genetically high HI in both sexes ( P < 9 x 10 ⁻³ ). No other associations were observed. Conclusions: Genetically high HI was associated with decreased risk of albuminuria, mediated through decreased T2D risk in both sexes. Opposite associations applied to genetically high ABSI and WHI in women only.

While overeating is considered a cause of the obesity epidemic as quantified by body mass index (BMI), the association of diet with a body shape index (ABSI) and hip index (HI), which are transformations of waist and hip circumference that are independent of BMI and which predict mortality risk, is poorly known. We used data from the Atherosclerosis Risk in Communities (ARIC) study of about 15,000 middle-aged adults to investigate associations between macronutrient intake (energy, carbohydrate, protein, and fat, the latter two divided into plant and animal sources, all based on self-reported food frequency) with anthropometric indices (BMI, ABSI, and HI). We also analyzed the association of diet and anthropometrics with death rate during approximately 30 years of follow-up. High intake of energy and animal fat and protein was generally associated with higher ABSI and lower HI at baseline, as well as greater mortality hazard. BMI was also positively linked with animal fat and protein intake. In contrast, higher intake of carbohydrates and plant fat and protein was associated with lower ABSI and BMI, higher HI, and lower mortality hazard. For example, after adjustment for potential confounders, each standard deviation of additional plant fat intake (as a fraction of total energy) was associated with a 5% decrease in mortality rate, while animal fat intake was associated with a 5% mortality increase per standard deviation. The directions of the associations between diet and anthropometrics are consistent with those found between anthropometrics and mortality without reference to diet.

Dual-energy X-ray absorptiometry (DEXA) is a non-invasive imaging modality that can estimate whole-body and regional composition in terms of fat, lean, and bone mass. We examined the ability of DEXA body composition measures (whole-body, trunk, and limb fat mass and fat-free mass) to predict mortality in conjunction with basic body measures (anthropometrics), expressed using body mass index (BMI) and a body shape index (ABSI). We used data from the 1999–2006 United States National Health and Nutrition Examination Survey (NHANES), with mortality follow-up to 2015. We found that all DEXA-measured masses were highly correlated with each other and with ABSI and that adjustment for BMI and ABSI reduced these dependencies. Whole-body composition did not substantially improve mortality prediction compared to basic anthropometrics alone, but regional composition did, with high trunk fat-free mass and low limb fat-free mass both associated with elevated mortality risk. These findings illustrate how DEXA body composition could guide health assessment in conjunction with the more widely employed simple anthropometrics.

Objectives: Excessive adiposity is associated with cardiovascular disease (CVD). Anthropometric indices are useful in screening individuals at higher risk for these diseases. However, there are no studies that show which of these indices has the best discriminatory power among Afro‐descendant Brazilian women. The objective of this study was to assess the accuracy of anthropometric indices in identifying risk factors for CVD in Afro‐descendant Brazilian women and define the one most suitable for use under the operating conditions prevailing in Quilombola communities.Methods: A household random sample of 1661 women descendants of African slaves were analyzed. The anthropometric predictors analyzed were waist circumference (WC), body mass index, waist‐to‐height ratio, conicity index (C‐index), body shape index, and percentage of body fat (%BF; estimated by bioimpedance). The assessed risk factors for CVD were arterial hypertension, diabetes mellitus, and dyslipidemias (hypertriglyceridemia; hypercholesterolemia; low high‐density lipoprotein). To identify the statistical significance between the differences in the areas under the ROC curves (AUC) obtained with the different predictors and outcomes, was used the Bonferroni test adjusted for multiple analyses by the Sidak method.Results: The AUC obtained with WC was higher (p < .05) or similar (p > .05) to those obtained with the other predictors 29 times out of 30 possibilities (six predictors x five outcomes). Only the AUC obtained with C‐index in identifying hypercholesterolemia was significantly higher than that with WC.Conclusion: Due to its accuracy and greater operational simplicity, WC was the most adequate predictor for identifying Afro‐descendant women at greatest risk for CVD.

Hand grip is a leading measure of muscle strength and general health, yet its association with body shape is not well characterized. Here, we examine correlations between grip strength, a body shape index (ABSI), and body mass index (BMI) in the 2011–2014 United States National Health and Nutrition Examination Survey cohorts. Grip strength was found to correlate negatively with ABSI (though positively with BMI), suggesting that those with a more central body profile tend to be weaker than others with the same weight. Individuals with low grip strength, as well as those with high ABSI, were more likely to die during follow up, whereas there was no association of BMI with mortality hazard. Transforming the grip strength, ABSI, and BMI by taking their logarithm prior to standardization did not meaningfully change the associations seen. These findings suggest that combining anthropometrics (ABSI, BMI) with grip strength may better identify individual mortality hazard in research studies and clinical practice.

Aims. A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects. Methods. PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated. Results. Of a total of the 52 subjects examined (67.9% males, mean age 61.8 ± 6.0), 46 (88.4%) were still sufficiently active as defined by IPAQ thresholds at follow-up. PA levels, anthropometric indices and related risks improved at follow-up in respect to the baseline and to the end of the intervention, although only PA levels, BMI and related measures, and ARI risk changed significantly. Habitual PA increased significantly after the intervention (p < 0.01) and this increase correlated with changes in BMI z-scores (r = −0.29, p = 0.04). BMI risk was significantly lower (p < 0.01) in participants still active at follow-up. Conclusions. This study testifies to the persistence of compliance to PA and health benefits of a combined exercise-based and motivational intervention in subjects with T2D.

Independent indices (height, body mass index, a body shape index, and hip index) derived from basic anthropometrics have been found to be powerful predictors of mortality hazard, especially when the attributable risks are summed over these indices to give an anthropometric risk index (ARI). The metabolic syndrome (MS) is defined based on the co-occurrence of anthropometric, clinical, and laboratory criteria and is also widely employed for evaluating disease risk. Here, we investigate correlations between ARI and MS in a general population sample, the United States Third National Health and Nutrition Examination Survey. Baseline values of ARI and MS were also evaluated for their association with mortality over approximately 20 years of follow-up. ARI was found to be positively correlated with each component of MS, suggesting connections between the two entities as measures of cardiometabolic risk. ARI and MS were both significant predictors of mortality hazard. Although the association of ARI with mortality hazard was stronger than that of MS, a combined model with both ARI and MS score as predictors improved predictive ability over either construct in isolation. We conclude that the combination of anthropometrics and clinical and laboratory measurements holds the potential to increase the effectiveness of risk assessment compared to using either anthropometrics or the current components of MS alone.