Comparing the performance of body mass index, waist circumference and waist-to-height ratio in predicting Malaysians with excess adiposity

Abstract

Background

Body mass index (BMI) is a widely used surrogate tool to screen for obesity/adiposity, but it cannot differentiate between lean and fat mass. Thus, alternative tools to detect excess adiposity should be identified.

Aim

This study aimed to compare the performance of BMI, waist circumference (WC) and waist-to-height ratio (WtHR) in predicting Malaysians with excess body fat defined by dual-energy X-ray absorptiometry (DXA).

Subjects and methods

A total of 399 men and women aged ≥40 years were recruited from Klang Valley, Malaysia. The body composition of the subjects, including body fat percentage, was measured by DXA. The weight, height, WC and WHtR of the subjects were also determined.

Results

BMI [sensitivity = 55.7%, specificity = 86.1%, area under curve (AUC) = 0.709] and WC (sensitivity = 62.7%, specificity = 90.3%, AUC = 0.765) performed moderately in predicting excess adiposity. Their performance and sensitivity improved with lower cut-off values. The performance of WHtR (sensitivity = 96.6%, specificity = 36.1, AUC = 0.664) was optimal at the standard cut-off value and no modification was required.

Conclusion

The performance of WC in identifying excess adiposity was greater than BMI and WHtR based on AUC values. Modification of cut-off values for BMI and WC could improve their performance and should be considered by healthcare providers in screening individuals with excess adiposity.

Keywords:

• Body fat percentage
• fat mass
• obesity
• overweight
• screening tool

Acknowledgments

We thank Azlan Mohd Arslamsyah, Mustazil Mohd Noor and Farhana Mohd Fozi from Department of Pharmacology, who offered invaluable assistance in the screening sessions.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki, and approved approved by the Ethics Committee of Uni-versiti Kebangsaan Malaysia Medical Centre (approval code: UKM PPI/111/8/JEP 2017-721). Informed consent was obtained from all subjects involved in the study.

Author contributions

Conceptualisation, Kok-Yong Chin, Soelaiman Ima-Nirwana, Norliza Muhammad, Ahmad Fairus, Pei Yuen Ng, Jamil Nor Aini, Noorazah Abd Aziz and Norazlina Mohamed; Data curation, Chin Yi Chan and Shaanthana Subramaniam; Formal analysis, Nie Yen Low and Kok-Yong Chin; Funding acquisition, Kok-Yong Chin, Soelaiman Ima-Nirwana, Norliza Muhammad, Ahmad Fairus, Pei Yuen Ng, Jamil Nor Aini, Noorazah Abd Aziz and Norazlina Mohamed; Investigation, Chin Yi Chan and Shaanthana Subramaniam; Project administration, Kok-Yong Chin, Soelaiman Ima-Nirwana, Ahmad Fairus, Pei Yuen Ng, Jamil Nor Aini, Noorazah Abd Aziz and Norazlina Mohamed; Supervision, Kok-Yong Chin, Soelaiman Ima-Nirwana and Norliza Muhammad; Validation, Kok-Yong Chin; Writing – original draft, Nie Yen Low and Jamil Nor Aini; Writing – review & editing, Kok-Yong Chin, Soelaiman Ima-Nirwana, Norliza Muhammad, Ahmad Fairus, Pei Yuen Ng, Noorazah Abd Aziz and Norazlina Mohamed.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data of this study are available at reasonable request from the corresponding authors.

Additional information

Funding

This study is funded by Universiti Kebangsaan Malaysia through [grant AP-2017-009/1].