Choosing an index for abdominal obesity: An opportunity for epidemiologic clarification

Abstract

Despite numerous reports that abdominal obesity is related to disease risk, the study of body-fat distribution remains a largely empirical science. Elucidation of the pathophysiologic linkage between abdominal obesity and disease would be better served by generating hypotheses and testing them—the process of deductive science. Physiologists have proposed that adipose tissue of the intra-abdominal compartment (that drained by the portal vein) contributes strongly to atherosclerosis. If this is so, then the volume of the intra-abdominal fat depot might be better correlated with disease states than a less specific anthropometric index such as the waist-to-hip girth ratio. Alternative abdominal-obesity indices (e.g. sagittal abdominal diameter divided by thigh girth) could be tested in epidemiologic studies to improve our pathophysiologic understanding of how body-fat distribution is related to atherosclerosis and other diseases.