title: Ratio of trunk to leg volume as a new body shape metric for diabetes and mortality.
abstract: BACKGROUND
  Body shape is a known risk factor for diabetes and mortality, but the methods estimating body shape, BMI and waist circumference are crude. We determined whether a novel body shape measure, trunk to leg volume ratio, was independently associated with diabetes and mortality.
  
  
  METHODS
  Data from the National Health and Nutritional Examination Survey 1999-2004, a study representative of the US population, were used to generate dual-energy X-ray absorptiometry-derived trunk to leg volume ratio and determine its associations to diabetes, metabolic covariates, and mortality by BMI category, gender, and race/ethnicity group.
  
  
  RESULTS
  The prevalence of pre-diabetes and diabetes increased with age, BMI, triglycerides, blood pressure, and decreased HDL level. After adjusting for covariates, the corresponding fourth to first quartile trunk to leg volume ratio odds ratios (OR) were 6.8 (95% confidence interval [CI], 4.9-9.6) for diabetes, 3.9 (95% CI, 3.0-5.2) for high triglycerides, 1.8 (95% CI, 1.6-2.1) for high blood pressure, 3.0 (95% CI, 2.4-3.8) for low HDL, 3.6 (95% CI, 2.8-4.7) for metabolic syndrome, and 1.76 (95% CI, 1.20-2.60) for mortality. Additionally, trunk to leg volume ratio was the strongest independent measure associated with diabetes (P<0.001), even after adjusting for BMI and waist circumference. Even among those with normal BMI, those in the highest quartile of trunk to leg volume ratio had a higher likelihood of death (5.5%) than those in the lowest quartile (0.2%). Overall, trunk to leg volume ratio is driven by competing mechanisms of changing adiposity and lean mass.
  
  
  CONCLUSIONS
  A high ratio of trunk to leg volume showed a strong association to diabetes and mortality that was independent of total and regional fat distributions. This novel body shape measure provides additional information regarding central adiposity and appendicular wasting to better stratify individuals at risk for diabetes and mortality, even among those with normal BMI.
authors.affiliation: University of California Berkeley-University of California San Francisco Graduate Program in Bioengineering, San Francisco, California, United States of America.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Wilson
authors.forename: Alka M
authors.initials: AM
authors.lastname: Kanaya
authors.forename: Bo
authors.initials: B
authors.lastname: Fan
authors.forename: John A
authors.initials: JA
authors.lastname: Shepherd
mesh_terms: D000328:Adult; D000368:Aged; D049628:Body Size / Q000502:physiology; D001837:Body Weights and Measures / Q000379:methods*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007866:Leg / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009749:Nutrition Surveys; D009929:Organ Size / Q000502:physiology; D015995:Prevalence; D012307:Risk Factors; D013008:Somatotypes / Q000502:physiology*; D013909:Thorax / Q000033:anatomy & histology*; D055815:Young Adult