title: Indicators of abdominal size relative to height associated with sex, age, socioeconomic position and ancestry among US adults.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Henry S
authors.identifier: http://orcid.org/0000-0003-2533-1562
authors.initials: HS
authors.lastname: Kahn
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Kai McKeever
authors.initials: KM
authors.lastname: Bullard
mesh_terms: D050153:Abdominal Fat / Q000473:pathology; D050154:Adiposity; D000328:Adult; D001827:Body Height / Q000208:ethnology*; D015992:Body Mass Index; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000208:ethnology / Q000473:pathology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D055105:Waist Circumference / Q000208:ethnology*