Relationship of metabolic variables to abdominal adiposity measured by different anthropometric measurements and dual-energy X-ray absorptiometry in obese middle-aged women P Rissanen 1 , P Ha Èma Èla Èinen 2 , E Vanninen 3 , M Tenhunen-Eskelinen 3 and M Uusitupa 2 1 Department of Clinical Nutrition, University of Kuopio and Obesity Research Group, Helsinki; 2 Department of Clinical Nutrition, University of Kuopio; and 3 Department of Clinical Physiology, Kuopio University Hospital OBJECTIVES: To investigate how abdominal adiposity assessed by different anthropometric measurements and dual- energy X-ray absorptiometry measurements is associated with metabolic risk factors for cardiovascular disease and non-insulin-dependent diabetes mellitus in obese women. DESIGN: Cross-sectional study. SUBJECTS: Forty-three healthy, obese, middle-aged women (age: 29±64 y, BMI: 28±42 kg/m 2 ). MEASUREMENTS: (1) Anthropometry: waist circumference, waist-to-hip ratio, waist-to-height ratio, abdominal sagittal and transverse diameters and their ratio. (2) Dual-energy X-ray absorptiometry: the amount of total and regional abdominal fat. (3) Metabolic measurements: serum total, VLDL, LDL, HDL cholesterol, triglycerides, fasting and postglucose serum insulin and glucose. RESULTS: After adjustment for age and BMI, all the anthropometric measurements except waist-to-hip ratio and waist-to-height ratio related signi®cantly to HDL and LDL cholesterol. On the other hand, waist-to-hip ratio and waist- to-height ratio showed an association with triglycerides. In addition, all the anthropometric measurements except transverse diameter correlated signi®cantly with fasting insulin and fasting glucose. Waist-to-hip ratio was the only measure that associated with 2 h glucose concentration. The differences between the correlation coef®cients were not statistically signi®cant in the z-transformed correlation coef®cient test. As to dual-energy X-ray absorptiometry results, the region from the dome of diaphragm to the top of femur (`abdominal fat') and the area between the ®rst and the fourth lumbal vertebrae (`upper lumbal fat') inversely related to HDL cholesterol and positively to triglycerides. Both of these regions correlated signi®cantly with fasting insulin, and `upper lumbal fat' associated also with fasting glucose even after adjustment for age and BMI. CONCLUSION: None of the anthropometric measurements (waist circumference, waist-to-hip ratio, waist-to-height ratio or sagittal diameter) was signi®cantly superior to others to assess the metabolic risk pro®le. `Upper lumbal fat' (the area between the ®rst and the fourth lumbal vertebrae) measured by dual-energy X-ray absorptiometry discerned obese women with elevated fasting insulin and fasting glucose. Keywords: abdominal obesity, anthropometry, dual-energy X-ray absorptiometry, metabolic risk factors Introduction The strong risk of central obesity for coronary heart disease (CHD) and non-insulin-dependent diabetes mellitus (NIDDM) is mediated via different metabolic alterations. It has been suggested that increased lipo- lytic activity of abdominal fat, especially visceral fat results in excess release of free fatty acids (FFAs) into portal vein. 1 Increased portal FFA availability may result in reduced hepatic insulin clearance, 2,3 increased hepatic glucose production 4 and increased very-low-density-lipoprotein (VLDL) triglyceride synthesis. 5 All these abnormalities provide a concep- tual rationale for examining the relationship between various metabolic disturbances and adipose tissue distribution. Waist-to-hip ratio (WHR) is the most commonly used anthropometric measure in the estimation of abdominal obesity. In recent studies also sagittal and transverse diameters were assessed, but they were measured by computerized tomography (CT) 6 or by magnetic resonance imaging (MRI). 7 Thus, little information is available on the usefulness of different anthropometric methods in evaluation of the associa- tion between fat distribution and metabolic risk fac- tors for CHD and NIDDM. Correspondence: P Rissanen, Obesity Research Group, Paasikivenkatu 4, FIN-00250 Helsinki, Finland. Received 25 July 1996; revised 5 December 1996; accepted 20 January 1997 International Journal of Obesity (1997) 21, 367±371 ß 1997 Stockton Press All rights reserved 0307±0565/97 $12.00