Original article Assessing body shape index as a risk predictor for cardiovascular diseases and metabolic syndrome among Iranian adults Q12 Fahimeh Haghighatdoost a, b , Nizal Sarrafzadegan c , Nooshin Mohammadifard c , Seddighe Asgari c , Maryam Boshtam c , Leila Azadbakht a, b, * Q1 a Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran b Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran c Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran article info Article history: Received 19 June 2013 Accepted 17 October 2013 Keywords: A body shape index Waist-to-height ratio Clinica Universidad de Navarra-Body Adiposity Estimator Cardiovascular risks Metabolic syndrome abstract Objective: Several studies have concluded a positive association between abdominal obesity, general obesity, and chronic diseases. However, the best anthropometric measures to predict the risk for chronic diseases should be clarified in each population. Therefore, the aim of this study was to compare the predictive power of A Body Shape Index (ABSI), body mass index (BMI), and waist- to-height ratio and Clinica Universidad de Navarra-Body Adiposity Estimator for metabolic syn- drome (MetS) and cardiovascular disease (CVD) risks among Iranians in different age and sex categories. Methods: This population-based cross-sectional study conducted on 9555 individuals, ages 19 y. Anthropometric measures, blood pressure, and biochemical markers were measured using stan- dard protocols. Hypertension, hyperglycemia, hypercholesterolemia, high low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol levels were considered as the CVD risks. Results: Mean (SD) of age and BMI of participants were 38.7 y (mean 15.5) and 25.7 kg/m 2 (mean 4.6), respectively. ABSI demonstrated the weakest correlations and lowest area under curve (AUC) for various risk factors and MetS. However, the highest odds ratio was observed for ABSI and MetS in different age and sex categories. Conclusions: Based on the AUC, we concluded that ABSI is a weak predictor for CVD risks and MetS. More studies are needed to determine the best predictor of CVD risk among the Iranian population. Ó 2013 Elsevier Inc. All rights reserved. Introduction Chronic diseases and cardiovascular diseases (CVD) are increasing at an alarming rate worldwide [1–3]. In eastern Mediterranean countries, 54% of deaths are attributed to CVD [4], which is one of the main causes of death in Iran [5]. Metabolic syndrome (MetS) is a chronic disease with a high prevalence rate among Iranians [6] and is associated with increased risk for CVD [7]. MetS is defined as the existence of metabolic disorders such as hyperglycemia, dyslipidemia, central obesity, insulin resis- tance and hypertension [8]. A growing trend for general and abdominal obesity has been reported worldwide [9,10]. Based on nationally representative data in Iran, 66% and 33% of Iranian women and men are centrally obese, respectively [11]. Several studies have found a strong direct association between central obesity and chronic diseases, as well as MetS [12,13]. Although the positive relation between chronic diseases and body mass index (BMI) as an indicator of general obesity has been well established, some limitations remain to be considered. Lack of discerning between fat and muscle mass and not declaring the fat distribution are two important limitations of BMI [14–16]. These limitations are worthwhile because central obesity is associated with increased risk for non-communicable chronic diseases. However, gluteofemoral fat is protective against chronic diseases and mortality rate [17,18]. Additionally, higher muscle mass, unlike fat mass, reduces the risk for pre- mature death [19]. Waist circumference (WC) has been sug- gested to predict the risk for chronic diseases to modulate the limitations of BMI [20]. However, the strong correlation between WC and BMI should not be neglected. Based on some studies, another central obesity index, waist-to-height ratio (WHtR), has been proposed as a better predictor of CVD risks than WC [21–23]. Because of an inverse association between height and CVD risks, a corrected WC for individual height (WHtR) may predict CVD risks better than an uncorrected index (WC) [24]. In * Corresponding author. Tel.: þ98 311 792 2719; fax: þ98 311 668 2509. E-mail address: Azadbakht@hlth.mui.ac.ir (L. Azadbakht). 0899-9007/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nut.2013.10.021 Contents lists available at ScienceDirect Nutrition journal homepage: www.nutritionjrnl.com Please cite this article in press as: Haghighatdoost F, et al., Assessing body shape index as a risk predictor for cardiovascular diseases and metabolic syndrome among Iranian adults, Nutrition (2013), http://dx.doi.org/10.1016/j.nut.2013.10.021 Nutrition xxx (2013) 1–9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 NUT9147_proof ■ 11 December 2013 ■ 1/9