Indicators of abdominal size relative to height associated with sex, age, socioeconomic position and ancestry among US adultsReport as inadecuate

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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.


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.


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.


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.

Author: Henry S. Kahn , Kai McKeever Bullard



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