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Measurement of the sagittal abdominal diameter by use of a sliding-beam caliper in NHANES, 2011–2012.
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The sagittal abdominal diameter (SAD) measured in supine position is an alternative adiposity indicator that estimates the quantity of dysfunctional adipose tissue in the visceral depot. However, supine SAD's distribution and its association with health risk at the population level are unknown. Here we describe standardized measurements of SAD, pro...
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Aims/introduction:
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Materials and methods:
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Citations
... Our finding that cut-points for sagittal diameter (DXA-measured and anthropometric) of ~ 23-24 cm in males and ~ 19-22 cm in females for detecting ≥ 2 non-adipose metabolic risk factors are close to the thresholds of ~ 24.6 cm (males) and ~ 22.5 cm (females) for this parameter (determined anthropometrically) for the detection of MetS in Mexican adults [37]. detection of insulin resistance, dysglycemia, diabetes, elevated cardiovascular risk score and coronary heart disease [15,[38][39][40][41]. ...
Background
Metabolic syndrome (MetS) is a clustering of metabolic risk factors, including large waist circumference (WC). Other anthropometric parameters and visceral fat mass (VFM) predicted from these may improve MetS detection. Our aim was to assess the ability of such parameters to predict this clustering in a cross-sectional, diagnostic study.
Method
Participants were 82 males and 86 females, aged 20–74 years, of Asian Indian ethnicity. VFM was estimated by dual-energy X-ray absorptiometry (DXA) through identification of abdominal subcutaneous fat layer boundaries. Non-anthropometric metabolic risk factors (triglycerides, HDL cholesterol, blood pressure and glucose) were defined using MetS criteria. We estimated the ability of anthropometry and VFM to detect ≥ 2 of these factors by receiver operating characteristic (ROC) and precision-recall curves.
Results
Two or more non-anthropometric metabolic risk factors were present in 45 (55%) males and 29 (34%) females. The area under the ROC curve (AUC) to predict ≥ 2 of these factors using WC was 0.67 (95% confidence interval: 0.55–0.79) in males and 0.65 (0.53–0.77) in females. Optimal WC cut-points were 92 cm for males (63% accuracy) and 79 cm for females (53% accuracy). VFM, DXA-measured sagittal diameter and suprailiac skinfold thickness yielded higher AUC point estimates (by up to 0.06), especially in females where these measures improved accuracy to 69%, 69% and 65%, respectively. Pairwise combinations that included WC further improved accuracy.
Conclusion
Our findings indicate that cut-points for readily obtained measures other than WC, or in combination with WC, may provide improved detection of MetS risk factor clusters.
... 8 Studies demonstrate a strong positive correlation between BMI and AP abdominal diameter, where the greater the BMI, the thicker is the abdominal diameter. 9,10 Optimisation is considered as one of the pillars of radiation protection in radiography. Optimisation refers to recognising the level of radiographic image quality required for diagnostic purposes and determining which radiographic technique reaches that level of image quality while delivering the least possible amount of radiation. ...
Introduction:
This study aims to identify optimal exposure parameters, delivering the lowest radiation dose while maintaining images of diagnostic quality for the antero-posterior (AP) abdomen x-ray projection in large patients with an AP abdominal diameter of >22.3 cm.
Methodology:
The study was composed of two phases. In phase 1, an anthropomorphic phantom (20 cm AP abdominal diameter) was repetitively radiographed while adding 3 layers (5 cm thick each) of fat onto the phantom reaching a maximum AP abdominal diameter of 35 cm. For every 5 cm thickness, images were taken at 10 kVp (kilovoltage peak) intervals, starting from 80 kVp as the standard protocol currently in use at the local medical imaging department, to 120 kVp in combination with the use of automatic exposure control (AEC). The dose area product (DAP), milliampere-second (mAs) delivered by the AEC, and measurements to calculate the signal to noise ratio (SNR) and contrast to noise ratio (CNR) were recorded. Phase 2 included image quality evaluation of the resultant images by radiographers and radiologists through absolute visual grading analysis (VGA). The resultant VGA scores were analysed using visual grading characteristics (VGC) curves.
Results:
The optimal kVp setting for AP abdominal diameters at: 20 cm, 25 cm and 30 cm was found to be 110 kVp increased from 80 kVp as the standard protocol (with a 56.5% decrease in DAP and 76.2% in mAs, a 54.2% decrease in DAP and 76.2% decrease in mAs and a 29.2% decrease in DAP and 59.7% decrease in mAs, respectively). The optimal kVp setting for AP abdominal diameter at 35 cm was found to be 120 kVp increased from 80 kvp as the standard protocol (with a 50.7% decrease in DAP and 73.4% decrease in mAs). All this was achieved while maintaining images of diagnostic quality.
Conclusion:
Tailoring the exposure parameters for large patients in radiography of the abdomen results in a significant reductions in DAP which correlates to lower patient doses while still maintaining diagnostic image quality.
Implications for clinical practice:
This research study and resultant parameters may help guide clinical departments to optimise AP abdomen radiographic exposures for large patients in the clinical setting.
... Sagittal abdominal diameter has been associated with components of the metabolic syndrome (Mukuddem-Petersen et al., 2006;Guzzaloni et al., 2009) and insulin resistance (Risérus et al., 2004;Petersson et al., 2007), which is a good predictor of glucose dysregulation and diabetes incidence (Gletsu-Miller et al., 2013;Pajunen et al., 2013;Kahn et al., 2014;Firouzi et al., 2018). Furthermore, SAD is strongly associated with cardiovascular risk (Richelsen and Pedersen, 1995;Kahn et al., 1996a;Gustat et al., 2000;Ohrvall et al., 2000;Rådholm et al., 2017) and increased mortality (Seidell et al., 1994;Kahn et al., 1996b;Empana et al., 2004;Iribarren et al., 2006). ...
Obesity is characterized by the accumulation of an excessive amount of fat mass (FM) in the adipose tissue, subcutaneous, or inside certain organs. The risk does not lie so much in the amount of fat accumulated as in its distribution. Abdominal obesity (central or visceral) is an important risk factor for cardiovascular diseases, diabetes, and cancer, having an important role in the so-called metabolic syndrome. Therefore, it is necessary to prevent, detect, and appropriately treat obesity. The diagnosis is based on anthropometric indices that have been associated with adiposity and its distribution. Indices themselves, or a combination of some of them, conform to a big picture with different values to establish risk. Anthropometric indices can be used for risk identification, intervention, or impact evaluation on nutritional status or health; therefore, they will be called anthropometric health indicators (AHIs). We have found 17 AHIs that can be obtained or estimated from 3D human shapes, being a noninvasive alternative compared to X-ray-based systems, and more accessible than high-cost equipment. A literature review has been conducted to analyze the following information for each indicator: definition; main calculation or obtaining methods used; health aspects associated with the indicator (among others, obesity, metabolic syndrome, or diabetes); criteria to classify the population by means of percentiles or cutoff points, and based on variables such as sex, age, ethnicity, or geographic area, and limitations.
... Although some of the previous studies have reported the risk factors of depressive symptoms in women, studies have quantified the strong reciprocal association between risk factors for depression and obesity. Recent findings suggest that the sagittal abdominal diameter (SAD), also known as "abdominal height," can be used as a noninvasive method to index visceral fat [15][16][17][18][19][20]. Moreover, visceral fat has a greater association with a myriad of metabolic disturbances than overall obesity. ...
... Further background on NHANES can be acquired at https:// www.cdc.gov/nchs/nhanes/default.aspx. [15,16]. Then, the lower arm of the caliper was placed under the back, and the upper arm was raised above the abdomen to align with the top. ...
... All four readings were used to get the mean value of the SAD in cases where the two outlying measurements are equal to the two closest measurements [25]. In our study, we defined the SAD of each participant as the average of two initial measurements or up to four measurements, as specified in the NHANES online analysis instructions [15]. According to the SAD of individuals at the baseline, three groups (trisection) were categorized as T1: low (11.8-18.4 ...
Objective:
To estimate the relationship between obesity (defined by both BMI and SAD) and various levels of depressive symptoms in women in the United States.
Methods:
This is a cross-sectional design. All data were collected from NHANES 2011-2012 and 2013-2014. The Patient Health Questionnaire (PHQ-9) was the primary variable used to index depressive symptoms. SAD was assessed using an abdominal caliper. We stratified participates into three groups according to SAD (trisection): T1: low (11.8-18.4 cm), T2: middle (18.5-22.8 cm), and T3: high (22.9-40.1 cm). Other data were collected following the NHANES protocols. We aimed to investigate the effects of obesity on the depression in the NHANES populations.
Results:
A total of 4477 women were enrolled in the final study population. Participants with a high SAD had the highest risk of clinical depression symptoms (OR = 1.2, 95% CI: 1.1-1.4), which was, in particular, the case for moderate-severe depression (OR = 1.4, 95% CI: 1.1-1.7) and severe depression (OR = 1.4, 95% CI: 1.0-1.9). We also found a significant relationship between SAD and BMI (r = 0.836). We did, however, not find a significant relationship between BMI and severe depression.
Conclusions:
SAD had a better correlation with clinical depression symptoms than BMI, especially regarding severe depression symptoms.
... Limitations of the present study are 1) the crosssectional study design, residual confounding due to unmeasured life style markers such as alcohol consumption and smoking cannot be ruled out, and 2) the use of biomarkers compared to studies with a prospective design and hard endpoints such as CVD, T2D, and mortality. Moreover, the majority of the included individuals (98%) were overweight or obese whereas other studies included both normal weight and overweight individuals [27,28]. One strength of the present study is the use of a clinically relevant population group, which is at risk of developing T2D and CVD and which would benefit from establishing a highly predictable anthropometric measure. ...
Background and aims
Body mass index (BMI) and waist circumference (WC) are commonly used markers of cardiometabolic risk. However, sagittal abdominal diameter (SAD) has been proposed as a possibly more sensitive marker of intra-abdominal obesity. We investigated differences in how SAD, WC, and BMI were correlated with cardiometabolic risk markers.
Methods and results
This cross-sectional study investigated anthropometric and metabolic baseline measurements of individuals from six trials. Multiple linear regression and (partial) correlation coefficients were used to investigate associations between SAD, WC, and BMI and cardiometabolic risk markers, including components of the metabolic syndrome as well as insulin resistance, blood lipids, and lowgrade inflammation.
In total 1516 mostly overweight or obese individuals were included in the study. SAD was significantly more correlated with TG than WC for all studies, and overall increase in correlation was 0.05 (95% CI (0.02; 0.08). SAD was significantly more correlated with the markers TG and DBP 0.11 (95% CI (0.08, 0.14)) and 0.04 (95% CI (0.006, 0.07), respectively compared to BMI across all or most studies.
Conclusion
This study showed that no single anthropometric indicator was consistently more strongly correlated across all markers of cardiometabolic risk. However, SAD was significantly more strongly correlated with TG than WC and significantly more strongly correlated with DBP and TG than BMI.
... Therefore, the aim of this NHANES analysis was to examine associations of snacking and weight status among U.S. adults, comparing four definitions of a snack based on definitions commonly used in the literature. Measures of weight status include body mass index (BMI), as well as waist circumference (WC) and sagittal abdominal diameter (SAD); two emerging parameters related with cardio metabolic health [23,29,30]. ...
... In addition to BMI, WC and SAD were also collected during the health examination by trained health technicians using standardized NHANES protocol [54]. WC cut-points of �102 cm for men and �88 cm for women were used to define abdominal obesity, as well as SAD cut-points of �25 cm and �24cm in men and women, respectively [29,30,55]. ...
... This analysis focused on the effects of frequency and size of snacking occasions on multiple metrics of adiposity in a nationally representative sample of U.S. adults. While BMI categories and WC are primarily used to define weight status, SAD is an additional proposed measure that may provide a more accurate indicator of adiposity associated with increased risk of adverse metabolic effects/metabolic syndrome [23,29,30]. ...
Snacks, while widely consumed in the United States (U.S.), do not have a standard definition, complicating research to understand associations, if any, with weight status. Therefore, the purpose of this study was to examine the association between snacking frequency and weight status using various snacking definitions that exist in the scientific literature among U.S. adults (NHANES 2013–2016; ≥20y n = 9,711). Four event-based snacking definitions were operationalized including participant-defined snacks, eating events outside of meals, and operationally defined snacks based on absolute thresholds of energy consumed (>50 kcal). Weight status was examined using body mass index (BMI), waist circumference, and sagittal abdominal diameter risk. Logistic regression models examined snacking frequency and associations with weight status. Outcomes varied by the definition of a snack employed, but the majority of findings were null. Mean energy from snacks was significantly higher among women with obesity compared to women with normal weight when a snack was defined as any event outside of a typical mealtime (i.e. other than breakfast, lunch, dinner, super, brunch), regardless of whether or not it contributed ≥50 kcal. Further investigation into ingestive behaviors that may influence the relationship between snacking frequency and weight status is needed.
... In agreement with the literature, SAD was correlated with Homa-IR and anthropometric measurement of visceral obesity in the elderly older, regardless of sex, age, hypertension or diabetes. [14,20] Changes occur with aging, such as decreased body mass and stature, reduced fat free mass and changes in body fat compartments. This study's finding that decreased peripheral and increased visceral adipose tissue is aligned with SAD values applied to both genders. ...
Background:
Longevity, combined with a higher prevalence of obesity, particularly visceral obesity, has been associated with an increased risk of cardiovascular diseases. Insulin resistance (IR) is an important link between visceral obesity and cardiovascular diseases. An important association has been found between sagittal abdominal diameter, visceral obesity and IR. The objective of this study is to evaluate sagittal abdominal diameter as a marker of visceral obesity and correlate it with IR in older primary health care patients.
Methods:
A cross-sectional study was performed with 389 patients over 60 years of age (70.6 ± 6.9), of whom 74% were female. Their clinical, anthropometric and metabolic profiles were assessed and their fasting serum insulin level was used to calculate the homeostasis model assessment insulin resistance (HOMA-IR). Sagittal abdominal diameter was measured in the supine position at the midpoint between the iliac crest and the last rib with abdominal calipers.
Results:
Sagittal abdominal diameter was significantly correlated with anthropometric measures of general and visceral obesity and with HOMA-IR in both genders. There was no change in the association between sagittal abdominal diameter and HOMA-IR after adjusting for age, sex, diabetes and hypertension.
Conclusion:
It is feasible to use sagittal abdominal diameter in older primary care patients as a tool to evaluate visceral obesity, which is an indicator of cardiovascular risk.
... The table provides evidence-based SAD normative reference values derived from recent NHANES epidemiological data to identify those with elevated visceral fat mass. These data were collected in 2011 to 2012 from 4,817 U.S. adults representative of the demographic makeup of the American population (28). The average SAD value in this sample of people was 22.5 cm. ...
... Until now, morphometric studies on the abdomen have mainly involved external measures, such as WC, which has also been measured here, or sagittal abdominal diameter (Kahn et al., 2014). Medical imaging was used only to determine the general muscle and fat distribution of the abdomen. ...
Introduction:
Ventral hernia surgery does not usually account for the individuality of the abdominal wall anatomy. This could be both because medical imaging is rarely performed before surgery and because data on abdominal wall variability are limited. The objective of the present study was to perform an exhaustive morphometric analysis of abdominal wall components based on computed tomography (CT) scans.
Materials and methods:
A retrospective study was performed on 120 abdominopelvic CT scans of clinically normal adults aged 18-86 y equally divided between women and men and into four age groups. Each abdominal wall muscle was evaluated in terms of area, thickness, shape ratio, fat infiltration, and aponeuroses width. The influence of age, gender, and BMI was investigated, as well as muscular asymmetry.
Results:
The abdominal wall muscle area represented 8.5 ± 2.5% of the abdominal area. The internal oblique muscle had the largest area, the rectus abdominis was the thickest, the transversus abdominis was the narrowest and had the smallest area. The width of the linea alba was 20.3 ± 12.0 mm. The evolution of the abdominal wall with age was quantified, as well as the large differences between the sexes and BMI groups, resulting in strong correlations and highlighting the specific pattern of the transversus abdominis. The asymmetry of the left and right muscle areas oscillated around 17%.
Conclusions:
The various components of the abdominal wall have been precisely described. Knowledge of their variability could be used to enhance the planning of ventral hernia surgery or to develop numerical modeling of the abdominal wall. This article is protected by copyright. All rights reserved.
... Several anthropometric parameters, e.g. abdominal and thigh circumferences as well as sagittal abdominal diameter (27), have been related to the amount of body fat, particularly visceral fat, which in turn is associated with insulin sensitivity (28). The subjects in the case group were taller and the ...
... The rate of overweight in our cohort was lower than that of the whole Swedish adult population which may be explained by the lack of subjects above 40 years of age. The females, but not the males, with a high birth weight had larger abdominal circumferences and sagittal abdominal diameter, findings which may indicate increased risk of metabolic disease (27). ...
Aim:
To investigate whether a high birth weight was associated with an increased proportion of body fat or with impaired glucose tolerance in adulthood.
Methods:
Our cohort comprised 27 subjects with birth weights of 4,500 g or more, and 27 controls with birth weights within ±1 standard deviation scores, born at Uppsala University Hospital 1975-1979. The subjects were 34-40 years old at the time of study. Anthropometric data was collected, and data on body composition was obtained by air plethysmography and bioimpedance and was estimated with a three compartment model. Indirect calorimetry, blood sampling for fasting insulin and glucose as well as a 75 g oral glucose tolerance test were also performed. Insulin sensitivity was assessed using homeostasis model assessment 2 and Matsuda index.
Results:
There were no differences in body mass index, body composition or insulin sensitivity between subjects with a high birth weight and controls.
Conclusion:
In this cohort of adult subjects, although limited in size, those born with a moderately high birth weight, did not differ from those with birth weights within ±1 standard deviation scores, regarding body composition or glucose tolerance. This article is protected by copyright. All rights reserved.
