Anthropometric indices are associated with Arterial stiffness markers:
Several studies have also examined the association between conventional and novel anthropometric measures, and similar results have been obtained. In a study using healthy, hypertensive, and diabetic subjects, WHtR, ABSI, and BRI were found to be better predictors of PWV in both genders (31). Another study in obese and overweight people showed a relationship between PWV and visceral fat, BRI, and ABSI (32).
New anthropometric indices such as ABSI and BRI were developed due to the limitation of the traditional index (BMI) in the accurately reflect of BFM and visceral adipose tissue. The ABSI is independent of BMI, has been reported more closely associated with visceral adipose tissue, cardiovascular mortality, and risk of death than traditional anthropometric index such as BMI (33). In the present study, we found that ABSI was associated only with cAIx, but not PWV. Another parameter, BRI, based WC and height, has been suggested as a superior predictor of both BFM and visceral adiposity, compared to BMI (17). Some studies found that BRI had a potential predictive value to identify dyslipidemia and CVD (34, 35). However, a few studies have been conducted about BRI, and limited evidence has examined the association of BRI with AS indicators for predicting cardiovascular health status. The results of the present study demonstrated that BRI was associated with both PWV and cAIx, even after adjustment for potential confounders.
Common anthropometric indices, including BMI, WC, and WHR also assessed, and the results indicated that both WC and WHR were independently related to PWV and cAIx, but not BMI, which was consistent with other studies. BMI, as one of the most common anthropometric indices, cannot distinguish between adipose tissue and muscle mass, as well as peripheral and abdominal obesity (36). To eliminate this limitation, WC and WHR as substantial diagnostic components of metabolic syndrome and CVD are used alternatively as an indicator of abdominal obesity (37, 38). At the same time, WC and WHR could be used as an alternative to BMI and plays an essential role in assessing cardiovascular, metabolic risk (39). However, these parameters cannot distinguish between abdominal BFM and visceral fat. It should also be noted that height is not involved in calculating WC and WHR, which may lead to underestimated and overestimated in short and tall participants, respectively.
On the other hand, height can represent long-term nutrition and social status, which is likely to affect cardio-metabolic risk (40), as Smith et al. indicated a negative association between height and CVD risk (41). To figure it out, WHtR was presented as a modification of WC with height, and we found that WHtR was related to cf-PWV. Some evidence showed that WHtR could assess cardiovascular risk factors and optimally used in predicting the incidence of metabolic syndrome in non-obese people, and is suggested as a screening tool for metabolic risk factors (42, 43). This means that WHtR is probably an appropriate index to evaluate abdominal obesity and can be used as a predictive value in metabolic syndrome, CVD, and AS.
In our analysis, we also included a visceral fat area and BFM, which independently associated with cAIx. Other studies using hypertensive, middle-aged, and older adults, reported that visceral fat was correlated with AS more closely than other parameters such as BMI and WC (44-46). This relationship may be explained by the positive association of visceral fat with free fatty acids and insulin levels that results in decreased nitric oxide production and increased sympathetic activity (47, 48). Indeed, we found that the NC of participants had a positive and negative correlation with PWV and cAIx, respectively. However, in the regression model, the relationship between this variable and AS was not significance, and it is not able to predict the AS value.