Comparative performance of anthropometric indices in predicting cardiometabolic risk severity in black adults

Abstract Background Waist-to-Height ratio (WHtR), Body Roundness Index (BRI), and A Body Shape Index (ABSI) are emerging anthropometric indicators of obesity that provide alternative assessments of body shape and fat distribution. Purpose This study evaluated the performance of these indices relative to the traditional Body Mass Index (BMI) in predicting cardiometabolic risk severity (cMetS) among Black adults. Methods 75 Black adults of sub-Saharan African descent (51% female; mean age: 40 ± 10 years) residing in the West Midlands, UK, were assessed for WHtR, BRI, ABSI, BMI, and cMetS. The cMetS score was calculated using standardised z-scores for waist circumference, systolic blood pressure, random glucose, non-HDL cholesterol, and HDL cholesterol. Pearson correlation analyses were conducted to explore bivariate associations, while multiple linear regression was used to evaluate the independent contributions of the anthropometric measures to cMetS. Results Average cMetS score was −0.04 ± 0.5, with males showing a higher mean score (0.1 ± 0.6) compared to females (−0.2 ± 0.5). The mean WHtR, BRI, ABSI and BMI were 0.55 ± 0.08, 4.4 ± 1.6, 0.74 ± 0.06, and 29.4 ± 5.6 kg/m², respectively. Significant positive correlations were observed between cMetS and WHtR (r = 0.54), BRI (r = 0.53), ABSI (r = 0.36), and BMI (r = 0.40) (p 0.001 for all). After adjusting for age, linear regression analyses showed that WHtR (adjusted R2 = 0.27, B = 3.59, β = 0.523, p 0.001), BRI (adjusted R2 = 0.26, B = 0.17, β = 0.513, p 0.001), ABSI (adjusted R2 = 0.11, B = 3.16, β = 0.336, p = 0.006) and BMI (adjusted R2 = 0.17, B = 0.04, β = 0.394, p 0.001), were all independent predictors of cMetS. Conclusion Anthropometric measures evaluated in this study showed significant positive associations with cMetS, but Waist-to-Height ratio and Body Roundness Index accounted for greater variance in risk, indicating superior discriminatory performance and thus, stronger predictors of cardiometabolic risk severity than the conventional Body Mass Index among Black adults. Notwithstanding, WHtR offers a superior balance of accuracy, simplicity, and practicality, making it a more feasible tool for widespread clinical and community-based use.