Association of Traditional and Emerging Anthropometric Indices With Subclinical Carotid Atherosclerosis in Young Healthy Adults: Insights From the Tehran Lipid and Glucose Study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Subclinical carotid atherosclerosis in young healthy adults (n=572). Intervention: Anthropometric obesity indices (BMI, WC, WHtR, BRI, ABSI) vs. Carotid intima-media thickness (cIMT) 75th percentile (n=89). Primary outcome: Carotid intima-media thickness (cIMT) and elevated cIMT (>75th percentile) (AUC 0.549 (for BRI and WHtR); r = 0.103 (unadjusted correlation for BRI and WHtR with cIMT), p=0.149).

Q: What does this research mean for the field?

In young healthy adults, body roundness index (BRI) and waist-to-height ratio (WHtR) have modest unadjusted correlations with carotid intima-media thickness that attenuate after multivariable adjustment, showing limited discriminative ability for subclinical atherosclerosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Behnaz Abiri; Amirhossein Ramezani Ahmadi; Farhad Hosseinpanah; Pooneh Dehghan; Azra Ramezankhani; Maryam Mataji Amirroud; Nika Farsinajad; Fereidoun Azizi; Majid Valizadeh

doi:10.1002/edm2.70369

October 22, 2026Endocrinology Diabetes & MetabolismOpen Access

Association of Traditional and Emerging Anthropometric Indices With Subclinical Carotid Atherosclerosis in Young Healthy Adults: Insights From the Tehran Lipid and Glucose Study

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Key result

Anthropometric obesity indices fail to identify elevated cIMT in young healthy adults.

AUC 0.549 (for BRI and WHtR); r = 0.103 (unadjusted correlation for BRI and WHtR with cIMT)
P=0.149
n=572

Figures

Graphical abstract published by Endocrinology Diabetes & Metabolism — Graphical abstract · Published by Endocrinology Diabetes & Metabolism · CC BY

Why the study?

Traditional obesity measures like BMI and waist circumference have limitations, while emerging indices like BRI and ABSI may better reflect fat distribution and cardiovascular risk. Their association with carotid intima-media thickness in young healthy adults needed examination.

Do traditional and emerging anthropometric indices (BMI, WC, WHtR, BRI, and ABSI) associate with or predict subclinical carotid atherosclerosis (measured by cIMT) in young healthy adults?

Key Points

To evaluate the associations between traditional and emerging anthropometric indices and subclinical carotid atherosclerosis measured by carotid intima-media thickness in young healthy adults.
Cross-sectional analysis of 572 healthy adults aged 20–40 years (53.8% male, 46.2% female) from the Tehran Lipid and Glucose Study.
Assessed body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI) alongside carotid ultrasound measurements of carotid intima-media thickness (cIMT).
Evaluated associations using correlation, multivariable linear regression adjusted for metabolic and lifestyle factors, and receiver operating characteristic (ROC) curves.
BRI and WHtR showed near-perfect collinearity (r = 0.997) and modest unadjusted correlations with cIMT (r = 0.103 for both; p < 0.01 for BRI, p < 0.05 for WHtR), which lost significance after full cardiometabolic adjustment.
Waist circumference was the sole independent predictor of cIMT after adjusting for age, sex, education, smoking, and physical activity (B = 0.001, p = 0.022), but significance vanished in fully adjusted models.
ROC analyses showed no significant discriminative ability for any index in detecting elevated cIMT above the 75th percentile, with AUC values ranging from 0.457 to 0.549 (AUC for BRI and WHtR = 0.549 ± 0.035; AUC for ABSI = 0.457 ± 0.033; p > 0.05 for all).

Study Design

Type

Cross-Sectional (n=572)

Blinding

Blinded outcome assessment (radiologists blinded to participant information)

Multicenter

No

Structured PICO

Do traditional and emerging anthropometric indices (BMI, WC, WHtR, BRI, and ABSI) associate with or predict subclinical carotid atherosclerosis (measured by cIMT) in young healthy adults?

P

Population

572 young healthy Iranian adults aged 20–40 years (mean age 28.55 years, 46.2% female) with BMI 18.5–35 kg/m2 and free of diabetes, hypertension, and dyslipidemia, evaluated cross-sectionally during Phase VI of the Tehran Lipid and Glucose Study.

E

Exposure

Anthropometric assessment of traditional and emerging obesity indices: Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Height Ratio (WHtR), Body Roundness Index (BRI), and A Body Shape Index (ABSI)

O

Outcome

Carotid intima-media thickness (cIMT), measured via B-mode ultrasound at three distinct sites on the distal left common carotid artery (LCCA) by two blinded radiologists, analyzed as a continuous variable and categorized as elevated (>75th percentile)surrogate

Main Result

Effect estimate: AUC 0.549 (for BRI and WHtR); r = 0.103 (unadjusted correlation for BRI and WHtR with cIMT)

p-value: p=0.149

In young healthy adults free of cardiometabolic comorbidities, neither traditional (BMI, WC, WHtR) nor emerging (BRI, ABSI) anthropometric indices independently predict or discriminate subclinical carotid atherosclerosis after adjusting for metabolic and lifestyle risk factors.

Limitations

Cross-sectional design limits causal inference between obesity indices and vascular changes
Underpowered to detect modest differences in AUC (only 89 participants in the high cIMT group)
Absence of ECG gating during carotid ultrasound measurements
Internally derived 75th percentile cIMT cutoff is not clinically validated and falls within the normal range for young adults
Restricted to young healthy Iranian adults with BMI 18.5-35 kg/m2, limiting generalizability to older or clinical populations
Potential residual confounding from unmeasured factors such as muscle mass or nutritional status
No a priori sample size calculation was performed; with 89 participants in the high cIMT group, statistical power to detect modest differences in AUC is likely low
Regression models were not stratified by sex due to limited statistical power within strata
Electrocardiography (ECG) was not performed during the ultrasound scan, so the precise phase of the cardiac cycle at which cIMT measurements were taken could not be identified
Hip circumference was measured over light clothing, which may introduce a small degree of measurement error affecting WHR estimates
The 75th percentile threshold for high cIMT was internally derived and not clinically validated, potentially reflecting an inability to discriminate within the normal range

Implication

Anthropometric indices should not guide cIMT assessment in young adults; leaves open longitudinal predictive value.

Abstract

Background Obesity is a major risk factor for cardiovascular disease, but traditional measures like BMI and waist circumference have limitations. New indices, BRI and ABSI, may better reflect fat distribution and cardiovascular risk. This study examined their association with carotid intima‐media thickness (cIMT) in young healthy adults. Methods In this cross‐sectional study within the Tehran Lipid and Glucose Study (TLGS) framework, 572 adults aged 20–40 years underwent anthropometric assessments, biochemical tests and carotid ultrasound for cIMT measurement. Anthropometric indices including BMI, WC, waist‐to‐height ratio (WHtR), ABSI and BRI were calculated. Associations between these indices and cIMT were analysed using correlation and multivariable linear regression models adjusting for demographic, metabolic and lifestyle factors. Receiver operating characteristic (ROC) curve analyses assessed the predictive ability of the indices for elevated cIMT. Result BRI and WHtR were nearly collinear ( r = 0.997) and showed modest positive correlations with cIMT in unadjusted analyses ( r = 0.103 for both), but these associations weakened after adjustment for cardiometabolic risk factors. WC was the only independent predictor of cIMT in partially adjusted models, though this significance disappeared in fully adjusted analyses. ABSI exhibited a significant but mechanistically unexpected inverse association with cIMT. ROC analyses indicated limited discriminative power for all anthropometric measures in predicting high cIMT, with BRI and WHtR having the highest but still modest area under the curve (AUC). Conclusion In young healthy adults, BRI and WHtR showed modest associations with subclinical carotid atherosclerosis, which weakened after adjustment. Waist circumference was an inconsistent predictor, and ABSI demonstrated an inverse relationship with cIMT. Further longitudinal studies are needed to confirm their clinical utility.

Discussion

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Cite This Study

Abiri et al. (2026) conducted a cross-sectional in Subclinical carotid atherosclerosis in young healthy adults (n=572). Anthropometric obesity indices (BMI, WC, WHtR, BRI, ABSI) vs. Carotid intima-media thickness (cIMT) <75th percentile (n=483) vs >75th percentile (n=89) was evaluated on Carotid intima-media thickness (cIMT) and elevated cIMT (>75th percentile) (AUC 0.549 (for BRI and WHtR); r = 0.103 (unadjusted correlation for BRI and WHtR with cIMT), p=0.149). Traditional and emerging anthropometric indices (BMI, WC, WHtR, BRI, ABSI) failed to significantly discriminate elevated cIMT in young healthy adults (max AUC 0.549, p=0.149) or maintain significance after full adjustment.

synapsesocial.com/papers/6adc966ca704d151585a5e56 https://doi.org/10.1002/edm2.70369

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Association of Traditional and Emerging Anthropometric Indices With Subclinical Carotid Atherosclerosis in Young Healthy Adults: Insights From the Tehran Lipid and Glucose Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of Traditional and Emerging Anthropometric Indices With Subclinical Carotid Atherosclerosis in Young Healthy Adults: Insights From the Tehran Lipid and Glucose Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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