Associations of body mass index, waist circumference, and weight-adjusted waist index with body composition and biomarkers: a multinational pooled analysis

Background: The widely used anthropometric indices, such as body mass index (BMI) and waist circumference (WC), have limitations in their use as indicators of body composition. Recent studies proposed weight-adjusted waist index (WWI = WC/√(body weight)) as an alternative index for body composition but it is unclear whether WWI reflects body composition in different racial/ethnic groups. Objectives: We examined the associations of WWI, BMI, and WC with dual-energy X-ray absorptiometry (DEXA)-measured body composition, biomarkers (fasting blood glucose, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride), and handgrip strength. Methods: A multinational pooled analysis was conducted among 81,215 racially diverse participants (aged ≥20 y) with whole-body DEXA-measured body composition data in the UK Biobank, United States National Health and Nutrition Examination Survey (NHANES), and Korea NHANES. Weight, height, and WC were measured by medical staff. We performed logistic and linear regression models, adjusting for age, sex, and race/ethnicity, to estimate the associations of WWI, BMI, and WC with DEXA-measured body composition and related markers. Results: WWI (highest compared with lowest quintiles) was monotonically inversely associated with the prevalence of “high fat-free/low fat mass” body composition type [odds ratio (95% confidence interval): 0.29 (0.27, 0.30)] and was monotonically positively associated with the prevalence of “low fat-free/high fat mass” body type [3.70 (3.21, 4.26)]. BMI and WC showed inverse U-shaped relationships with these body composition types. BMI, WC, and WWI were all positively associated with blood glucose and triglyceride (all P-trend < 0.01) but only WWI was inversely associated with handgrip strength (P-trend < 0.01). Consistent results were observed in each sex, race/ethnicity, and country. Conclusions: Our data suggest that WWI is associated with unhealthy body composition (high fat, low fat-free mass) in populations of diverse age, sex, and race/ethnicities and may serve as an alternative index to BMI and WC.