Comparison of Measures of Adiposity and Cardiovascular Disease Risk Factors Among African American Adults: the Jackson Heart Study

  • Ronny A. Bell
  • Haiying Chen
  • Santiago Saldana
  • Alain G. Bertoni
  • Valery S. Effoe
  • Kristen G. Hairston
  • Rita R. Kalyani
  • Arnita F. Norwood


Obesity, particularly central adiposity, is a well-established risk factor for cardiovascular disease (CVD). Waist circumference (WC) is measured in numerous epidemiologic studies as a relatively simple indicator of central adiposity. However, recently, investigators have considered a measure that takes height into consideration, waist-to-height ratio (WHtR) as a more sensitive predictor of CVD. A limited number of studies have examined the association between various measures of central adiposity and obesity with CVD, but there is a dearth of information on this topic focused specifically on African American adults. Given the high rates of cardiovascular disease and metabolic risk factors in this population, it is important to develop validated, easy-to-measure indicators of CVD risk for clinical use. Data from 4758 African American adults participating in the baseline visit of the Jackson Heart Study with available risk factor data were examined, with three measures of body habitus (body mass index (BMI), WC, and WHtR) and five CVD risk factors (HDL and LDL cholesterol, triglycerides, diabetes, and hypertension), the latter also categorized into multiple (2+) risk factors present. C-statistics for waist circumference (WC), BMI, and WHtR were computed and compared for each model to assess their discriminant abilities. WHtR was a stronger correlate of HDL cholesterol, triglycerides, diabetes, hypertension, and multiple risk factors compared to BMI, and was a stronger correlate of HDL cholesterol when compared to WC. These data indicate that, for African American adults, WHtR may be more appropriate measure to identify those at elevated risk for CVD.


Obesity Cardiovascular disease Waist circumference African Americans 



The authors thank the participants and data collection staff of the Jackson Heart Study. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services. Data from this analysis were presented in poster format at the 2016 Obesity Society’s Annual Scientific Conference, October 31–November 4, 2016.


This manuscript was approved by the Jackson Heart Study Publications and Presentations Committee. The Jackson Heart Study is supported by contracts HHSN268201300046C, HHSN268201300047C, HHSN268201300048C, HHSN268201300049C, and HHSN268201300050C from the NHBLI and the NIMHD. This secondary analysis was funded by NHLBI Grant (R01HL117285-01, Bertoni, PI).

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

Informed consent was obtained from all individual participants included in this study in accordance with the protocol of the parent study.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Ronny A. Bell
    • 1
  • Haiying Chen
    • 2
  • Santiago Saldana
    • 2
  • Alain G. Bertoni
    • 3
  • Valery S. Effoe
    • 4
  • Kristen G. Hairston
    • 5
  • Rita R. Kalyani
    • 6
  • Arnita F. Norwood
    • 7
  1. 1.Department of Public HealthEast Carolina UniversityGreenvilleUSA
  2. 2.Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of MedicineMedical Center BoulevardWinston-SalemUSA
  3. 3.Department of Epidemiology and Prevention, Division of Public Health Sciences, Maya Angelou Center for Health Equity, Wake Forest School of MedicineMedical Center BoulevardWinston-SalemUSA
  4. 4.Department of Medicine, Division of General Internal MedicineMorehouse School of MedicineAtlantaUSA
  5. 5.Section on Endocrinology and Metabolism, Maya Angelou Center for Health Equity, Wake Forest School of MedicineMedical Center BoulevardWinston-SalemUSA
  6. 6.Johns Hopkins Center on Aging and Health, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of MedicineBaltimoreUSA
  7. 7.Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA

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