Association of sagittal abdominal diameter with cardiovascular disease and cardiometabolic risk factors among US adults: A cross-sectional study

Obesity, a major cardiovascular disease (CVD) risk factor, can be assessed through sagittal abdominal diameter (SAD), though its link to CVD is less studied. This study investigates the relationship between SAD and CVD and compares the predictive ability of SAD, body mass index (BMI), and waist circumference (WC) for CVD in US adults. A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2016. Restricted cubic splines and multivariable logistic regression were used to assess the association between SAD and CVD. The predictive performance of SAD, BMI, and WC was compared using receiver operating characteristic curve analysis. The study included 10,854 adults aged 20 years and older (representing 158.7 million; mean age 45.7 ± 16.1 years; 50.6% male, 66.3% non-Hispanic White). The weighted mean (95% confidence interval [CI]) of SAD was 22.6 (22.4-22.8) cm, and the prevalence of CVD was 7.0%. Higher SAD was associated with increased CVD prevalence (odds ratio [OR], 1.11; 95% CI, 1.08-1.13) after multivariate adjustment. Compared with participants with SAD < 19.4 cm, those with SAD > 25.4 cm had a significantly higher cardiovascular risk (OR, 1.87; 95% CI, 1.31-2.67). The area under the receiver operating characteristic curve for SAD (0.65 [0.64-0.65]) was the largest compared to BMI (0.57 [0.56-0.58]) and WC (0.63 [0.62-0.64]). Higher SAD was associated with more CVD events, and it demonstrated better clinical utility for predicting CVD risk compared with BMI and WC.