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Open Access Research article

Association of body mass index, sagittal abdominal diameter and waist-hip ratio with cardiometabolic risk factors and adipocytokines in Arab children and adolescents

Omar S Al-Attas12*, Nasser M Al-Daghri12, Majed S Alokail12, Khalid M Alkharfy13, Hossam Draz14, Sobhy Yakout1, Shaun Sabico1 and George Chrousos15

Author Affiliations

1 Biomarkers Research Program, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia

2 Center of Excellence in Biotechnology, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia

3 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, 11451, Kingdom of Saudi Arabia

4 Department of Biochemistry, National Research Centre, Cairo, 12311, Egypt

5 First Department of Pediatrics, Athens University Medical School, Athens, 11527, Greece

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BMC Pediatrics 2012, 12:119  doi:10.1186/1471-2431-12-119

Published: 7 August 2012



Sagittal abdominal diameter (SAD) is a novel anthropometric measure hypothesized to be a surrogate measure of visceral abdominal obesity in adults. This study aims to determine whether SAD is superior to other anthropometric measures such as body mass index (BMI) and waist to hip ratio (WHR) in terms of association to cardiometabolic risk and circulating adipocytokine concentrations in a cohort of Saudi children and adolescents.


A total of 948 (495 boys and 453 girls) apparently healthy children with varying BMI, aged 10–17 years, were included in this cross sectional study. Fasting glucose, lipid profile, leptin, adiponectin, resistin, insulin, TNF-α and aPAI-1 were measured in serum and HOMA-IR was calculated. MetS components were defined according to the International Diabetes Federation (IDF) criteria.


BMI was superior to SAD as well as WHR, and had the highest number of significant associations to MetS components and adipocytokines even after adjustment for age and gender, including blood pressure, lipids, glucose and leptin.


In conclusion, while SAD is significantly associated with components of MetS among children and adolescents, it is not superior to BMI. The use of SAD therefore may not be practical for use in the pediatric clinical setting. Follow-up studies are needed to determine whether SAD has clinical significance in terms of harder outcomes such as predicting diabetes mellitus or cardiovascular diseases.

Sagittal abdominal diameter; Insulin resistance; Adipocytokines; Arab children