Sagittal Abdominal Diameter Is a Strong Anthropometric Marker of Insulin Resistance and Hyperproinsulinemia in Obese Men

  1. Ulf Risérus, MMED, PHD1,
  2. Johan Ärnlöv, MD, PHD1,
  3. Kerstin Brismar, MD, PHD2,
  4. Björn Zethelius, MD, PHD1,
  5. Lars Berglund, BSC3 and
  6. Bengt Vessby, MD, PHD1
  1. 1Clinical Nutrition Research Unit, Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
  2. 2Department of Molecular Medicine, Karolinska Institute, Stockholm, Sweden
  3. 3Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  1. Address correspondence and reprint requests to Dr. Ulf Risérus, Churchill Hospital, Oxford Centre for Diabetes, Endocrinology and Metabolism, OX3 7LJ Oxford, U.K. E-mail: ulf.riserus{at}


OBJECTIVE—It is clinically important to find noninvasive markers of insulin resistance and hyperproinsulinemia because they both predict cardiovascular and diabetes risk. Sagittal abdominal diameter (SAD) or “supine abdominal height” is a simple anthropometric measure previously shown to predict mortality in men, but its association with insulin resistance and hyperproinsulinemia is unknown.

RESEARCH DESIGN AND METHODS—In a common high-risk group of 59 moderately obese men (aged 35–65 years, BMI 32.6 ± 2.3 kg/m2), we determined anthropometry (SAD, BMI, waist girth, and waist-to-hip ratio [WHR]); insulin sensitivity (euglycemic-hyperinsulinemic clamp); and plasma concentrations of intact proinsulin, specific insulin, C-peptide, glucose, and serum IGF binding protein-1 (IGFBP-1). To compare SAD with other anthropometric measures, univariate and multiple regression analyses were used to determine correlations between anthropometric and metabolic variables.

RESULTS—SAD showed stronger correlations to all measured metabolic variables, including insulin sensitivity, than BMI, waist girth, and WHR. SAD explained the largest degree of variation in insulin sensitivity (R2 = 0.38, P < 0.0001) compared with other anthropometric measures. In multiple regression analyses, including all anthropometric measures, SAD was the only independent anthropometric predictor of insulin resistance (P < 0.001) and hyperproinsulinemia (P < 0.001).

CONCLUSIONS—In obese men, SAD seems to be a better correlate of insulin resistance and hyperproinsulinemia (i.e., cardiovascular risk) than other anthropometric measures. In overweight and obese individuals, SAD could represent a simple, cheap, and noninvasive tool that could identify the most insulin resistant in both the clinic and clinical trials evaluating insulin sensitizers. These results need confirmation in larger studies that also include women and lean subjects.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted May 8, 2004.
    • Received December 4, 2003.
| Table of Contents