Abstract
Background: Hypertension is strongly linked to obesity, but whether DXA measures provide clinically meaningful discriminatory value beyond anthropometric measures and whether any additional value reflects visceral rather than total adiposity remains uncertain. This study examined whether DXA-derived adiposity measures provide incremental discriminatory value beyond routine anthropometric measures for hypertension.
Methods: We analyzed 7,817 adults aged 20–59 years from the 2013–2018 National Health and Nutrition Examination Survey with valid DXA measurements. Discriminatory performance and the incremental value of DXA-derived adiposity measures beyond anthropometric assessment were evaluated using receiver operating characteristic curve analysis, model fit, and reclassification analyses.
Results: Among routinely available anthropometric measures, waist circumference demonstrated the highest discriminatory performance for hypertension (AUC 0.791, 95% CI: 0.780–0.802). Addition of DXA-derived visceral adiposity substantially improved discrimination (AUC 0.865, ΔAUC = 0.074) and significantly improved model fit beyond waist circumference (P <0.001), whereas total adiposity measured by fat mass index provided negligible incremental value (ΔAUC = 0.0020) and did not improve model fit. Reclassification metrics yielded consistent findings, which remained robust across sensitivity analyses.
Conclusion: Waist circumference remained the best-performing routine anthropometric measure for hypertension discrimination. Among DXA-derived adiposity measures, only visceral adiposity provided statistically significant incremental value beyond WC, whereas total adiposity did not. These findings suggest that when DXA-based body composition assessment is performed, the clinically relevant information is derived from visceral rather than total adiposity.