Leg fat-to-total fat ratio improves waist-to-height ratio for discriminating metabolic syndrome: a nationwide cross-sectional study.

Authors

Sena Hwang, Hyun Min Kim

Published in

Journal of endocrinological investigation. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

To evaluate whether regional fat distribution or skeletal muscle mass provides incremental discriminative value for metabolic syndrome (MetS) beyond the waist-to-height ratio (WHtR) in a nationally representative Korean population.
Data from 15,838 adults in the Korea National Health and Nutrition Examination Survey (KNHANES) 2008-2011 who underwent dual-energy X-ray absorptiometry were analyzed. Ten anthropometric indices were compared using receiver operating characteristic (ROC) curve analysis. Incremental discriminative value was evaluated using multivariable logistic regression models combining WHtR with the leg fat-to-total fat (LF/TF) ratio and the appendicular skeletal muscle mass-to-body weight (ASM/BW) ratio. Subgroup analyses were performed by sex, age, and obesity status.
Among the 15,838 participants, 26.4% had MetS. WHtR showed the highest area under the ROC curve (AUC) among the individual indices (0.852; 95% CI, 0.845-0.860). Adding the LF/TF ratio significantly increased the AUC to 0.876 (p < 0.001), with a greater improvement among adults aged <65 years than among those aged ≥65 years (ΔAUC, +0.027 vs. +0.016; p = 0.002). Although ASM/BW was inversely associated with MetS, adding it to WHtR produced minimal improvement (ΔAUC, +0.003) and no meaningful benefit beyond the combination of WHtR and LF/TF ratio (p = 0.964).
WHtR was the strongest individual anthropometric discriminator of MetS, but incorporating the LF/TF ratio further improved discrimination, particularly among younger adults. These findings suggest the clinical relevance of DXA-derived lower-extremity fat distribution as a complement to central adiposity for MetS discrimination. Prospective studies in diverse populations are warranted to validate this approach.

PMID:
42720889
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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