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Background  Obesity is a recognized risk factor for various cardiometabolic diseases and several indices are used clinically to assess overall cardiometabolic risk. This study aims to determine the sensitivity of six anthropometric indices [Body mass index (BMI), waist, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body adiposity index (BAI) and visceral adiposity index (VAI)] in determining diabetes mellitus type 2, coronary heart disease, dyslipidemia, hypertension and metabolic syndrome (MetS) in Saudi adults recruited from two independent cohorts (2008–2009 and 2013–2014).    Methods  A total of 6,821 Saudi adults [2008–2009, N = 3,971 (1,698 males and 2,273 females); 2013–2014, N = 2,850 (926 males and 1,924 females)] aged 18–70 years old were included in this descriptive, cross-sectional study. Anthropometrics were obtained and fasting blood samples analyzed for glucose and lipids. BMI, WHR, WHtR, BAI and VAI were computed mathematically.    Results  VAI was the most sensitive index in determining DMT2 (AUC 0.72; p < 0.001) in the 2008–2009 cohort and MetS (AUC = 0.84; p < 0.001) in the 2013–2014 cohort. WHR was most discriminating for CHD in both cohorts (AUC 0.70 and 0.84 for 2008–2009 and 2013–2014, p values <0.001, respectively). WHtR was most sensitive but rather modest in determining hypertension (AUC 0.66; p < 0.001), while waist circumference was most sensitive for dyslipidemia (AUC 0.72; p < 0.001) in the 2008–2009 cohort and MetS (AUC 0.85; p < 0.001) in the 2013–2014 cohort. BAI was the least sensitive adiposity index.    Conclusion  Sensitivity of adiposity indices regarding cardiometabolic diseases highlight the importance of body fat distribution in determining overall cardiometabolic risk, with indices involving abdominal obesity being more clinically significant than BMI and BAI. The sensitivity of these adiposity indices should be noted in assessing a particular cardiometabolic disease.    Electronic supplementary material  The online version of this article (doi:10.1186/s12933-015-0265-5) contains supplementary material, which is available to authorized users.

Sensitivity of various adiposity indices in identifying cardiometabolic diseases in Arab adults