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Epidemiology and Population Health

Modelling the direct and indirect associations between anthropometric and behavioural factors when predicting atherogenic risk index (TC/HDL-C) ratio

International Journal of Obesity volume 49, pages 1856–1863 (2025)Cite this article

Subjects

Abstract

Objectives

To identify the association between body size and atherogenic risk index (Total Cholesterol/High Density Lipoprotein (TC/HDL) ratio) associated with ischemic heart disease (IHD).

Methods

Allometric models were used to reveal the association between body size and social behaviours associated with TC:HDL based on the effect sizes obtained from the log-transformed allometric models. Mediation analysis was used to explain why moderate (MPA) or vigorous physical activity (VPA) were strongly associated with body size dimensions or directly associated with TC/HDL.

Results

An allometric model for the atherogenic risk index (TC/HDL) ratio identified waist circumference (WC) and smoking as having the strongest association (strongest effect sizes) with cholesterol-related indices and hence IHD. A strong negative exponent or effect associated with height was also identified, suggesting that taller individuals will inherently have lower cholesterol-related indices. The mediation analysis identified that MPA and VPA were both strongly associated with reducing WC but only VPA was directly associated with the TC/HDL.

Conclusions

These results confirm that taller, non-smokers who have smaller WC are more likely to have a lower atherogenic risk index (TC/HDL) ratio and hence be at reduced risk of IHD. Participation in regular moderate activity to reduce their WC is not necessarily or directly associated with lower atherogenic risk index (TC/HDL) and hence a lower risk of IHD. Being taller with smaller WC, possibly but not necessarily due to taking MVPA, was associated with a lower atherogenic risk index (TC/HDL-C) ratio and hence have lower risk of IHD.

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Fig. 1: The association of waist circumference and cholesterol related indices.
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Data availability

Data are available upon reasonable request from the authors of the manuscript.

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Authors and Affiliations

  1. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK

    Alan M. Nevill

  2. Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, UK

    Michael J. Duncan

  3. Schools of Sport Rehabilitation & Exercise Science, University of Essex, Colchester, UK

    Gavin Sandercock

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  1. Alan M. Nevill
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  2. Michael J. Duncan
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  3. Gavin Sandercock
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Conceptualisation (AN, MD, GS), Methodology (AN, MD, GS), Statistical Analysis (AN, GS), Writing Manuscript (AN, MD, GS), Editing (AN, MD, GS).

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Correspondence to Michael J. Duncan.

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Nevill, A.M., Duncan, M.J. & Sandercock, G. Modelling the direct and indirect associations between anthropometric and behavioural factors when predicting atherogenic risk index (TC/HDL-C) ratio. Int J Obes 49, 1856–1863 (2025). https://doi.org/10.1038/s41366-025-01835-0

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