document: obesity is a common metabolic disease world - wide and dyslipidemias among the most common metabolic disorders associated with obesity [ 17 ] . 
   obesity is often described by classical parameters such as body mass index ( bmi ) , waist circumference ( wc ) , and waist - to - hip ratio ( whr ) [ 13,7,8 ] . 
   results of meta - regression analysis of prospective , randomized studies showed that whr and wc may play important roles in assessment of increased risk of cardiovascular ( cv ) events . in recent years 
   , attention has been drawn to new obesity indices ( e.g. , waist - to - height ratio ( whtr ) , visceral adiposity index ( vai ) , and body adiposity index ( bai ) , which also take into account adipose tissue distribution [ 1316 ] . 
   results of the some recently published studies suggest that whtr , the newer obesity index , may be helpful for assessing risk of metabolic complications , including dyslipidemia , and it may also be a predictor of cardiovascular events in obese patients [ 1,8,1620 ] . nevertheless , there is little data about the associations between other newer obesity indices ( e.g. , vai and bai ) and lipid profile in obese patients . 
   therefore , the aim of this study was to examine the relationship between obesity parameters or indices ( bmi , wc , whr , whtr , bai , vai ) and serum lipid levels of total cholesterol ( tc ) , low - density lipoprotein cholesterol ( ldl - c ) , high - density lipoprotein cholesterol ( hdl - c ) , triglycerides ( tg ) , and lipid indices such as tc / hdl - c , ldl - c / hdl - c , and tg / hdl - c ratios in obese non - diabetic patients . 
   this cross - sectional study was conducted in a population of 66 consecutively enrolled obese non - diabetic patients ( bmi 30 kg / m ) with mean age of 55.811.6 years , including 40 women ( mean age 57.510.8 years ) and 26 men ( mean age 53.312.3 years ) treated in the outpatient department of hypertension and lipid disorders of wam university hospital in lodz , poland . patients with fasting hyperglycemia 5.6 
   mmol / l ( 100 mg / dl ) underwent a glucose tolerance test ( 75 g ) to exclude diabetes mellitus ( dm ) . 
   patients with dm , pregnancy , cancer , acute stroke , acute hepatic or renal diseases and acute cardiovascular events or with history of abdominal surgery , which could have an impact on abdominal fat distribution , were excluded from the study . 
   patients with psychiatric disorders receiving antipsychotic agents that might impact appetite and lead to weight gain were also excluded . based on calculated bmi values , patients were divided into 3 groups according to their obesity level : group i consisted of patients with obesity class i with bmi of 30.034.9 kg / m ; group ii consisted of patients with obesity class ii with bmi of 35.039.9 kg / m ; and group iii consisted of patients with obesity class iii with bmi 40 kg / m . 
   the study was conducted after receiving approval from the bioethics committee of the medical university of lodz , resolution no . 
   all the patients underwent a complete blood count , lipid and liver profile , tsh , glucose , renal function indices ( bun and creatinine ) , and general urinalysis . 
   the serum ldl - c level was calculated based on friedewald s formula ( in mmol / l ) : measurements accurate to within 0.1 kg were made of body mass , and measurements accurate to within 0.5 cm were made of height , wc , and hc . wc was measured at mid - distance between the last rib and the iliac crest , while hc was measured at the level of the greater trochanter . 
   based on these measurements , the following body mass - related indices were calculated using the following formulas : bmi = body mass ( kg ) / [ height ( m ) ] whr = wc ( cm ) / hc ( cm ) whtr = wc ( cm ) / height ( cm ) men vai = [ wc / 39.68 + ( 1.88  bmi ) ]  ( tg / 1.03 )  ( 1.31 / hdl ) ; women vai = [ wc / 36.58 + ( 1.89  bmi ) ]  ( tg / 0.81 )  ( 1.52 / hdl ) . 
   bai = [ hip circumference ( cm ) / height ( m ) ]  18 [ 1315,18 ] . 
   in addition , based on the lipid profile results obtained , the following lipid metabolism indices were calculated : tc / hdl - c ratio 
   values > 5 indicate increased cardiovascular risk ; ldl - c / hdl - c ratio  increased cardiovascular risk with values > 3 ; tg / hdl - c ratio  increased cardiovascular risk with values 3 . 
   the results are presented as mean values with standard deviation ( normality of distribution was tested using the shapiro - wilk test ) . 
   significance of differences between groups was assessed using the t - test for independent samples , and in the case of multiple comparisons ( more than 2 study groups ) , univariate analysis of variance ( anova ) was applied with subsequent use of post - hoc multiple comparison tests ( tukey s test ) . for statistical analysis of discontinuous results , 
   values of p<0.05 were assumed to be statistically significant . to assess the relationship and correlation between obesity indices and lipid metabolism parameters , pearson s linear correlation analysis was used , along with a linear regression model with a 95% confidence interval . 
   this cross - sectional study was conducted in a population of 66 consecutively enrolled obese non - diabetic patients ( bmi 30 kg / m ) with mean age of 55.811.6 years , including 40 women ( mean age 57.510.8 years ) and 26 men ( mean age 53.312.3 years ) treated in the outpatient department of hypertension and lipid disorders of wam university hospital in lodz , poland . patients with fasting hyperglycemia 5.6 
   mmol / l ( 100 mg / dl ) underwent a glucose tolerance test ( 75 g ) to exclude diabetes mellitus ( dm ) . 
   patients with dm , pregnancy , cancer , acute stroke , acute hepatic or renal diseases and acute cardiovascular events or with history of abdominal surgery , which could have an impact on abdominal fat distribution , were excluded from the study . 
   patients with psychiatric disorders receiving antipsychotic agents that might impact appetite and lead to weight gain were also excluded . based on calculated bmi values , patients were divided into 3 groups according to their obesity level : group i consisted of patients with obesity class i with bmi of 30.034.9 kg / m ; group ii consisted of patients with obesity class ii with bmi of 35.039.9 kg / m ; and group iii consisted of patients with obesity class iii with bmi 40 kg / m . 
   the study was conducted after receiving approval from the bioethics committee of the medical university of lodz , resolution no . 
   all the patients underwent a complete blood count , lipid and liver profile , tsh , glucose , renal function indices ( bun and creatinine ) , and general urinalysis . 
   the serum ldl - c level was calculated based on friedewald s formula ( in mmol / l ) : measurements accurate to within 0.1 kg were made of body mass , and measurements accurate to within 0.5 cm were made of height , wc , and hc . wc was measured at mid - distance between the last rib and the iliac crest , while hc was measured at the level of the greater trochanter . based on these measurements , 
   the following body mass - related indices were calculated using the following formulas : bmi = body mass ( kg ) / [ height ( m ) ] whr = wc ( cm ) / hc ( cm ) whtr = wc ( cm ) / height ( cm ) men vai = [ wc / 39.68 + ( 1.88  bmi ) ]  ( tg / 1.03 )  ( 1.31 / hdl ) ; women vai = [ wc / 36.58 + ( 1.89  bmi ) ]  ( tg / 0.81 )  ( 1.52 / hdl ) . 
   bai = [ hip circumference ( cm ) / height ( m ) ]  18 [ 1315,18 ] . 
   in addition , based on the lipid profile results obtained , the following lipid metabolism indices were calculated : tc / hdl - c ratio  values 
   > 5 indicate increased cardiovascular risk ; ldl - c / hdl - c ratio  increased cardiovascular risk with values > 3 ; tg / hdl - c ratio  increased cardiovascular risk with values 3 . 
   the results are presented as mean values with standard deviation ( normality of distribution was tested using the shapiro - wilk test ) . 
   significance of differences between groups was assessed using the t - test for independent samples , and in the case of multiple comparisons ( more than 2 study groups ) , univariate analysis of variance ( anova ) was applied with subsequent use of post - hoc multiple comparison tests ( tukey s test ) . for statistical analysis of discontinuous results , 
   values of p<0.05 were assumed to be statistically significant . to assess the relationship and correlation between obesity indices and lipid metabolism parameters , pearson s linear correlation analysis was used , along with a linear regression model with a 95% confidence interval . 
   there were no statistically significant differences in clinical characteristic between compared groups ( table 1 ) . among persons enrolled in the study , 
   the largest group consisted of dyslipidemic patients , accounting for 90.9% of the general study population , while hypercholesterolemia was present in 43.9% , mixed hyperlipidemia in 36.4% , and hypertriglyceridemia in 10.6% of subjects ( table 1 ) . 
   hypertension was diagnosed in 83.3% patients from the whole study population ( table 1 ) . 
   patients from group iii had greater mean wc compared to group ii and i ( table 2 ) . 
   patients in obesity class ii also had greater mean wc than in group i. mean whtr , bmi , and bai values were higher in group iii compared to group ii and group i ( table 2 ) . 
   higher mean whtr and bmi were observed in group ii compared to group i ( table 2 ) . 
   mean serum tc and ldl - c in group iii were significantly lower than in group i ( table 2 ) . 
   negative significant correlations were found in the whole study population between : bmi and tc , ldl - c , hdl - c ; wc , whr , vai and hdl - c ( table 3 ) . 
   by contrast , positive significant correlations were found between wc , whr , and tg / hdl - c , as well as between vai and : tc , tg , tc / hdl - c , ldl / hdl - c , and tg / hdl - c ( table 3 ) . 
   lipid disorders were the most frequent concomitant disorders in our study population . the high incidence of dyslipidemia in obese patients was also shown in 2 large polish epidemiological studies 
   interestingly , the group of patients with class iii obesity had lower mean serum levels of tc and ldl - c compared with patients from the other 2 groups , and this difference was statistically significant when compared to the patients with class i obesity . 
   this result was not related to lipid - lowering treatment because of lack of statistically significant differences between compared groups . 
   similar results were obtained in the study lipidogram 2004 , where higher serum levels of tc , ldl - c , and tg were found in overweight people compared with the obese . on the other hand 
   , the negative correlations observed in our study between bmi , wc , and ldl - c might have resulted from a lower ldl - c level in patients with morbid obesity as previously observed by others [ 2628 ] . 
   found a 2-phase relationship between bmi , wc , and ldl - c levels , especially in women . 
   increase in bmi and wc values initially resulted in increases in ldl - c levels , subsequently leading to reductions in the most obese persons . in native americans , 
   increase in ldl - c levels was positively correlated with bmi only for the first 3 quartiles , then this relationship was reversed . 
   the authors suggest that increase in adipose tissue in this population may decrease ldl - c levels in 2 ways : through increased activity of ldl - c receptors in adipose tissue or because of diluting the circulating pool of ldl - c through the increased circulating blood volume in more obese people . 
   it must also be noted that levels of small , dense ldl ( sdldl ) fractions , as in our study , were not measured and a preponderance of sdldl induced by insulin resistance can lead to significant reductions in ldl - c . 
   howard et al . concluded , based on results of clinical studies , that the relationship between bmi and ldl - c serum levels is complex and depends on numerous factors such as age or sex . 
   it was demonstrated that higher ldl - c levels were seen in young ( 2044 years of age ) obese women , and were positively correlated with bmi . 
   the authors did not observe significant differences between patients from different obesity classes with regards to levels of hdl - c and tg . in the strong heart study conducted in 773 women and 739 men of native american origin , 
   hu et al . found significant negative correlation between bmi and hdl - c in women . 
   wc values were positively correlated with serum tg levels and negatively correlated with hdl - c levels , and the relation between wc and assessed lipid fraction levels in women was much stronger than in the case of bmi . in men , 
   positive correlations were observed between bmi , wc , and tg levels , as well as a negative correlation between bmi , wc , and hdl - c levels , although , in contrast with women , the strength of correlation was comparable for both obesity parameters . 
   data obtained from the available literature suggest that increasing bmi results in decreasing hdl - c levels and increasing tg levels . 
   these studies , however , were conducted in general populations rather than selected groups of patients with obesity . 
   these observations are also supported by the results of a study conducted in 1518 adult peruvians , where the authors found a very strong negative correlation between bmi , vai , and the hdl - c fractions , as well as a positive correlation with tg ; however , this was irrespective of gender . 
   we also found a negative correlation between bmi , wc , whr , and hdl - c , but not with tg . 
   similar findings were observed in the prospective epidemiological study of myocardial infarction ( prime ) and by mojiminiyi et al . . 
   the negative correlation between wc and hdl - c levels observed in our study is supported by results presented by hu et al . 
   ; however , unlike the present authors , no statistically significant correlation between bmi , wc , and tg was found , although a similar tendency was present . 
   the above - mentioned negative correlation between wc and hdl - c was also reported by chehrei et al . in 750 non - obese people . 
   the results of our study suggest that obesity , especially abdominal obesity , is significantly associated with dyslipidemia , which manifests itself mainly with reductions in hdl - c . 
   it is especially evident with the vai index , which demonstrated the strongest correlation with tg and hdl - c levels and with the lipid indices tc / hdl - c , ldl - c / hdl - c , and tg / hdl - c . 
   this is not surprising , however , given the fact that the vai formula includes both the hdl - c and tg levels . 
   the positive correlation observed in our study between whr and tg / hdl - c ratio is supported by results obtained by marrotta et al . 
   results of our study demonstrate a relationship between some selected obesity indices , especially those pertaining to visceral obesity , and lipid parameters . 
   this is especially the case with new , recently proposed obesity indices , such as vai , whtr , and bai , which have been investigated in only a few studies to date [ 1,1316 ] . 
   one strength of this study is that there is relatively little information on obese patients grouped according to obesity level , especially among the morbidly obese ( bmi 40 kg / m ) . 
   most studies have assessed the relationship between obesity indices and lipid metabolism parameters in the general population , and sometimes in non - overweight or healthy people . 
   obesity is associated with lipid disturbances , especially with hdl - c reduction , in obese non - diabetic patients . 
   vai is strongly related with lipid profile and thus may be the most valuable obesity index in obese patients with dyslipidemias . 
   
summary: backgroundthe aim of this cross - sectional study was to examine the relationship between obesity and lipid markers.material/methodswe divided 66 non - diabetic adult obese patients ( mean age : 55.811.6 years ) into 3 groups according to body mass index ( bmi ) . 
   all patients were measured for waist circumference ( wc ) , hip circumference ( hc ) , body mass index ( bmi ) , waist - to - hip ratio ( whr ) , waist - to - height ratio ( whtr ) , body adiposity index ( bai ) , and visceral adiposity index ( vai ) . 
   serum levels of total cholesterol ( tc ) , high - density lipoprotein cholesterol ( hdl - c ) , low - density lipoprotein cholesterol ( ldl - c ) , and triglycerides ( tg ) were determined , and lipid indices tc / hdl , ldl / hdl , and tg / hdl were also estimated.resultstc and ldl - c in group iii were lower than in group i ( 5.01.0 vs. 6.01.0 mmol / l , and 2.90.9 vs. 3.81.2 
   mmol / l ; p<0.05 for both ) . 
   negative correlations were found between : bmi and tc , ldl , and hdl ( r=0.291 ; r=0.310 , r=0.240 , respectively ) ; and wc , whr , vai , and hdl ( r=0.371 , r=0.296 , r=0.376 , respectively ) . 
   positive correlations were found between wc , whr , and tg / hdl ( r=0.279 , r=0.244 , respectively ) and between vai and : tc ( r=0.327 ) , tg ( r=0.885 ) , tc / hdl ( r=0.618 ) , ldl / hdl ( r=0.480 ) , and tg / hdl ( r=0.927).conclusionsobesity is associated with lipid disturbances , especially with hdl - c reduction , in obese non - diabetic patients . 
   vai is strongly related to lipid profile and thus may be the most valuable obesity index in obese patients with dyslipidemias .