Anthropometric and metabolic assessment in adults with Down syndrome: the need for novel indices and tailored criteria

Background/aim: This study aimed to evaluate the metabolic profile of adults with Down syndrome (DS) using novel anthropometric and metabolic indices, while also highlighting the limitations of traditional obesity assessment methods compared with the non-DS population. Materials and methods: This cross-sectional study included 22 adults with DS and 28 age-and sex-matched non-DS controls. Anthropometric measurements, including BMI, waist circumference (WC), and hip circumference (HC), were recorded alongside novel indices such as waist-to-height ratio (WHtR), body adiposity index (BAI), A body shape index (ABSI), and visceral adiposity index (VAI). Metabolic parameters (fasting plasma glucose, HbA1c, lipid profiles, HOMA-IR) and CBC-derived inflammation indices (NLR, PLR, MHR, NHR, LHR, PHR, SII, AISI, SIRI) were evaluated. Results: Despite comparable BMI, individuals with DS exhibited significantly higher WHtR and BAI values (p < 0.001), suggesting greater central adiposity. Interestingly, the prevalence of metabolic syndrome was lower in the DS group (9.1%), and diastolic blood pressure was significantly lower as well. WHtR and BAI demonstrated stronger associations with metabolic markers than BMI. Among inflammatory indices, PLR was uniquely elevated in individuals with DS (p = 0.038), while VAI showed strong correlations with both. Conclusion: Adults with DS display distinct cardiometabolic profiles that are poorly captured by traditional indices. Novel markers such as WHtR, BAI, and VAI offer enhanced insight into metabolic risk, whereas PLR emerges as a potential inflammatory biomarker. These findings underscore the need for population-and sex-specific criteria in evaluating metabolic health in DS. Tailored diagnostic models may improve risk stratification and clinical outcomes for this vulnerable group.