Waist circumference cut-off points for identification of abdominal obesity among the tunisian adult population

AIMS: Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. METHODS: We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. RESULTS: ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. CONCLUSIONS: Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).     

Association of change in waist circumference and dyslipidaemia risk: The rural Chinese cohort study

Objective

To investigate the association of change in waist circumference (WC) and incidence of dyslipidaemia in a cohort study of a rural Chinese population.

Methods

Change in WC (ΔWC) was defined as the value at follow‐up minus the corresponding value at baseline. Risk of dyslipidaemia associated with ΔWC was assessed by odds ratios and 95% confidence intervals in a logistic regression model, and the odds ratios were transformed to relative risks (RRs).

Results

Among 7691 participants without dyslipidaemia at baseline, 3213 (41.78%) showed dyslipidaemia at 6 year follow‐up. Risk of dyslipidaemia was decreased for participants with the first quartile of ΔWC and normal baseline WC (adjusted RR [aRR] = 0.79 [95% confidence interval: 0.64‐0.98]) and was increased with the fourth quartile of ΔWC and male gender, age 18 to 30 years, age 31 to 50 years, or normal baseline WC (aRR = 1.55 [1.19‐2.03], 2.40 [1.16‐4.95], 1.32 [1.06‐1.64], and 1.66 [1.35‐2.04], respectively). The risk of dyslipidaemia increased with change in WC from normal at baseline to abnormal at follow‐up for both genders (aRR = 1.88 [1.39‐2.55] for men and 1.60 [1.30‐1.97] for women) and decreased with abnormal baseline WC changed to normal WC for women (aRR = 0.61 [0.45‐0.83]).

Conclusions

Dynamic change in waist circumference was closely related to the incidence of dyslipidaemia in a rural Chinese population. Waist circumference reduction could decrease dyslipidaemia risk, whereas WC increase may increase the risk. Interventions to control or reduce WC to within the normal range are important for early prevention of dyslipidaemia.     

Accuracy of anthropometric indicators of obesity to predict cardiovascular risk

CONTEXT: Obesity is associated with various cardiovascular risk factors. The body mass index (BMI) is the standard measure of overweight and obesity. However, more recently, waist to hip ratio (WHR) or waist circumference (WC) as more sensitive measures for visceral obesity have been proposed to be more indicative of cardiovascular risk. OBJECTIVE: This study was performed to test the predictive value of anthropometric parameters for the presence of several cardiovascular risk conditions. DESIGN: The DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) study is a cross-sectional, clinical-epidemiological study. PARTICIPANTS: We studied 5377 unselected subjects (2016 men, 3361 women) without arteriosclerotic disease, aged 20-79 yr, from the DETECT laboratory sample. SETTING: This study was conducted by primary care physicians. INTERVENTION: We measured anthropometric parameters and assessed cardiovascular risk by clinical examination, patient history, and a standardized laboratory program. MAIN OUTCOME MEASURES: We assessed the associations of BMI, WC, hip circumference, WHR, and waist to height ratio (WHtR) to cardiovascular risk by calculating the area under the receiver-operating characteristic curve and adjusted odds ratios for metabolic syndrome, dyslipidemia, and type 2 diabetes. RESULTS: The area under the receiver-operating characteristic curve for WHtR was significantly higher than for all other anthropometric parameters with respect to all risk conditions in women and to dyslipidemia and type 2 diabetes in men. The odds ratios for the presence of risk conditions with 1 sd increase of each anthropometric parameter were highest for WHtR or WC. CONCLUSIONS: There are some indications that WHtR or WC may predict prevalent cardiovascular risk better than BMI or WHR, even though the differences are small.     

Metabolic risks in individuals with normal body mass index and normal waist circumference.

BACKGROUND: Risk of cardiovascular diseases increases in Asian adults within the normal limits of body mass index and waist circumference. OBJECTIVE: To determine a point of body mass index and waist circumference above which the chances of having cardiovascular risk factors increased. METHODS: Data on anthropometric indices, blood pressure and biochemical measures were collected in a cross-sectional study of 3447 participants (1781 males and 1666 females) with normal body mass index (19 to <25 kg/m for both sexes) and normal waist circumference (<102 cm for men and <88 cm for women). Metabolic abnormalities were defined on the basis of the standard published criteria. RESULTS: Individuals at the highest category of body mass index (24 to <25 kg/m) had significantly higher odds for having metabolic risk factors (odds ratios ranging from 1.3 to 1.6 for men and 1.36 to 2.0 for women for different risk factors) compared with those at first category (19 to <20 kg/m). Furthermore, individuals at the top category of waist circumference (95 to <102 cm for men and 85-88 cm for women) had significantly higher chances of having metabolic abnormalities (odds ratios ranging from 2.6 to 4.5 for men and 2.1 to 2.6 for women for different risk factors) compared with those in the first category (62 to <70 cm for men and 60 to <65 cm for women) in both sexes. CONCLUSION: We concluded that the cut-off points of body mass index and waist circumference suggested by the World Health Organization are inappropriate for the Tehranian urban population.     

Waist-to-hip ratio is a better screening measure for cardiovascular risk factors than other anthropometric indicators in Tehranian adult men

BACKGROUND: It is essential to identify the best anthropometric index in any population to predict chronic disease risk. OBJECTIVE: To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian men. DESIGN: Population-based cross-sectional study. SUBJECTS: A representative sample of 4,449 men aged 18-74 y, participants of the Tehran Lipid and Glucose Study METHODS: Demographic data were collected; anthropometric indices and blood pressure were measured according to standard protocol. In the 18-34 y age category, cutoff points for BMI, WHpR, WHtR and WC were 24 kg/m(2), 0.86, 0.47 and 81 cm, respectively. In the 35-54 y age category these cut points were 26 kg/m(2), 0.91, 0.52 and 89 cm, and in the 55-74 y age category 26 kg/m(2), 0.95, 0.54 and 91 cm, respectively. Hypertension was defined based on JNC VI. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose > or =126 mg/dl or 2hPG > or =200 mg/dl and dyslipidemia based on ATP III. The presence of 'at least one risk factor' from the three major cardiovascular risk factors (hypertension, dyslipidemia and diabetes) was also evaluated. RESULTS: Mean age of men was 41.8+/-15.4 y. Mean BMI, WHpR, WC and WHtR for subjects were 25.6+/-4.2 kg/m(2), 0.91+/-0.07, 87.7+/-11.7 cm and 0.51+/-0.02, respectively. Dyslipidemia and 'at least one risk factor' are more prevalent risk categories. Although all anthropometric indicators had a significant association to cardiovascular risk factors, WHpR had the highest correlation coefficients compared to other anthropometric measures. For all risk factors in all age categories, the highest odds ratios were pertained to WHpR. Of the four individual indicators, WHpR had the highest sensitivity, specificity and accuracy to predict cardiovascular risk factors. Cutoff points for WHpR were seen to have a higher percentage of correct prediction than BMI, WC and WHtR in all age categories. CONCLUSION: It is concluded that WHpR is a better predictor for cardiovascular risk factors than BMI, WC and WHtR in Tehranian adult men.     

Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals

OBJECTIVE: To determine the cut-off points of indices of obesity for detecting hypertension, dyslipidemia and diabetes mellitus in Japanese individuals. DESIGN: Cross-sectional study. SUBJECTS: A total of 2728 Japanese individuals (768 males and 1960 females, aged 20-79 y) who attended the Fukuoka Health Promotion Center, Japan for health check-up. MEASUREMENTS: Body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) were measured. Percentage fat mass (%FM), trunk fat mass (FM(trunk)) and trunk fat mass-leg fat mass ratio (FM(trunk)/FM(legs)) were obtained by dual-energy X-ray absorptiometry (DXA). Cardiovascular risk factors were determined by blood pressure, serum lipids, fasting blood glucose and hemoglobin A(1C). RESULTS: The cut-off points of BMI, WC and WHR were around 23.5 kg/m(2), 84 cm and 0.9 for males, and 22.5 kg/m(2), 72 cm and 0.8 for females. The cut-off points of %FM, FM(trunk) and FM(trunk)/FM(legs) were around 24%, 8 kg and 1.6 for males, and 35%, 9 kg and 1.4 for females. WHR and FM(trunk)/FM(legs) most accurately detected the risk factors. CONCLUSIONS: For Japanese individuals, the cut-off points for detecting cardiovascular risk factors are lower than the criteria by the World Health Organization. Indices of fat distribution detected the cardiovascular risk factors more accurately than those of overall adiposity. The accuracy of detecting the risk factors was comparable between the anthropometric indices and indices obtained by DXA.     

Chronic hepatitis B virus infection and risk of dyslipidaemia: A cohort study

Hepatitis B virus (HBV) infection has been associated with a decreased prevalence of dyslipidaemia in cross‐sectional studies, but cohort studies are limited. We investigated the longitudinal effects of chronic HBV infection on the development of dyslipidaemia. We performed a cohort study of 62 287 non‐cirrhotic adult men and women free of dyslipidaemia who underwent serologic testing for hepatitis B surface antigen (HBsAg) and were followed annually or biennially for an average of 4.46 years. A parametric proportional hazard model was used to estimate the adjusted hazard ratio with 95% confidence interval (CI) for incident dyslipidaemia according to HBsAg seropositivity status. We identified 12 331 incident cases of hypercholesterolaemia during 278 004.4 person‐years of follow‐up (incident rate 44.4 per 1000 person‐years). In models adjusted for age, sex, body mass index, year of screening exam, smoking status, alcohol intake, regular exercise and education level, the adjusted hazard ratios (95% CIs) for incident hypercholesterolaemia, high LDL cholesterolaemia; hypertriglyceridaemia, high non‐HDL cholesterolaemia and low HDL cholesterolaemia comparing HBsAg‐positive to HBsAg‐negative participants was 0.71 (0.64‐0.79), 0.83 (0.78‐0.89), 0.61 (0.54‐0.70), 0.69 (0.63‐0.75) and 1.10 (0.98‐1.24), respectively. An inverse association between HBsAg positivity and incident high apolipoprotein B were also identified, with a corresponding a hazard ratio of 0.63 (0.55‐0.72). In a large cohort of apparently healthy Korean adults, HBsAg seropositivity was associated with lower risk of development of dyslipidaemia, suggesting a role of HBV infection in lipid metabolism.     

Anthropometric indexes in the prediction of type 2 diabetes mellitus, hypertension and dyslipidaemia in a Mexican population.

OBJECTIVE: To determine values of simple anthropometric measurements which are associated with the presence of type 2 diabetes mellitus, hypertension and dyslipidaemia and to assess anthropometric cut-off values for predicting the likelihood of these chronic conditions in a Mexican population. DESIGN AND SETTING: The data were obtained from PRIT (Prevalence of Cardiovascular Risk Factors in General Hospital Workers) surveys from 1994 to 2000 adjusted to the structure of the overall Mexican population. SUBJECTS: A total of 2426 men and 5939 women aged 38.99+/-7.11 and 39.11+/-14.25 y, respectively. MEASUREMENTS: The optimal sensitivity and specificity of using various cut-off values of BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumference) and WTH (waist-to-height ratio) to predict type 2 diabetes mellitus (DM), hypertension (HT), or dyslipidaemia were examined by receiver operating characteristic curve (ROC) analysis. The likelihood ratios for having diabetes, hypertension and dyslipidaemia in subjects with various cut-off values of BMI, WHR, WC and WTH were calculated. Multiple step-wise logistic regression analysis was used to examine the independent relationship between the anthropometric indexes, age and smoking, and the odds ratio of having chronic conditions. RESULTS: The BMI cut-off to predict DM, HT, or dyslipidaemia varied from 25.2 to 26.6 kg/m2 in both men and women. The optimal WC cut-offs were 90 cm in men and 85 cm in women. The WHR cut-off was about 0.90 in men and 0.85 in women, and the optimal WTH cut-off was 52.5 in men and varied from 53 to 53.5 in women. The cut-off levels for WC, WHR and WTH corresponded to the inflexion points in the likelihood ratio graphs. In the case of BMI likelihood ratio graphs, we found a significant increase in the risk for chronic conditions from 22 to 23 BMI levels in both genders. Logistic regression analyses disclosed that only BMI and age were included in all the models as well as the influence of smoking in DM and dyslipidaemia in men. CONCLUSION: Although these results may not be readily applied to the rest of the Mexican population or to other Hispanic populations, they point to the necessity of similar studies with large randomized samples to find the cut-off levels for chronic conditions in different populations.     

中国成人多重心血管危险因素聚集的最佳腰围切割点

目的探讨中国成人多重心血管危险因素聚集的最佳腰围切割点。方法分析1994年全国糖尿病普查的15628例年龄≥25岁的中国成人资料。以腰围〈70cm组（每隔5cm分为一组）作为对照,计算其他各组发生多重心血管危险因素的优势比OR值和95％CI。采用ROC曲线分析计算不同腰围水平对多重心血管危险因素聚集识别的敏感性和特异性,以诊断指数（诊断指数=1-假阳性-假阴性）最大的腰围作为最佳切割点。结果无论男性还是女性。胰岛素抵抗、血脂异常、高血压和高血糖的百分比均随着腰围的增加而增加。男性腰围≥85cm、女性腰围≥80cm后发生代谢综合征的OR值显著增加[分别为2．08（95％CI1．80-2．39）和1．66（95％CI1．41-1．97）1。ROC分析显示以上相应腰围切割点具有最佳的敏感性和特异性。结论反映中国成人多重心血管危险因素聚集的男性最佳腰围切割点为85cm、女性为80cm。     

Prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups

Background and aimsThe aim of this study was to evaluate the prevalence of cardiovascular risk factors in middle-aged Lithuanian women in different body mass index and waist circumference groups.Methods and resultsData selected from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program between 2009 and 2016. This community-based cross-sectional study comprised 53,961 women aged 50–64 years old. We compared the prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, smoking, and metabolic syndrome in different body mass index (BMI) and waist circumference (WC) groups. The most prevalent cardiometabolic risk factor was dyslipidaemia (91.71%, n = 49,488). The prevalence of arterial hypertension, dyslipidaemia, diabetes mellitus, and metabolic syndrome was greater in those with higher-than-normal BMI and WC. Smoking was the most prevalent in women with low BMI and normal WC (24.00% and 13.17% respectively).ConclusionThe analysis showed that all risk factors, except smoking, were significantly more prevalent in women with higher-than-normal BMI and with increased WC or abdominal obesity. The prevalence of dyslipidaemia was surprisingly high in all BMI and WC groups. Obesity measured by WC was more strongly associated with an adverse metabolic profile.     

Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity

OBJECTIVE: To test the validity of internationally accepted waist circumference (WC) action levels for adult Asian Indians. DESIGN: Analysis of data from multisite cross-sectional epidemiological studies in north India.Subjects:In all, 2050 adult subjects >18 years of age (883 male and 1167 female subjects). MEASUREMENTS: Body mass index (BMI), WC, waist-to-hip circumference ratio, blood pressure, and fasting samples for blood glucose, total cholesterol, serum triglycerides, and high-density lipoprotein cholesterol. RESULTS: In male subjects, a WC cutoff point of 78 cm (sensitivity 74.3%, specificity 68.0%), and in female subjects, a cutoff point of 72 cm (sensitivity 68.7%, specificity 71.8%) were appropriate in identifying those with at least one cardiovascular risk factor and for identifying those with a BMI >21 kg/m(2). WC levels of > or =90 and > or =80 cm for men and women, respectively, identified high odds ratio for cardiovascular risk factor(s) and BMI level of > or =25 kg/m(2). The current internationally accepted WC cutoff points (102 cm in men and 88 cm in women) showed lower sensitivity and lower correct classification as compared to the WC cutoff points generated in the present study. CONCLUSION: We propose the following WC action levels for adult Asian Indians: action level 1: men, > or =78 cm, women, >/=72 cm; and action level 2: men, > or =90 cm, women, > or =80 cm.     

Segregation analysis of waist circumference, hip circumference and waist-to-hip ratio in the Korean Nationwide Family Study

AIM: A central distribution of adipose tissue is frequently associated with cardiovascular disease and its risk factors. In this study, we investigated environmental, familial and genetic influences on waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) in 2507 members of 435 families who had participated in the Korean Nationwide Health Examination Survey. METHOD: Maximum likelihood methods were used to fit several genetic and nongenetic models of inheritance to these data to determine whether an unobserved Mendelian major gene could explain the familial distribution of WC, HC and WHR. Adjustments for age, age(2), body mass index, smoking, alcohol consumption and exercise were carried out separately for males and females by multiple regression procedures for WC, HC and WHR phenotypes prior to segregation analysis. Regression models were used to test genetic and non-genetic models in these 435 families. RESULTS: Segregation analysis did not provide statistical evidence of a major gene controlling either HC or WHR. Mendelian single-locus models with two underlying genotypic distributions were best supported by these data on WC, and this putative major gene explained the 22.4% of variance in adjusted WC. CONCLUSION: Future linkage studies may be worthwhile to further clarify the mechanisms controlling WC.     

Excess accumulation of body fat is related to dyslipidemia in normal-weight subjects

OBJECTIVE: To assess the relationship of fat mass (FM) and its distribution to hypertension and dyslipidemia in normal-weight Japanese individuals. DESIGN: Cross-sectional study. SUBJECTS: Apparently healthy Japanese subjects with a body mass index (BMI) between 20 and 23.5 kg/m(2) (265 males and 741 females, age 21-69 y). MEASUREMENTS: BMI, waist circumference (WC), waist-hip ratio (WHR), systolic and diastolic blood pressure, serum levels of total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C) and triglyceride (TG) were measured. Low-density lipoprotein-cholesterol (LDL-C) was calculated by the Friedewald formula. Percentage fat mass (%FM) and trunk fat mass-leg fat mass ratio (FM(trunk)/FM(legs)) were obtained by dual-energy X-ray absorptiometry. RESULTS: WC, WHR, %FM and FM(trunk)/FM(legs) were significantly correlated with TC, LDL-C, HDL-C and TG with the tendency of FM(trunk)/FM(legs) to show the strongest correlations. For %FM and FM(trunk)/FM(legs) in both sexes, odds ratios (ORs) of the third tertiles with respect to the first tertiles increased for LDL-C elevation, TG elevation and dyslipidemia. In males, ORs of the third tertiles of WC were significantly high for LDL-C elevation and dyslipidemia whereas those of WHR were high for TG elevation and dyslipidemia. ORs of the third tertiles of WC and WHR were significantly high for TG elevation in females. BMI was not associated with the risk of abnormal lipid levels. ORs for hypertension showed significant increases in none of the variables of obesity. CONCLUSIONS: Excess accumulation of FM, especially to the upper body, was related to dyslipidemia in normal-weight subjects. Simple anthropometric variables, WC and WHR, may be useful for screening and management of dyslipidemia in these subjects.     

Obesity and cardiovascular risk factors in Hong Kong Chinese

The purpose of this cross‐sectional study was to examine the risk associations between obesity indexes body mass index (BMI) and waist circumference (WC)], cardiovascular risk factors plasma glucose and lipids, blood pressure and urinary albumin excretion (UAE)] and morbidity conditions (Type 2 diabetes mellitus, hypertension, dyslipidaemia and/or albuminuria) in Hong Kong Chinese. Seven‐hundred and two Hong Kong Chinese subjects (18–65 years of age, 59.4% of whom had at least one morbidity condition) were recruited from the Prince of Wales Hospital, Hong Kong SAR. The measurements taken of the subjects included: height; weight; waist and hip circumferences; blood pressure; fasting plasma glucose and lipids; and 24‐h UAE. The mean BMI was 22.4 and 25.7 kg m^?2 in healthy subjects and patients, respectively. The mean WC measurements of healthy subjects and patients were 77.1 and 86.4 cm in males and 71.0 and 81.8 cm in females, respectively. There were increasing trends between obesity indexes and the severity of cardiovascular risk factors and the prevalence of morbidity conditions (all P‐values for trend <0.05). Using 19.0–20.9 kg m^?2 and <70 cm as a referent, subjects with a BMI of ≥25.0 kg m^?2 (in both sexes) and/or a WC of ≥85 cm in males and ≥75 cm in females had an age‐adjusted odds ratio between 3.2 and 4.4 for the occurrence of at least one morbidity condition. Patients with a greater number of comorbidities also had higher BMI and WC measurements (all P‐values for the trend were <0.05 with adjustment for age and gender). Hence, despite Hong Kong Chinese being less obese than Caucasians, the intimate relationships among obesity, cardiovascular risk factors and morbidity conditions remain. Our data support using lower BMI and WC levels to define obesity and its associated health risks rather than using the criteria established from Caucasians who generally have larger body frames.     

Obesity indices and cardiovascular risk factors in Thai adults

OBJECTIVE: To examine the relationship of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) with cardiovascular risk factors and diabetes in Thai population. DESIGN: A national cross-sectional survey of cardiovascular risk factors. SUBJECTS: Five thousand and three hundred five Thai adults aged > or =35 years. MEASUREMENTS: Body weight, height, waist and hip circumference and cardiovascular risk factors including blood pressure, total plasma cholesterol, high-density lipoprotein, triglyceride and fasting plasma glucose were measured. Age- and sex-specific means and prevalence of cardiovascular risk factors were calculated and compared among anthropometric measurements. RESULTS: There were increasing trends of severity of cardiovascular risk factors and prevalence of morbidity conditions across increasing levels of BMI, WC, WHpR and WHtR categories. For age group > or =65 years, WC, WHpR and WHtR provided more consistent association with cardiovascular risk factors than BMI. Area under the curve indicated that measurement of central obesity could predict cardiovascular risk better than BMI. The optimal cutoff points for anthropometric measurements were in line with the Asia-Pacific recommendation; however, similar cutoff point for men and women between 82 and 85 cm was observed. CONCLUSION: Central obesity indices were slightly better associated with cardiovascular risk factors compared to BMI in Thai adults aged > or =35 years.     

Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults

OBJECTIVES: To compare body mass index (BMI), waist circumference and waist-hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia. DESIGN AND SETTING: A national sample of 11 247 Australians aged > or =25 years was examined in 2000 in a cross-sectional survey. MAIN OUTCOME MEASURES: The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity. RESULTS: The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior. CONCLUSIONS: Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.     

The relationship between waist circumference and metabolic risk factors: cohorts of European and Chinese descent

Waist circumference (WC) may be the best anthropometric index for identifying individuals at risk for cardiovascular disease (CVD) and diabetes mellitus (DM). The objectives of this study were to determine if the relationship between WC and metabolic risk factors is similar in men and women of Chinese and European descent, and to assess the effect of ethnicity on these relationships. Apparently healthy men and women of Chinese (n = 92) and European (n = 99) descent were recruited from hospital staff and assessed for anthropometric variables and blood pressure (BP), lipids, insulin, and glucose. The study cohort was stratified by sex, and regression analyses were performed with the various metabolic risk factors as the outcome and WC and ethnicity as predictors. Chinese men and women had significantly lower WC than European men and women. Age and metabolic risk factors were similar between the 2 ethnic groups except for BP. Metabolic risk factors significantly correlated with WC within each gender and ethnic cohort. In men, ethnicity was an independent predictor for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and the ratio of TC to high-density lipoprotein cholesterol (HDL-C) after controlling for WC. In women, ethnicity significantly interacted with WC as an independent predictor of TG, TC:HDL-C ratio, insulin, and glucose. As ethnic descent modifies the relationship between WC and metabolic risk factors, current WC targets derived from relationships in European populations are not applicable to Chinese men and women. Therefore, ethnic background should be considered when using WC as a marker of cardiovascular risk.     

Sex specificity of asthma associated with objectively measured body mass index and waist circumference: the Humboldt study

STUDY OBJECTIVE: To investigate the possibility of sex specificity for the association of obesity and asthma using objective measures of body mass index (BMI) and waist circumference (WC). DESIGN: Cross-sectional study of adults (n = 2,057) living in Humboldt, SK, Canada in 2003. SETTING: A rural community. MEASUREMENTS: Ever-asthma was defined as lifetime physician-diagnosed asthma, and recent asthma was defined as asthma diagnosed by a physician during the past 12 months. BMI and WC were objectively measured. RESULTS: Among the participants, 5.6% of men and 10.0% of women reported having ever-asthma, and 2.7% and 6.0% had recent asthma, respectively. Higher levels of both BMI and WC were significantly associated with asthma in women but not in men. The adjusted odds ratios for women with a BMI of at least 30.0 kg/m2 relative to women with a BMI of < 25.0 kg/m2 were 2.06 (95% confidence interval [CI], 1.42 to 4.05) for ever-asthma and 3.47 (95% CI, 1.64 to 7.32) for recent asthma. CONCLUSIONS: Our study demonstrated that the increased risk of asthma associated with obesity was only significant in women but not in men even when BMI was objectively measured, and this association was robust to the anthropometric measures.     

Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong Chinese

OBJECTIVE: It is important to determine what values of simple anthropometric measurements are associated with the presence of adverse cardiovascular risk factors such as diabetes or hypertension to provide an indication for further detailed investigations. In this analysis, we aimed to assess which anthropometric cutoff values are best at predicting the likelihood of diabetes, hypertension, dyslipidaemia and albuminuria in Hong Kong Chinese. DESIGN AND SETTING: The data were obtained from a previously reported prevalence survey for glucose intolerance in a representative Hong Kong Chinese working population. SUBJECTS: 1513 subjects (910 men and 603 women) with mean age+/-s.d. 37.5+/-9.2 y. MEASUREMENTS: We examined the likelihood ratios of having diabetes, hypertension, dyslipidaemia and albuminuria in subjects with various cutoff values of the four simple anthropometric indexes, namely, body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height. RESULTS: We developed a nomogram to show the predictive values of different indexes for the cardiovascular risk factors using likelihood ratio analysis. Using Caucasian mean levels of the simple anthropometric indexes to predict diabetes or hypertension in Hong Kong Chinese gave a high likelihood ratio of 2:3:5. CONCLUSION: Higher levels of body mass index, waist-hip ratio, waist circumference and the ratio of waist-to-height are associated with risk of having diabetes mellitus or hypertension in Hong Kong Chinese as in Caucasians. However, the cutoff values of those anthropometric indexes to define obesity used in Caucasians may not be applicable to Chinese.     

Cannabinoid Receptor 1 (CNR1) 4895 C/T Genetic Polymorphism was Associated with Obesity in Japanese Men

Aim: The aim of this study was to investigate the association of cannabinoid receptor 1 (CNR1) 4895 C/T gene polymorphism with obesity and obesity-related cardiovascular disease (CVD) risk factors in Japanese.Method: This study included 1,452 Japanese (678 men and 774 women, aged 25 to 74) from rural communities in Shimane Prefecture, Japan.Results: The frequency of the C minor allele of CNR1 4895 C/T polymorphism was 47%. In men, the CC genotype carriers showed significantly greater body mass index (BMI) and waist circumference (WC) values than T allele carriers, even after adjusting for age and medications for hypertension, dyslipidemia and type 2 diabetes. The frequency of obesity (BMI ≥25 kg/m(2)) in CC genotype carriers was significantly greater than in T allele carriers (31.8% vs 21.5%), but the frequency of central obesity (WC ≥85 for men and WC ≥90 cm for women) was not significant by CNR1 4895 C/T genotype. CC genotype carriers of CNR1 4895 C/T showed, in logistic regression analysis, significantly greater odds for obesity than T allele carriers, even after adjustment for age and the above-mentioned medications. Systolic blood pressure (SBP) values were also significantly different between the CC genotype and T allele carriers after controlling for age, medications for hypertension, dyslipidemia, and type 2 diabetes, and BMI or WC.Conclusion: This study supports the association of CNR1 4895 C/T with interindividual differences in obesity in men.