Superiority of skinfold measurements and waist over waist-to-hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults

OBJECTIVE: To determine which anthropometric measurement is the most reliable alternative for fat distribution as measured by dual-energy X-ray absorptiometry (DXA). DESIGN: Population-based survey carried out in Amsterdam, The Netherlands. SUBJECTS AND METHODS: A total of 376 individuals (200 women) with a mean age of 36.5 years and mean body mass index (BMI) of 24.0 (+/-3.1) kg/m2 underwent various anthropometric and DXA measurements of central (CFM) and peripheral fat mass (PFM). Furthermore, for the assessment of apple-shaped body composition, CFM-to-PFM ratio was calculated. Anthropometric measurements were waist and hip circumference, waist-to-hip ratio (WHR), BMI, waist/length and the skinfold thickness of biceps, triceps, suprailiacal (SI), subscapular (SS) and upper leg. We determined whether equations of combined anthropometrics were even more reliable for the assessment of fat mass. RESULTS: In both women and men, reliable alternatives for CFM are central skinfolds and waist (Pearson's correlation (r) >or= 0.8). Peripheral skinfolds are the best predictors of PFM (r >or= 0.8). In contrast, WHR correlated only marginally with any of the DXA measurements. Equations based on several anthropometric variables correlate with CFM even better (R2 >or= 0.8). CFM-to-PFM ratio has the highest correlation with the ratio (SS+SI)/BMI in women (r = 0.66) and waist/length in men (r = 0.71). Equations are reasonable alternatives of CFM-to-PFM ratio (R2 >or= 0.5). CONCLUSION: Waist and skinfolds are reliable alternatives for the measurement of body fat mass in a cohort of Caucasian adults. WHR is not appropriate for the measurement of fat distribution.     

Overweight and obesity among Alaskan Eskimos of the Bering Straits Region: the Alaska Siberia project

OBJECTIVE: To document the height, weight, BMI and prevalence of obesity for Eskimo residents of four villages of the Bering Straits Region of Alaska. DESIGN AND SUBJECTS: 454 Non-pregnant residents over 24 y of age, with at least one Eskimo grandparent participated in one cross sectional survey within each village. MEASUREMENTS: Height, weight, calculation of BMI (kg/m2), proportion of 'overweight' (BMI 25-29.9), and proportion of 'obese' (BMI>/=30). RESULTS: For women and men, respectively, mean heights were 153.4 and 165.2 cm; weights were 64.2 and 71.6 kg; and BMI were 27.2 and 26.2 kg/m2 after age standardization. For women, 27.9% were overweight, and 32.8% were obese compared with 36.2% and 15.6%, respectively, for men. Alaskan Eskimo participants of the Alaska Siberia Project had a significantly lower proportion of total overweight (BMI>/=25, 54.9% for women, and 32.0% for men) compared with the three sites of the Strong Heart Study, which ranged from 65.9 to 80.2% for women and 53.6 to 66.7% for men. Compared with American men of all races, the proportion of overweight and obese participants was similar for Eskimo men. The proportion of obese was significantly higher for Eskimo women compared with American women of all races, but the proportion of overweight was similar. CONCLUSION: Although the prevalence of obesity among the Alaskan Eskimos is lower than for American Indians, the high proportion of overweight observed in this study is of concern for Alaskan Eskimo adults, especially for women.     

Misclassification of high-risk older subjects using waist action levels established for young and middle-aged adults--results from the Rotterdam Study

OBJECTIVES: In the literature, cutoff points based on waist circumference (waist action levels) have been suggested to replace cutoff points based on body mass index (BMI) and waist-hip ratio (WHR) in identifying subjects who are overweight or obese and/or with central fat distribution. These cutoff points have been based on analysis in mainly middle-aged and younger adults. In this article, we examine the applicability of the suggested waist action levels in an older population. PARTICIPANTS: A total of 6,423 men and women aged 55 or over participating in the Rotterdam Study, a population-based cohort study. MEASUREMENTS: Sensitivities and specificities of the proposed waist action levels in relation to the cutoff points for BMI and WHR were calculated. Also, cardiovascular risk factor levels at baseline examination in the different categories defined by high/low waist circumference, BMI and WHR were investigated. RESULTS: At waist action level 1 (waist circumference > or =94 cm in men, > or =80 cm in women), sensitivity was 71% in men and 86% in women for detecting those with high BMI (> or =25 kg/m2) and/or WHR (> or =0.95 in men, > or =0.80 in women). At waist action level 2 (waist circumference > or =102 cm in men, > or =88 cm in women in comparison with BMI > or =30 kg/m2 and/or WHR > or =0.95 in men, > or =0.80 in women), sensitivity was considerably lower: 35% in men and 59% in women. This was mainly due to a large proportion of subjects with low waist and BMI but high WHR. Specificity was high (>90%) at both action levels. Cardiovascular disease risk factors, except smoking, tended to increase with increasing waist circumference, WHR, and BMI. CONCLUSIONS: The suggested cutoff points for waist circumference are only to a limited degree useful in identifying subjects with overweight and obesity and/or central fat distribution in an older population. This concerns especially the upper cutoff point (waist action level 2) and is mainly due to the increased central distribution of fat with advancing age.     

Waist circumference and abdominal sagittal diameter as surrogates of body fat distribution in the elderly: their relation with cardiovascular risk factors

OBJECTIVE: To evaluate the relationship between supine sagittal abdominal diameter (SAD) and other indicators of body fat distribution with cardiovascular (CVD) risk factors in the elderly. SUBJECTS: One-hundred and forty-six women aged from 67 to 78 y with a body mass index (BMI) ranging from 18.7 to 50.6 kg/m2 and 83 men aged between 67 and 78 y with BMI ranging from 19.8 to 37.1 kg/m2. MEASUREMENT: Body fat distribution was assessed using anthropometric indicators: waist circumference, SAD, waist-to-hip ratio (WHR), waist-to-height ratio and SAD-to-thigh ratio. RESULTS: In women, there was a negative correlation between HDL-cholesterol and body weight, BMI, waist, SAD, WHR, waist-to-height ratio and SAD-to-thigh ratio. A significant association was found between triglycerides, basal glucose, 2 h glucose during oral glucose tolerance test (OGTT), systolic blood pressure (SBP), diastolic blood pressure (DBP) and anthropometric variables. In men a negative correlation was found between HDL-cholesterol and all the anthropometric variables. A significant association was found between triglycerides, DBP and body weight, BMI, waist, SAD and waist-to-height ratio. In women, after adjusting for age and BMI, a significant correlation was observed between waist and HDL-cholesterol, triglycerides and basal glucose. This was also seen with SAD and SAD-to-thigh ratio and triglycerides, basal and 2 h glucose. In men, after adjusting for age and BMI a significant correlation was found between SAD and HDL-cholesterol and triglycerides. When adjustments were made for age and waist, the correlations between BMI and metabolic variables as well between BMI and SBP and DBP were no longer significant. CONCLUSIONS: Our study shows that indicators of body fat distribution are associated with CVD risk factors in the elderly independently of BMI. Our data also show that waist and SAD are the anthropometric indicators of fat distribution which are most closely related to CVD risk factors in old age.     

Body fat distribution reference standards in Spanish adolescents: the AVENA Study

OBJECTIVE: To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body. DESIGN: Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years. SUBJECTS: A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females). MEASUREMENTS: Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences. RESULTS: In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established. CONCLUSION: These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.     

Topical fat reduction from the waist

OBJECTIVE: Topical fat reduction from the thigh in women using aminophylline cream has been demonstrated, but the local fat reduction in other body areas or in men by lowering the local lipolytic threshold has not been demonstrated. This study is designed to test the hypothesis that aminophylline cream application to the waist will reduce waist circumference compared with a control. RESEARCH METHODS AND PROCEDURES: Fifty men and women who are 21-65 years of age with a BMI greater than 27 kg/m(2) and a waist to hip ratio > or =average were randomized in a 1 : 1 ratio to 0.5% aminophylline cream to the waist twice a day or no treatment to the waist. All subjects were instructed to follow a 1200 kcal balanced diet, participate in a walking program and return biweekly to encourage compliance. A theophylline level was drawn monthly, and the waist, BMI and waist to hip ratio were remeasured at 12 weeks. RESULTS: At week 12, there was a significant reduction in BMI from baseline that was not different between the groups. The reduction in waist circumference was 11 +/- 1.0 cm in the aminophylline cream group and 5.0 +/- 0.6 cm in the control group (p < 0.001). The reduction in waist circumference was significant for both women and men, but the women lost significantly more waist girth. The waist to hip ratio, a measure of fat distribution, declined. Aminophylline levels were undetectable, and there were no adverse events. DISCUSSION: Aminophylline cream offers a safe and effective method for cosmetic local fat reduction from the waist.     

The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study

OBJECTIVE: We evaluated the association of obesity with various markers of chronic inflammation, in a population-based sample of 3,042 adults. METHODS: During 2001-2002, we randomly enrolled 1,514 men (18-87 years old) and 1,528 women (18-89 years old), from the Attica area, Greece; the sampling was stratified by the age-sex distribution of the region (census 2001). Among several variables, we also measured various inflammatory markers (C-reactive protein, tumor necrosis factor alpha, amyloid A, white blood cells and interleukin-6) and anthropometric variables (weight, height, waist and hip circumferences). Central fat was defined as waist-to-hip ratio>or=0.95 in men and>or=0.8 in women, while obesity as body mass index (BMI)>29.9 kg/m(2). RESULTS: Central fat prevailed in 36% of men and 43% of women (p<0.001), while obesity prevailed in 20% of men and 15% of women, respectively. Compared to participants with normal body fat distribution, those with central fat exhibited 53% higher C-reactive protein levels, 30% higher tumor necrosis factor, alpha levels, 26% higher amyloid A levels, 17% higher white blood cell counts and 42% higher interleukin-6 levels (all p<0.05). We observed that all inflammation markers were related to BMI (index for obesity), waist and to waist-to-hip ratio (indices for central fat), in both genders. Moreover, the models that included waist or waist-to-hip ratio as independent variable had higher explanatory ability (i.e. R(2)) than the models included BMI, especially in women, even after adjusting for age and various other potential confounders. CONCLUSION: Our results suggest a relationship between central adiposity and inflammation process, irrespective of age and other potential confounders. This association was more prominent than the relationship between total obesity and inflammation. It could be hypothesized that a disproportionate accumulation of visceral fat mass could be partially associated with increased coronary risk, through inflammation process.     

Differences in body composition between Tongans and Australians: time to rethink the healthy weight ranges?

OBJECTIVE: The prevalence of obesity varies considerably between countries when compared using the common international standard. This study investigated body size and body composition in Tongan and Australian Caucasian adults. DESIGN: Cross-sectional comparative study. SUBJECTS: A total of 543 Tongans and 393 Australians. MEASUREMENTS: Weight, height, waist and hip circumference, four skinfolds, midarm circumference, elbow breadth, and body composition by bioelectrical impedance using sex- and ethnic-specific regression equations. RESULTS: Tongan women (mean body mass index (BMI)+/-s.e.=32.6+/-0.4 kg/m2) were larger than Australian women (BMI=25.8+/-0.4 kg/m2), with more fat-free mass (FFM; 52.2+/-0.4; 42.6+/-0.3 kg), fat mass (37.1+/-0.7; 26.6+/-0.8 kg) and percentage body fat (%fat) (40.5+/-0.4; 37.0+/-0.5%), respectively. Tongan men also had higher BMI (Tongan= 30.3+/-0.3 kg/m2; Australian=26.5+/-0.3 kg/m2), FFM (70.2+/-0.5; 62.3+/-0.6 kg) and fat mass (23.5+/-0.6; 20.7+/-0.7 kg). When compared with Australians within the same BMI range, Tongans had significantly higher FFM, elbow width, midarm muscle area and significantly lower %fat. The %fat at BMIs of 25 and 30 kg/m2 in Australian women was equivalent to the %fat found in Tongan women at 28.8 and 35.1 kg/m2, respectively. BMIs of 25 and 30 kg/m2 in Australian men corresponded with 27.5 and 35.8 kg/m2 in Tongan men. Skinfold thicknesses, waist, hip and WHR measurements suggested differences in fat distribution and body shape between ethnic groups, particularly in women. CONCLUSION: These results suggest that the standard healthy weight ranges recommended for international use may not be appropriate standards for use in the Tongan population.     

The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis.

OBJECTIVE: To evaluate the merit of body mass index (BMI), % body fat, waist circumference and waist-to-hip ratio as predictors of abdominal visceral fat (AVF) level. DESIGN: Cross-sectional measurements obtained from 458 female and 331 male subjects of French Canadian descent with an age range from 18-72 y. MEASUREMENTS: AVF level was assessed by computed tomography. BMI was calculated as weight (in kg) divided by stature2 (in m), body density was derived from underwater weighing and % body fat was computed from the estimate of body density with the Siri equation. Waist-to-hip ratio was calculated as waist circumference divided by hip circumference. Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off points. RESULTS: In younger women (< 40 y, n = 258), waist-to-hip ratio was the poorest predictor of AVF level with areas under the ROC curves (Az) ranging from 0.684-0.716, sensitivity (Sen) from 63.3-68.8% and specificity (Spe) from 64.0-67.5%, whereas the Az, Sen and Spe for other predictors ranged from 0.924-0.983, 87.0-96.8, and 83.4-92.7, respectively. The same trend was observed in older (> or = 40 y, n = 200) women, although differences between waist-to-hip ratio and other predictors were less pronounced. In older men, waist circumference was the best overall predictor (Az from 0.88-0.92), whereas BMI showed the lowest Az values (0.831-0.875, P < or = 0.001 vs waist circumference). In younger men, BMI had the smallest Az (P < 0.007 vs others) with the lowest AVF cut-off point (100 cm2). However, with higher AVF cut-offs the differences were not significant. CONCLUSION: Waist circumference is the best overall predictor of abdominal visceral obesity, whereas in women waist-to-hip ratio is a poor indicator of AVF and its use as a surrogate measure of visceral fat should be avoided.     

Anthropometric measures and absolute cardiovascular risk estimates in the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study.

BACKGROUND: Framingham risk functions are widely used for prediction of future cardiovascular disease events. They do not, however, include anthropometric measures of overweight or obesity, now considered a major cardiovascular disease risk factor. We aimed to establish the most appropriate anthropometric index and its optimal cutoff point for use as an ancillary measure in clinical practice when identifying people with increased absolute cardiovascular risk estimates. DESIGN: Analysis of a population-based, cross-sectional survey was carried out. METHODS: The 1991 Framingham prediction equations were used to compute 5 and 10-year risks of cardiovascular or coronary heart disease in 7191 participants from the Australian Diabetes, Obesity and Lifestyle Study (1999-2000). Receiver operating characteristic curve analysis was used to compare measures of body mass index (BMI), waist circumference, and waist-to-hip ratio in identifying participants estimated to be at 'high', or at 'intermediate or high' absolute risk. RESULTS: After adjustment for BMI and age, waist-to-hip ratio showed stronger correlation with absolute risk estimates than waist circumference. The areas under the receiver operating characteristic curve for waist-to-hip ratio (0.67-0.70 in men, 0.64-0.74 in women) were greater than those for waist circumference (0.60-0.65, 0.59-0.71) or BMI (0.52-0.59, 0.53-0.66). The optimal cutoff points of BMI, waist circumference and waist-to-hip ratio to predict people at 'high', or at 'intermediate or high' absolute risk estimates were 26 kg/m2, 95 cm and 0.90 in men, and 25-26 kg/m2, 80-85 cm and 0.80 in women, respectively. CONCLUSIONS: Measurement of waist-to-hip ratio is more useful than BMI or waist circumference in the identification of individuals estimated to be at increased risk for future primary cardiovascular events.     

Measurement of abdominal fat by magnetic resonance imaging, dual-energy X-ray absorptiometry and anthropometry in non-obese men and women.

OBJECTIVE: To investigate whether the dual-energy X-ray absorptiometry (DEXA) was a better predictor of abdominal fat, measured by magnetic resonance imaging (MRI) at the level of L2-L3, than anthropometric measurements in non-obese men and non-obese women. DESIGN: Observational, cross sectional study. SUBJECTS: 34 healthy subjects (17 men and 17 women) aged 20-53 y with a body mass index (BMI) < 30 kg/m2. MEASUREMENTS: Fat distribution parameters including waist circumference and waist-to-hip ratio (WHR); intra abdominal fat (IAF) by MRI; and central abdominal fat (CAF) by DEXA. RESULTS: Measurement of IAF by MRI, was highly correlated to the CAF measured by DEXA. In men, both waist circumference and WHR had similar correlation to IAF as DEXA. In women, waist circumference was less well correlated with IAF than DEXA, and the WHR had a weaker non significant correlation with IAF. CONCLUSIONS: In non-obese men; DEXA, waist circumference and WHR can predict IAF equally well, while in non-obese women, DEXA is superior to waist circumference and much better than WHR.     

Impact of polymorphisms of the human beta2-adrenoceptor gene on obesity in a French population

OBJECTIVE: To investigate the impact of two common polymorphisms in the human beta2-adrenoceptor gene (Gly16Arg and Gln27Glu substitutions) on obesity and anthropometric measurements as well as blood variables in a large sample of a French population. DESIGN AND SUBJECTS: Within the framework of the WHO-MONICA project, a population study composed of 1195 subjects aged 35-64 y was randomly sampled from the electoral rolls of the Urban Community of Lille, in northern France. Subjects without any medical treatment (for hypercholesterolaemia, hypertension or diabetes mellitus) susceptible to interfere with body weight and biological variables were selected (n = 836, 419 men/417 women, age = 49.5+/-8.1 y, body mass index (BMI) = 25.7+/-4.4 kg/m2). Subjects with a body mass index > or = 30 kg/m2 were considered as obese (n = 119, age = 49.5+/-8.2 y, BMI = 33.9+/-3.3 kg/m2 range 30-44). MEASUREMENTS: Genotyping was carried out with allele-specific oligonucleotides hybridization. Association between genotypes and various obesity markers (body weight, body mass index, waist and waist-to-hip ratio), lipid, glucose and insulin variables were studied. RESULTS: The Gly16Arg and Gln27Glu polymorphisms were in complete linkage disequilibrium. Gln27Gln subjects had an increased risk of obesity (odds ratio (OR) = 1.77, 95% CI 1.19-2.62, P = 0.005). This effect was mainly detected in men (OR = 2.40, 95% CI 1.34-4.27, P = 0.003). Men bearing the Gln27Gln genotype had higher body weight, BMI, waist and hip circumferences and waist-to-hip ratio than others. Moreover, if Gln27Gln men carried in addition the Arg16 allele, the increase in body weight, BMI and waist-to-hip ratio was more important. CONCLUSION: Our results suggest that genetic variability of the beta2-adrenoceptor gene is implicated in body weight regulation and in the onset of obesity in French men.     

The influence of obesity on arterial compliance in adult men and women

The objective of this study was to determine whether differences in large and small arterial compliance existed among normal weight, overweight, and obese older men and women, and whether large and small arterial compliance were associated with abdominal, hip, and subcutaneous fat distribution. A total of 134 individuals who were 40 years of age and older (age = 62 +/- 11 years; mean +/- SD) were grouped into normal weight (BMI: 18.5-24.9 kg/m2; n = 33), overweight (BMI: 25.0-29.9 kg/m2; n = 48), or obese (BMI: > or =30.0 kg/m2; n = 53) categories. The hemodynamic and arterial compliance measurements were obtained using the HDI/PulseWave CR-2000 CardioVascular Profiling System (Hypertension Diagnostics, Inc). Body mass index, nine-site sum of skinfolds, and circumference measures around the hip and waist were used for analysis. Large and small arterial compliance was lower (p < 0.001) in the obese group (12.4 +/- 4.8 ml/mmHg x 10 vs 4.6 +/- 2.5 ml/mmHg x 100, respectively) than the normal weight (16.2 +/- 4.9 ml/mmHg x 10 vs 5.5 +/- 2.7 ml/mmHg x 100) and overweight (15.2 +/- 4.3 ml/mmHg x 10 vs 5.0 +/- 2.2 ml/mmHg x 100) groups. This difference remained (p < 0.001) after adjusting for body surface area, sex, hyperlipidemia, and hypertension. Additionally, large arterial compliance correlated (p < 0.05) with sum of skinfolds (r = - 0.209), while small arterial compliance correlated with hip circumference (r = - 0.189). Arterial compliance measures were not related (p > 0.05) to waist circumference or waist-to-hip ratio. In conclusion, obesity was associated with a decrease in large and small arterial compliance independent of conventional risk factors. Additionally, subcutaneous fat and fat around the hips were inversely related to arterial compliance.     

Increased occurrence of diabetes in people with ischemic cardiovascular disease and general and abdominal obesity

BACKGROUND: Diabetes worsens the prognosis of patients with ischemic cardiovascular disease (ICVD). Increased body weight and abdominal obesity have been shown to increase the risk of diabetes in people without ICVD. Such a relationship has not been assessed in patients with ICVD who may have a different occurrence due to their disease and medications. OBJECTIVE: To examine the risk of developing diabetes among patients with ICVD according to body mass index (BMI), waist-to-hip ratio and waist circumference METHODS: Anthropometric measurements were done in 4699 men and 1187 women with ICVD (mean age 66 years) and without known diabetes at entry to the Heart Outcomes Prevention Evaluation (HOPE) study. During the median 4.5-year follow-up, a diagnosis of diabetes was reported in 261 (4.4%) participants. RESULTS: There was a positive and graded association between increased BMI, waist circumference and waist-to-hip ratio, and the risk of developing diabetes (P for trends <0.0001). After adjusting for all baseline characteristic differences including medications, the relative risk of developing diabetes after the first 40th percentile of each anthropometric measure increased by 12% (95% CI 9% to 15%) for every 1 kg/m2 increase in BMI; the relative risk increased by 5% (95% CI 4% to 6%) for every 1 cm increase in waist circumference and by 38% (95% CI 18% to 61%) for every 0.1 unit increase in waist-to-hip ratio. CONCLUSION: In patients with ICVD, increased BMI, waist-to-hip ratio and particularly waist circumference constitute independent risk factors for development of diabetes.     

Association between different measurements of obesity and the incidence of hypertension

BACKGROUND: Obesity is a risk factor for the incidence of hypertension, but it is still unclear whether this risk can be better estimated by body mass index (BMI) or waist circumference (WC). METHODS: In the baseline evaluation of a population-based cohort, 1089 adults answered a pretested questionnaire and had their baseline blood pressure (BP) and anthropometric measurements assessed according to standardized recommendations. Excluding the individuals with hypertension at baseline, and those deceased or lost during the follow-up, 592 individuals (80.5% of those eligible) were visited again. Obesity was defined as BMI >/=30 kg/m(2) for both genders, and WC >/=102 cm for men and WC >/=88 cm for women. Incident cases of hypertension were characterized by BP >/=140/90 mm Hg or use of BP medication in the follow-up visit. RESULTS: After a mean follow-up of 5.6 +/- 1.1 years, 127 incident cases of hypertension were identified. The hazard ratios (Cox model), adjusted for age and baseline systolic BP (95% CI and P), for BMI higher than 30 kg/m(2) were 1.08 (0.52-2.24, P =.82) in men and 1.74 (0.93-3.26, P =.08) in women. The corresponding figures were 1.78 (0.76-4.09, P =.18) for men with WC >/=102, and 1.72 (1.09-2.73, P =.02) for women with WC >/=88 cm. CONCLUSIONS: We conclude that the risk for hypertension may be better identified by obesity defined by higher WC than higher BMI.     

Abdominal fat distribution and functional limitations and disability in a biracial cohort: the Atherosclerosis Risk in Communities Study

OBJECTIVE: To examine the associations of abdominal fat and obesity with functional limitations and disability in late adulthood. DESIGN: Longitudinal, cohort study. PARTICIPANTS: African American and white men and women aged 45-64 y at baseline with measured waist circumference, waist-to-hip ratio (WHR), and body mass index (BMI) who participated in the Atherosclerosis Risk in Communities (ARIC) Study (n = 9416). OUTCOME MEASURES: Self-reported functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) at ages 52-75 y. RESULTS: Waist circumference, WHR, and BMI were positively associated with functional limitations and ADL and IADL impairment approximately 9 y later among African American and white men and women. For example, in African American women the odds ratios (95% CI) associated with a one standard deviation (s.d.) increment in waist circumference (13.3 cm) for severe functional limitations and ADL and IADL impairment were 2.36 (2.00-2.79), 1.41 (1.25-1.58), and 1.49 (1.34-1.66), respectively. In white women, the odds ratios (95% CI) were 2.66 (2.39-2.96), 1.60 (1.47-1.74), and 1.42 (1.31-1.53), respectively. Similar associations were found in men. A 1 s.d. increment in WHR (0.08 U) and BMI (5.06 kg/m2) produced similar results. The associations of waist circumference and WHR with functional limitations and ADL and IADL impairment were attenuated but, in general, remained statistically significant when BMI was added to the models. CONCLUSIONS: Maintaining a healthy body weight and avoiding increases in abdominal fat should be investigated for their potential to reduce the risk of functional limitations and disability in an aging population.     

Body circumferences as alternatives to skinfold measurements of body fat distribution in Mexican-Americans

The ratios of circumferences (waist/hip, waist/thigh) have been proposed in lieu of skinfold measurements for studies of obesity and body fat distribution. The purpose of this paper is to present our experience in measuring a series of body circumferences and skinfolds in an obese population, and seek the relationship between these two kinds of variables as indicators of fatness and body fat distribution using canonical correlation analysis. With this method, weighted vectors of circumferences on the one hand and skinfolds on the other, are formed in such a way that the correlation between the two sets of variables is maximized. The weights (regression coefficients) and their signs help us select the best combination of circumferences which describe a component of centralized obesity. Our experience showed that 21 percent of women would have been excluded from this multivariate analysis due to skinfolds what could not be measured (mainly due to poor fold definition). Few men were so excluded (6 per cent), and almost all circumferences could be measured in both sexes. A first canonical correlation was substantial (0.84 in women, 0.89 in men) and appeared to relate to level of fatness. A second canonical correlation was moderate (0.59 in women, 0.42 in men) and statistically significant (P less than 0.01) in both sexes. Only in women was it independent of age, but in both sexes it reflected differences in central and peripheral (especially lower limb) fat. The simple waist/thigh ratio correlated well with the second canonical variate (0.79 in women, 0.67 in men).(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Correlates of blood pressure in an urban Zimbabwean population and comparison to other populations of African origin

We have evaluated the relationship between systolic blood pressure (SBP) and age, body mass index (BMI), waist circumference, sodium to potassium ratio (Na/K), and tobacco use in an urban African population. We conducted a random, population-based, cross-sectional survey of people 25 years and older in Marondera, Zimbabwe, with over-sampling in older age groups (n = 775), using a method comparable to that used in International Collaborative Study on Hypertension in Blacks (ICSHIB). The age-adjusted prevalences of hypertension in Marondera (SBP >/=140/DBP >/=90/antihypertensive medication) were 30% for women and 21% for men. The average BMI was 26.3 kg/m2 for women and 21.4 kg/m2 for men. The prevalence of hypertension had a steep association with age and in women ranged from 15% (25-34 years) to 63% (55 years and over) and in men from 9% to 47%. No tobacco use in women and greater Na/K ratio in spot urines in men were significantly associated with an increased SBP. In both men and women the levels of hypertension and SBP were strongly positively associated with BMI, although the relationship appeared to plateau in women with a BMI greater than >/=25 kg/m2. At a given BMI, men and women had similar SBPs and prevalences of hypertension. There is a very high prevalence of hypertension among urban Zimbabweans, particularly among women. Under the assumption the studies are comparable, the prevalence of hypertension in Zimbabwean women (41%) and men (26%) after age adjustment to the ICSHIB populations, appeared higher than almost all of the ICSHIB populations, including those with higher average body mass indexes. Journal of Human Hypertension (2000) 14, 65-73.     

Adiposity, insulin and lipid metabolism in post-menopausal women

OBJECTIVE: To investigate relationships between body fat and its distribution and carbohydrate and lipid tolerance using statistical comparisons in post-menopausal women. DESIGN: Sequential meal, postprandial study (600 min) which included a mixed standard breakfast (30 g fat) and lunch (44 g fat) given at 0 and 270 min, respectively, after an overnight fast. SUBJECTS: Twenty-eight post-menopausal women with a diverse range of body weight (body mass index (BMI), mean 27.2, range 20.5-38.8 kg/m2) and abdominal fat deposition (waist, mean 86.4, range 63.5-124.0 cm). Women with BMI < 18 or > 37 kg/m2, age > 80 y and taking hormone replacement therapy (HRT) were excluded. MEASUREMENTS: Anthropometric measurements were performed to assess total and regional fat deposits. The concentrations of plasma total cholesterol, high density lipoprotein (HDL) cholesterol, triacylglycerol (TAG), glucose, insulin (ins), non-esterified fatty acids (NEFA) and apolipoprotein (apo) B-48 were analysed in plasma collected at baseline (fasted state) and at 13 postprandial time points for a 600 min period. RESULTS: Insulin concentrations in the fasted and fed state were significantly correlated with all measures of adiposity (BMI, waist, waist-hip ratio (W/H), waist-height ratio (W/Ht) and sum of skinfold thickness (SSk)). After controlling for BMI, waist remained significantly and positively associated with fasted insulin (r=0.559) with waist contributing 53% to the variability after multiple regression analysis. After controlling for waist, BMI remained significantly correlated with postprandial (IAUC) insulin (r=0.535) contributing 66% of the variability of this measurement. No association was found between any measures of adiposity and glucose concentrations, although insulin concentration in relation to glucose concentration (glucose-insulin ratio) was significantly negatively correlated with all measures of adiposity. A significant positive correlation was found between fasted TAG and BMI (r=0.416), waist (r=0.393) and Ssk (r=0.457) and postprandial (AUC) TAG with BMI (r=0.385) and Ssk (r=0.406). A significantly higher postprandial apolipoprotein (apo) B-48 response was observed in those women with high BMI (> 27 kg/m2). Fasting levels of NEFA were significantly and positively correlated with all measures of adiposity (except W/H). No association was found between cholesterol containing particles and any measure of adiposity. CONCLUSION: Hyperinsulinaemia associated with increasing body fat and central fat distribution is associated with normal glucose but not TAG or NEFA concentrations in postmenopausal women.