Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study

BACKGROUND: A high waist-to-hip ratio is associated with unfavorable cardiovascular disease risk factors. This could be due to either a relatively large waist or a small hip girth. OBJECTIVE: We sought to define the separate contributions of waist girth, hip girth, and body mass index (BMI) to measures of body composition, fat distribution, and cardiovascular disease risk factors. DESIGN: Three-hundred thirteen men and 382 women living in the greater Quebec City area were involved in this cross-sectional study. Percentage body fat, anthropometric measurements, and abdominal fat distribution were obtained and BMI (in kg/m2) and waist-to-hip ratio were calculated. Serum blood lipids were determined from blood samples collected after subjects had fasted overnight RESULTS: A large waist circumference in men and women (adjusted for age, BMI, and hip circumference) was associated significantly with low HDL-cholesterol concentrations (P < 0.05) and high fasting triacylglycerol, insulin, and glucose concentrations (P < 0.01). In women alone, a large waist circumference was also associated with high LDL-cholesterol concentrations and blood pressure. A narrow hip circumference (adjusted for age, BMI, and waist circumference) was associated with low HDL-cholesterol and high glucose concentrations in men (P < 0.05) and high triacylglycerol and insulin concentrations in men and women (P < 0.05). Waist and hip girths showed different relations to body fat, fat-free mass, and visceral fat accumulation. CONCLUSIONS: Waist and hip circumferences measure different aspects of body composition and fat distribution and have independent and often opposite effects on cardiovascular disease risk factors. A narrow waist and large hips may both protect against cardiovascular disease. These specific effects of each girth measure are poorly captured in the waist-to-hip ratio.     

Obesity, abdominal obesity, and clustering of cardiovascular risk factors in South Korea

The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79 y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI > or = 25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2; as a referent, subjects with BMI of 23 kg/m2; and 27 kg/m2; had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of > or = 90 cm in men and > or = 85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.     

Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults

BACKGROUND: Recent data suggest that current overweight and central adiposity guidelines based on Western populations are not appropriate for Asian populations. The published data among Chinese are insufficient to address this issue. OBJECTIVE: We aimed to identify cutoffs for body mass index (BMI; in kg/m(2)) and waist circumference that confer increased risk of cardiovascular disease in Chinese adults as would be consistent with overweight and central adiposity. DESIGN: A nationally representative, cross-sectional sample of 15 239 Chinese adults aged 35-74 y was studied. RESULTS: Mean blood pressure, total cholesterol, LDL-cholesterol, triacylglycerol, and glucose values were incrementally higher and mean HDL-cholesterol values were incrementally lower with each unit increase in BMI and waist circumference in both men and women. Both the point at which sensitivity equaled specificity and the shortest distance in the receiver operating characteristic curves for hypertension, dyslipidemia, diabetes, or >/=2 of these risk factors suggested a BMI cutoff of 24 and a waist circumference cutoff of 80 cm for both men and women. CONCLUSIONS: Lower cutoffs for BMI and waist circumference are needed in the identification of Chinese patients at high risk of cardiovascular disease.     

《国民体质测定标准》中肥胖参数与高血压风险关系

目的评价《国民体质测定标准》中肥胖指标与正常偏高血压及高血压风险关系,并确定判定切点,为高血压的预防控制提供参考依据。方法采用分层整群抽样方法对在辽宁省沈阳、丹东、朝阳市3个国民体质监测点抽取的5 809名20～69岁未接受高血压药物治疗的居民进行体格检查。结果 5 809名居民的正常偏高血压率和高血压率分别为16.92%和24.89%,其中男性居民正常偏高血压率和高血压率分别为20.98%和31.57%,均高于女性居民的12.94%和18.33%,差异均有统计学意义(P<0.01);多因素logistic回归分析结果表明,年龄≥40岁和体质指数(BMI)是正常偏高血压的危险因素,女性是正常偏高血压的保护因素;年龄≥30岁、BMI和腰围是高血压的危险因素,女性是高血压的保护因素;控制年龄、性别的影响后,BMI每升高1个标准差,正常偏高血压和高血压的风险分别增大1.38倍(95%CI=1.28～1.50)和1.57倍(95%CI=1.39～1.78);腰围每升高1个标准差,高血压的风险增大1.37倍(95%CI=1.20～1.56);以约登指数最大确定切点,BMI判定正常偏高血压的切点为男性24.0 kg/m2、女性24.3 kg/m2,BMI判定高血压的切点为男性25.1 kg/m2、女性24.3 kg/m2,腰围判定高血压的切点为男性87.0 cm,女性80.6 cm;以灵敏度≥80%确定切点,BMI判定正常偏高血压的切点为男性23.0 kg/m2、女性22.3 kg/m2,BMI判定高血压的切点为男性23.4 kg/m2、女性22.8 kg/m2,腰围判定高血压的切点为男性82.0 cm、女性76.9 cm。结论高血压的风险随BMI及腰围的增加而增大,BMI与高血压的关联强度大于腰围。     

Waist circumference and mortality

The authors examined the association between waist circumference and mortality among 154,776 men and 90,757 women aged 51-72 years at baseline (1996-1997) in the NIH-AARP Diet and Health Study. Additionally, the combined effects of waist circumference and body mass index (BMI; weight (kg)/height (m)(2)) were examined. All-cause mortality was assessed over 9 years of follow-up (1996-2005). After adjustment for BMI and other covariates, a large waist circumference (fifth quintile vs. second) was associated with an approximately 25% increased mortality risk (men: hazard ratio (HR) = 1.22, 95% confidence interval (CI): 1.15, 1.29; women: HR = 1.28, 95% CI: 1.16, 1.41). The waist circumference-mortality association was found in persons with and without prevalent disease, in smokers and nonsmokers, and across different racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Asians). Compared with subjects with a combination of normal BMI (18.5-<25) and normal waist circumference, those in the normal-BMI group with a large waist circumference (men: > or =102 cm; women: > or =88 cm) had an approximately 20% higher mortality risk (men: HR = 1.23, 95% CI: 1.08, 1.39; women: HR = 1.22, 95% CI: 1.09, 1.36). The finding that persons with a normal BMI but a large waist circumference had a higher mortality risk in this study suggests that increased waist circumference should be considered a risk factor for mortality, in addition to BMI.     

Divergent associations of plasma choline and betaine with components of metabolic syndrome in middle age and elderly men and women

Choline is involved in the synthesis of phospholipids, including blood lipids, and is the immediate precursor of betaine, which serves as a methyl group donor in a reaction converting homocysteine to methionine. Several cardiovascular risk factors are associated with plasma homocysteine, whereas little is known about their relationship to choline and betaine. We examined the relation of plasma choline and betaine to smoking, physical activity, BMI, percent body fat, waist circumference, blood pressure, serum lipids, and glucose in a population-based study of 7074 men and women aged 47-49 and 71-74 y. Overall plasma concentrations (means +/- SD) were 9.9 +/- 2.3 micromol/L for choline and 39.5 +/- 12.5 micromol/L for betaine. Choline and betaine were lower in women than in men and in younger subjects compared with older (P < 0.0001). Multivariate analyses showed that choline was positively associated with serum triglycerides, glucose, BMI, percent body fat, waist circumference (P < 0.0001 for all), and physical activity (P < 0.05) and inversely related to HDL cholesterol (P < 0.05) and smoking (P < 0.0001). Betaine was inversely associated with serum non-HDL cholesterol, triglycerides, BMI, percent body fat, waist circumference, systolic and diastolic blood pressure (P < 0.0001 for all), and smoking (P < 0.05) and positively associated with HDL cholesterol (P < 0.01) and physical activity (P < 0.0001). Thus, an unfavorable cardiovascular risk factor profile was associated with high choline and low betaine concentrations. Choline and betaine were associated in opposite directions with key components of metabolic syndrome, suggesting a disruption of mitochondrial choline dehydrogenase pathway.     

Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices

PURPOSE: To determine which is the best anthropometric index among body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to stature ratio (WSR) in relation to cardiovascular risk factors. METHODS: A representative sample of 2895 Hong Kong Chinese aged 25 to 74 years received medical examinations in 1995 and 1996. Anthropometric indices and cardiovascular risk factors in blood were measured, and partial correlation and Receiver Operator Characteristic (ROC) curves were used in analysis. RESULTS: Among 11 cardiovascular risk factors in partial correlation analysis, including ties WSR had the highest r in 6 in men, and 5 in women; followed by WC with 4 in men and 6 in women. In ROC analyses of 21 risk factors and health conditions, the area under curve (AUC) of WSR was the largest for most (13 of 21) factors in men and 10 in women; followed by WHR with 14 in women but only 5 in men. The optimal WSR cutoff value was 0.48 for both men and women. CONCLUSIONS: WSR is the best simple anthropometric index in predicting a wide range of cardiovascular risk factors and related health conditions. A simple message that one's waist circumference should not exceed half the stature is recommended for the public.     

Does waist circumference add to the predictive power of the body mass index for coronary risk?

OBJECTIVES: To examine the power of the combined measurements of body mass index (BMI) and waist circumference (WC) for the prediction of abnormality in coronary heart disease risk factors and to determine whether the additional measurement of WC is predictive in older men and women. RESEARCH METHODS AND PROCEDURES: 1190 men and 751 women of the Baltimore Longitudinal Study of Aging were dichotomized into younger (<65 years) and older (65+ years) age groups. Coronary risk factors in the realms of glucose/insulin metabolism, blood pressure, and plasma lipids were assessed. The relationship of BMI and WC, singly and combined, to 10 risk factors for coronary heart disease was examined. RESULTS: In younger and older men and women, BMI and WC are highly correlated (0.84 to 0.88). BMI and WC are also significantly correlated to all 10 coronary risk factors in younger men and women and to 8 of the 10 in the older men and women. Both partial correlation and logistic regression analyses revealed a modest but significant improvement in the prediction of coronary risk in younger men and women by WC after controlling for the level of BMI. There was no improvement in the older subjects. DISCUSSION: WC adds only modestly to the prediction of coronary risk in younger subjects once BMI is known, and adds nothing to the production of risk in older subjects.     

Appropriate waist circumference cutoff values for persons with multiple cardiovascular risk factors in Japan: a large cross-sectional study

BACKGROUND: In Japan, the current standard waist circumference cutoff value for persons with multiple cardiovascular risk factors remains controversial. In this study we aimed to analyze the health-check examination data from a large Japanese population and propose a revised waist circumference cutoff value. METHODS: Subjects of this study were 12,725 adults who underwent a health-check by thorough medical examination between April 2006 and March 2007. Medical examinations included measurement of waist circumference, fasting blood triglycerides, HDL cholesterol, glucose concentrations, blood pressure and collection of demographic characteristics. Receiver operating characteristic (ROC) curve analysis was utilized to find appropriate waist circumference cutoff values in relation to multiple cardiovascular risk factors with two or more of the following: dyslipidemia (hypertriglyceridemia or low HDL cholesterol), hypertension, and hyperglycemia defined by the Japanese criteria of metabolic syndrome. RESULTS: The average age of the subjects was 50.7 years (standard deviation [SD]: 8.8) for men and 49.7 years (SD: 8.6) for women. ROC curve analysis showed maximum sensitivity plus specificity at a waist circumference of 87 cm in men (0.66 and 0.62, respectively) and 83 cm in women (0.73 and 0.70). When analyzed by ten-year age groups, the ROC curves for younger age groups were shifted up and to the left compared to older age groups, but associations between cutoff values and age were not clear. CONCLUSION: In Japan, the appropriate cutoff value of waist circumference for persons with multiple cardiovascular risk factors is 87 cm for men and 83 cm for women.     

Changes in health-related behaviours and cardiovascular risk factors in young adults: associations with living with a partner

OBJECTIVE: To examine changes in cardiovascular risk factors and health-related behaviours in young Australian adults at a stage of transition from the family environment. STUDY DESIGN: Repeated surveys between 9 and 25 years of age in a community-based group that included 569 eighteen-year-olds and 600 twenty-five-year-olds. RESULTS: There were significant increases (P < 0.001 for all variables) in body mass index (BMI) [men 2.5 kg/m2 (2.0); women 1.7 kg/m2 (2.9)], waist girth [men 7.6 cm (6.5); women 4.3 cm (7.2)], BP (systolic/diastolic) [men 5(12)/7(8) mm Hg; women 3(10)/6(7) mm Hg] and in total cholesterol [men 15% increase; women 9%]. The proportion of sedentary behaviour increased from 19% to 39% in men (P < 0.001) and from 40% to 41% (P = 0.801) in women. Cohabitation was associated with significantly greater increases in BMI, waist circumference, and total cholesterol, associated with dietary change in women and decreased physical activity in men. In mothers, waist girth increased by 8.0 cm (0.1) compared with 3.5 cm (0.6) in women without children (P = 0.003), and physical fitness decreased [-0.5 W/kg (0.4) vs. 1.2 W/kg (0.2), respectively; P = 0.001]. CONCLUSION: Encouragement of a healthy lifestyle, particularly physical activity, should be a priority in this age group, particularly among newly cohabiting couples and in young mothers.     

Comparisons between anthropometric indices for predicting the metabolic syndrome in Japanese

AIMS: Most definitions of the metabolic syndrome (MS) employ waist circumference as an indicator of central obesity. However, several reports, mainly from Asia, argue that other indices, for example the waist/height ratio, are superior to waist circumference for identifying subjects with cardiovascular risk factors. We therefore investigated correlations between the predictive power of several anthropometric indices and risk factor accumulation (RFA) defined by the existence of two or more disorders among hypertension, dyslipidemia (high triglycerides and/or low levels of high density lipoprotein cholesterol) and fasting hyperglycemia; each of which is a component of MS. METHODS: We conducted a cross-sectional analysis using data from a part of the Japan Public Health Center-based Cohort. A total of 315 men and 314 women, 51 to 70 years of age were examined for variables including waist and hip circumferences, blood pressure, fasting plasma glucose and lipids at an annual health check-up. RESULTS: The prevalence of RFA increased almost linearly in parallel with increasing waist circumference up to 95 cm. Receiver operating characteristic analysis demonstrated that waist circumference was better than waist/ height ratio, waist/hip ratio and BMI at predicting RFA; but the differences were not statistically significant. However, even in the case of waist circumference, no clear cut-off point yields sufficiently high sensitivity and specificity simultaneously. CONCLUSIONS: The predictive power of waist circumference was not inferior to those of other indices. Therefore, waist circumference is practically the most convenient measure for predicting MS because of its simplicity.     

我国成人体重指数和腰围对相关疾病危险因素异常的预测价值:适宜体重指数和腰围切点的研究

目的：确定我国成人适宜的体重指数（BMI）范围和超重肥胖的划分界限。国际生命科学学会中国办事处中国肥胖问题工作组，对国内现有体量指标和相关疾病危险因素的研究数据组织了汇总分析。方法：有13项1990年以后的调查资料人选，共计20－70岁以上成人23972人，有腰围数据者111411人，有血脂和血糖化验数据者8万余人。数据进入分析的人群分布于大陆21个省市、自治区儿台湾。汇总方法是由各负责单位根据统一制定的表格和标准提供数据，汇总分析中心进行核对、汇总和统计分析。结果；高血压、糖尿病、血清总胆固醇升高、高密度脂蛋白胆固醇过低、甘油三酯升高和危险因素聚集（一个人具有2个及以上危险因素）的现患率均随BMI或腰围的增高而上升。通过不同BMI和腰围切点对于检出各项危险因素异常的敏感度和特异度分析，提出敏感度特异度较好、假阳性率较低的BMI切24为中国成人超重的界限，特异度达90％的BMI切点28为肥胖的界限；男性腰围≥85cm，女性≥80cm为腹部脂肪蓄积的界限。结论：切点以上的人群归因危险度百分比显示：将BMI控制到24以下，可能防止人群中45％－50％的危险因素聚集。对BMI在28及以上者药物控制到此点以下，可能防止15％－17％的危险因素聚集，从而降低心血管病和糖尿病的发病危险。男性腰围控制在85cm以下，女性腰围控制到80cm以下， 可能防止约47％－58％的解除因素聚集。根据以上分析结果，提出了对中国成人超重和肥胖界限的建议。     

Nutritional risk assessment and obesity in rural older adults: a sex difference

BACKGROUND: Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators. OBJECTIVE: This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk. DESIGN: This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers. RESULTS: Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference). CONCLUSIONS: Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.     

Non-obese (body mass index < 25 kg/m2) Asian Indians with normal waist circumference have high cardiovascular risk

OBJECTIVE: Although the prevalence of obesity is not high in Asian Indians, increased prevalence rates of metabolic perturbations and cardiovascular risk factors have been reported. In this study, we evaluated body mass index (BMI), anthropometric measurements, and body fat profiles of obese and non-obese subjects and correlated those values with cardiovascular risk factors. METHODS: This cross-sectional study involved 639 subjects (170 men and 469 women) from low socioeconomic stratum residing in urban slums of New Delhi. Non-obese subjects were categorized into quartiles of percentage of body fat (%BF) and waist circumference (WC). Using logistic regression analysis, the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of cardiovascular risk factors (diabetes mellitus [DM], hypertension, hypercholesterolemia, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and high levels of low-density lipoprotein cholesterol) were computed with first quartile in the non-obese group as the reference category for the following five categories: %BF and WC quartiles in the non-obese group and obese group (BMI > or = 25 kg/m(2)). RESULTS: In the non-obese group, approximately 66% of men and 88% of women had at least one risk factor. In non-obese women, significantly high ORs and 95% CIs were found for hypertension (3.2, 1.4-7.2), DM (2.8, 1.2-6.3), and hypertriglyceridemia (3.9, 1.9-8.3) in the upper quartiles of %BF, and significantly high OR (95% CIs) was observed for hypertriglyceridemia (3.9, 1.4-10.8) in non-obese men. Among non-obese men, significantly high OR (95% CIs) was found for hypertriglyceridemia (3.2, 1.0-10.3); among non-obese women, significantly high ORs (95% CIs) were observed for hypertension (2.5, 1.1-5.8) and hypertriglyceridemia (2.5, 1.2-5.2) in the normal range of WC (70-80 cm). CONCLUSION: The study showed that Asian Indians have excess cardiovascular risk at BMI and WC values considered "normal." These data suggested that definitions of "normal" ranges of BMI and WC need to be revised for Asian Indians.     

Waist circumference, body mass index and health risk factors among middle aged Thais

Body mass index (BMI) and waist circumference (WC) are important contributors to major causes of health risk factors such as high blood cholesterol, high fasting blood sugar and high blood pressure. This analysis was designed to assess the associations between WC, BMI and each health risk factor in suitable cut-off points for WC and BMI among middle aged men and women of Thai population. Cross sectional data from the Second National Health Survey in Thailand was analysed. This set of data collected by the Ministry of Public Health from 1996 to 1997 was obtained from a total of 998 subjects (comprising 396 men and 602 women) aged 45-50. Results from the Receiver Operating Characteristic curve (ROC curve) identified those with health risk factors demonstrating cut-off points for WC between 81.5-84 centimeters for men and 76-80.5 centimeters for women and BMI between 23.3-23.9 kg/m2 for both genders, respectively. Results from the Multiple logistic regression analysis demonstrated lower risks of having high blood cholesterol, high fasting blood sugar and high blood pressure with cutoff points 84 cm for men, 80 cm for women and BMI 23 kg/m2 for both genders compared to cut-off points 102 cm for men, 88 cm for women and BMI 25 kg/m2 for both genders as specified for the population in Western countries. This study has proposed a waist circumference of 84 cm (33.6 inches) for middle aged Thai men and 80 cm (32 inches) for middle aged Thai women and BMI of 23 kg/m2 for both genders. Monitoring changes in the waist circumference over time along with BMI may be convenient and useful for middle aged Thais to prevent health risk conditions, even in the absence of a change in BMI.     

The association between cheese consumption and cardiovascular risk factors among adults

Background Although current dietary guidelines recommend limiting foods high in fat and saturated fat, such as high‐fat dairy, the effect of cheese consumption on body composition and cardiovascular risk factors is largely unknown. Methods Participants from a US population‐based survey, NHANES III, aged 25–75 years who completed a food frequency questionnaire and had measures of body composition and cardiovascular risk factors were included (n = 10 872). Linear regression was used to compare anthropometrics, blood lipids, blood pressure and blood glucose across categories of cheese consumption (combined full and low‐fat). Results In women, more frequent cheese consumption was associated with higher HDL‐C and lower LDL‐C (p for trend, < 0.05). However, in men, more frequent cheese consumption was associated with a higher body mass index (BMI), waist circumference, HDL‐C and LDL‐C, and diastolic blood pressure (p for trend, < 0.05). Men consuming 30 + servings/month had significantly higher BMI, waist circumference, and diastolic blood pressure compared to nonconsumers (P < 0.05). Conclusions More frequent cheese consumption was associated with less favourable body composition and cardiovascular risk profile in men, but with a more favourable cardiovascular risk profile in women. However, the type of cheese consumed by men and women may have differed resulting in opposing trends on body composition and cardiovascular risk factors.     

Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study

OBJECTIVE: A higher waist-to-hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. RESEARCH METHODS AND PROCEDURES: For this cross-sectional study we used baseline data from the Hoorn Study, a population-based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75-g oral glucose tolerance test; hemoglobin A(1c) and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. RESULTS: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized beta values in women were -0.164 for fasting, -0.206 for post-load glucose, -0.190 for hemoglobin A(1c) (all p < 0.001), and -0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from -0.093 to -0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. DISCUSSION: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

Impact of obesity and body fat distribution on cardiovascular risk factors in Hong Kong Chinese

OBJECTIVE: Body fat distribution has been reported to differentially contribute to the development of cardiovascular risk. We report the relative associations between general and central obesity and risk factors in 2893 Chinese subjects recruited from the Hong Kong population. RESEARCH METHODS AND PROCEDURES: Anthropometric parameters [waist circumference (WC) and BMI], surrogate measures of insulin resistance (fasting plasma glucose and insulin, oral glucose tolerance test, 2 hours glucose and insulin), fasting lipids (total, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides) and systolic and diastolic blood pressure were measured. General obesity was classified as BMI > or =25.0 kg/m(2) and central obesity as a WC > or =80 or > or =90 cm in women and men, respectively. RESULTS: A total of 39.2% of the population was found to be obese. Obesity per se increased the levels of the risk factors, but central adiposity contributed to a greater extent to adverse high-density lipoprotein-cholesterol, triglyceride, and insulin resistance levels. There was a continuous relationship between increasing obesity, both general and central, and cardiovascular risk, with lowest risk associated with the lowest indices of obesity. In the 1759 nonobese subjects divided into quartiles of BMI or WC, the levels of the cardiovascular risk factors still significantly increased with increasing quartiles of adiposity. DISCUSSION: Central adiposity appears to contribute to a greater extent than general adiposity to the development of cardiovascular risk in this population. The relationship between obesity parameters and risk is a continuum, with risk factors significantly increasing even at levels usually considered nonobese. These observations support the proposed redefinition of overweight and obesity in Asian populations using lower cut-off points.     

Body fat distribution, serum lipoproteins and blood pressure in middle-aged Finnish men and women

The association of body fat distribution as measured by the ratio of waist to hip girth (WHR) to age, to serum total cholesterol and HDL-cholesterol and to blood pressure was studied in a population-based sample of 2461 men and 2768 women aged 25 to 64 years not treated with cardiovascular drugs. In men, the relationships of age with WHR and age with body mass index (BMI) were similar, an increase levelling at the age of about 50 years. In women, BMI increased linearly, but WHR exponentially with age. In both sexes, age-adjusted WHR and BMI associated positively with non-HDL cholesterol, and with systolic and diastolic blood pressure, and inversely with HDL-cholesterol and the HDL/non-HDL cholesterol ratio. WHR and BMI were independently related to several cardiovascular risk factors. HDL-cholesterol concentration was 19% lower in men, and 17% lower in women who belonged to the upper tertile of both WHR and BMI, than in the subjects in the lower tertiles of WHR and BMI. Age-adjusted WHR and BMI also predicted fasting and 2-hour post-challenge blood glucose values in women aged 45 to 64 years, but not in men. The WHR provides additional information on elevated cardiovascular risk factors in cross-sectional analysis among middle-aged men and women independently of BMI. The measurement of WHR in large-scale risk factor surveys should be recommended, in order to assess the independent contribution of WHR to the risk of cardiovascular disease, and to find out the importance of WHR for the prevention of chronic diseases.     

Application of obesity treatment algorithms to Canadian adults

OBJECTIVE: The purpose of this study was to apply obesity treatment algorithms to a representative sample of Canadians to determine their potential impact on the population. DESIGN: The Canadian Heart Health Surveys (1986-1992) were used to describe the prevalence of adults (18-64 y) that would be eligible for weight loss treatment according to the US NIH algorithm, which uses body mass index (BMI), waist circumference (WC), and the presence of two or more cardiovascular disease (CVD) risk factors. Similar algorithms based on CVD risk factors and a single measure of either BMI or WC alone were also evaluated. RESULTS: Using the NIH algorithm, 24% of Canadians (28% men, 19% women) would be identified for weight loss treatment. Virtually, all subjects received the same treatment recommendations when using BMI and CVD risk factors only, while 22% (23% men, 21% women) would meet the criteria for treatment using WC and CVD risk factors only. CONCLUSIONS: Approximately one in four Canadians would be eligible for weight loss treatment using the NIH obesity treatment algorithm. However, the algorithm may be improved through the incorporation of more sensitive WC thresholds.