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.     

Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies.

AIMS: The objectives of this study were to determine the association of waist circumference (WC) and waist-to-hip ratio (WHR) with the risk of incident cardiovascular disease (CVD) events and to determine whether the strength of association of WC and WHR with CVD risk is different. METHODS AND RESULTS: This meta-regression analysis used a search strategy of keywords and MeSH terms to identify prospective cohort studies and randomized clinical trials of CVD risk and abdominal obesity from the Medline, Embase, and Cochrane databases. Fifteen articles (n = 258 114 participants, 4355 CVD events) reporting CVD risk by categorical and continuous measures of WC and WHR were included. For a 1 cm increase in WC, the relative risk (RR) of a CVD event increased by 2% (95% CI: 1-3%) overall after adjusting for age, cohort year, or treatment. For a 0.01 U increase in WHR, the RR increased by 5% (95% CI: 4-7%). These results were consistent in men and women. Overall risk estimates comparing the extreme quantiles of each measure suggested that WHR was more strongly associated with CVD than that for WC (WHR: RR = 1.95, 95% CI: 1.55-2.44; WC: RR = 1.63, 95% CI: 1.31-2.04), although this difference was not significant. The strength of association for each measure was similar in men and women. CONCLUSION: WHR and WC are significantly associated with the risk of incident CVD events. These simple measures of abdominal obesity should be incorporated into CVD risk assessments.     

Obesity in Turkish adults: Prevalence,validity as coronary risk factor,and interrelation with other risk factors

Interrelation between obesity and six other risk factors was investigated based on the data obtained in a cross-sectional population study of a representative sample of 3689 Turkish subjects 20 years of age or older. Obesity was defined as a body mass index (BMI) of 30 kg/m² in both genders. One hundred seventy-three participants (93 men and 80 women) were diagnosed as having definite or suspected coronary heart disease. Odds ratio was calculated for obesity, and its validity was checked. Prevailing in 42% of Turkish women and 16% of men 40–59 years of age, obesity interacted with a variety of risk factors. The relation between BMI and plasma total cholesterol was significant in young (20–39 years) subjects alone, and that plasma triglyceride in young and middle-aged participants. Both the systolic and diastolic blood pressure rose significantly, with a rise in BMI in women and in young (20–29 years) men. The prevalence of diabetes among obese women was almost threefold that of nonobese women. Except for men in age group 50–59 years, the relative weight did not seem to be affected by physical activity. Though obesity did not represent a coronary risk factor in Turkish men, in women it constituted a significant risk factor valid for all adult ages having an odds ratio of 1.76 and a population attributable risk of 0.146. Despite this, obesity did not prove to be an independent risk factor on multivariate analysis but appeared to act through association with the other factors.Presented at the 35th World Congress, International College of Angiology, Copenhagen, Denmark, July 1993     

Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index

BACKGROUND: Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio (WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults. OBJECTIVE: To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin. SUBJECTS AND METHODS: A total of 1,037 boys and 950 girls with mean age 11.4+/-0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholestrol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most significant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors. CONCLUSION: Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.     

Cardiovascular disease risk factors in males with normal body weight and high waist-to-hip ratio.

BACKGROUND: Overweight and the distribution of body fat are both associated with the development of cardiovascular diseases (CVD). The relation of abdominal body fat distribution to CVD may depend on the degree of obesity. OBJECTIVE: The purpose of the present study was to evaluate the cardiovascular disease risk factor levels in males with high waist-to-hip ratio (WHR) in the absence of overweight. DESIGN: Cross-sectional study of 231 male subjects (21-69 years old). METHODS: Anthropometric measurements (height, weight, BMI, fat%, skinfolds, waist circumference, WHR), systolic and diastolic blood pressure (BPsyst, BPdiast), serum lipids and lipoproteins (CHOL, HDL-C, LDL-C, TG), glucose (GL), and physical working capacity. A questionnaire was drawn up to evaluate physical activity level and lifestyle patterns. RESULTS: Subjects with WHR > or = 0.9, BMI < 27.0 and with WHR > or = 0.9, BMI > or = 27.0 showed statistically significant differences in all measured anthropometric and blood pressure values in comparison with the control group (WHR < 0.9, BMI < 27.0). Compared with the controls, subjects with WHR > or = 0.9, BMI > or = 27.0 had significantly higher risk (OR) for hypertension and elevated LDL-C. Physical activity was a significant determinant of the high WHR. CONCLUSIONS: WHR has independent associations with some CVD risk factors, but the effect increases with weight.     

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

BACKGROUND: Body mass index (BMI) and waist circumference (WC) correlate with cardiovascular (CV) risk factors in childhood which track into adulthood. WC provides a measure of central obesity, which has been specifically associated with CV risk factors. Reference standards for WC, and for WC and BMI risk threshold values are not established in Chinese children. OBJECTIVES: To construct reference percentile charts of WC, establish relationships between WC, BMI and other risk factors, and propose WC and BMI threshold values predictive of CV risk factors in Hong Kong ethnic Chinese children. METHODS: Weight, height, waist and hip circumference were measured in 2593 (52% boys, 47% girls) randomly sampled Hong Kong school children aged 6-12 years. In 958 of these and 97 additional overweight children (n=1055), the relationships between WC, BMI, waist/hip and waist/height ratio and six age-adjusted CV risk factors (>85% percentile levels of blood pressure (BP), fasting triglycerides, low-density lipoprotein (LDL) cholesterol, glucose and insulin levels, and <15% percentile levels of high-density lipoprotein (HDL) cholesterol) were studied. Receiver-operating characteristic analysis was employed to derive optimal age-adjusted sex-specific WC and BMI thresholds for predicting these measures of risk. RESULTS: WC percentiles were constructed. WC correlated slightly more than BMI with CV risk factors and most strongly with insulin and systolic BP, but poorly or not with LDL and glucose. Optimal WC and BMI risk thresholds for predicting four of these six CV risk factors were ca. the 85th percentiles (sensitivities approximately 0.8, specificities approximately 0.87) with age-specific cutoff values in girls/boys from approximately 57/58 to approximately 71/76 cm and 17/18 to 22/23 kg/m(2). CONCLUSION: These are the first set of WC reference data for Chinese children. WC risk cutoff values are proposed which, despite a smaller waist in Chinese children, are similar to those reported for American children. WC percentiles may reflect population risk.     

A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys

OBJECTIVE: To comparatively evaluate cut-off points of waist circumference, body mass index and waist to hip ratio with respect to their ability to predict other individual and multiple cardiovascular disease risk factors. DESIGN: Population-based, cross-sectional surveys. SUBJECTS: A total of 9913 men and women aged 18-74, selected using health insurance registries from five Canadian provinces. MEASUREMENTS: Anthropometric measures, other cardiovascular risk factors, receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values. RESULTS:: Waist circumference may be the best single indicator of other individual and multiple cardiovascular risk factors. Optimal cut-off points of all anthropometric measures are dependent on age, sex and the prevalence of the risk factor(s) being considered. For waist circumference, cut-off points of > or =90 cm in men and > or =80 cm in women may be most appropriate for prediction of individual and multiple risk factors in Caucasian populations. CONCLUSION: Health professionals should incorporate the use of waist circumference measurements in their routine clinical examination of adult patients.     

Waist measure and waist-to-hip ratio and identification of clinical conditions of cardiovascular risk: multicentric study in type 2 diabetes mellitus patients

Abdominal obesity is associated with cardiovascular disease. This study aims to compare two measures of abdominal obesity [waist and wais-to-hip ratio (WHR)] in patients with DM2 to identify cardiovascular risk factors: ischemic cardiopathy, hypertension, dislipidemia, obesity and diabetic nephropathy. A multicentric study was performed in 820 patients with type 2 DM. Waist circumference strongly correlated with body mass index (BMI), for men (r= 0.814; P< 0.05) and women (r= 0.770; P< 0.05). On the other hand, WRH was weakly correlated (r= 0.263, P< 0.05 for men; r= 0.092, P< 0.05 for women). Only waist circumference correlated with systolic pressure (r= 0.211, P< 0.05 for men; r= 0,224, P< 0.05 for women). ROC curve analysis demonstrated the superiority of waist circumference measurement compared to WHR regarding obesity and hypertension for men and women, and dyslipidemia for men. In conclusion, waist circumference is better correlated with cardiovascular risk factor than WRH.     

Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women.

AIMS: To assess joint associations of physical activity and different indicators of obesity (body mass index, waist circumference, and waist-to-hip ratio) with the risk of cardiovascular disease (CVD). METHODS AND RESULTS: The study comprised 18,892 Finnish men and women aged 25-74 years without history of coronary heart disease, stroke, or heart failure at baseline. Physical activity, different indicators of obesity, education, smoking, blood pressure, total and high-density lipoprotein cholesterol and history of diabetes were measured at baseline. An incident CVD event was defined as the first stroke or coronary heart disease event or CVD death based on national hospital discharge and mortality register data. The median follow-up time was 9.8 years. Physical activity had a strong, independent, and inverse association with CVD risk in both genders. All obesity indicators had a significant direct association with CVD risk after adjustment for age, smoking, education and physical activity. Further adjustment for the obesity-related risk factors weakened the associations and they remained statistically significant in men only. Physical activity and the obesity indicators both predicted CVD risk in men, but in women the joint effect was inconsistent. CONCLUSION: Both regular physical activity and normal weight can reduce the risk of CVD. Physical inactivity seems to have an independent effect on CVD risk, whereas obesity increases the risk partly through the modification of other risk factors.     

Low serum ionized to total calcium ratio: association with geriatric diabetes mellitus and with other cardiovascular risk factors?

Serum total calcium concentrations (CaT) were increased, ionized calcium concentrations (CaI) normal, and the CaI/CaT ratios decreased in 125 geriatric diabetics as compared with 379 non-diabetic controls. In the whole population of 558 consecutive geriatric inpatients, the CaI/CaT ratios were inversely correlated with body weight, diastolic blood pressure and plasma glucose. The findings and calculations help to explain some inconsistencies and discrepancies in previous studies concerning calcaemia in diabetes, hypertension and the 'metabolic syndrome' of clustered risk factors for cardiovascular diseases. They also demonstrate that CaT and the 'correction' of CaT for serum albumin concentration can be biased in diabetes and other conditions closely associated with cardiovascular risks. Increased serum free fatty acids could at least in part explain low ratios.     

Prevalence of cardiovascular risk factors in adults with congenital heart disease.

BACKGROUND: Empirical evidence indicates that patients with congenital cardiac anomalies may be prone to developing coronary heart disease. Although primary prevention of ischaemic heart disease in patients with congenital heart defects is important, data on the prevalence of cardiovascular risk factors in these patients are not available. The aims of this study are therefore to describe the prevalence of risk factors for coronary heart disease in a large sample of adults with congenital cardiac anomalies, and compare this with the prevalence in the general population. DESIGN: A retrospective analysis of computerized patient records. METHODS: At our outpatient clinic, all patients are examined by an advanced practice nurse and a congenital heart disease cardiologist. Data on smoking behaviour, sports participation, blood pressure, body mass index, and the diagnosis of diabetes are recorded systematically. Data on the general population were derived from national health surveys. RESULTS: In a 4-year period, we collected data on 1976 individual patients. Male patients had a significantly higher prevalence of smoking and elevated blood pressure, whereas women were less engaged in sports activities and were more often obese. In comparison with the general population, our patients reported less smoking and more participation in sports, but presented more often with hypertension or diabetes. Only 20.4% of men and 21.0% of women have a fully heart-healthy lifestyle, as they presented without any risk factor. CONCLUSION: A substantial number of patients had one or more cardiovascular risk factors. Therefore, primary prevention by strengthening educational efforts becomes critically relevant in patients with congenital heart disease, to avoid the additional burden of coronary events in this growing population of patients.     

Validity of self-reported abdominal obesity in Thai adults: A comparison of waist circumference, waist-to-hip ratio and waist-to-stature ratio

Background and aims

Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio (WSR), being common proxy measures of abdominal obesity, are useful tools in epidemiologic studies, but little is known about their validity when the indices are derived from self-reported measurements. We determine and compare the validity of self-reported WC, WHR and WSR in order to identify the optimal index for use in epidemiologic surveys.

Methods and Results

Technician- and self-reported measurements of height, waist and hip circumference were obtained from 613 Thai adults (mean age 35 years). Regarding technician-reported measurements as reference, diagnostic test properties were derived and performances of the indices compared using receiver-operator-characteristic curves and the area-under-the-curve (AUC) analyses. There was good agreement between technician- and self-reported measurements for WC and WSR (concordance correlation coefficients ranged from 0.84 to 0.90) but not for WHR (0.50 in men, 0.45 in women). The sensitivity and specificity of self-reported WC and self-reported WSR as measures of abdominal obesity were superior to those of self-reported WHR in both sexes. AUCs for WC and WSR were comparable (0.93 and 0.92, respectively, in men; 0.88 and 0.87 in women) and significantly higher than for WHR (0.80 in men; 0.76 in women; p < 0.0001).

Conclusion

WC and WSR derived from self-reported waist and height measurements are valid methods for determining abdominal obesity. Self-reported measurements should not be used to derive the WHR. In Asian populations, WSR may be the optimal index of abdominal obesity when measurements are derived from self-reports in epidemiologic surveys.     

Waist circumference in the assessment of obesity and associated risk factors in coronary artery disease patients

Waist circumference ‘action levels’ have been recommended as a screening tool for overweight/obesity and associated metabolic risk factors. The use of waist circumference action levels in identifying need for weight management and higher metabolic risk was evaluated in 541 consecutive coronary artery disease patient referrals (85 female) to a long-term maintenance, community-based cardiac rehabilitation programme. Recommended waist circumference action levels identified overweight and obese patients (body mass index (BMI ≥ 25.0 kg·m^–2and ≥ 30.0 kg·m^–2, respectively) and those with lower BMI but abdominal adiposity (waist:hip ratio ≥ 0.95 males, ≥ 0.80 females) with high sensitivity and specificity values. The prevalence of several metabolic risk factors was different between male and female patients in this cohort. Male patients exceeding the lower waist circumference action level (≥ 94 cm) showed significantly increased odds ratios for hypertriglyceridemia; those at the higher action level (≥ 102 cm) additionally exhibiting low high density lipoprotein cholesterol, a raised TC:HDL-C ratio and diastolic hypertension. Male subjects with increased waist circumferences were also 2–3 times as likely to have multiple (≥ 3) metabolic risk factors. Higher odds ratios were evident only for hypertriglyceridemia in female patients above the higher action level (≥ 88 cm). Waist circumference action levels (94 cm and 102 cm in males; 80 and 88 cm in females) may be utilized in secondary prevention settings to identify subjects requiring weight management. Furthermore, waist circumferences higher than the recommended action levels may also indicate increased metabolic risk despite standard cardioprotective drug therapy.     

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.     

腰围身高比值与2型糖尿病心血管病危险因素的关系

目的探讨腰围身高比值（WHtR）用于2型糖尿病（T2DM）评估腹型肥胖及其与心血管病危险因素的关系。方法新诊断T2DM患者4ll例，测血压、血糖、血脂、身高、体重、腰围（WC）、臀围，计算BMI、WHtR及腰臀比（WHR），分析WHtR、BMI、WC及WHR与身高的关系，各肥胖指数与血压、血脂的关系。结果（1）WHtR与血压、TG及HDL-C的相关程度均大于与BMI、WC、wHR的相关程度。WHtR与高血压、高TG及低HDL-C均显著相关。结论WHtR升高与血压、血脂关系密切，可作为评估腹型肥胖及预测T2DM心血管疾病危险因素指标之一。     

Obesity in Castile and Leon, Spain: epidemiology and association with other cardiovascular risk factors

A cross-sectional study of obesity in a random sample of 4012 individuals aged ≥ 15 years in Castile and Leon, Spain, was carried out. The prevalence of obesity (i.e. a body mass index ≥ 30 kg/m2) and abdominal obesity (i.e. a waist circumference > 102 cm in males or > 88 cm in females) was determined and associations between both types of obesity and other cardiovascular risk factors were investigated. The overall prevalence of obesity was 21.7% (95% confidence interval [CI], 20.3%-23.2%): it was higher in women, at 23.2% (95% CI, 20.9%-25.5%), than in men, at 20.4% (95% CI, 18.0%-22.7%). The prevalence of abdominal obesity was 36.7% (95% CI, 34.6%-38.9%): again it was higher in women, at 50.1% (95% CI, 47%-53.1%) than in men, at 22.8% (95% CI, 20.3%-25.2%). Associations were found between obesity and all classic cardiovascular risk factors, except smoking. The 10-year Systematic Coronary Risk Evaluation (SCORE) and Framingham risk scores were higher in obese individuals.