Modification of the relationship between simple anthropometric indices and risk factors by ethnic background

Current targets for body mass index (BMI) and waist circumference (WC) may not be appropriate for those of South Asian origin. The objectives of this study were to determine whether the relationship between BMI and WC with risk factors for cardiovascular disease (CVD) is the same for men and women of South Asian and European descent. Apparently healthy men and women of European (n = 88) and South Asian (n = 93) descent were recruited from 3 hospital communities and assessed for BMI, WC, waist-to-hip ratio (WHR), blood pressure (BP), lipids, insulin, glucose, and CRP. The study cohort was stratified by sex, and regression analyses were performed with individual risk factors as outcomes and ethnicity with either BMI or WC as predictors adjusting for age and height (WC only). BMI and WC were similar between the European and South Asian men and women. South Asian men had significantly higher values for total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), total cholesterol:high-density lipoprotein-cholesterol (HDL-C) and CRP, and significantly lower values of HDL-C. South Asian women had significantly higher values for TG, TC:HDL-C and CRP and significantly lower values of HDL-C, glucose, systolic BP and diastolic BP. In men, ethnicity was an independent predictor for all risk factors except for glucose and insulin, after adjusting for either BMI or WC independent of age and height. For women, ethnicity was an independent predictor for all risk factors except for total cholesterol (WC model only) and insulin (BMI model only), after adjusting for either BMI or WC independent of age and height. The relationship between BMI or WC and risk factors is such that men and women of South Asian descent present with a more adverse risk profile than those of European descent at the same BMI and/or WC.     

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

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

Obesity and C‐reactive protein in various populations: a systematic review and meta‐analysis

Obesity has been associated with elevated levels of C‐reactive protein (CRP), a marker of inflammation and predictor of cardiovascular risk. The objective of this systematic review and meta‐analysis was to estimate the associations between obesity and CRP according to sex, ethnicity and age. MEDLINE and EMBASE databases were searched through October 2011. Data from 51 cross‐sectional studies that used body mass index (BMI), waist circumference (WC) or waist‐to‐hip ratio (WHR) as measure of obesity were independently extracted by two reviewers and aggregated using random‐effects models. The Pearson correlation (r) for BMI and ln(CRP) was 0.36 (95% confidence interval [CI], 0.30–0.42) in adults and 0.37 (CI, 0.31–0.43) in children. In adults, r for BMI and ln(CRP) was greater in women than men by 0.24 (CI, 0.09–0.37), and greater in North Americans/Europeans than Asians by 0.15 (CI, 0–0.28), on average. In North American/European children, the sex difference in r for BMI and ln(CRP) was 0.01 (CI, ?0.08 to 0.06). Although limited to anthropometric measures, we found similar results when WC and WHR were used in the analyses. Obesity is associated with elevated levels of CRP and the association is stronger in women and North Americans/Europeans. The sex difference only emerges in adulthood.     

Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study

OBJECTIVES: To evaluate whether body mass index (BMI) and other anthropometric indices of visceral obesity vary by ethnic group in their distribution and their relationship to metabolic abnormalities. DESIGN: Cross-sectional study. PARTICIPANTS: Canadian men and women, aged 35-75 years, of South Asian (n=342), Chinese (n=317), European (n=326) and Aboriginal (n=301) descent were recruited using stratified random sampling. PRIMARY MEASURES: Anthropometric indices (BMI, waist to hip ratio (WHR) and waist circumference (WC)), metabolic markers (fasting glucose, HbA1c, the ratio of total cholesterol/HDL) and clinical markers (systolic blood pressure) were assessed. RESULTS: In subjects with BMI<30 kg/m2, the mean marker levels in people with elevated WC (>88 cm in women, >102 cm in men) vs people with normal WC were 6.16 vs 5.34 mmol/l for fasting glucose, 6.05 vs 5.66% for HbA1c and 5.46 vs 4.68 for the ratio of total cholesterol to HDL (P<0.001 in each case). At nearly every given level of BMI, non-European ethnic groups displayed significantly higher marker levels than Europeans. For example, for a given BMI, age and sex, the difference between European and non-European groups in HbA1c levels was 0.53% (95% confidence interval (CI): 0.37-0.69) for South Asians, 0.37% (95% CI: 0.2-0.54) for Chinese and 0.95% (95% CI: 0.78-1.12) for Aboriginal People. CONCLUSIONS: Uniform cut-points for the classification of obesity using BMI, WHR or WC result in marked variation in the levels of glucose-metabolic abnormalities between ethnic groups. Existing action thresholds for these anthropometric indices do not apply to non-European ethnic groups and warrant revision.     

Association between simple anthropometric indices and cardiovascular risk factors.

OBJECTIVE: To identify which of the three simple anthropometric indices, body mass index (BMI), waist-to-hip ratio (WHR) and waist circumference (WC), best predicts cardiovascular risk factors, and to determine if the association between the anthropometric indices and cardiovascular risk factors varies with gender. DESIGN AND METHODOLOGY: A cross-sectional population-based survey was carried out during 1995-1996. One thousand and ten Chinese people (500 men and 510 women) aged 25-74 y were recruited as subjects for the study. Metabolic profiles and anthropometric indices were measured. RESULTS: Partial correlation and co-variance analyses showed that WC exhibited the highest degree of association with almost all of the studied metabolic profiles for both men and women. We observed significant gender differences in the association between central or general obesity with cardiovascular risk factors. BMI had an independent and significant association with metabolic risks in men, but not in women, whereas WHR was more strongly correlated with metabolic risks for women than for men. Logistic regression analysis further confirmed the magnitude of the association between the obesity indices and metabolic risks. Among the studied metabolic variables, serum insulin showed the highest degree of association with the obesity indices, followed by plasma glucose, triglyceride, HDL and blood pressure. Total cholesterol and LDL-cholesterol had a small but significant correlation with obesity. No threshold values in the relation between either the anthropometric indices and metabolic values, or with hypertension, diabetes and dislipidemia were observed. CONCLUSION: The association of central or general obesity and metabolic syndrome varied with gender. In addition, the useful anthropometric predictors for cardiovascular risk factors were BMI and WC for men, and WC and WHR for women.     

A comparison of proxy measures of abdominal obesity in Chinese, European and South Asian adults.

AIMS: To assess whether four proxy measures of abdominal obesity (waist circumference; waist-to-hip ratio (WHR); waist-to-height ratio and C index, a measure of body shape) were uniformly associated with features of the metabolic syndrome (triglycerides, high density lipoprotein (HDL) cholesterol, 2-h glucose) in three ethnic groups. METHODS: Anthropometric and biochemical data were collected in 629 Europeans (320 men, 309 women), 380 Chinese (183 men, 197 women) and 597 South Asians (275 men, 322 women) aged 25-64 years in Newcastle upon Tyne, UK. Linear regression models were used to determine whether relationships differed between ethnic groups. RESULTS: Linear regression analysis showed that most proxy measures of abdominal obesity were associated with features of the metabolic syndrome. There were significant interactions between WHR and ethnicity and C index and ethnicity in the relationship with log triglycerides when comparing European and Chinese women. Interactions existed between all proxy measures and ethnicity in the relationship with log triglycerides and HDL cholesterol when comparing European and South Asian women. In men, interactions between ethnicity and waist circumference, WHR and C index when comparing Europeans and South Asians, and between ethnicity and WHR and C index when comparing South Asian and Chinese for log 2-h glucose were significant (P < 0.001). All interactions remained significant when differences in smoking, alcohol and physical activity were taken into account. CONCLUSIONS: Not all the proxy measures of abdominal obesity were consistently related to features of the metabolic syndrome across the ethnic groups studied. However, waist circumference and waist to height ratio were the most consistent and WHR the least when comparing across the ethnic groups.     

The relationship between asthma symptoms and anthropometric markers of overweight in a Hispanic population.

BACKGROUND: Previous studies have revealed the relationship between asthma and obesity, but the relationship with other markers of overweight and obesity has not yet been investigated. OBJECTIVE: To establish the relationship between asthma symptoms and simple anthropometric indexes (BMI, waist circumference (WC), and waist-to-hip ratio (WHR)) as markers of overweight in an adult Hispanic population. METHODS: The data were obtained from the PRIT (Prevalence of Cardiovascular Risks in General Hospital Workers) 2001 survey. The participants were workers at the Hospital General de México in Mexico City and included 135 men and 398 women aged 43.8 +/- 11.9 and 43.0 +/- 10.5, respectively. Odds ratios for asthma symptoms at different BMI, WC, and WHR cutoff points associated with excessive weight were calculated. The likelihood ratios for having asthma symptoms in participants with various cutoff values of BMI, WC, and WHR also were calculated. RESULTS: Asthma symptoms were not related to anthropometric markers of overweight or obesity in men, while they were associated in women with WC cutoff levels of 80 and 85 cm, and BMI of 25 and 27 kg/m2. No level of WHR was related to asthma symptoms in women. In women, the likelihood ratio for asthma symptoms increased proportionally from WC levels of 73.5 cm up to 86 cm, while this risk increased significantly from BMI levels of 22 up to 29 kg/m2. CONCLUSION: Overweight as assessed by BMI and WC (but not WHR) was related to asthma symptoms in women in the studied population.     

Relation between androgens and cardiovascular risk factors in a young population

Objective The relationship between androgens and blood pressure, insulin resistance, lipid profile, adiponectin and hs‐CRP in a young Middle‐Eastern population has not been examined previously. We studied this relationship in a randomly selected population of Lebanese students. Methods Three hundred and sixty‐eight subjects (201 men and 167 women) aged 18–30 years were included in the study. Anthropometric and biological parameters [waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), triglycerides, total cholesterol, HDL cholesterol, homeostasis model assessment of insulin resistance (HOMA‐IR), total testosterone (TT), dehydroepiandrostenedione sulphate (DHEAS), sex hormone‐binding globulin (SHBG), adiponectin (ADP) and hs‐CRP] were measured. Results In men, there were inverse associations of both TT and SHBG with body mass index (BMI), WC, HOMA‐IR, triglycerides and hs‐CRP. After adjustment for major confounders (BMI, WC, age and smoking), associations disappeared except for those between TT and hs‐CRP, and for SHBG HOMA‐IR, hs‐CRP and triglycerides. In women, only SHBG was inversely associated with BMI, WC, HOMA‐IR and hs‐CRP and positively correlated with adiponectin. Except for the association between SHBG and adiponectin, these correlations disappeared after adjustment for confounders. Although DHEAS appeared to correlate negatively with blood pressure in men, this relationship disappeared after adjustment for confounders, while a relationship between DHEAS and triglycerides in women persisted after such adjustment. In multivariate regression analysis, SHBG was an independent predictor of hs‐CRP, triglycerides and HOMA‐IR in men and of adiponectin in women. Conclusion Our results suggest that SHBG is independently associated with HOMA‐IR, adiponectin, hs‐CRP and triglycerides. A gender difference in these associations is observed. Further studies are needed to elucidate these findings.     

Is waist circumference a useful measure in predicting health outcomes in the elderly?

OBJECTIVE: To examine the effect of age on the relationship between body mass index (BMI) and waist circumference (WC), and the usefulness of BMI, WC and waist-hip ratio (WHR) in predicting mortality and cardiovascular risk in the elderly population. DESIGN: Longitudinal observational study of 36 months duration. SUBJECTS AND METHOD: A stratified random sample of 2,032 Chinese subjects (990 male, 1,033 female) mean age (s.d.) 80.1 (7.5), interviewed and examined at baseline and after 36 months. Deaths and presence of diabetes mellitus and hypertension were documented. A younger data set of 1,010 subjects (500 male, 510 female), mean age (s.d.) 45.5 (11.6), was used for comparison of the BMI-WC relationship between younger and older subjects. In predicting outcomes using different values of BMI, WC and WHR, receiver operating characteristic curve analysis was used to derive cut-off values with optimal sensitivity and specificity, and the likelihood ratios for mortality, diabetes and hypertension for different anthropometric values were plotted. RESULTS: The waist circumference values corresponding to BMI values of 25 and 30 kg/m(2) were higher in elderly (92 and 103 cm for men; 88 and 99 cm for women) compared with younger subjects (85 and 97 cm for men; 78 and 88 cm for women). BMI and WC are inversely associated with mortality, in both men and women, positively associated with diabetes in men but not in women. WC was positively associated with hypertension in men and women. WHR was not associated with any outcome measures. The anthropometric measurement at the point of intersection of the likelihood curves for mortality and diabetes may be considered the optimum value, being BMI=21 kg/m(2) for men and 25 kg/m(2) for women, WC between 80 and 85 cm, and WHR 0.88-0.90. CONCLUSION: Waist measurement values for predicting health outcomes in elderly people aged 70 y and over are different compared with younger subjects, and have similar predictive accuracy compared with body mass index. Waist-hip ratio is not a useful predictor.     

Distribution and determinants of adiponectin, resistin and ghrelin in a randomly selected healthy population

OBJECTIVE: Adiponectin, resistin, ghrelin and the IGF-I system seem to play an important role in the regulation of body composition throughout life, but the mechanisms are not well understood. The aim of our study was to analyse the distribution among sexes and all decades of the adult life of adiponectin, resistin and ghrelin and their relationship with anthropometric, body composition parameters and the IGF-I system. SUBJECTS: One hundred and thirty-four men and 127 healthy women were included in the study. MEASUREMENTS: Plasma concentration of adiponectin, resistin, ghrelin, total IGF-I, free IGF-I and IGFBP-3 were determined in all subjects. Body composition was evaluated by bioelectrical impedance. RESULTS: Resistin and ghrelin were not affected by age. Plasma adiponectin correlated negatively with age, body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), fat mass (FM) and body fat (BF) in men. Adiponectin correlated negatively with WHR and positively with free IGF-I in women. Resistin correlated positively with BMI and WC only in men, and ghrelin correlated positively with WC, BMI and FM and negatively with free IGF-I in men. In multiple regression analysis adiponectin remained associated with WHR (beta=-0.19, P=0.01) in women. Resistin was positively associated with BMI (beta=0.30, P=0.003) in women and ghrelin was negatively related to free IGF-I (beta=-0.158, P=0.019) in men. CONCLUSIONS: Plasma adiponectin declines with age and is negatively associated with FM in men. Our data suggest the existence of a positive correlation of adiponectin and the IGF-I axis in women and of an inverse relationship between ghrelin and the IGF-I system in men.     

Cellular adhesion molecules and their relationship with measures of obesity and metabolic syndrome in a multiethnic population

BACKGROUND: The relationships between adhesion molecules and measures of obesity and metabolic syndrome in different ethnic populations are unclear. OBJECTIVE: Our aim was to study the association between body mass index (BMI), waist-hip ratio (WHR) and the parameters of the metabolic syndrome with four different adhesion molecules, adjusting for potential confounders, in men and women from different ethnic origins. METHODS: Soluble plasma adhesion molecules (sP-selectin, sE-selectin, intracellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were measured in 261 white (120 women), 188 African origin (99 women) and 215 South Asian (99 women) individuals living in South London. All were free from coronary heart disease (CHD), stroke and other cardiovascular disease (CVD), diabetes, drug therapy for hypertension or high lipids, hormone replacement therapy or oral contraceptive pill. RESULTS: sE-selectin levels were positively and significantly associated with both BMI (P < 0.001) and WHR (P < 0.001). There were no major interactions with either sex or ethnicity. The strength of the association between sE-selectin and WHR was not affected by multiple adjustment for age, sex, ethnicity smoking, blood pressure, serum lipids and insulin (P < 0.001), whereas the association with BMI was attenuated by multiple adjustments (P = 0.037). An approximate 2% higher sE-selectin levels would be associated with a 1 unit higher BMI and a 0.01 unit greater WHR. CONCLUSIONS: The relationships between adhesion molecules and conventional measures of obesity are adhesion molecule specific and are strongest between sE-selectin and WHR.     

Obesity, independent of insulin resistance, is a major determinant of blood pressure in normoglycemic Hong Kong Chinese

Obesity and insulin resistance are considered important links underlying the development of hypertension. In Caucasians, there have been many reports of an association between insulin resistance and hypertension. However, this relationship is not consistently found in other ethnic groups. In this study, we examined the involvement of insulin resistance (assessed as fasting insulin-glucose product, FIGP) and general and central obesity as potential links in the development of hypertension in 413 normoglycemic Hong Kong Chinese (56.9% hypertensive) subjects. Anthropometric parameters (waist circumference [WC], waist-to-hip ratio [WHR], body mass index [BMI]), surrogate measures of insulin resistance (fasting plasma glucose, insulin, FIGP), fasting lipids and systolic (SBP) and diastolic (DBP) blood pressure were measured. Both male and female hypertensives were more obese and dyslipidemic, and the females had higher indices of insulin resistance than the normotensive subjects of the same gender. Before adjustment for age, gender, and adiposity, FIGP correlated with SBP in the total (r = .19, P = .009) and low BMI (r = .23, P < .05) and low WHR (r = .25, P < .01) groups. However, after adjustment, there was no significant relationship between FIGP and blood pressure. In contrast, BMI and WC were strongly associated with blood pressure (r > or = .41, P < .001 for both DBP and SBP in the total population), although in the group with general obesity, the strength of the relationship was weaker (r > or = .13). These relationships persisted after adjustment for age, gender, and FIGP. Obesity, therefore, appears to have a predominant role compared with insulin resistance in determining blood pressure in these normoglycemic Chinese.     

Comparison of body mass index with waist circumference, waist-to-hip ratio, and waist-to-stature ratio as a predictor of hypertension incidence in Mauritius

OBJECTIVE: Comparison of BMI with waist circumference, waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) as a predictor of hypertension incidence. METHODS: A total of 1658 men and 1976 women of Mauritian Indian and Mauritian Creole ethnicity, aged 25-74 years, free of hypertension, diabetes, cardiovascular disease, and gout at baseline in 1987 or 1992, were re-examined in 1992 and/or 1998 using the same survey methodology. Hazard ratios (HRs) for hypertension incidence were estimated applying an interval censored survival analysis (R program) using age as timescale based on baseline obesity indicators. RESULTS: A total of 787 incident hypertension cases were identified during the follow-up. HRs for hypertension incidence adjusting for baseline systolic blood pressure and cohort corresponding to a 1 SD increase in BMI, waist circumference, WHR, and WSR were 1.20 (1.24), 1.19 (1.21), 1.14 (1.10), and 1.20 (1.26) in Mauritian Indian men (women) and 1.23 (1.32), 1.34 (1.23), 1.41 (1.13), and 1.43 (1.33) in Mauritian Creoles, respectively, indicating that all obesity indicators significantly predicted hypertension incidence except for WHR in Mauritian Creole women. Paired homogeneity tests showed that there was no difference between BMI and the other three indicators for most of the comparisons with two exceptions: WSR was stronger than BMI (P = 0.002) in Mauritian Creole men but BMI was stronger than WHR (P = 0.047) in Mauritian Indian women in predicting the incident cases of hypertension. CONCLUSION: The relation of the development of hypertension with BMI was as strong as that with central obesity indicators in the population studied.     

Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease.

OBJECTIVE: To investigate the distribution of waist circumference (WC) and waist-to-hip ratio (WHR), their relationships with a number of established risk factors and their relevance to cardiovascular morbidity in a random sample of Turkish general adult population. DESIGN: Cross-sectional population-based study. Subjects: The subjects comprised 958 men and 1014 women, aged 25-74 years. MEASUREMENTS: Waist circumference was measured midway between the lower rib and iliac crest while that of the hip at the level of trochanters. Mean of two blood pressure measurements was used for analysis. Plasma total cholesterol (Cho) and triglyceride (Trg) concentrations were measured by the enzymatic dry method with a Reflotron apparatus. RESULTS: Overall mean WC measured 93+/-12 cm in men, and 88.6+/-13 cm in women. Mean WHR was 0.919+/-0.077 and 0.823+/-0.074, respectively, and a rise by about 0.001 was associated with each year of age. In multiple regression analysis a model was utilized that included age, body mass index (BMI), systolic and diastolic blood pressure (BP), plasma total Cho and Trg and category of smoking. This revealed age, BMI, and Trg as independent determinants of WHR in both genders, and diastolic BP in women alone. Age, BMI, and diastolic BP proved to be independently associated with WC in both genders, while Cho did so in men alone, Trg and systolic BP in women alone. Partial correlation coefficients on univariate analysis between all four variables of blood pressure and plasma lipids and either WC or WHR, controlled for age, were highly significant though moderately weak in both genders. These were stronger in men than in women, and stronger with respect to WC than to WHR. Cigarette smoking men and women had significantly lower WC or WHR than nonsmokers and ex-smokers, though these associations did not prove to be independent. When the relevance of WC and WHR to CHD risk was tested in this cohort (for the age bracket 45-74 years) comprising 138 cases with a clinical diagnosis of CHD, only WHR in women proved to be significantly associated. Odds ratio for a value of >0.845 was 1.6. CONCLUSION: WC and WHR are strongly associated with BMI and age as well as with parameters reflecting insulin resistance such as diastolic blood pressure and plasma triglycerides. WHR was significantly associated with coronary heart disease in Turkish women.     

Nutrient intakes as predictors of body weight in European people with type 1 diabetes.

BACKGROUND: Overweight and obesity are also found among persons with type 1 diabetes. OBJECTIVE: The present study examined which nutrients predict the body mass index (BMI), the waist-to-hip ratio (WHR) and the waist circumference (WC) of European persons with type 1 diabetes. DESIGN: Cross-sectional, clinic-based study (EURODIAB Complications Study). SUBJECTS AND METHODS: Nutrient intakes (assessed by a 3-day dietary record) predicting measures of body weight (BMI, WHR and WC) were determined by stepwise forward regression analysis in 1458 males and 1410 females with type 1 diabetes (P< or =0.05 for inclusion). RESULTS: In men, a higher carbohydrate intake was a significant independent predictor for lower levels of BMI, WHR and WC, an increased saturated fat intake and a lower intake of cereal fibre predicted a higher WHR, a higher monounsaturated fat intake and a lower glycaemic index of the diet determined lower levels of WHR and WC, and a moderate consumption of alcohol determined an increased WC. In women, a higher carbohydrate intake predicted a lower BMI and a thinner WC, no alcohol consumption determined a lower BMI, and an increased intake of saturated fat and a lower consumption of cereal fibre were significant independent predictors for a higher WHR. CONCLUSIONS: A modified fat intake, an increase of carbohydrate and cereal fibre intake and a preferred consumption of low glycaemic index foods are independently related to lower measures of body weight in European persons with type 1 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.     

Association between indices of obesity and fasting hyperglycemia in Taiwan

OBJECTIVE: To examine the association of body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC) with fasting hyperglycemia after adjustment for age, cigarette smoking, and alcohol use. DESIGN: A cross-sectional survey was conducted among individuals visiting four health-screening centers across Taiwan. SUBJECTS: A total of 61 568 subjects (28 734 men and 32 834 women) between 25 and 64 years of age were included. Fasting hyperglycemia was defined as fasting plasma glucose > or =6.1 mmol/l or current diagnosis and use of insulin or hypoglycemic agent. RESULTS: Fasting hyperglycemia was found in 11.0% of men and 8.3% of women. The factors significantly associated with fasting hyperglycemia in men were age, BMI, WHR, and heavy drinking, while for women these factors were age, educational level, BMI, WHR, and heavy smoking. For men, increased risk of fasting hyperglycemia started from age 30 to 34 years, BMI > or =25 kg/m2, and WHR > or =0.82. For women, increased risk of fasting hyperglycemia started from age 35 to 39 years, BMI > or =24 kg/m2, and WHR > or =0.74. WC lost its significance as a predictor of fasting hyperglycemia when WHR included in the model. CONCLUSION: This study found that central obesity and general obesity were both independently associated with increased risk of fasting hyperglycemia in Taiwanese. The relationship between fasting hyperglycemia and central fat accumulation (WHR) begins to appear at levels that would not be regarded as representing obesity in Western populations, suggesting the need to redefine cutoffs for central obesity in this population.     

Generalized abdominal visceral fat prediction models for black and white adults aged 17-65 y: the HERITAGE Family Study

OBJECTIVE: To determine if the relationship between abdominal visceral fat (AVF) and measures of adiposity are different between Black and White subjects and to develop valid field prediction models that accurately identify those individuals with AVF levels associated with high risk for chronic disease. DESIGN: Cross-sectional measurements obtained from 91 Black men, 137 Black women, 227 White men, and 237 White women subjects, ages 17-65 y, who were participants in the HERITAGE Family Study, both at baseline and following 20 weeks of endurance training. MEASUREMENTS: AVF, abdominal subcutaneous fat (ASF), abdominal total fat (ATF), and sagittal diameter (SagD) were measured by computed tomography (CT). Body density was determined by hydrostatic weighing and was used to estimate relative body fat. Arm, waist (WC), and hip circumferences and skinfold thickness measures were taken, and BMI was calculated from weight (kg) and height (m(2)). Since CT abdominal fat variables were skewed, a natural log transformation (Ln) was used to produce a normal distribution. The General Linear Model (GLM) procedure was used to test the relationship between AVF and two different groups of variables-CT and anthropometric. RESULTS: The AVF of White men and women was significantly higher than that of Black men and women, independent of BMI, WHR, WC, and age, and was greater for men than for women. The CT model showed that the combination of SagD, Ln (ASF), age, and race accounted for 84 and 75% of the variance in AVF in men and women, respectively. The anthropometric model provided two valid generalized field AVF prediction equations. The Field-I equation, which included BMI, WHR, age and race, had an r(2) of 0.78 and 0.73 for men and women, respectively. The Field-II equation, which included BMI (women only), WC, age, and race, had an r(2) of 0.78 and 0.72 for men and women, respectively. The field model equations became less accurate as the estimated AVF increased. CONCLUSIONS: (1) At the same age and level of adiposity, Black men and women have less AVF than White men and women. These differences are greater in men than in women. (2) The field regression equations can be generalized to the diverse group of adults studied, both in an untrained and trained state. However, their accuracy decreases with increasing levels of AVF.     

A comparison of body mass index and waist-to-hip ratio as indicators of hypertension risk in an urban Argentine population: a hospital-based study

BACKGROUND AND AIM: To examine the relationship between 24-h ambulatory blood pressure monitoring (ABPM) and three commonest anthropometric measurements for obesity [body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR)] in patients with essential hypertension never treated or after a 3 week placebo period, living in Buenos Aires. METHODS AND RESULTS: Cross-sectional survey among outpatients at the Hypertension Program of Buenos Aires University Hospital de Clinicas. Three-hundred seventy-seven essential hypertensives, aged 18-86 years, of either sex, were consecutively recruited. All subjects underwent 24 h ABPM performed with a blood pressure (BP) device. The prevalence of overweight-obesity was 56.76% in women and 75.86% in men. High WHR prevalence in non-obese women was 4.5% and 4.1% in non-obese men while high values of WC were observed in 3.0% of non-obese women and in 0% of non-obese men. The two-way ANCOVA showed that in women with high values of WHR, 24 h DBP was higher in those with BMI<25 than in those with BMI> or =25. Those females with a BMI> or =25 had a higher prevalence of top tertile values of PP (> or =68 mmHg) (P<0.05) than non-obese females. Only in women was mean pulse pressure (PP) significantly correlated with age (r=0.38; P<0.0001), WC (r=0.22; P<0.005), WHR (r=0.21, P<0.008), and BMI (r=0.20; P<0.01) while in men there was no significant correlation between variables. Logistic regression showed that the odds of morning blood pressure surge (MBPS) increased with age, central obesity (represented by high WHR and dipper status), while the odds of higher mean PP increased with age and high WHR. CONCLUSION: These results indicated a high prevalence of overweight-obesity (more than 56% of women and 75% of men) in our hospital-based sample of essential hypertension and that the WHR offers additional information beyond BMI and WC to predict the hypertension risk according to the ABPM.     

Cross-sectional associations of C-reactive protein with vascular risk factors and vascular complications in the DCCT/EDIC cohort

OBJECTIVE: To determine the relationships between C-reactive protein (CRP) levels and features of Type 1 diabetes. RESEARCH DESIGN AND METHODS: Serum CRP was measured by nephelometry in a cross-sectional study of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort (n=983) and nondiabetic subjects (n=71). RESULTS: CRP levels [geometric mean (95% CI)] were higher in diabetic than in control subjects, 1.6 (1.5-1.7) vs. 1.2 (1.1-1.5) mg/l, P=.019. CRP was higher in diabetic women (n=438) than in men (n=545) [2.0 (1.8-2.3) vs. 1.3 (1.2-1.5), P<.001]. Diabetic subjects formerly in the DCCT intensive treatment group had higher CRP levels than those who were randomized to the conventional treatment group [1.8 (1.6-1.9), n=479 vs. 1.5 (1.3-1.6), n=456, P=.010], attributable to greater BMI in the prior intensive group. In diabetes, CRP correlated with HbA(1c) (r=0.13, P<.0001) and with insulin resistance traits: BMI (r=0.34, P<.0001), waist-to-hip ratio (WHR; males: r=0.35, P<.0001; females: r=0.22, P<.0001), diastolic blood pressure (r=0.07, P=.025), triglycerides (r=0.19, P<.0001), apoB (r=0.22, P<.0001), LDL particle concentration (r=0.26, P<.0001), and LDL particle size (r=-0.22, P<.0001). CRP was not associated with complications. Significant independent predictors of CRP in diabetes were gender, BMI, WHR, concurrent HbA(1c), and oral contraceptive pill use. CONCLUSIONS: CRP was elevated relative to nondiabetic subjects, and in diabetes was higher in females. Elevated CRP in Type 1 diabetes was associated with poor glycemic control, larger body habitus, and other factors that comprise the insulin resistance syndrome. Nevertheless, CRP levels were not associated with complications. Longitudinal studies are warranted.