Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls

OBJECTIVES: (a). to explore the relationship between waist circumference and certain cardiovascular risk factors in a group of girls; and (b). to assess the clinical relevance of waist circumference in identifying girls with higher cardiovascular risk across puberty. SUBJECTS AND METHODS: One-hundred and fifty-five overweight or obese girls aged 5-16 y were recruited. Overweight and obesity were defined on the basis of BMI, according to Cole. RESULTS:: Waist circumference was significantly correlated with plasma insulin (r=0.43; P<0.001), systolic blood pressure (r=0.22; P=0.007) and IR(HOMA) (r=0.40; P<0.001). A multivariate linear correlation analysis showed that, when adjusted for age and Tanner stage, waist circumference was significantly associated with plasma insulin (r(2)=0.23; P<0.01), IR(HOMA) (r(2)=0.17; P<0.02), systolic and diastolic blood pressure (r(2)=0.20; P=0.006 and r(2)=0.32; P<0.001, respectively). A logistic regression analysis, using IR(HOMA) as the dependent variable, showed that waist circumference was a significant independent risk factor of insulin resistance (IR(HOMA)>or=2.6) in this group of girls (OR 1.10; 95% CI 1.03-1.18; P=0.003), independently of their age and Tanner stage. CONCLUSIONS: Waist circumference of these girls was independently associated with certain cardiovascular risk factors, in particular insulin resistance and diastolic blood pressure, independently of age and Tanner stage. Thus suggesting that waist circumference may be reasonably included in clinical practice as a simple tool that may help to identify sub-groups of obese girls at higher metabolic risk across puberty.     

中国7～18岁学龄儿童青少年腰围界值点研究

目的 根据儿童不同腰围水平罹患心血管疾病的危险,研究中同学龄儿童青少年腰围的适宜界值点.方法 利用受试者工作特征曲线(ROC)法分析从全国汇总的65 898名7～18岁学龄儿童青少年腰围及其相关代谢指征数据,探索预测心血管疾病的腰围最佳界值点.结果 儿童青少年腰围值小于第75百分位数(P75)时,收缩压、舒张压、血糖、总胆固醇、甘油三酯和低密度脂蛋白胆固醇水平以及血压升高率、血糖升高率、血脂异常率随腰围变化趋势不明显,当腰围大于P75后,上述指标逐渐增加,从P90开始,增加趋势明显,高密度脂蛋白胆固醇的变化趋势相反.ROC曲线结果表明,预测血压增加的腰围最佳界值点为P75;预测至少两项心血管疾病危险因素聚集的最佳界值点为P90.与腰围低于P75,的儿童青少年相比,在腰围处于P75～P90者中至少聚集两项心血管疾病危险因素的比例增加了1倍,腰围大于P90者中该比例则增加了5倍.按体重指数分类标准分层后,儿童青少年血压升高率仍然随腰围增加而显著增加.结论 建议将中国儿童青少年腰围的年龄别性别P7,和P90作为儿童青少年心血管病危险开始增加和明显增加的界值点.     

Waist circumference cut-off values for the prediction of cardiovascular risk factors clustering in Chinese school-aged children: a cross-sectional study

Background  

Waist circumference has been identified as a valuable predictor of cardiovascular risk in children. The development of waist circumference percentiles and cut-offs for various ethnic groups are necessary because of differences in body composition. The purpose of this study was to develop waist circumference percentiles for Chinese children and to explore optimal waist circumference cut-off values for predicting cardiovascular risk factors clustering in this population.     

Waist circumference home measurement--a device to find out patients in cardiovascular risk

Background: New strategies are needed to prevent the globalepidemic of diabetes and subsequent rise in cardiovascular diseases.We describe a community-based, two-stage screening strategyusing home waist circumference measurement and a risk factorquestionnaire as a primary screening tool. Methods: We maileda tape for measurement of waist and a risk factor questionnaireto every inhabitant aged 45–70 years living in the ruraltown of Harjavalta in Finland. Thereafter we performed an oralglucose tolerance test, anthropometric variables and blood pressureof subjects having at least one risk factor for type 2 diabetesor cardiovascular disease. People with previously known diabetesor vascular disease were excluded. Results: Seventy-three percent(2085/2856) of the invited inhabitants participated, and 84%of the respondents had at least one pre-specified risk factor.Waist circumference 80 cm in women and 94 cm in men (n = 1168),positive metabolic syndrome criteria of the International DiabetesFederation (n = 681) or the Finnish Diabetes Risk Score questionnaire12 points (n = 697) identified 95, 92 and 63% of the new casesof type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively.Conclusion: The International Diabetes Federation criteria forelevated waist circumference are very sensitive but lack specificityin diagnosing glucose disorders. The criteria for metabolicsyndrome and the Finnish Diabetes Risk Score questionnaire aremore efficient tools for the selection of patients for furtherrisk stratification in general practise.     

北京与全国7～18岁儿童青少年腰围适宜界值对心血管危险因素筛查效度的对比分析

目的 比较北京与全国7～18岁儿童青少年腰围(WC)适宜界值对心血管危险因素的筛查效度和预测价值.方法 采用LMS曲线拟合法拟合北京市21 787名3～18岁儿童青少年WC百分位曲线,以性别、年龄别第75百分位数(P75)及第90百分位数(P90)作为北京市7～18岁儿童青少年WC适宜界值.在4927名7～18岁儿童青少年组成的验证人群中,比较北京和全国7～18岁儿童青少年WC适宜界值对高血压、脂代谢紊乱、糖耐量受损及非酒精性脂肪肝(NAFLD)等心血管危险因素诊断的特异度和灵敏度,通过回归分析比较该2个界值对心血管危险因素的预测价值.结果 北京市3～18岁儿童青少年WC适宜界值分别为:男童:P75为51.8～78.2 cm,P90为54.0～86.0 cm;女童:P75为50.8～72.1 cm,P90为53.3～77.3 cm.北京与全国界值筛查心血管危险因素的灵敏度分别为:高血压:男童分别为0.74和0.82,女童分别为0.68和0.73;低高密度脂蛋白胆固醇:男童分别为0.69和0.80,女童分别为0.64和0.71;NAFLD:男童分别为0.98和1.00,女童均为0.93.北京与全国界值筛查心血管危险因素的特异度分别为:高血压:男童分别为0.62和0.53,女童分别为0.68和0.63;低高密度脂蛋白胆固醇:男童分别为0.59和0.50,女童分别为0.66和0.61;NAFLD:男童分别为0.60和0.50,女童分别为0.56和0.51.北京和全国7～18岁儿童青少年WC的P90适宜界值预测心血管危险因素的OR(95%CI)值分别为:高血压分别为6.3(5.2～7.7)和6.0(4.9～7.4);空腹血糖受损均为1.3(1.1～1.5);脂代谢紊乱均为2.9(2.5～3.4);NAFLD分别为49.1(12.0～201.6)和69.8(9.7～504.2).结论 北京市7～18岁儿童青少年WC适宜界值可提高对心血管危险因素筛查的特异度;除对NAFLD预测价值低于全国界值外,北京界值对其他心血管危险因素的预测价值与全国界值没有明显差别.

Abstract：

Objective To compare the optimal references of waist circumference (WC) between Beijing and China in detecting cardiovascular risk factors in school-age children.Methods Percentile curves for WC were drawn by sex using LMS method based on 21 787 children and adolescents aged 7-18 from Beijing Child and Adolescent Metabolic Syndrome Study. The 75th and the 90th percentiles by age and by gender of WC percentile curves were chosen as the optimal WC reference for 3-18 years old children and adolescents in Beijing. The sensitivities(Se) and specificities(Sp) were compared between Beijing and China WC references based on the evaluation of cardiovascular risk factors including hypertension, dyslipidmia, impaired fasting glucose and non-alcoholic fatty liver disease (NAFLD) in the test population being composed of 4927 school children aged 7-18 years. The predictive values for those cardiovascular risk factors were compared between the two optimal thresholds through comparison of the odds ratio(OR) in regression analysis.Results The optimal reference for Beijing children and adolescents aged 3-18 years ranged from 51.8 to 78.2 cm for the 75th percentile in boys and 50.8 to 72.1 cm in girls, and the 90th percentile increased from 54.0 to 86.0 cm in boys and 53.3 to 77.3 cm in girls. The Ses of Beijing and China WC references in detecting hypertension were 0.74 and 0.82 in boys and 0.68 and 0.73 in girls; the Ses were 0.69 and 0.80 in detecting low-high density lipoprotein in boys and 0.64 and 0.71 in girls; and they were 0.98 and 1.00 in boys and both were 0.93 in girls for NAFLD. The Sps of Beijing and China WC references in screening hypertension were 0.62 and 0.53 in boys and 0.68 and 0.63 in girls, respectively. In predicting low-high density lipoprotein, the Sps were 0.59 and 0.50 in boys and 0.66 and 0.61 in girls, the Sps were 0.60 and 0.50 in boys and 0.56 and 0.51 in girls for predicting NAFLD. After adjustment for age and gender,ORs and their 95% credibility intervals(CI) of the 90th WC percentiles of Beijing and China school children were 6.3 (5.2-7.7) and 6.0 (4.9-7.4) in predicting hypertension. Both predictive ORs and their 95%CIs were 1.3 (1.1-1.5) in predicting impaired fasting glucose and the both were 2.9 (2.5-3.4) for dyslipdmia. In predicting NAFLD the ORs and their 95%CIs were 49.1(12.0-201.6) and 69.8 (9.7-504.2) for Beijing and China WC optimal references, separately.Conclusion Compared with Chinese WC reference, WC reference of Beijing had high Sps in screening cardiovascular risk factors in 7-18 years old children. The predictive values were not significant different between Beijing and China WC references for almost all cardiovascular risk factors except NAFLD. The WC reference in Beijing was more practical and handy for reference in Beijing and other north developed metropolises.     

Relationship of neck circumference to cardiovascular risk factors

OBJECTIVE: To determine a relationship between neck circumference (NC) and risk factors for coronary heart disease by evaluating the components of the metabolic syndrome. RESEARCH METHODS AND PROCEDURES: The study group included 561 subjects (231 men and 330 women) who had no known major medical conditions and were not receiving any medication therapy. The subjects were those who attended a family health clinic for any reason between 1998 and December 2001. Main indicators studied included NC, waist circumference, waist-to-hip ratio, body mass index, blood pressure, and lipoprotein, glucose, and uric acid levels. RESULTS: Pearson's correlation coefficients indicated a significant association between NC and body mass index (men, r = 0.71; women, r = 0.81; each, p < 0.0001), waist circumference (men, r = 0.75; women, r = 0.79; each, p < 0.0001), waist-to-hip ratio (men, r = 0.56; women, r = 0.63; each, p < 0.0001), total cholesterol (men, r = 0.50; women, r = 0.66; each, p < 0.0001), low-density lipoprotein-cholesterol (men, r = 0.42; women, r = 0.60; each, p < 0.0001), triglycerides (men, r = 0.48; women, r = 0.49; each, p < 0.0001), glucose (men, r = 0.21, p < 0.001; women, r = 0.44; p < 0.0001), uric acid (men, r = 0.50, p < 0.0001; women, r = 0.60, p < 0.001), and systolic (men, r = 0.53; women, r = 0.69; each, p < 0.0001), and diastolic (men, r = 0.55; women, r = 0.65; each, p < 0.0001) blood pressure. DISCUSSION: Higher NC is correlated positively with the factors of the metabolic syndrome; therefore, it is likely to increase the risk of coronary heart disease.     

上海市儿童青少年腰围百分位数值及曲线

目的 建立适合上海市儿童青少年生长发育特点的年龄别腰围、腰围指数的百分位数及曲线,为科学评价儿童青少年生长发育水平及中心性肥胖的防治提供参考.方法 以2010年上海市学生体质健康调研的7 ～18岁中小学生14 301名为样本,应用国际通用的LMS法分性别建立年龄别腰围、腰围指数正常值及百分位数曲线.结果 腰围百分位数曲线随年龄增长呈递增趋势,符合儿童青少年生长发育规律;腰围指数的P50百分位数曲线具有明显性别差异,7 ～12岁男生逐年上升,且高于女生,自13岁开始经交叉后低于女生.获得上海市7 ～18岁儿童青少年男女年龄别腰围、腰围指数百分位数(P5,P10,P15,P50,P85,P95,P95)及曲线.结论 儿童青少年年龄别腰围、腰围指数百分位数存在地区、性别差异.本研究所获得的百分位数及曲线可为进一步研究儿童青少年中心性肥胖提供基本数据.     

Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease

ABSTRACT: BACKGROUND: Abdominal obesity is a more important risk factor than generalised obesity for the development of type 2 diabetes and cardiovascular disease. For preventive and public health purposes it is vital that risk factors are detected as early as possible, in order to affect the lifestyle choices at an individual level. METHODS: We used the data from a community based study assessing the risk for type 2 diabetes and cardiovascular disease and the prevalence of the metabolic syndrome among middle-aged men in Helsinki. From the data we performed sensitivity and specificity analysis including positive and negative predictive values, and corresponding 95% CI for eleven different cut-off points with 1 cm intervals (92 to 102 cm) of waist circumference to identify those with increased risk for type 2 diabetes and/or cardiovascular disease. RESULTS: Waist circumference => 94 cm in middle-aged men, identified subjects with increased risk for type 2 diabetes and/or for cardiovascular disease with a sensitivity of 84.4% (95% CI 76.4% to 90.0%), and specificity of 78.2% (95% CI 68.4% to 85.5%). The respective positive predictive value is 82.9% (95% CI 74.8% to 88.8%), and negative predictive value 80.0% (95% CI 70.3% to 87.1%). CONCLUSIONS: Measurement of waist circumference in middle-aged men is a reliable test to identify individuals at increased risk for type 2 diabetes and cardiovascular disease. This measurement should be used more in daily practice in primary health care to identify individuals at risk and when planning health counselling and interventions.     

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.     

中国学龄儿童青少年腰围的地区分布和人群特征

目的 分析中国儿童青少年代表性人群的腰围分布,为建立标准腰围界值点提供依据.方法 收集内地15省(区、市)和香港地区7～18岁人群横断面调查资料,样本对象共178 865人,划分沿海城市、其他城市、北方乡村、南方乡村和香港地区5个群体,分析各人群腰围分布状况.结果 5个群体人群体格发育水平的差异有统计学意义."沿海城市"群体在7～18岁时腰围第85百分位数(P85)始终高于其他群体.相反,"南方乡村"群体腰围P85不仅低于城市且低于"北方乡村"群体."香港地区"群体在学龄初期腰围水平高,但进入青春期后增长缓慢,腰围P85最终落后于"北方乡村"群体.南、北方乡村群体自青春期开始腰围水平表现为追赶趋势.该差异不仅源自地区社会经济发展水平和城乡差异,也源于南、北方地区差异,预示在使用腰围进行筛查时,超重、肥胖检出率在上述群体中将呈梯层分布趋势.相关分析显示腰围与身高、体重、BMI等体格指标间高度相关.将中国人群腰围分布与美国、荷兰比较,提示有必要建立适合本国人群的腰围筛查界值点,应用LMS法为中国儿童建立性别年龄别腰围百分位数曲线.结论 研究结果将为建立中国儿童人群腰围筛查界值点提供依据.     

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.     

Race-ethnicity-specific waist circumference cutoffs for identifying cardiovascular disease risk factors

BACKGROUND: Waist circumferences (WCs) in white men and women that represent a risk of cardiovascular disease (CVD) equivalent to that of body mass indexes (BMIs; in kg/m2) of 25 and 30 have been identified. However, WC cutoffs for other race-ethnicity groups remain unknown. OBJECTIVE: The objective was to determine WC cutoffs for CVD risk in non-Hispanic blacks (blacks), Mexican Americans (MA), and non-Hispanic whites (whites). DESIGN: Data from 10,969 participants in the third National Health and Nutrition Examination Survey (1988-1994) were analyzed. The presence of CVD risk factors was the main outcome. Sex- and race-ethnicity-specific WC cutoffs were determined with logistic regression models by linking WC cutoffs with equivalent CVD risk based on BMI cutoffs for overweight and obesity. WC cutoffs for metabolic syndrome risk factors were similarly calculated. RESULTS: Correlations between WC and lipid profiles, blood pressure, and glucose were significantly higher than those between BMI and these same variables in all groups. The WC cutoffs were approximately 5-6 cm greater for white than for black men at BMIs between 25 and 40, and those for MA were intermediate. In women, few differences in WC cutoffs were observed between the groups. Simplified WC cutoffs corresponding to BMIs of 25 and 30, largely independent of age, for the 3 race-ethnicity groups were 89 and 101 cm for men and 83 and 94 cm for women. Minimal distances in receiver operating characteristic curves tended to be shorter when WC cutoffs rather than BMI cutoffs were used. CONCLUSIONS: WC is a better indicator of CVD risk than is BMI in the 3 race-ethnicity groups studied. The proposed WC cutoffs are more sensitive than are BMI cutoffs in predicting CVD risk.     

Waist circumference and waist-to-height ratio of Hong Kong Chinese children

Background  

Central body fat is a better predictor than overall body fat for cardiovascular (CV) risk factors in both adults and children. Waist circumference (WC) has been used as a proxy measure of central body fat. Children at high CV risk may be identified by WC measurements. Waist-to-height ratio (WHTR) has been proposed as an alternative, conveniently age-independent measure of CV risk although WHTR percentiles have not been reported. We aim to provide age- and sex-specific reference values for WC and WHTR in Hong Kong Chinese children.     

Waist circumference and not body mass index explains obesity-related health risk

BACKGROUND: The addition of waist circumference (WC) to body mass index (BMI; in kg/m(2)) predicts a greater variance in health risk than does BMI alone; however, whether the reverse is true is not known. OBJECTIVE: We evaluated whether BMI adds to the predictive power of WC in assessing obesity-related comorbidity. DESIGN: Subjects were 14 924 adult participants in the third National Health and Nutrition Examination Survey, grouped into categories of BMI and WC in accordance with the National Institutes of Health cutoffs. Odds ratios for hypertension, dyslipidemia, and the metabolic syndrome were compared for overweight and class I obese BMI categories and the normal-weight category before and after adjustment for WC. BMI and WC were also included in the same regression model as continuous variables for prediction of the metabolic disorders. RESULTS: With few exceptions, overweight and obese subjects were more likely to have hypertension, dyslipidemia, and the metabolic syndrome than were normal-weight subjects. After adjustment for WC category (normal or high), the odds of comorbidity, although attenuated, remained higher in overweight and obese subjects than in normal-weight subjects. However, after adjustment for WC as a continuous variable, the likelihood of hypertension, dyslipidemia, and the metabolic syndrome was similar in all groups. When WC and BMI were used as continuous variables in the same regression model, WC alone was a significant predictor of comorbidity. CONCLUSIONS: WC, and not BMI, explains obesity-related health risk. Thus, for a given WC value, overweight and obese persons and normal-weight persons have comparable health risks. However, when WC is dichotomized as normal or high, BMI remains a significant predictor of health risk.     

银川市儿童青少年体脂百分比腰围与心血管病危险因素的关联

分析银川市学龄儿童青少年体脂百分比(fat mass percentage,FMP)和腰围(waist circumference,WC)与心血管病危险因素的关联性,为防治儿童青少年心血管病发生提供依据.方法 采用方便整群抽样的方法,抽取银川市1 043名12~ 18岁学龄儿童青少年,进行问卷调查、体格检查、体成分测定及生化检测.结果 FMP和WC均可预测儿童青少年发生血压偏高、高三酰甘油(TG)血症的风险(P值均<0.01),FMP和WC对心血管代谢异常的预测风险能力分别是心血管代谢正常组的1.14~2.36和1.32~2.09倍.FMP和WC结合对心血管病危险因素变异的解释(4.9%~22.1%)大于FMP或WC单独对其的解释(3.5%~22.0%),FMP对总胆固醇(TC)和低密度脂蛋白(LDL-C)的标准化回归系数(0.25和0.22)大于WC(0.17和0.14),FMP对收缩压(SBP),舒张压(DBP),TG,高密度脂蛋白(HDL-C)的标准化回归系数的绝对值小于WC.FMP肥胖联合WC肥胖组对血压偏高、高TG血症、高TC血症、低HDL-C血症和高LDL-C血症的预测风险分别是2个指标均正常组的3.67(95%CI=2.42~5.56)、3.09(95%CI=2.04~ 4.69)、3.37(95%CI=1.38~8.28)、2.00(95%CI=1.35~2.98)和4.73(95%CI=2.15~10.44)倍(P值均<0.01),高于其他不同组合对心血管病危险因素的风险预测.结论 FMP和WC均可作为预测学龄儿童青少年心血管病危险因素的检测指标.建议将FMP与WC结合起来预测学龄儿童青少年罹患心血管疾病的风险.     

腰围指标是重要的疾病风险预测工具

已有大量肯定的科学证据证实,中心型肥胖与心血管病、糖尿病、高血压等慢性病相关.而与此关联的指标如腰围、腰臀比(WHR)、腰围身高比(WHtR)的研究,探讨了这些指标对于疾病危险的预测力,提出这些指标与体重指数(BMI)同时应用可以增强对疾病的预测力,且腰围、WHtR可能是独立于BMI以外很强的预测指标.     

Waist circumference as a health index and its related factors]

There are many health indexes such as Body Mass Index (BMI), however, very few studies have reported about waist circumference. The purpose of this study was to investigate the relationship between waist circumference and BMI, and relationships with diet and daily life. The subjects were 213 males aged over 35 yr. A self-report questionnaire was used to survey subjects, and waist circumference was measured and a blood sample taken. The subjects with abnormal BMI and blood tests, blood pressure, TG, GPT and gamma-GTP, had waist circumferences were larger than the normal blood test group. Groups of subjects who ate fried-food, were eating out 4 or 5 times per week (p = 0.004), or exercising 2 to 3 times per week had waist circumferences which were larger than the other groups. Multivariate logistic regression analysis revealed that the subjects who had a disease (OR: 2.10, p = 0.046), or an abnormal blood test (OR: 3.54, p = 0.009) had a significantly larger waist circumference. According to these results, waist circumference could be a health index. The people who ate less fried-food or exercised kept normal waist circumferences which protected them from internal obesity.     

BMI,waist circumference,and clustering of cardiovascular risk factors in Japanese adults

Objective  

To examine whether the association between waist circumference (WC) and clustering of cardiovascular risk factors varies with obesity (BMI) status.