Waist circumference,BMI, smoking,and mortality in middle-aged men and women

OBJECTIVE: Measurement of waist circumference alone as a proxy of abdominal fat mass has been suggested as a simple clinical alternative to BMI for detecting adults with possible health risks due to obesity. RESEARCH METHODS AND PROCEDURES: From 1993 to 1997, 27,178 men and 29,875 women, born in Denmark, 50 to 64 years of age, were recruited in the Danish prospective study Diet, Cancer and Health. By the end of the year 2000, 1465 deaths had occurred. We evaluated the relationship between waist circumference and BMI (simultaneously included in the model) and all-cause mortality. We used Cox regression models to estimate the mortality-rate ratios and to consider possible confounding from smoking. RESULTS: Waist circumference among both men and women showed a strong dose-response type of relationship with mortality when adjusted for BMI, whereas the low range of BMI was inversely associated with mortality when adjusted for waist circumference. A 10% larger waist circumference corresponded to a 1.48 (95% confidence interval: 1.36 to 1.61) times higher mortality over the whole range of waist circumference. The associations were independent of age and time since baseline examination. Restriction to never smokers showed a similar pattern, but a weakening of the associations. DISCUSSION: Despite the high correlation between waist circumference and BMI, the combination may be very relevant in clinical practice because waist circumference for given BMI was a strong predictor of all-cause mortality. The inverse association between BMI and mortality for given waist circumference was diminished in never smokers, particularly for high values of BMI.     

Waist circumference measurement in clinical practice

The obesity epidemic is a major public health problem worldwide. Adult obesity is associated with increased morbidity and mortality. Measurement of abdominal obesity is strongly associated with increased cardiometabolic risk, cardiovascular events, and mortality. Although waist circumference is a crude measurement, it correlates with obesity and visceral fat amount, and is a surrogate marker for insulin resistance. A normal waist circumference differs for specific ethnic groups due to different cardiometabolic risk. For example, Asians have increased cardiometabolic risk at lower body mass indexes and with lower waist circumferences than other populations. One criterion for the diagnosis of the metabolic syndrome, according to different study groups, includes measurement of abdominal obesity (waist circumference or waist-to-hip ratio) because visceral adipose tissue is a key component of the syndrome. The waist circumference measurement is a simple tool that should be widely implemented in clinical practice to improve cardiometabolic risk stratification.     

北京市城乡学生腰围臀围腰臀比分析

目的了解2010年北京市7～18岁中小学生腰围臀围和腰臀比的年龄、性别特征,为学生体质健康研究资料提供有益补充。方法对2010年北京市体质调研7～18岁中小学生的腰围、臀围和腰臀比进行描述性分析。结果男生腰围均值、腰臀比高于女生;城区男生臀围均值高于女生,差异有统计学意义(P<0.05或P<0.01),郊区男、女生臀围差异无统计学意义(P>0.05)。腰围均值12岁前有随年龄增长而增加的趋势。学生臀围均值有随着年龄的增长而增加的趋势,差异有统计学意义(P值均<0.05)。城区男生腰围均值高于郊区男生(P<0.05);城区女生腰围均值与郊区女生差异无统计学意义(P>0.05);城区男女生臀围均值大于郊区学生,差异有统计学意义(P<0.05);城郊区男生腰臀比均值差异无统计学意义(P>0.05);郊区女生腰臀比均值高于城区女生,差异有统计学意义(P<0.05)。结论北京城乡7～18岁学生腰围、臀围和腰臀比随年龄变化总趋势一致,但城乡各指标间年龄、性别特征存在差异。     

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 and cardiovascular risk factors in prepubertal children

OBJECTIVE: Intra-abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body-fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body-fat distribution and cardiovascular risk factors are available in children, especially before puberty. RESEARCH METHODS AND PROCEDURES: This cross-sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. RESULTS: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. DISCUSSION: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood-lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.     

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 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 values in Spanish children--gender related differences.

OBJECTIVE: To obtain reference values of the waist circumference in Spanish children, and to investigate their dependence on age and gender. DESIGN: Cross-sectional study. SETTING: General school-age population. SUBJECTS: A representative sample of the schools in Zaragoza, Spain, was drawn from seven schools. The population selected comprised 1728 children with ages ranging from 6.0-14.9y. Of the original sample, 368 children (21.29%) were excluded because of chronic diseases or refusal. Finally, 1360 children and adolescents: 701 boys and 659 girls, were studied. INTERVENTIONS: Waist and hip circumferences were measured with an unelastic tape. RESULTS: Waist circumference tended to be higher in males than in females and this difference was significant after 11.5y. In general, hip circumference was higher in females than in males (statistically significant differences at 7.5, 10.5, 12.5 and 13.5 y). In general, percentile values of waist circumference were higher in males than in females, especially after 12.5 y. Difference between males and females on percentile 95 at 14.5 y was 7.6 cm. Hip was greater than waist in both sexes, and the two curves run nearly parallel in males. In females, while hip enlarges continuously, waist shows the reverse tendency between 11.5 and 14.5 y. CONCLUSIONS: Waist circumference showed higher values in boys than in girls, especially after 11.5 y, and waist values increase with age both in males and females. These findings justify the use of age and gender specific reference standards.     

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.     

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.     

Waist circumference in the prediction of obesity-related adverse pregnancy outcomes

The aim of this study is to evaluate the diagnostic properties of waist circumference in the prediction of obesity-related gestational outcomes. Pregnant women 20 years or older were consecutively enrolled in six Brazilian State capitals from 1991 to 1995. Weight, height, and waist circumference were measured and an oral glucose tolerance test was performed. Patients were followed through childbirth by chart review. Diagnostic performance for the different outcomes, as measured by area under the receiver operating characteristic (ROC) curve, was estimated through logistic regression. Areas under the ROC curve (95%CI) for waist circumference were 0.621(0.589-0.652) for gestational diabetes, 0.640 (0.588-0.692) for preeclampsia, and 0.645(0.617-0.673) for macrosomia. These areas were similar to those for BMI (p > 0.05). A waist circumference of 82 cm jointly maximized sensitivity (63%) and specificity (57%). Cutoff points of 23 kg/m(2) for pre-pregnancy BMI and 26 kg/m(2) for BMI at enrollment produced similar diagnostic properties. In conclusion, waist circumference predicts obesity-related adverse pregnancy outcomes at least as well as BMI.     

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 and the risk of hypertension and prediabetes among Filipino women

Objectives

To examine waist circumference as a risk factor for having hypertension only, impaired fasting glucose only, or both hypertension and impaired fasting glucose, and assess whether the associations vary according to overweight status. Furthermore, optimal cut-offs for waist circumference in overweight women and non-overweight women were explored.

Data and methods

Data from 1,871 women aged 35–68 years in the 2005 Cebu Longitudinal Health and Nutrition Survey were used. Multinomial logistic regressions were used to model how waist circumference influenced the likelihood of having the three illness categories compared to having neither condition. Waist circumference cut-offs were explored using receiver operating characteristic analysis.

Results

Adjusted for age and other confounders, each cm increase in waist circumference increased the odds of hypertension by 5 % for non-overweight women and 3 % for overweight women; impaired fasting glucose by 9 and 3 % for non-overweight and overweight women, respectively; and hypertension and impaired fasting glucose by 17 % among non-overweight versus 9 % for overweight women. Waist circumference cut-offs for non-overweight women were lower than overweight women.

Conclusion

Waist circumference was significantly associated with impaired fasting glucose and both hypertension and impaired fasting glucose, and the associations vary by overweight status.     

Waist circumference predicts insulin resistance in offspring of diabetic patients

The purpose of the study was to identify a good abdominal obesity index for insulin resistance in offspring of diabetic patients. A total of 74 non-diabetic subjects (male =36; female =38) were recruited from a diabetic family study. The waist circumference (W), waist-hip ratio (WHR) and conicity index were used as the abdominal obesity indices. The body mass index (BMI) and indices obtained from bioelectric impedance analysis (BIA) (body fat percentage, fat mass and fat mass index) were used as overall obesity indices. Fasting plasma insulin (FPI), homeostasis model assessment for insulin resistance (HOMA-IR) and Matsuda-Defronzo index from oral glucose tolerance test were chosen as the insulin sensitivity indices. We correlated obesity indices with insulin resistance indices with age and family adjusted. W was closely correlated in both sexes of subjects with Matsuda-DeFronzo index (male, r=-0.661,p<0.001; female, r=-0.419,p=0.026), FPI (male, r=0.614,p=0.001; female, r=0.503,p=0.006) and HOMA-IR (male, r=0.609,p=0.001; female, r=0.472,p=0.011). WHR and its log transformation predicted insulin resistance only in males. BMI as an overall obesity index was in good correlation with Matsuda-DeFronzo index (male, r=-0.646,p<0.001; female, r=-0.469,p=0.012), FPI (male, r=0.711,p<0.001; female, r=0.464,p=0.013) and HOMA-IR (male, r=0.708,p<0.001; female, r=0.469,p=0.012). Overall obesity indices from BIA were similar to BMI to predict insulin resistance. In conclusion, W is a good abdominal obesity predictor of insulin resistance in offspring of diabetic patients in Taiwan.     

北京市中小学生腰围臀围腰臀比及其与相关指标关系

目的了解北京市7～18岁中小学生腰围、臀围和腰臀比水平及与年龄、性别、体型特征的关系,为儿童肥胖的早期防治提供科学依据。方法对北京市7～18岁中小学生的腰围、臀围和腰臀比进行描述性分析,研究其分布特征及与年龄、性别、体型特征的相关性。结果中小学生腰围、臀围水平随年龄的增长而增加,12岁以前增幅迅速。腰臀比有随年龄增长而下降趋势。各年龄组男生腰围和腰臀比均值大于女生,差异有统计学意义(P值均<0.01)。臀围除10～12,13～15岁性别间差异无统计学意义外(P值均>0.05),其他年龄组差异均有统计学意义(P值均<0.05)。不同体型学生腰围、臀围和腰臀比差异均有统计学意义,肥胖组>超重组>正常组(P<0.01)。男生腰臀比与身高呈负相关(r=-0.353,P<0.01),女生腰臀比与体重呈负相关(r=-0.084,P<0.01)。结论北京市不同性别学生腰围、臀围和腰臀比随年龄变化总趋势一致,但不同体型学生各指标差异显著。     

Waist circumference and abdominal adipose tissue distribution: influence of age and sex

BACKGROUND: The influence of age and sex on the distribution of abdominal adipose tissue for a given waist circumference (WC) is unclear. OBJECTIVE: The objective was to investigate the influence of age and sex on total (TAAT), visceral (VAT), and abdominal subcutaneous (ASAT) adipose tissue for a given WC. DESIGN: Body composition was assessed by whole-body magnetic resonance imaging in 147 younger men (< 50 y), 83 older men, 171 younger (premenopausal) women, and 80 older (postmenopausal) women with a wide range (16-40; in kg/m(2)) of body mass indexes. RESULTS: Within each sex, the regression lines between WC and TAAT were not significantly different (P > 0.1) between younger and older groups. Collapsed across age groups, women had more TAAT for a given WC than did men; however, this difference was significantly reduced with increasing WC (P < 0.05). Within each sex, regression lines derived for WC and ASAT were not significantly different between younger and older groups (P > 0.1). Collapsed across age groups, women had 1.8 kg more ASAT for a given WC (P < 0.05) than did men across the range of WCs. Within each sex, older men and women had a significantly greater increase in VAT for a given WC (P < 0.05) than did younger men and women. Furthermore, independent of age group, the slopes for WC and VAT were significantly higher (P < 0.05) in men than in women. CONCLUSIONS: There are significant sex differences in TAAT, VAT, and ASAT for a given WC. Furthermore, the relation between WC and VAT is substantially influenced by age.     

Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people

OBJECTIVE: To investigate waist circumference (WC), waist-hip ratio, hip circumference and body mass index (BMI) as risk factors for cardiovascular disease in Aboriginal Australians. METHODS: This cohort study included 836 adults aged 20-74 y in a remote Aboriginal community. WC, waist-hip ratio, hip circumference and BMI were obtained from a screening program. The participants were followed for up to 10 y for cardiovascular events. A Cox regression model was used to calculate the rate ratio (RR) and 95% confidence interval (CI) for the first-ever cardiovascular event (fatal and nonfatal). RESULTS: RRs for the first-ever cardiovascular event were 1.31 (95% CI: 1.11, 1.54), 1.29 (95% CI: 1.09,1.53), 1.28 (95% CI: 1.08, 1.52) and 1.10 (95% CI: 0.93, 1.30) per standard deviation increase in WC, BMI, hip circumference and waist-hip ratio, respectively, after adjustment for diabetes mellitus, total cholesterol, systolic blood pressure and smoking status. WC, BMI and hip circumference were significantly associated with cardiovascular risk, independent of other cardiovascular risk factors. Dividing each of the four parameters into quartiles, WC had the highest likelihood statistics (12.76) followed by BMI (11.45), hip circumference (10.57) and waist-hip ratio (3.15) for predicting first CV events. CONCLUSION: WC, BMI and hip circumference are associated with cardiovascular outcome, independent of traditional risk factors. However, WC appears to be a better predictor for cardiovascular risk than other parameters. Waist-hip ratio is not as useful as other measurements.     

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.     

Waist circumference percentiles for Canadian youth 11-18y of age

OBJECTIVE: To develop age- and sex-specific waist circumference reference data for Canadian youth. DESIGN: Cross-sectional population survey. SETTING: 1981 Canada Fitness Survey. SUBJECTS: Nationally representative sample of 3064 youth (1540 boys and 1524 girls) 11-18 y of age. INTERVENTIONS: Waist circumference was measured with a flexible anthropometric tape. MAIN OUTCOME MEASURES: Smoothed and weighted 5th, 10th, 25th, 50th, 75th, 90th, and 95th waist circumference percentiles derived from LMS regression. RESULTS: Waist circumference increases with age in both boys and girls, and boys have higher values of waist circumference than girls at every age and percentile level. CONCLUSIONS: These reference data can be used to identify youth with an elevated risk of developing obesity-related disorders and can serve as a baseline for future studies of temporal trends in waist circumference. SPONSORSHIP: This research was funded by the Heart and Stroke Foundation of Ontario (Grant #T4946).