Obesity, body mass index, waist circumference and mortality

Obesity belongs to civilization diseases with its incidence and prevalence increasing all over the world. Complications of obesity represent a serious socioeconomic problem. Obesity is a part of the metabolic syndrome and an independent mortality risk factor in all age categories, however, this relation is twice as strong in individuals under fifty years of age. Slight overweight in old age is associated with reduced total mortality risk. Simple evaluation of obesity via calculation of body mass index and measurement of waist circumference can be carried out in every medical consulting room.     

Metabolic risks in individuals with normal body mass index and normal waist circumference.

BACKGROUND: Risk of cardiovascular diseases increases in Asian adults within the normal limits of body mass index and waist circumference. OBJECTIVE: To determine a point of body mass index and waist circumference above which the chances of having cardiovascular risk factors increased. METHODS: Data on anthropometric indices, blood pressure and biochemical measures were collected in a cross-sectional study of 3447 participants (1781 males and 1666 females) with normal body mass index (19 to <25 kg/m for both sexes) and normal waist circumference (<102 cm for men and <88 cm for women). Metabolic abnormalities were defined on the basis of the standard published criteria. RESULTS: Individuals at the highest category of body mass index (24 to <25 kg/m) had significantly higher odds for having metabolic risk factors (odds ratios ranging from 1.3 to 1.6 for men and 1.36 to 2.0 for women for different risk factors) compared with those at first category (19 to <20 kg/m). Furthermore, individuals at the top category of waist circumference (95 to <102 cm for men and 85-88 cm for women) had significantly higher chances of having metabolic abnormalities (odds ratios ranging from 2.6 to 4.5 for men and 2.1 to 2.6 for women for different risk factors) compared with those in the first category (62 to <70 cm for men and 60 to <65 cm for women) in both sexes. CONCLUSION: We concluded that the cut-off points of body mass index and waist circumference suggested by the World Health Organization are inappropriate for the Tehranian urban population.     

Larger body mass index and waist circumference are associated with lower mortality in Chinese long-term care facility residents

OBJECTIVES: To investigate the association between body mass index (BMI) and waist circumference (WC) and all‐cause mortality of Chinese residents in long‐term care facilities in Taiwan. DESIGN: Prospective cohort study. SETTING: Eight long‐term care facilities in Taiwan. PARTICIPANTS: Three hundred fifty‐four residents aged 60 and older (median 78.4, range 60–101; 156 men, 198 women) were recruited during the study period. MEASUREMENTS: Anthropometrics and metabolic parameters were measured at baseline. Mean BMI was 21.7±4.2 kg/m² (range 11.6–35.3 kg/m², and mean WC was 82.4±10.9 cm (range 55.0–124.0 cm). Mortality data were from the Department of Health in Taiwan. RESULTS: There were 219 deaths during the 5 years of follow‐up. After adjusting for age, sex, albumin, Karnofsky performance status scale, hypertension, and diabetes mellitus, subjects in the highest quartile of BMI (27.3± 2.8 kg/m²) and WC (96.7±7.4 cm) had a significantly lower mortality rate than did subjects in the lowest quartile (BMI, 16.7±1.7 kg/m²; WC, 69.6±4.2 cm). After further stratification according to central obesity status, the subjects in the two highest BMI quartiles had a lower mortality rate than those in the lowest BMI quartile but only in the central obesity group (≥90 cm in men or ≥80 cm in women). The adjusted relative risk for all‐cause mortality in the highest versus lowest BMI quartile was 0.17 (95% confidence interval=0.05–0.57). CONCLUSION: BMI and WC were negative predictors for all‐cause mortality in older Chinese adults living in long‐term care facilities. Participants with higher WC and BMI had lower all‐cause mortality.     

沧州农村地区老年人群体质量指数和腰围与高血压的相关性研究

目的探讨沧州农村地区老年人群体质量指数和腰围与高血压患病率的关系。方法按照整体随机抽样方法,对沧州某农村地区年龄60⁸9岁1560例居民进行问卷调查、医学体检,根据高血压诊断标准分为高血压组868例和非高血压组692例。以不同体质量指数及腰围分层,比较高血压患病率及相关危险因素。结果高血压组超重(33.6%vs 10.8%)、肥胖(38.8%vs 9.7%)、腹型肥胖(36.6%vs 19.4%)、超重伴腹型肥胖(23.3%vs6.1%)检出率明显高于非高血压组(P<0.01)。而腰围异常老年人群患高血压风险度是腰围正常者的2.41倍(95%CI:1.90689岁1560例居民进行问卷调查、医学体检,根据高血压诊断标准分为高血压组868例和非高血压组692例。以不同体质量指数及腰围分层,比较高血压患病率及相关危险因素。结果高血压组超重(33.6%vs 10.8%)、肥胖(38.8%vs 9.7%)、腹型肥胖(36.6%vs 19.4%)、超重伴腹型肥胖(23.3%vs6.1%)检出率明显高于非高血压组(P<0.01)。而腰围异常老年人群患高血压风险度是腰围正常者的2.41倍(95%CI:1.906³.042,P=0.000)。相关因素分析发现,不良饮食习惯、吸烟、饮酒为该地区老年人群超重或肥胖的高危因素。结论沧州农村地区老年人群超重和肥胖形势严峻,体质量指数和腰围与高血压关系密切,不良生活习惯为其高危因素,改善不良饮食结构是高血压等慢性疾病防治的根本。     

Fifteen-year changes in body mass index and waist circumference in Finnish adults.

BACKGROUND: Obesity is an increasing health problem. Data on long-term obesity trends are most often based on the measurement of body mass index (BMI). Abdominal obesity, assessed by waist circumference may, however, be more closely related to health risks than overall obesity. The aim of this study was to investigate 15-year changes in general and abdominal obesity among adults in Finland, and furthermore, to assess whether obesity trends differ between educational groups. DESIGN: Four cross-sectional population surveys conducted at 5-year intervals between 1987 and 2002. METHODS: Altogether, 9025 men and 9950 women aged 25-64 years participated in these surveys. The weight, height, and waist circumferences of the participants were measured using a standardized protocol. RESULTS: Mean waist circumference increased by 2.7 cm in men and 4.3 cm in women in 15 years. Whereas the distribution of BMI values did not change much, a remarkable shift towards higher waist circumference values was observed in 15 years. In both sexes, mean and high values of waist circumference increased in all educational groups. However, the values remained highest among the subjects with the lowest education. CONCLUSIONS: These results indicate that adverse changes in body shape have taken place from the late 1980s to the early 2000s. Given that one in five Finnish adults is defined as obese based on BMI, there is an even larger group of individuals at risk of obesity-related metabolic disorders because of abdominal obesity, particularly among low-educated individuals.     

The relation between drinking pattern and body mass index and waist and hip circumference

OBJECTIVES: To study the association between alcohol drinking pattern and obesity. DESIGN: Cross-sectional population study with assessment of quantity and frequency of alcohol intake, waist and hip circumference, height, weight, and lifestyle factors including diet. SUBJECTS: In all, 25 325 men and 24 552 women aged 50-65 y from the Diet, Cancer and Health Study, Denmark, 1993-1997 participated in the study. MEASUREMENTS: Drinking frequency, total alcohol intake, body mass index (BMI), and waist and hip circumference. RESULTS: Among men, total alcohol intake was positively associated with high BMI (>/=30 kg/m(2)), large waist circumference (>/=102 cm) and inversely associated with small hip circumference (<100 cm). Among women, the total alcohol was associated with high BMI, large waist (>/=88 cm), and small hips only for the highest intake (28+ drinks/week). The most frequent drinkers had the lowest odds ratios (OR) for being obese. Among men, OR for having a high BMI were 1.39 (95% confidence interval: 1.36-1.64), 1.17 (1.02-1.34), 1.00 (reference), 0.87 (0.77-0.98), and 0.73 (0.65-0.82) for drinking 1-3 days/month, 1 day/week, 2-4 days/week, 5-6 days/week, and 7 days/week, respectively. Similar estimates were found for waist circumference. Corresponding results were found for women. CONCLUSION: For a given level of total alcohol intake, obesity was inversely associated with drinking frequency, whereas the amount of alcohol intake was positively associated with obesity. These results indicate that frequent drinking of small amounts of alcohol is the optimal drinking pattern in this relation.     

Association of waist circumference,body mass index and conicity index with cardiovascular risk factors in postmenopausal women

Abstract

In menopause, changes in body fat distribution lead to increasing risk of cardiovascular disease and metabolic disorders. The aim of this study was to assess the association of adiposity using the conicity index (CI), body mass index (BMI) and waist circumference (WC) with cardiovascular risk factors (hypertension, diabetes and dyslipidaemia). The sample of this cross-sectional study was collected from June to October 2010 and 165 consecutive menopausal women who had attended the Health and Treatment Centre and Endocrine Research Centre of Firoozgar Hospital in Tehran, Iran were assessed. Age, weight, height, WC, waist–hip ratio (WHR), CI and fat mass were measured. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose, insulin, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) levels were also determined. All statistical analyses were performed by SPSS version 17 (SPSS Inc, Chicago, IL, USA).Results showed that BMI was positively and significantly associated with SBP (r = 0.21; p = 0.009). WC was positively and significantly correlated with SBP (r = 0.26; p = 0.02) and DBP (r = 0.16; p = 0.05). WHR was also significantly and positively associated with SBP (r = 0.29; p = 0.001). Age and WC were associated with CI quartiles at the 0.05 significance level. The correlation of CI quartiles with SBP and weight were at the 0.01 significance level.We showed a significant association of WC with SBP and DBP, and that BMI could be an important determining factor of SBP. For assessing the association between CI and cardiovascular risk factors, future studies with larger sample sizes are recommended.     

体质指数和腰围对高血压患者降压疗效的影响

目的:明确体质指数(BMI)和腰围是否影响高血压患者降压疗效,指导肥胖型高血压患者的治疗。方法:选取原发性高血压住院患者,收集其人口学资料、入院血压及用药情况等基线数据,于出院后2个月随访血压水平,应用Logistic回归分析BMI和腰围对降压疗效的影响。结果:共有338例患者纳入最终分析,随访2个月时总的血压达标率为66.6%,多因素回归分析显示:BMI和腰围都是血压不达标的独立危险因素。在用1类降压药、正常体质量和肥胖的患者中,BMI和腰围不是血压不达标的独立危险因素;在用2~3类降压药和腹型肥胖的患者中,BMI和腰围是血压不达标的独立危险因素;在超质量患者中,仅BMI是血压不达标的独立危险因素。结论:在使用多种降压药及腹型肥胖的患者中,BMI和腰围都是影响高血压患者降压达标的独立危险因素。     

Interrelationships between body mass to waist circumference ratio,body mass index,and total body muscularity in older women

PurposeTo examine the relationships between body mass to waist circumference (BM:W) ratio or body mass index (BMI) and muscularity, 140 overweight (BMI ≥ 25 kg/m² and <30 kg/m²), 265 normal weight (BMI > 18.5 kg/m² and <25 kg/m²) and 26 underweight (BMI ≤ 18.5 kg/m²) Japanese women aged 60–80 years volunteered (overall 431 women).MethodsMuscle thickness was measured by ultrasound at six sites on the anterior and posterior aspects of the body. Total muscle mass (TMM) was estimated from an ultrasound-derived prediction equation. BMI and BM:W ratio were calculated using anthropometrical variables.ResultsWhen the overall sample was used, BMI was positively correlated with the TMM (r = 0.573, p < 0.001) and TMM index (r = 0.659, p < 0.001). BM:W ratio was also positively correlated with the TMM (r = 0.566, p < 0.001) and TMM index (r = 0.400, p < 0.001). In normal weight women, BMI was positively correlated with the TMM (r = 0.460, p < 0.001) and TMM index (r = 0.496, p < 0.001). Similarly, BM:W ratio was positively correlated with the TMM (r = 0.514, p < 0.001) and TMM index (r = 0.318, p < 0.001). In overweight and underweight women, TMM was significantly and positively correlated with BM:W ratio (r = 0.442 and r = 0.715, respectively; p < 0.001), but not BMI (r = 0.077 and r = 0.315). TMM index was also positively correlated with BM:W ratio in both overweight (r = 0.184, p < 0.05) and underweight (r = 0.500, p < 0.01) women. BMI was positively correlated with TMM index (r = 0.230, p < 0.01) and inversely correlated to the percentage of TMM in body mass (r = −0.262, p < 0.01) in overweight women.ConclusionThese results suggest that, compared to BMI, BM:W ratio may provide a simple and potential index for assessing muscularity in Japanese older underweight women. However, in normal and overweight women, BMI and BM:W ratio are both preferred in assessing muscularity.     

体重指数完全代替腰围或腰臀比用于肥胖评估的可行性研究

目的 比较腰围、腰臀比及BMI与代谢相关指标的相关性,探讨BMI本身存在的性别差异及其完全取代腰围或腰臀比的可行性.方法 利用仁济医院健康保健(体检)中心2009年1月至2010年6月客户体检数据库,研究纳入人数2054例,其中男性1322例,女性732例,按不同的性别分析腰围、腰臀比及BMI异常对血脂、血糖及血压的影响,同时比较腰围、腰臀比及BMI用于评估同一群体肥胖发生率的差异.结果 本研究结果显示除了女性BMI正常组和异常组之间总胆固醇水平的差异无统计学意义(P>0.05)外,腰围、腰臀比和BMI异常组的三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖、糖化血红蛋白及血压水平与正常组相比差异均有统计学意义(P<0.05).在评估同一群体的肥胖发生率时,3种方式的评估结果差异也有统计学意义(P<0.05).男性和女性BMI＜25 kg/m2的群体中,腰围异常的比例分别为19.3%和33.8%.进一步对女性群体的分析发现,如果女性BMI以23.2 kg/m2为切点,对于腹型肥胖筛查的灵敏度和特异度可分别提高到78.1%和87.9%.结论 BMI不能完全取代腰围或腰臀比对腹型肥胖人群的筛查价值.BMI存在明显的性别差异,如果女性BMI以23.2 kg/m2为切点,可以明显提高腹型肥胖筛查的准确度.     

不同体重指数及腰围2型糖尿病患者甲状腺功能的变化探讨

目的 探讨不同体重指数（BMI）及腰围（WC）2型糖尿病（T2DM）患者促甲状腺激素（TSH）和甲状腺激素（TH）水平的变化及肥胖对TSH、TH的影响。方法 收集住院T2DM患者275例,根据BMI不同将其分为正常组（18.5kg/m²≤BMI＜24kg/m²,88例）、超重组（24kg/m²≤BMI＜28kg/m²,90例）和肥胖组（BMI≥28kg/m²,97例）,比较3组患者的血脂水平及甲状腺功能。再根据性别和WC不同将其分为M1组（男性WC<85cm）、M2组（男性WC≥85cm）、F1组（女性WC<80cm）、F2组（女性WC≥80cm）,比较各组间上述指标。相关性分析采用Spearman相关分析,影响因素分析采用多元线性逐步回归分析。结果 与正常组比较,超重组及肥胖组患者的TSH水平明显增加（P<0.05）。F2组TSH水平明显高于F1组和M2组,游离甲状腺素（FT₄）水平低于M2组（P<0.05）。相关性分析结果显示,T2DM患者BMI与TSH呈正相关(r=0.25,P<0.05),TC与游离三碘甲腺原氨酸（FT₃）呈负相关(r=-0.39,P<0.05),BMI、WC与FT₄(r=-0.31,r=-0.29,P<0.05)呈负相关。多元线性逐步回归分析结果显示,BMI是TSH的独立相关因素,WC是FT₄的独立相关因素（P<0.05）。结论 肥胖T2DM患者TSH水平升高,FT₄下降,女性较男性腹型肥胖者变化更加明显。     

Influences of body mass index and waist circumference on physical function in older persons with heart failure

BACKGROUND:

In older persons with heart failure (HF), body composition may influence physical function and treatment effectiveness. There is a lack of research concerning the associations between waist circumference (WC) or body mass index (BMI) and physical function in this population.

OBJECTIVE:

To determine whether BMI and WC are associated with physical function in older men and women with HF.

METHODS:

Seventy-one men and 36 women 65 years of age and older living with HF completed two surveys spaced three months apart. Height, weight, WC, time since diagnosis, edema, comorbidities and physical function were self-reported at baseline and follow-up. Physical function was determined using the physical component score of the Short Form-12 and the physical limitation domain (PLD) of the Kansas City Cardiomyopathy Questionnaire. Multivariate linear regression and analysis of covariance were used to evaluate the relationships between WC and BMI, as well as cross-classifications of WC and BMI with physical function, after adjusting for confounders and interactions.

RESULTS:

The cross-sectional and short-term follow-up analyses did not detect an association between WC or BMI and physical function, with the exception of changes in the PLD, which were significantly different across WC categories. Persons with a moderate WC experienced the greatest improvement in function. The physical component and PLD scores were lower than those reported by Canadians 75 years of age and older and stable HF patients, respectively. Women reported lower physical function scores than men.

CONCLUSION:

Findings from the present study indicate that older persons with HF, especially women, have poor physical functioning regardless of their WC or BMI.     

体重指数和腰围与代谢综合征发生风险的比较研究

目的 比较体重指数、腰围与代谢综合征发生风险的相关性.方法 554例人选者(男316例,女238例),按照体重指数和腰围被分为周围肥胖组192例、腹部肥胖组135例和混合肥胖组237例,7年后进行随访.结果 共随访到520例.周围肥胖组代谢综合征累积发生率26.3%(49/186),腹部肥胖组代谢综合征累积发生率41.7%(50/120),混合肥胖组代谢综合征累积发生率43.0%(92/214).腹部肥胖组和混和肥胖组代谢综合征累积发生率显著高于周围肥胖组(X2分别为7.825和12.082,均P＜0.01),且基线时舒张压、甘油三酯、空腹血糖、空腹胰岛素及稳态模型评估法胰岛素抵抗指数(HOMA-IR)也显著高于前者(均P＜0.05).以有或无代谢综合征分组后基线资料比较,代谢综合征组无论男女,腰围和腰臀比均高于非代谢综合征组(P＜0.01和P＜0.05),体重指数在两组无统计学差异,并且代谢综合征组空腹血糖、空腹胰岛素和HOMA-IR显著高于非代谢综合征组(均P＜0.05).Logistic回归显示,与代谢综合征发生风险相关的因素主要为腰围(P=0.021)、腰臀比(P=0.009)、HOMA-IR(P=0.004).结论 腹部脂肪堆积及胰岛素抵抗是代谢综合征发生的两个重要因素,腰围比体重指数与代谢综合征的发生风险关系更密切.     

Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis

OBJECTIVE: To determine if the combination of body mass index (BMI) and waist circumference (WC) explains an additional component of arthritis and knee osteoarthritis risk than is accounted for by either anthropometric measure alone. DESIGN: Cross-sectional study. PARTICIPANTS: Participants were part of the Third National Health and Nutrition Examination Survey, a representative sample of Americans conducted from 1988 to 1994. The arthritis analyses included 15 570 participants aged 18 years and older. The knee osteoarthritis analyses included 2323 participants aged 60 years and older. Body mass index and WC were measured in all participants and classified into sex-specific tertiles. OUTCOME MEASURES: Arthritis (determined by self-report) and knee osteoarthritis (determined by radiograph). RESULTS: Independent of sex, the likelihood of arthritis and knee osteoarthritis increased in a graded fashion when moving from the lowest to highest BMI tertile and when moving from the lowest to highest WC tertile (Ptrend < 0.01). In the next phase of analyses, subjects were divided into WC tertiles within each of the BMI tertiles. Within the lowest BMI tertile, the likelihood of arthritis and knee osteoarthritis was not different in the lowest, middle and highest WC tertiles (P > 0.1). Within the middle BMI tertile, the middle and high WC tertiles were more likely to have knee osteoarthritis compared to the lowest WC tertile (P < 0.05). Within the highest BMI tertile, the highest WC tertile was more likely to have arthritis and knee osteoarthritis compared to the lowest WC tertile (P < 0.05). CONCLUSIONS: Both BMI and WC were strong predictors of arthritis and knee osteoarthritis. When a categorical approach was used for BMI and WC, similar to that in the clinical setting, independent effects of these anthropometric variables were observed.