不同体重指数和腰围水平与其他心血管病危险因素聚集的关系

目的探讨不同体重指数(BMI)和腰围水平对人群中其他心血管病危险因素聚集的影响.方法将1992～1994年和1998年在我国不同地区中年人群中进行的2次心血管病危险因素调查资料合并共30 561人,比较不同BMI和腰围分组的研究对象其他心血管病危险因素聚集率和聚集的相对危险,其中危险因素聚集定义为同一研究对象具有高血压、高血清总胆固醇、低高密度脂蛋白胆固醇或空腹血糖异常之中的任意2项或2项以上者.结果随着BMI和(或)腰围的增加,人群其他心血管病危险因素的聚集率呈明显上升趋势, 按BMI分层各组中,男女两性腰围与其他心血管病危险因素的聚集率均呈明显的线性上升趋势,同样在不同的腰围分组中,BMI均与其他心血管病危险因素的聚集率呈明显的线性趋势.男性和女性年龄调整心血管病危险因素聚集率在BMI<24 kg/m2、腰围(男/女)<85/80 cm组分别为11.1%和10.4%,BMI<24 kg/m2、腰围(男/女)85～95.9/80～89.9 cm组分别为24.2%和16.9%, BMI 24.0～27.9 kg/m2、腰围(男/女)<85/80 cm组分别为24.0%和17.0%,BMI 24～27.9 kg/m2、腰围(男/女)85～95.9 /80～89.9 cm组分别为34.3%和24.0%. BMI 24.0～27.9 kg/m2、腰围(男/女)≥95/90 cm组分别为40.8%和29.6%,BMI≥28 kg/m2、腰围(男/女)85～95.9/80～89.9 cm组分别为44.2%和29.9%,BMI≥28 kg/m2、腰围(男/女)≥95/90 cm组分别为54.7%和35.4%.结论 BMI和腰围水平均与其他心血管病危险因素的聚集有独立的正相关性.保持BMI和腰围均在正常范围对心血管健康是很重要的.     

Obesity, abdominal obesity, and clustering of cardiovascular risk factors in South Korea

The aim of this study was first, to investigate the prevalence of obesity, abdominal obesity, and clustering of cardiovascular (CVD) risk factors, and secondly, to identify the BMI or waist circumference (WC) level at which clustering increases in South Koreans. A population-based, cross-sectional National Health Examination Survey was carried out in 1998. A total of 8,816 subjects (4,029 men and 4,787 women) aged 15-79 y were selected by stratified multistage probability sampling design. The measurements taken of the subjects included: height, weight, waist and hip circumference, blood pressure, fasting glucose, and lipids. The prevalence of BMI > or = 25 kg/m2 was 25.3% for men and 28.3% for women. The prevalence of WC >90 cm in men, and >80 cm in women was 18.5%, and 38.5%, respectively. Clustering of 3 or more CVD risk factors was 22.7% in men ad 21.7% in women. Using <21 kg/m2; as a referent, subjects with BMI of 23 kg/m2; and 27 kg/m2; had an odds ratio of 3.5 and 10.2 in men, and 3.1 and 6.7 in women, respectively for clustering of CVD risk factors. Using <65 cm as a referent, subjects with a WC of > or = 90 cm in men and > or = 85 cm in women had an odds ratio of 13.4, and 13.6, respectively for clustering of CVD risk factors. Considering the significant associations between clustering of CVD risk factors and BMI or WC, the present study suggests that high prevalence of overweight may have important implications for the health care system, even at a lower level of BMI or WC.     

Alcohol consumption and insulin resistance syndrome parameters: associations and evolutions in a longitudinal analysis of the French DESIR cohort

PURPOSE: To determine the effects of average alcohol consumption and changes in alcohol intake on the insulin resistance syndrome parameters in a 3-year follow-up study. METHODS: Longitudinal study of 1856 and 1529 alcohol drinking men and women in the French DESIR study (Data from an Epidemiological Study on the Insulin Resistance syndrome), aged 30 to 64 years. RESULTS: In men, fasting glucose, body mass index, waist circumference, systolic blood pressure, and HDL-cholesterol were positively associated with average alcohol consumption while there was no association with insulin or triglycerides concentrations. A change in alcohol intake was positively associated with HDL-cholesterol concentration and systolic blood pressure at follow-up. These effects of alcohol could not be attributed specifically to the intake of wine. In women, while the alcohol HDL-cholesterol relation was similar to that found in the men, the only significant effect of average alcohol intake was an increase in systolic blood pressure, with a spurious decrease in blood pressure related to a 3-year increase in alcohol intake. CONCLUSIONS: Alcohol only provided a beneficial effect on HDL-cholesterol. The beneficial effect seen by other authors of moderate alcohol drinking on diabetes and cardiovascular risk may be due to effects on parameters other than those included in the current definitions of the insulin resistance syndrome.     

Food and drinking patterns as predictors of 6-year BMI-adjusted changes in waist circumference

Few studies have investigated the prospective associations between diet or drinking patterns and abdominal obesity; we therefore investigated whether food and beverage groups or patterns predicted 6-year changes in waist circumference (WC) and whether these associations were independent of concurrent changes in BMI as a measure of general obesity. The subjects were 2300 middle-aged men and women with repeated measurements of dietary intake, BMI and WC from 1982 to 1993. Intakes from ten food groups and from coffee, tea, wine, beer and spirits were assessed; gender-specific food factors were identified by factor analyses. Multiple linear regression analyses were done before and after adjustment for concurrent changes in BMI. A high intake of potatoes seemed to prevent gain in WC for men, while a high intake of refined bread was associated with gain in WC for women. The association persisted for refined bread, but not for potatoes, after adjustment for concurrent BMI changes. Among women, but not men, high intakes of beer and spirits were associated with gain in WC in both models. A high intake of coffee for women and moderate to high intake of tea for men were associated with gain in WC, but the associations were weakened, especially for women, after adjustment for BMI changes. None of the food factors was associated with WC changes. Based on the present study, we conclude that very few food items and no food patterns seem to predict changes in WC, whereas high intakes of beer and spirits among women, and moderate to high tea intake among men, may promote gain in WC.     

Biological predictors of change in functioning in the Whitehall II study

PURPOSE: To examine whether risk factors for CHD are related to change in functioning independent of the presence or development of disease. METHODS: Longitudinal follow up of 4768 men and 2034 women civil servants from 20 London-based departments with complete data for the SF-36, biological variables, and BMI and health related behaviors. Data are used from two phases of the Whitehall II study, phase 3 (1991-1993) and phase 4 (1995) with an interval of 36 months. Weight, height, fasting insulin, 2-hour post load glucose, total and HDL-cholesterol, fibrinogen, von Willebrand factor, diastolic and systolic blood pressure, and waist hip ratio were measured at phase 3. Demographic and socio-economic information, health related behaviors, and the SF-36 were obtained at both phases by questionnaire. RESULTS: Waist hip ratio, fasting insulin, triglycerides, and HDL-cholesterol were associated with a decline in physical functioning in the total cohort and when those with poor health at baseline were removed from the analyses. Principal component analysis revealed that these variables clustered with total cholesterol and may represent insulin resistance. The biological variables had a cumulative effect on decline in physical functioning such that those with poor waist hip ratio, fasting insulin, triglycerides, and HDL-cholesterol was two times greater than those without. This relationship was independent of exercise, smoking, and alcohol intake which explained only 17% and 5.4% of the association in men and women, respectively. CONCLUSIONS: A number of biological variables, which may represent insulin resistance, are associated with decline in physical functioning in men and women independent of prevalent ill health or health related behaviors.     

Dietary fiber and associations with adiposity and fasting insulin among college students with plausible dietary reports

ObjectiveWe examined dietary fiber intake, food sources of dietary fiber, and relation of dietary fiber to body composition and metabolic parameters in college students with plausible dietary reports.MethodsStudents (18–24 y of age) provided data on anthropometry, fasting blood chemistries, and body composition (bioelectric impedance). Diet and physical activity were assessed with the Diet History Questionnaire and the International Physical Activity Questionnaire. Plausible dietary reporters were identified (±1 SD cutoffs for reported energy intake as a percentage of predicted energy requirement). Multiple regression analyses were conducted with the total (n = 298) and plausible (n = 123) samples, adjusting for age, race, sex, smoking status, physical activity, energy intake, and fat-free mass (where applicable).ResultsFood sources of dietary fiber were similar in men and women. In the plausible sample compared with the total sample, dietary fiber was more strongly associated with fat mass (β = ?0.24, P < 0.001), percentage of body fat (β = ?0.23, P < 0.001), body mass index (β = ?0.11, P < 0.01), waist circumference (β = ?0.67, P < 0.05), and fasting insulin (β = ?0.15, P < 0.001). When the effect of sex was investigated, dietary fiber was inversely related to fasting insulin and fat mass in men and women and inversely related to percentage of body fat, body mass index, and waist circumference in men only (P < 0.05).ConclusionInclusion of implausible dietary reports may result in spurious or weakened diet–health associations. Dietary fiber is negatively associated with fasting insulin levels in men and women and consistently associated with adiposity measurements in men.     

Intake of macronutrients as predictors of 5-y changes in waist circumference

BACKGROUND: The diet may influence the development of abdominal obesity, but the few studies that have prospectively examined the relations between diet and changes in waist circumference (WC) have given inconsistent results. OBJECTIVE: Associations between total energy intake, energy intake from macronutrients, and energy intake from macronutrient subgroups based on different food sources and 5-y differences in WC (DWC) were investigated. DESIGN: A Danish cohort of 22 570 women and 20 126 men aged 50-64 y with baseline data on WC, diet, BMI, and potential confounders reported their WC 5 y later. Associations of baseline diet with DWC were assessed by multiple linear regression analysis. RESULTS: Neither total energy intake nor energy intake from each of the macronutrients was associated with DWC, except for an inverse association with protein, especially animal protein. In women, positive associations with DWC were seen for carbohydrate from refined grains and potatoes and from foods with simple sugars, whereas carbohydrate from fruit and vegetables was inversely associated and significantly different from any other carbohydrate subgroup. The results for men resembled those for women, although none were significant. Vegetable fat was positively associated with DWC for both men and women in a combined analysis. A U-shaped association between alcohol from wine and DWC was present for both sexes, and alcohol from spirits was positively associated with DWC in women. CONCLUSIONS: Although no significant associations with total energy or energy from fat, carbohydrate, or alcohol were observed, protein intake was inversely related to DWC, and some macronutrient subgroups were significantly associated with DWC.     

Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity

OBJECTIVE: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension-diabetes comorbidity (HDC). RESEARCH METHODS AND PROCEDURES: Data (n = 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cut-points of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. RESULTS: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was approximately 73% and approximately 61%, respectively. The corresponding values for black and Hispanic women were approximately 115% and approximately 125%, respectively. CONCLUSIONS: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.     

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.     

The association between magnesium intake and fasting insulin concentration in healthy middle-aged women

OBJECTIVE: We assessed the association between magnesium intake and fasting insulin levels in a large cohort of women. METHODS: Female nurses free of diabetes, cardiovascular diseases and cancer from the Nurses Health Study provided blood samples between 1989-1990. We selected a sub-sample of 219 women for this analysis. Magnesium intake was assessed by a food frequency questionnaire in 1990 and categorized into quartiles. Cross-sectional geometric means of fasting insulin concentrations by quartiles of magnesium intake were obtained with Generalized Linear Model and adjusted for several risk factors and lifestyle characteristics. RESULTS: After adjustment for age, body mass index (BMI), total energy, physical activity, hours per week spent sitting outside work, alcohol intake, smoking, and family history of diabetes, magnesium intake was inversely associated with fasting insulin concentration. The multivariate adjusted geometric mean for women in the lowest quartile of magnesium intake was 11.0 microU/mL and 9.3 microU/mL among those in the highest quartile of magnesium intake (p for trend = 0.04). The inverse association remained when we considered magnesium from only food sources. CONCLUSION: Higher magnesium intake is associated with lower fasting insulin concentrations among women without diabetes. Because lower fasting insulin concentrations generally reflect greater insulin sensitivity, these findings provide a mechanism through which higher dietary magnesium intake may reduce the risk of developing type 2 diabetes mellitus.     

Cigarette smoking, alcohol use, and physical activity in relation to serum leptin levels in a multiethnic population: The Miami Community Health Study

PURPOSE: To examine the correlates of plasma leptin, including fasting insulin, adiposity, and several health habits and behaviors among a nondiabetic multiethnic population. METHODS: A cross-sectional study was conducted among 25-44 year old African-Americans (n = 126), Cuban-Americans (n = 107), and non-Hispanic whites (n = 189) randomly selected from Dade County Florida. Fasting leptin levels were correlated with fasting insulin, percent body fat, smoking, alcohol use, and physical activity within each sex. Multiple linear regression and analysis of covariance were used to estimate the independent determinants of plasma leptin concentration separately among men and women. RESULTS: Stepwise linear regression analyses revealed statistically significant associations of leptin with percent body fat, fasting insulin, cigarette smoking, and physical activity (both inversely) among men (p < 0.05 for each). Among women, percent body fat, fasting insulin (both positively), cigarette smoking, and alcohol use (inversely) were independent predictors of leptin levels explaining over 70% of the variance. Analyses of covariance revealed that women had higher adjusted mean leptin levels than men (13.1 ng/ml vs. 5.9 ng/ml; p < 0.001), whereas no separate effect of ethnicity was noted. CONCLUSIONS: Although adiposity was the strongest correlate of leptin levels, fasting insulin and several health habits and behaviors were independently associated with leptin. After adjustment for these factors, women had significantly higher mean leptin levels than men. The independent association among leptin and insulin levels is intriguing and suggests additional avenues for epidemiologic research.     

Perinatal and early adulthood factors associated with adiposity

We used body mass index (BMI) and waist circumference (WC) as fat indicators to assess whether perinatal and early adulthood factors are associated with adiposity in early adulthood. We hypothesized that risk factors differ between men and women and are also different when WC is used for measuring adiposity as opposed to BMI. We conducted a longitudinal study based on a sample of 2,063 adults from the 1978/1979 Ribeir?o Preto birth cohort. Adjustment was performed using four sequential multiple linear regression models stratified by sex. Both perinatal and early adulthood variables influenced adulthood BMI and WC. The associations differed between men and women and depending on the measure of abdominal adiposity (BMI or WC). Living with a partner, for both men and women, and high fat and alcohol intake in men were factors that were consistently associated with higher adulthood BMI and WC levels. The differences observed between sexes may point to different lifestyles of men and women, suggesting that prevention policies should consider gender specific strategies.     

Changing patterns in health behaviors and risk factors related to chronic diseases, 1990-2000

PURPOSE: Assess changes in chronic disease-related health behaviors and risk factors from 1990 to 2000, by race/ethnicity, age, and gender. DESIGN: Stratified cross-sectional design. SETTING: United States. SUBJECTS: 16,948 black, 11,956 Hispanic, and 158,707 white women and men, ages 18 to 74. MEASURES: Cigarette smoking, obesity, sedentary behavior, low vegetable or fruit intake. From the Behavioral Risk Factor Surveillance System. RESULTS: Young women and men, ages 18 to 24, had poor health profiles and experienced adverse changes from 1990 to 2000. After the variables were adjusted for education and income, these young people had the highest prevalence of smoking (34%-36% current smokers among white women and men), the largest increases in smoking (10%-12% increase among white women and men; 9% increase among Hispanic women), and large increases in obesity (4%-9% increase, all gender and racial/ethnic groups). Young women and men from each racial/ethnic group also had high levels of sedentary behavior (approximately 20%-30%) and low vegetable or fruit intake (approximately 35%-50%). In contrast, older Hispanic women and men and older black men, ages 65 to 74, showed some of the most positive changes. They had the largest decreases in smoking (Hispanic women), largest decreases in sedentary behavior (Hispanic women and black men), and largest increases in vegetable or fruit intake (Hispanic women and men, and black men). CONCLUSION: The poor and worsening health profile of young women and men is a particular concern, as they will soon enter the ages of high chronic disease burden.     

Cross-sectional association between total level and type of alcohol consumption and glycosylated haemoglobin level: the EPIC-Norfolk Study

OBJECTIVE: To investigate the association between total level and type of alcohol consumed and glycaemia. DESIGN: Cross-sectional study. SETTING: The EPIC-Norfolk Study, a population-based cohort study of diet and chronic disease. SUBJECTS AND METHODS: Non-diabetic men (n=2842) and women (n=3572), aged 40-78 y. Alcohol intake was assessed by self-reported questionnaire, and glycaemia measured by glycosylated haemoglobin (HbA(1c)). RESULTS: Ten percent of men and 18% of women reported drinking no alcohol. Among drinkers, median alcohol intake was 8 units/week for men and 3 units/week for women. In analyses stratified by sex and adjusted for age, total energy intake, education, fruit and vegetable intake, smoking, family history of diabetes, physical activity, body mass index and waist:hip ratio, alcohol intake was inversely associated with HbA(1c) in men and women, although the association was stronger in women. A 1 unit/week increase in alcohol intake was associated with 0.0049% (s.e.=0.00223; P-value=0.028) and 0.017% (s.e.=0.00343; P-value <0.001) reduction in HbA(1c) in men and women respectively. In similar multivariate analyses, wine intake was inversely associated with HbA(1c) in men, and wine, spirits and beer intake were inversely associated with HbA(1c) in women. When also adjusted for total alcohol intake, only the association between wine intake and HbA(1c) in men remained significant. CONCLUSION: Alcohol intake was associated with lower HbA(1c) level, an association not explained by confounding. The distinction between type of alcohol consumed was particularly important in men.     

Dyslipidemia and abdominal obesity: an assessment in three general populations

Several studies show a relationship between abdominal obesity and cardiovascular diseases, partially mediated through an altered metabolism of dyslipidemia. The present study was aimed at testing the robustness of this association across three contrasted populations and at assessing the performances of abdominal obesity as a screening tool for dyslipidemia. Data were drawn from three population health surveys recently conducted in two regions of a developed country (Switzerland, mostly of Caucasian origin, n = 2650) and in a less developed country (Seychelles, Indian Ocean, mostly of black descent, n = 806). Dyslipidemia was defined as a ratio of total cholesterol to high-density lipoprotein cholesterol (TC-HDL) greater than 5. Two anthropometric circumference measurements, waist-to-hip ratio (WHR) and waist circumference (WC), were used to define abdominal obesity either as WHR >/= 0.9 in men and WHR >/= 0.8 in women or as WC >/= 94 cm and WC >/= 80 cm, respectively. A consistent direct association between abdominal obesity and dyslipidemia (odds ratios varying from 1.85 to 4.56) was found in the three populations, independently of gender, age, body mass index, blood pressure, and smoking. This consistency across ethnicities and environments strengthens the hypothesis of a common etiopathological mechanism. The sensitivity for detecting dyslipidemia was generally higher for abdominal obesity, based on either WHR or WC, than for criteria based on the other risk factors under study. In addition, the sensitivity was higher in the study populations with a low prevalence of dyslipidemia (Swiss women and Seychellois of both sexes) than in the others. These findings support that WHR and WC may be useful as simple and inexpensive screening tools to select individuals eligible for more sophisticated and costly serum lipid determinations, especially in developing countries.     

Serum concentrations of beta-carotene and alpha-tocopherol are associated with diet, smoking, and general and central adiposity

BACKGROUND: Previous studies of associations between diet, obesity, and blood concentrations of alpha-tocopherol and beta-carotene have been equivocal. Furthermore, most studies used only body mass index (BMI) as an obesity measure. OBJECTIVES: Our objectives were to examine the associations between energy and nutrient intakes, alcohol consumption, tobacco use, and serum cholesterol and serum concentrations of alpha-tocopherol and beta-carotene, and to examine the associations between different measures of general and central adiposity and serum concentrations of alpha-tocopherol and beta-carotene. DESIGN: This was a cross-sectional, population-based study of 253 men and 276 women aged 46-67 y. Nutrient data were collected by a modified diet history method. Measures of obesity included BMI, percentage of body fat (impedance analysis), waist-to-hip ratio, and waist circumference. The associations between serum nutrient concentrations and the other factors were examined by multiple linear regression. RESULTS: Twenty-one percent of men and 34% of women used antioxidant supplements. The mean BMI was 26.1 in men and 25.4 in women. Serum beta-carotene concentration was positively associated with serum cholesterol concentration, fiber intake, and beta-carotene intake, and negatively associated with smoking and all measures of obesity. In men, serum beta-carotene concentration was not significantly associated with central adiposity after adjustment for body fat. Serum alpha-tocopherol concentration was positively correlated with serum cholesterol, obesity, and vitamin E intake. In women, serum alpha-tocopherol concentration was also positively associated with intakes of ascorbic acid and selenium. Serum alpha-tocopherol concentration was associated with central adiposity after adjustment for body fat. CONCLUSION: Serum beta-carotene and alpha-tocopherol concentrations have different associations with diet, smoking, general adiposity, and central adiposity.     

Evaluation of waist circumference to predict general obesity and arterial hypertension in women in Greater Metropolitan Belo Horizonte,Brazil

This study examined the capacity of waist circumference (WC) to identify subjects with overweight (BMI >/=25) and obesity (BMI >/=30), in agreement with internationally recommended levels of action. Data were obtained from 791 women, 15-59 years old. After identifying overweight and obesity according to WC values, sensitivity and specificity were calculated to verify whether WC could be a good risk predictor for hypertension. Associations were tested by linear regression and logistic regression, controlling for confounding. WC cut-off points of 80cm and 88cm correctly identified 89.8% and 88.5% of women with overweight and obesity, respectively. Abdominal obesity (WC >/=88cm) was statistically associated with hypertension in the multivariate analysis (OR = 2.88; 95% CI: 1.77-4.67). Hypertension was identified with a sensitivity of 63.8% and 42.8%, and with a specificity of 68.0% and 83.3%, for WC >/=80 and >/=88, respectively. The proposed cut-off points for abdominal obesity can potentially distinguish individuals at risk for future obesity, but has only moderate power to predict individuals with high blood pressure.     

Cigarette smoking and fat distribution in 21,828 British men and women: a population-based study

OBJECTIVE: To examine the relationship between cigarette smoking habits and fat distribution in a population-based cohort of men and women. RESEARCH METHODS AND PROCEDURES: We analyzed cross-sectional data from 21,828 men and women who were 45 to 79 years of age, residents in Norfolk, United Kingdom, and were recruited between 1993 and 1997. Cigarette smoking habits and other lifestyle factors were assessed using self-reported questionnaires. Anthropometric measures were obtained during a health examination. RESULTS: Waist-hip ratio was highest among current smokers and least among never smokers after adjusting for age, BMI, alcohol intake, total energy intake, physical activity, and education. Higher waist-hip ratio was directly associated with higher smoking pack-years in current and former smokers and inversely with duration since quitting smoking in former smokers. Adjusting for age, BMI, and other covariates, current smokers had higher waist circumference but lower hip circumference compared with former or never smokers. DISCUSSION: Cigarette smoking habits seem to influence fat distribution patterns. Although smokers have lower mean BMI compared with nonsmokers, they have a more metabolically adverse fat distribution profile, with higher central adiposity. The explanation for this association may help elucidate the mechanisms underlying the adverse health consequences of cigarette smoking and abdominal obesity.     

Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hypertension in overweight White, Black, and Hispanic American adults

Waist circumferences (WC) >/=102 cm for men and >/=88 cm for women have been proposed by an expert panel as cut-points for identifying increased risk for the development of obesity comorbidities for most adults. The aim of this investigation was to examine the predictive values of these WC cut-points for hypercholesterolemia, low concentration of high (HDL-C), and high concentration of low (LDL-C) density lipoprotein cholesterol, hypertriglyceridemia, type 2 diabetes, and hypertension in overweight American adults. Data from NHANES III were utilized for the analysis. Predictive abilities were determined by calculating sensitivity, specificity, positive (PV+) and negative (PV-) predictive values in overweight subjects with BMI 25-29.9 kg/m(2). Sensitivity of WC cut-point was stronger for high LDL-C compared to other risk factors with the highest values recorded in the 40-59 and 60-69 year age groups in men and women, respectively. PV+ of WC cut-points for dyslipidemia, type 2 diabetes, and hypertension were low in men compared to women. PV+ tended to increase with age, from 19-39, 40-59 to 60-90 year age groups in Whites, Blacks, and Hispanic men. In men, the highest PV+ were recorded for hypertriglyceridemia in the 60-90 years old groups, with values of 71.6%, 52.5%, and 43.3% in Whites, Blacks, and Hispanics, respectively. The CVD risk factor associated with the highest PV+ in women was diabetes with values of 97.2% in Whites and 88.9% in Blacks, and hypertriglyceridemia with a value of 93.8% in the 17-39 year age group in Hispanics. Among Black men 40-59 years of age, only 32% of a population of overweight hypertensives were detected by the WC cut-points, and among Black women, 40-59 years of age, only 54% were detected. Given the low sensitivity of these cut-points for detecting hypertension, one of the major co-morbidities of obesity, these cut-points failed to provide adequate evidence for the use of WC in determining or evaluating patients as to co-morbid states. We recommend further studies to determine a set of specific cut-points associated with increased risk of CVD in different population groups.     

Whole-grain intake and the prevalence of hypertriglyceridemic waist phenotype in Tehranian adults

BACKGROUND: Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, no epidemiologic data associate whole-grain intake with hypertriglyceridemic waist (HW) phenotype. OBJECTIVE: We aimed to evaluate the relation between whole-grain intakes and the prevalence of HW phenotype in adults in Tehran, Iran. DESIGN: Whole-grain intake, serum triacylglycerol concentration, and waist circumference (WC) were assessed in a population-based, cross-sectional study of 827 Iranian subjects (357 men and 470 women) aged 18-74 y. HW phenotype was defined as serum triacylglycerol concentrations > or =150 mg/dL and concurrent WC > or = 80 cm (men) and > or =79 cm (women). RESULTS: Mean (+/-SD) consumption of whole and refined grains was 93 +/- 29 and 201 +/- 57 g/d, respectively. Subjects in the highest quartile of whole-grain intake had a significantly lower prevalence of HW (29%) than did those in the lowest quartile (44%; P < 0.05). Conversely, those in the highest quartile of refined-grain intake had a significantly higher prevalence of HW (45%) than did those in the lowest quartile (27%; P < 0.05). After control for potential confounding factors, a significantly decreasing trend was observed for the risk of HW phenotype across quartiles of whole-grain intake (odds ratios among quartiles: 1.00, 0.95, 0.90, and 0.78, respectively; P for trend = 0.02). Higher consumption of refined grains was associated with better odds of HW phenotype (by quartile: 1.00, 1.38, 1.65, and 2.1; P for trend = 0.01). CONCLUSION: Whole-grain intake is inversely and refined-grain intake is positively associated with the risk of HW.