Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study

OBJECTIVE: A higher waist-to-hip ratio, which can be due to a higher waist circumference, a lower hip circumference, or both, is associated with higher glucose levels and incident diabetes. A lower hip circumference could reflect either lower fat mass or lower muscle mass. Muscle mass might be better reflected by thigh circumference. The aim of this study was to investigate the contributions of thigh and hip circumferences, independent of waist circumference, to measures of glucose metabolism. RESEARCH METHODS AND PROCEDURES: For this cross-sectional study we used baseline data from the Hoorn Study, a population-based cohort study of glucose tolerance among 2484 men and women aged 50 to 75. Glucose tolerance was assessed by a 75-g oral glucose tolerance test; hemoglobin A(1c) and fasting insulin were also measured. Anthropometric measurements included body mass index (BMI) and waist, hip, and thigh circumferences. RESULTS: Stratified analyses and multiple linear regression showed that after adjustment for age, BMI, and waist circumference, thigh circumference was negatively associated with markers of glucose metabolism in women, but not in men. Standardized beta values in women were -0.164 for fasting, -0.206 for post-load glucose, -0.190 for hemoglobin A(1c) (all p < 0.001), and -0.065 for natural log insulin levels (p = 0.061). Hip circumference was negatively associated with markers of glucose metabolism in both sexes (standardized betas ranging from -0.093 to -0.296, p < 0.05) except for insulin in men. Waist circumference was positively associated with glucose metabolism. DISCUSSION: Thigh circumference in women and hip circumference in both sexes are negatively associated with markers of glucose metabolism independently of the waist circumference, BMI, and age. Both fat and muscle tissues may contribute to these associations.     

常用人体测量指标对高血糖的筛查价值探讨

目的探讨体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰围身高比(WHtR)、腰腿比(WTR)与高血糖的关系及其对高血糖的筛查价值。方法 2010年8月整群抽取在北京世纪坛医院健康体检中心体检的某机关工作人员1280名,测量其身高、体重、腰围、臀围、腿围、血压与空腹血糖及生化指标等。结果①此人群空腹高血糖检出率为40.16%,且随着年龄增长高血糖检出率亦增加;高血糖组的WC、BMI、WHtR、WHR、WTR、SBP、DBP、AST、TC、TG、CRE、UA水平均显著高于血糖正常组,而HDL-C水平低于血糖正常组,同时高血糖组脂肪肝的检出率也显著高于血糖正常组。②对于高血糖,WTR的受试者工作特征曲线(ROC)下面积(AUC)为0.716,高于WHtR(0.690)(P<0.001)、WHR(0.682)(P<0.001)、WC(0.682)(P<0.001)、BMI(0.665)(P<0.001);按性别分层后,在男性中,对于高血糖WTR的AUC(0.648)高于WHtR(0.611)(P<0.001)、WHR(0.614)(P<0.001)、WC(0.598)(P<0.001)和BMI(0.587)(P<0.001);在女性中,WTR对于高血糖的AUC为0.758,低于WHtR(0.774)(P<0.001)和WC(0.761)(P<0.001),但高于BMI(0.738)(P<0.001)和WHR(0.732)(P<0.001);在年龄≥35岁的女性中,WTR对于高血糖的AUC为0.725,高于WHtR(0.716)(P<0.001)、WC(0.705)(P<0.001)、WHR(0.676)(P<0.001)和BMI(0.665)(P<0.001);③在调整年龄和性别后,WTR与高血糖的相关性最强(OR=1.70,95%CI 1.37～2.11,每1 SD增量)。结论该机关工作人员空腹高血糖问题较为严重,WTR比其他4个指标能更好地筛查男性高血糖,在年龄大于35岁的女性中,WTR比其他四个能更好地筛查高血糖。     

Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program

BACKGROUND: Greater central adiposity is related to the risk of diabetes. OBJECTIVE: We aimed to test the hypothesis that central adiposity measured by computed tomography (CT) is a better predictor of the risk of diabetes than is body mass index (BMI), waist circumference (WC), waist/hip ratio (WHR), or waist/height ratio. DESIGN: Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured at the L2-3 and L4-5 disc spaces in 1106 of the 3234 participants in the Diabetes Prevention Program. Sex-specific proportional hazards models were used to evaluate the association between VAT and SAT at both cuts, BMI, and other measures of central adiposity as predictors of the development of diabetes. RESULTS: Men had more VAT than did women. White subjects had more VAT at both cuts than did other ethnic groups. The ratio of VAT to SAT was lowest in African Americans of both sexes. Among men in the placebo group, VAT at both cuts, WC, BMI, waist/height ratio, and WHR predicted diabetes (hazard ratio: 1.79-1.44 per 1 SD of variable). Among women in the lifestyle group, VAT at both cuts predicted diabetes as well as did BMI, and L2-3 was a significantly better predictor than was WC or WHR. SAT did not predict diabetes. None of the body fat measurements predicted diabetes in the metformin group. CONCLUSIONS: In the placebo and lifestyle groups, VAT at both cuts, WHR, and WC predicted diabetes. No measure predicted diabetes in the metformin group. CT provided no important advantage over these simple measures. SAT did not predict diabetes.     

The relation of body fat distribution, as assessed by six girth measurements, to diabetes mellitus in women.

Independently of the amount of adipose tissue, certain patterns of fat distribution increase the risk of non-insulin-dependent diabetes. Although the ratio of waist to hip (WHR) circumferences has been consistently related to diabetes mellitus, it is possible that only two measures do not completely characterize fat topography. The current study, therefore, examines the cross-sectional relation of six girths (waist, hip, neck, bust, wrist, and ankle) to diabetes mellitus in 43,595 women. As compared with non-diabetics, Quetelet index (kg/m2) and all circumferences were elevated among diabetics. Stratified analyses showed that WHR, and waist, neck, and bust girths were consistently related to diabetes independently of the degree of overweight. As estimated from a logistic regression model that simultaneously controlled for age and all anthropometric variables, the prevalence of diabetes mellitus was positively related to Quetelet index, and to the waist, bust, and neck girths, with odds ratios (ORs) ranging from 1.4 to 2.6. However, diabetes was inversely related to hip (OR = 0.61) and ankle (OR = 0.73) girths; p less than 0.005 for each association. Although cross-sectional in nature, these results suggest that an adverse body fat distribution is not limited to the abdominal region, but that a relative preponderance of adipose tissue in various regions of the upper body is associated with diabetes mellitus in women.     

533名中老年人高血压患病情况及生理预测指标的探讨

目的：探讨简易体质参数(BMI、WC、WHR)预测高血压的可行性。方法：采用整群抽样调查533名能代表郴州市一般人群生活水平的三个不同社区中的人群。结果：三个社区中高血压患病率、知晓率、控制率分别为13．38％、21．39％、63．16％。体质参数BMI、WC与男女收缩压和舒张压均密切相关(P＜0．05)，而WHR仅与男性舒张压密切相关(P＜0．05)。结论：BMI、WC、WHR是高血压重要的危险因素，可作为高血压病的生理预测指标。     

Predicting incident diabetes in Jamaica: the role of anthropometry

OBJECTIVE: To evaluate the performance of the body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHTR) in predicting incident diabetes in Jamaica. RESEARCH METHODS AND PROCEDURES: A cohort of 728 nondiabetic adults (290 men and 438 women), ages 25 to 74 years and residents of Spanish Town, Jamaica, were followed for a mean of 4 years. Participants had fasting and 2-hour postchallenge glucose concentrations measured at baseline and follow-up. RESULTS: There were 51 cases of incident diabetes (17 men and 34 women). All indices were independent predictors of diabetes, and none was clearly superior. The area under the receiver operating characteristics curves (95% confidence interval) for BMI was 0.74 (0.59 to 0.88) for men and 0.62 (0.51 to 0.72) for women. For waist circumference, these values were 0.78 (0.65 to 0.91) in men and 0.61 (0.50 to 0.71) in women. Similar results were obtained for WHR and WHTR. "Optimal" cut-off points for BMI were 24.8 kg/m(2) (men) and 29.3 kg/m(2) (women). For waist circumference, these were 88 cm and 84.5 cm for men and women, respectively. Corresponding values for WHR were 0.87 and 0.80 and for WHTR were 0.51 and 0.54, respectively. DISCUSSION: Cut-off points for waist circumference and WHR were similar to those proposed in developed countries for women but lower in men. Waist circumference could be useful in health promotion as an alternative to BMI.     

Prescreening tools for diabetes and obesity-associated dyslipidaemia: comparing BMI, waist and waist hip ratio. The D.E.S.I.R. Study

OBJECTIVE: To compare the sensitivities of BMI, waist circumference and waist hip ratio (WHR) in identifying subjects who should be screened for diabetes and/or for obesity-associated dyslipidaemia. DESIGN: Cross-sectional study. SETTING: Central-western France. PARTICIPANTS: More than 3000 men and women, aged 40-64 years, from the French study: data from an epidemiological study on the insulin resistance syndrome (D.E.S.I.R.). MAIN OUTCOME MEASURES: Sensitivity and specificity for screened diabetes (fasting plasma glucose>or=7.0 mmol/l) and screened dyslipidaemia (triglycerides>or=2.3 mmol/l and/or HDL-cholesterol <0.9/1.1 mmol/l (men/women)) according to BMI, waist circumference and WHR. RESULTS: Sensitivities increased as more corpulent subjects were screened, but they increased slowly after screening the top 30%: body mass index (BMI)>or=27/26 kg/m(2) (men/women) or waist >or=96/83 cm or WHR>or=0.96/0.83. These values were chosen as thresholds. In men, BMI had a nonsignificantly higher sensitivity than waist or WHR for both diabetes and dyslipidaemia (77 vs 74 and 66% P<0.3, 0.09; 56 vs 54 and 49% P<0.5, 0.16). For women, waist had a slightly higher sensitivity than BMI or WHR (82 vs 77 and 77% P<0.8, 0.7) for diabetes; for dyslipidaemia, waist and WHR had similar sensitivities, higher than for BMI (65 and 67 vs 54% P<0.16, 0.13). CONCLUSIONS: We propose that for screening in a French population 40-64 years of age, the more obese 30% of the population, identified either by BMI, waist or WHR be screened for diabetes and obesity-associated dyslipidaemia.     

Independent association of hip circumference with metabolic profile in different ethnic groups

OBJECTIVE: In whites, a larger hip circumference has been shown to be associated with a better metabolic profile, after adjustment for BMI and waist circumference. Our aim was to investigate this association in a variety of ethnic groups, some highly susceptible to type 2 diabetes. RESEARCH METHODS AND PROCEDURES: We measured weight, height, waist and hip circumferences, systolic and diastolic blood pressure, fasting and 2-hour postload glucose, triglycerides, and high-density lipoprotein-cholesterol in 1020 Melanesians, 767 Micronesians, 3697 Indians, and 2710 Creoles from Pacific and Indian Ocean islands. Leptin and body fat percentage were determined in Indian and Creole Mauritians only. RESULTS: In all ethnic groups, larger hip circumference was associated with lower glucose and triglyceride levels in both sexes and higher high-density lipoprotein levels in women only, after adjustment for waist circumference, BMI, and age. Adjustment for height or leptin did not materially change the results. DISCUSSION: In conclusion, we confirmed the protective association of relatively larger hips in four nonwhite ethnic groups. Leptin does not seem to play a mediating role in this association.     

Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study

BACKGROUND: A high waist-to-hip ratio is associated with unfavorable cardiovascular disease risk factors. This could be due to either a relatively large waist or a small hip girth. OBJECTIVE: We sought to define the separate contributions of waist girth, hip girth, and body mass index (BMI) to measures of body composition, fat distribution, and cardiovascular disease risk factors. DESIGN: Three-hundred thirteen men and 382 women living in the greater Quebec City area were involved in this cross-sectional study. Percentage body fat, anthropometric measurements, and abdominal fat distribution were obtained and BMI (in kg/m2) and waist-to-hip ratio were calculated. Serum blood lipids were determined from blood samples collected after subjects had fasted overnight RESULTS: A large waist circumference in men and women (adjusted for age, BMI, and hip circumference) was associated significantly with low HDL-cholesterol concentrations (P < 0.05) and high fasting triacylglycerol, insulin, and glucose concentrations (P < 0.01). In women alone, a large waist circumference was also associated with high LDL-cholesterol concentrations and blood pressure. A narrow hip circumference (adjusted for age, BMI, and waist circumference) was associated with low HDL-cholesterol and high glucose concentrations in men (P < 0.05) and high triacylglycerol and insulin concentrations in men and women (P < 0.05). Waist and hip girths showed different relations to body fat, fat-free mass, and visceral fat accumulation. CONCLUSIONS: Waist and hip circumferences measure different aspects of body composition and fat distribution and have independent and often opposite effects on cardiovascular disease risk factors. A narrow waist and large hips may both protect against cardiovascular disease. These specific effects of each girth measure are poorly captured in the waist-to-hip ratio.     

Weight, shape, and mortality risk in older persons: elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death

BACKGROUND: Guidelines for optimal weight in older persons are limited by uncertainty about the ideal body mass index (BMI) or the usefulness of alternative anthropometric measures. OBJECTIVE: We investigated the association of BMI (in kg/m(2)), waist circumference, and waist-hip ratio (WHR) with mortality and cause-specific mortality. DESIGN: Subjects aged >/=75 y (n = 14 833) from 53 family practices in the United Kingdom underwent a health assessment that included measurement of BMI and waist and hip circumferences; they also were followed up for mortality. RESULTS: During a median follow-up of 5.9 y, 6649 subjects died (46% of circulatory causes). In nonsmoking men and women (90% of the cohort), compared with the lowest quintile of BMI (<23 in men and <22.3 in women), adjusted hazard ratios (HRs) for mortality were <1 for all other quintiles of BMI (P for trend = 0.0003 and 0.0001 in men and women, respectively). Increasing WHR was associated with increasing HRs in men and women (P for trend = 0.008 and 0.0002, respectively). BMI was not associated with circulatory mortality in men (P for trend = 0.667) and was negatively associated in women (P for trend = 0.004). WHR was positively related to circulatory mortality in both men and women (P for trend = 0.001 and 0.005, respectively). Waist circumference was not associated with all-cause or circulatory mortality. CONCLUSIONS: Current guidelines for BMI-based risk categories overestimate risks due to excess weight in persons aged >/=75 y. Increased mortality risk is more clearly indicated for relative abdominal obesity as measured by high WHR.     

Body fat distribution in relation to physical activity and smoking habits in 38-year-old European men. The European Fat Distribution Study

The authors studied 512 European men all born in 1950 from six different towns in the period October 1988 to May 1989. Anthropometric measurements were taken, including weight, height, and circumferences (waist, hip, thigh). Educational level, activity scores and information on smoking habits were obtained from a questionnaire. Higher educational level was associated with lower body mass index, waist/hip ratio, and waist/thigh ratio. The sports activity score was negatively related to waist/hip ratio (beta +/- standard error of the mean (SEM): -0.009 +/- 0.003) and waist/thigh ratio (-0.041 +/- 0.007), and this could be attributed to a negative relation with waist circumference and a positive relation to thigh circumference. Smoking habits were not related to body mass index but heavy smokers had larger waist circumferences (difference +/- SEM: 1.4 +/- 0.5 cm) as well as higher waist/hip ratios (difference +/- SEM: 0.014 +/- 0.005) and waist/thigh ratios (0.043 +/- 0.013) compared with men who never smoked. These associations between activity scores and smoking habits and fat distribution remained after adjustment for each other and for body mass index and educational level. The authors conclude that physical activity and smoking are independently related to indicators of fat distribution and may be potential confounders in the relations between fat distribution, risk factors, and disease.     

Waist-to-hip ratio is a better anthropometric index than body mass index for predicting the risk of type 2 diabetes in Taiwanese population

Body mass index (BMI) has been reported to be related to the risk of type 2 diabetes and hypertension. However, waist circumference or waist-to-hip ratio (WHR) can better reflect the accumulation of intra-abdominal fat and might be a better predictor than BMI of the risk of type 2 diabetes and hypertension. We hypothesized that other anthropometric indices rather than BMI could more accurately predict the risk of type 2 diabetes and hypertension. The purpose of this study was to determine which anthropometric index can be a better predictor for forecasting the risk of type 2 diabetes and hypertension in the Taiwanese population. We conducted a cross-sectional study and reviewed data derived from the Nutrition and Health Survey in Taiwan, 1993-1996. The subjects were 2545 men and 2562 women, aged 18 to 96 years. Receiver operating characteristic curve analysis was used to measure the predictive diabetic and hypertensive performance of each anthropometric measurement based on the area under the curve (AUC). Among 5 anthropometric indices, WHR had a significantly adjusted odds ratio (OR) and the highest AUC (0.72 for men and 0.80 for women) to predict the risk of type 2 diabetes. Although BMI had a significantly adjusted OR, the AUC was not the highest among the 5 anthropometric indices used to predict the risk of hypertension. Our findings suggested that WHR is a better anthropometric index for predicting the risk of type 2 diabetes, and the optimal cutoff values of WHR are considered as 0.89 for men and 0.82 for women in the Taiwanese population.     

Obesity in South Africa: the South African demographic and health survey

OBJECTIVES: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. RESEARCH METHODS AND PROCEDURES: A sample of 13,089 men and women (age, > or =15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. RESULTS: Mean BMI values for men and women were 22.9 kg/m(2) and 27.1 kg/m(2), respectively. For men, 29.2% were overweight or obese (> or =25 kg/m(2)) and 9.2% had abdominal obesity (WHR > or =1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m(2)) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. DISCUSSION: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.     

Effect of adiposity and fat distribution on endometrial cancer risk in Shanghai women

The authors conducted a population-based case-control study of 832 endometrial cancer cases and 846 frequency-matched controls in Shanghai, China (1997-2001), to examine the association of overall adiposity and body fat distribution with disease risk. Overall adiposity was estimated using weight and body mass index (BMI); upper body fat distribution was evaluated using waist circumference and waist:hip ratio. Overall and upper-body obesity were both associated with an elevated risk of endometrial cancer. Adjusted odds ratios and 95% confidence intervals for highest-versus-lowest quartile comparisons were 2.6 (95% confidence interval (CI): 2.0, 3.5) for weight, 2.9 (95% CI: 2.2, 3.9) for BMI, 4.7 (95% CI: 3.4, 6.4) for waist circumference, and 3.5 (95% CI: 2.6, 4.8) for waist:hip ratio. The positive associations with weight and BMI vanished after results were controlled for waist circumference, while associations with waist circumference and waist:hip ratio persisted after adjustment for BMI. The positive association with upper-body obesity was more pronounced among younger women, women who had never used oral contraceptives, and women with a history of diabetes mellitus (p for multiplicative interaction < 0.05). Upper-body obesity was related to increased risk among women with low BMI. These results suggest that obesity, particularly upper-body fat deposition, is associated with an increased risk of endometrial cancer.     

Which measure of body fat distribution is best for epidemiologic research?

Multivariate associations were sought between risk factor levels (total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, and systolic and diastolic blood pressures) and two sets of anthropometric variables (four circumferences and six skinfolds) to select a set of anthropometric indicators of body fat distribution that correlate most highly with risk of disease. Subjects were men (n = 285) and women (n = 672) from a study of gallbladder disease in a Mexican American population in Starr County, Texas, 1985-1986. The canonical correlations showed that circumferences (0.49-0.61) and skinfolds (0.42-0.60) were equally well correlated to risk factor levels independently of sex and age. Weights from the canonical analyses suggest that measurements at or above the waist and on the lower limb (thigh) are most heavily loaded toward risk (waist = highest risk; thigh = lowest risk). The simplest and most reliable index of body fat distribution for both sexes is the ratio of waist to thigh circumferences. The more commonly used waist/hip ratio proved more valid in women, but not in men. Simple skinfold indices of body fat distribution were more poorly correlated to risk factor levels than the corresponding circumference ratios. In women, body mass index and waist circumference by themselves did as well as body fat distribution indices in explaining variation in risk factors, suggesting the involvement of visceral fat in the body fat/body fat distribution disease relation.     

Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study

BACKGROUND: It remains controversial whether body mass index (BMI), waist circumference (WC), or waist-hip ratio (WHR) is a better risk predictor of type 2 diabetes. OBJECTIVE: The objective was to examine the sex-specific relevance of WC, WHR, and BMI to the development of type 2 diabetes. DESIGN: The prospective population-based cohort study was based on 3055 men and 2957 women aged 35-74 y who participated in the second (1989-1990) or third (1994-1995) MONICA (Monitoring Trends and Determinants on Cardiovascular Diseases) Augsburg survey. The subjects were free of diabetes at baseline. Hazard ratios (HRs) were estimated from Cox proportional hazards models. RESULTS: During a mean follow-up of 9.2 y, 243 cases of incident type 2 diabetes occurred in men and 158 occurred in women. Multivariable-adjusted HRs across quartiles of BMI were 1.0, 1.37, 2.08, and 4.15 in men and 1.0, 3.77, 4.95, and 10.58 in women; those of WC were 1.0, 1.15, 1.57, and 3.40 in men and 1.0, 3.21, 3.98, and 10.70 in women; those of WHR were 1.0, 1.14, 1.80, and 2.84 in men and 1.0, 0.82, 2.06, and 3.51 in women. In joint analyses, the highest risk was observed in men and women with a high BMI in combination with a high WC and a high WHR. CONCLUSIONS: Both overall and abdominal adiposity were strongly related to the development of type 2 diabetes. Because there was an additive effect of overall and abdominal obesity on risk prediction, WC should be measured in addition to BMI to assess the risk of type 2 diabetes in both sexes.     

Anthropometric indices of school children and familiar risk factors

BACKGROUND: Overweight in adolescence predicts adverse health effects in adulthood. We carried out a primary school health program and assessed children's growth and body composition. METHODS: Were screened 869 (448 M, 421 F) primary school children: height, weight, four skinfolds, and four circumferences were measured. A family-reported questionnaire was used to determine family composition, history, and lifestyle. RESULTS: Age was 118 +/- 5 months, BMI 18 +/- 3 kg/m(2). No difference by gender was observed as for BMI or blood pressure. Girls had higher skinfold thickness at the biceps (BCF), triceps (TCF), subscapular (SSF), and suprailiac (SIF) areas (P < 0.001), hip and thigh circumferences (P < 0.01), body fat percentage (P < 0.001). Boys had higher waist circumference (P < 0.01), waist/thigh ratio, and conicity index (P < 0.001). Offspring BMI was correlated with birth weight (P < 0.05), parental BMI and scholarship level (P < 0.001), children blood pressure (P < 0.001), and hours per day spent in television viewing (P < 0.01). Family history for diabetes was associated with higher BMI, SSF, waist circumference (P < 0.05), and upper thigh (P < 0.01). Family history for hypertension was associated with higher SSF/TCF ratio (P < 0.05). CONCLUSIONS: Three of 869 children had BMI >30 kg/m(2) (2 boys and 1 girl), 33 had BMI >25 kg/m(2) (17 boys and 16 girls). The percentages of children who could be considered overweight (BMI >/=95(th) percentile of age- and sex-specific NHANES I reference data) were boys, 10.0%, and girls, 9.3%. Anthropometric and anamnestic data on child and family yield more accurate estimates of risk profile: fat distribution seems relevant for metabolic and cardiovascular disorders.     

Skinfold and body circumferences as measures of body fat patterning in a French female active population: relationships with the metabolic risk profile

Body mass index (BMI), various anthropometric indices of abdominal fat distribution and some metabolic variables (blood lipids, fasting glucose, blood pressure) were measured in 408 French-born women from an occupational population who volunteered for the study. The aim of the study was to determine the best index for describing the relationships between the body fat pattern and the metabolic risk profile. The four age-adjusted circumference ratios (waist/hip, waist/thigh, xiphoid/hip, xiphoid/thigh) showed similar associations with the metabolic variables whereas the three age-adjusted skinfold ratios (epigastric/thigh, mesogastric/thigh, hypogastric/thigh) tended to be more weakly associated with the metabolic variables, particularly with apolipoprotein (Apo) B and fasting glucose. Multiple regression analyses showed that age-adjusted BMI was significantly related to high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, Apo A and Apo B, and blood pressure, independently of abdominal fat distribution. After controlling for the effects of BMI, the waist/thigh ratio remained significantly associated to triglyceride, Apo B, fasting glucose, and systolic blood pressure, whereas the waist/hip ratio and the mesogastric/thigh skinfold ratio were significantly related only to triglyceride and systolic blood pressure independently of BMI. With the exception of triglyceride and fasting glucose, the degree of association between the metabolic variables and the abdominal fat distribution tended to be weaker than that observed with the BMI. These results emphasize the importance of the global corpulence in the levels of metabolic variables. However, all indices of abdominal fat distribution were, to varying degrees, independently associated with an unfavorable metabolic profile. Among them, the waist/thigh circumference ratio seems to be a useful indicator of the body fat pattern in women.     

Use of anthropometric measurements in assessing risk for coronary heart disease: a useful tool in worksite health screening?

The study examined the association between the anthropometric measurements body mass index (BMI), waist/hip ratio (WHR), and waist/thigh ratio (WTR) and cardiovascular risk factors, and assessed whether a combination of BMI and WHR could be used in routine screening of risk for cardiovascular arteriosclerotic disease at worksites. The data were obtained from a cross-sectional survey designed to assess the nutritional situation, with special reference to cardiovascular risk factors. The study population comprised 372 healthy men working on platforms in the North Sea. Serum cholesterol, triglyceride, fibrinogen, and blood pressure were positively related to the anthropometric variables, while high-density lipoprotein (HDL) was inversely related with them. The relations remained after adjusting for possible confounders, such as age, smoking, physical activity, and an indicator of dietary fat intake. In stepwise multiple linear regression models, BMI, WHR, and WTR were positively related to serum cholesterol, triglycerides, fibrinogen, diastolic blood pressure, and systolic blood pressure, and inversely related to HDL. When controlling for the anthropometric variables WHR and WTR, BMI was not independently related to fibrinogen and risk score. WHR and WTR were not independently related to systolic and diastolic blood pressure, and WTR was in addition not related to triglycerides when controlling for BMI. Overall, the anthropometric variables BMI and WHR were considered the best predictors for CAD risk when taking several risk factors into consideration. A joint variable between BMI and WHR, called body score, constituted the four categories lean, lean android, overweight gynoid, and overweight ovoid. This body score was positively associated with levels of serum lipids, fibrinogen, and blood pressure, and inversely associated with HDL. In stepwise multiple linear regression models, controlling for possible confounding variables, body score was positively related to CAD risk. Dividing the risk score into tertiles, about 51% of the lean were in the first, while 46% of the overweight ovoid were in the third tertile. Those classified as lean android or overweight gynoid had about the same distribution, namely between 31% and 39% in each tertile if the two categories were combined. These data support the hypothesis that BMI, WHR, and WTR are independent predictors for risk factors for CAD among oil workers, and that combinations of BMI and WHR are strong enough predictors to be useful in routine screening for CAD risk at worksites. Based on these findings, supported by data from the literature, a matrix aimed at screening for follow-up at worksites is proposed.     

Relationship of total and abdominal adiposity with CRP and IL-6 in women

PURPOSE: To examine the relationship between different measures of adiposity as predictors of C-reactive protein (CRP) and interleukin-6 (IL-6) levels. METHODS: A cross-sectional study of 733 women free from preexisting cardiovascular disease or cancer at baseline. MEASUREMENTS: Total adiposity, as measured by body mass index (BMI). Abdominal adiposity, as measured by waist circumference (WC) and waist/hip ratio (WHR). High sensitivity CRP levels and IL-6 levels. RESULTS: BMI, WHR, and WC were all significantly correlated with CRP and IL-6, throughout the anthropometric spectrum. After adjustment for risk factors, the odds ratios (ORs) were 12.2 (95% CI, 6.44-23.0) for elevated CRP (>/=75th percentile) and 4.13 (95% CI, 2.37-7.18) for elevated IL-6 (>/=75th percentile) in comparisons of extreme BMI quartiles. Among women in the highest WC quartile, the OR for elevated CRP and IL-6 were 8.57 (95% CI, 4.59-16.0) and 4.40 (95%CI, 2.46-7.89), while ORs for the highest WHR quartile were 2.88 (95% CI, 1.60-5.19) and 1.76 (95% CI, 1.03-3.01), respectively. Compared with lean nonusers, women in the highest BMI quartile who did not use hormone therapy (HT) had an OR for elevated CRP of 7.79 (95% CI, 2.08-29.2) vs. 31.6 (95% CI, 7.97-125.6) for current hormone users. CONCLUSIONS: Indices of both total and abdominal adiposity were strongly associated with significant increased levels of CRP and IL-6. This association was evident across the entire spectrum of BMI.