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

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

Obesity in the elderly and its relationship with cardiovascular risk factors in Taiwan

OBJECTIVES: The obese elderly are at increased risk of mortality, morbidity, and functional disability. In this study, we examined the prevalence of obesity and relationship between various anthropometric indices (AI) and cardiovascular disease (CVD) risk factors in the elderly. RESEARCH METHODS AND PROCEDURES: A stratified multistage clustered sampling scheme was used in the Elderly Nutrition and Health Survey in Taiwan during 1999 to 2000. 2432 non-institutionalized subjects (age, 72.8+/-9.4 years; BMI, 23.6+/-6.4 kg/m2) were recruited. The receiver operating characteristic analysis was used to compare predictive validity of CVD risk factors among various AI, including BMI, waist circumference (WC), and waist-to-hip ratio (WHR). RESULTS: The prevalence of obesity was 29.0% in men and 36.8% in women by obesity criteria for Asians (BMI>or=25 kg/m2) and 13.3% in men and 21.0% in women by the Taiwanese definition (BMI>or=27 kg/m2). Odds ratios of acquiring various CVD risk factors increased significantly with increment of WC, WHR, and BMI. The areas under the curve predicting metabolic syndrome were all <0.8. The cut-off values of WC corresponding to the highest sensitivity and the highest specificity in predicting various CVD risk factors were 86.2-88.0 cm in men and 82.0-84.0 cm in women, respectively. DISCUSSION: Obesity was prevalent in the Taiwanese elderly. WC was related to CVD risk factors to a greater extent than BMI and WHR. However, none of them alone was a good screening tool for CVD risk factors. Therefore, how to apply AI prudently to screen elderly for CVD risk factors needs further research.     

Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the korean genome and epidemiology study

Background: In this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices.Methods: The cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001-2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices.Results: The numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m(2) in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively.Conclusions: Both overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.     

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.     

不同体重指数和腰围人群的血压均值及高血压患病率调查

目的：探讨体重指数(BMI和腰围(WC)对人群血压水平和高血压患病率的影响。方法：对1992—1994年和1998年在中国不同地区男女性中年人群中进行的两次心血管病危险因素调查资科合并共35 003人，比较不同BMI和WC分组的平均血压水平及其高血压患病率。结果：随着BMI和／或WC的增加，人群血压水平、高血压患病率呈明显的上升趋势，在多数BMI组中，男女性WC与血压均值和高血压患病车间存在明显的线性相关关系(线性趋势检验P＜0．05)，同样在不同的WC组中，BMI均与血压均值和高血压患病车间存在明显的线性相关关系。男女性按不同BMI及WC标准分组的年龄调整高血压患病率分别为16．5％、14．1％(BMI＜24kg／m^2，男／女：WC＜85／80cm)，29．8％、20．6％(BMI＜24kg／m^2，男／女：WC≥85／80cm)，29．6％、24．7％(BMI：24．0—27．9kg／m^2，男／女：WC＜85／80cm)，39．2％、30．3％(BMI：24．0—27．9kg／m^2，男／女：WC≥85／80cm)，57．5％、43．3％(BMI≥28kg／m^2，男／女：WC≥85／80cm)。结论：BMI和WC均与人群血压有相互独立的关联，保持BMI和WC均在正常范围是预防高血压的有效措施。     

简易体脂参数估测腹内型肥胖的可靠性评价

目的：评价体重指数（BMI）、腰围（WC）、腰臀比（WHR）估测腹内型肥胖的最佳临界点及敏感度、特异度。方法：应用核磁共振（MRI）对690名受试者（男305人，女385人）进行腹内脂肪（VA）测量，同时测量BMI、WC、WHR。以受试者工作特性（ROC）曲线评价简易体脂参数对腹内型肥胖的诊断价值。结果：①经MRI诊断，超重／肥胖者中61．7％，正常体重者中14．2％呈腹内型肥胖（VA≥100cm^2）；②BMI、WC、WHR与腹内脂肪面积呈显著正相关，尤以WC的相关性最好;③简易体脂参数估测腹内脂肪积聚的最佳切割点为BMI：26kg/m^2,WC:90cm,WHR:0.93;④BMI≥28kg/m^2、WC≥95cm时，95％的男性及90％左右的女性呈腹内型肥胖。结论：BMI、WC及WHR都可估测腹内型肥胖，但以腰围的准确率稍高。     

Body mass index, waist circumference, and risk of coronary heart disease: a prospective study among men and women

OBJECTIVE: The purpose of the study was to assess the risk of CHD associated with excess weight measured by BMI and waist circumference (WC) in two large cohorts of men and women. DESIGN, SETTING, SUBJECTS: Participants in two prospective cohort studies, the Health Professionals Follow-up Study (N = 27,859 men; age range 39-75 years) and the Nurses' Health Study (N = 41,534 women; 39-65 years) underwent 16-year follow-up through 2004. RESULTS: 1,823 incident cases of CHD among men and 1,173 cases among women were documented. Compared to men with BMI 18.5 to 22.9 kg/m2, those with a BMI > 30.0 kg/m2 had a multivariate-adjusted RR of CHD of 1.81 (95% CI 1.48 - 2.22). Among women, those with a BMI > 30.0 kg/m2 had a RR of CHD of 2.16 (95% CI 1.81 - 2.58). Compared to men with a WC < 84.0 cm, those with WC of greater than 102.0 cm had a RR of 2.25 (95% CI 1.77 - 2.84). Among women, the RR of CHD was 2.75 (95% CI 2.20 - 3.45) for those with WC of greater than 88.0 cm. CONCLUSIONS: In these analyses from two large ongoing prospective cohort studies, both BMI and WC strongly predicted future risk of CHD. Furthermore, WC thresholds as low as 84.0 cm in men and 71.0 cm in women may be useful in identifying those at increased risk of developing CHD. The findings have broad implications in terms of CHD risk assessment in both clinical practice and epidemiologic studies.     

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.     

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.     

BMI is strongly associated with hypertension, and waist circumference is strongly associated with type 2 diabetes and dyslipidemia, in northern Chinese adults

Background

Obesity is closely associated with chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia. We analyzed the optimal obesity index cut-off values for metabolic syndrome (MetS), and identified the obesity index that is more closely associated with these chronic diseases, in a population of northern Chinese.

Methods

We surveyed 8940 adults (age, 20–74 years) living in northern China for chronic diseases. Receiver operating characteristics (ROC) analysis, relative risk, and multivariate regression were used to develop an appropriate index and optimal cut-off values for MetS and obesity-related chronic diseases.

Results

Waist circumference (WC) and body mass index (BMI) were good markers for MetS, WC was a good marker for T2DM and dyslipidemia, and BMI was a good marker for hypertension. The optimal BMI cut-off value of MetS was 24 kg/m², and the optimal WC cut-offs were 86 cm and 78 cm in men and women, respectively. Relative risk regression models showed that BMI was associated with hypertension, T2DM, and hypertriglyceridemia and a higher prevalence ratio (PR) for hypertension: 2.35 (95% CI, 2.18–2.50). WC was associated with T2DM, hypertension, and hypertriglyceridemia, with PRs of 2.05 (1.63–2.55) for T2DM and 2.47 (2.04–2.85) for hypertriglyceridemia. In multivariate regression models, the standardized regression coefficients (SRCs) of BMI were greater for SBP and DBP, and the SRC of WC was greater for fasting blood glucose, 2-hour postload blood glucose, triglyceride, and total cholesterol.

Conclusions

Our analysis of a population of northern Chinese indicates that the optimal cut-off values for MetS are WCs of 86 cm in men and 78 cm in women and a BMI of 24 kg/m² in both sexes. BMI was strongly associated with hypertension, while WC was strongly associated with T2DM and dyslipidemia.Key words: obesity, chronic disease, cut-off value     

Derivation of anthropometric cut-off levels to define CVD risk in Sri Lankan adults

Obesity is associated with increased cardiovascular risk. Anthropometric cut-off values derived for Caucasians may not be applicable to other populations. The main objective of the present study was to derive population-specific anthropometric cut-off values to define high CVD risk for Sri Lankan adults. A nationally representative sample of 4474 non-institutionalised adults aged ≥?18 years was analysed. Cut-off values to provide optimum sensitivity and specificity were derived using receiver-operating characteristic curve analysis. BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure and overnight fasting venous blood samples were collected to measure glucose, HDL-cholesterol and TAG. An oral glucose tolerance test was also performed. The results suggested that the age-adjusted BMI, WC and WHR were significantly associated with all cardiovascular risk factors (P?相似文献   

Non-obese (body mass index < 25 kg/m2) Asian Indians with normal waist circumference have high cardiovascular risk

OBJECTIVE: Although the prevalence of obesity is not high in Asian Indians, increased prevalence rates of metabolic perturbations and cardiovascular risk factors have been reported. In this study, we evaluated body mass index (BMI), anthropometric measurements, and body fat profiles of obese and non-obese subjects and correlated those values with cardiovascular risk factors. METHODS: This cross-sectional study involved 639 subjects (170 men and 469 women) from low socioeconomic stratum residing in urban slums of New Delhi. Non-obese subjects were categorized into quartiles of percentage of body fat (%BF) and waist circumference (WC). Using logistic regression analysis, the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of cardiovascular risk factors (diabetes mellitus [DM], hypertension, hypercholesterolemia, hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and high levels of low-density lipoprotein cholesterol) were computed with first quartile in the non-obese group as the reference category for the following five categories: %BF and WC quartiles in the non-obese group and obese group (BMI > or = 25 kg/m(2)). RESULTS: In the non-obese group, approximately 66% of men and 88% of women had at least one risk factor. In non-obese women, significantly high ORs and 95% CIs were found for hypertension (3.2, 1.4-7.2), DM (2.8, 1.2-6.3), and hypertriglyceridemia (3.9, 1.9-8.3) in the upper quartiles of %BF, and significantly high OR (95% CIs) was observed for hypertriglyceridemia (3.9, 1.4-10.8) in non-obese men. Among non-obese men, significantly high OR (95% CIs) was found for hypertriglyceridemia (3.2, 1.0-10.3); among non-obese women, significantly high ORs (95% CIs) were observed for hypertension (2.5, 1.1-5.8) and hypertriglyceridemia (2.5, 1.2-5.2) in the normal range of WC (70-80 cm). CONCLUSION: The study showed that Asian Indians have excess cardiovascular risk at BMI and WC values considered "normal." These data suggested that definitions of "normal" ranges of BMI and WC need to be revised for Asian Indians.     

中国成年人代谢异常相关的体质指数和腰围切点研究

目的 研究中国成年人BMI和腰围与各项代谢危险因素之间的相关性,确定超重肥胖的适宜BMI和腰围切点。方法 中国慢性病前瞻性研究于2004-2008年进行基线调查,并于2013-2014年随机抽取了5%的研究对象进行第2次重复调查。本研究剔除体格指标或代谢危险因素变量缺失或极端值、自报患有恶性肿瘤者,基线纳入501 201人,第2次重复调查纳入19 201人。比较不同BMI和腰围下代谢危险因素异常率,通过受试者工作特征（ROC）曲线分析,确定预测高血压、糖尿病、血脂异常和危险因素聚集的适宜BMI和腰围切点。结果 随BMI或腰围的增加,高血压、糖尿病、血脂异常和危险因素聚集患病率均呈现上升的趋势。依据正确指数最大的原则选取BMI超重切点和腰围切点,男性和女性BMI超重切点均接近24.0 kg/m²,男性腰围切点接近85 cm,女性腰围切点约为80~85 cm。男性和女性中,检出各项代谢危险因素特异度达到90%的BMI切点范围为27.0~28.9 kg/m²,多数接近28.0 kg/m²,以28.0 kg/m²作为肥胖切点。结论 本研究在更新开展的大样本调查中进一步验证了中国肥胖问题工作组2002年推荐的超重和肥胖标准,超重和肥胖的BMI切点分别为24.0和28.0 kg/m²;中心性肥胖的腰围适宜切点男性为85 cm,女性为80~85 cm。     

Discrimination of health risk by combined body mass index and waist circumference

OBJECTIVE: NIH Clinical Guidelines (1998) recommend the measurement of waist circumference (WC, centimeters) within body mass index (BMI, kilograms per square meter) categories as a screening tool for increased health risk. RESEARCH METHODS AND PROCEDURES: The Canada Heart Health Surveys (1986 through 1992) were used to describe the prevalence of the metabolic syndrome in Canada and to test the use of the NIH guidelines for predicting metabolic risk factors. The sample included 7981 participants ages 20 to 74 years who had complete data for WC, BMI, high-density lipoprotein-cholesterol, triglycerides, diabetic status, and systolic and diastolic blood pressures. National Cholesterol Education Program Adult Treatment Panel III risk categories were used to identify the metabolic syndrome and associated risk factors. Logistic regression was used to test the hypothesis that WC improves the prediction of the metabolic syndrome, within overweight (25 to 29.9 kg/m(2)) and obese I (30 to 34.9 kg/m(2)) BMI categories. RESULTS: The prevalence of the metabolic syndrome was 17.0% in men and 13.2% in women. The odds ratios (OR) for the prediction of the metabolic syndrome were elevated in overweight [OR, 1.85; 95% confidence interval (95%CI), 1.02 to 3.35] and obese (OR, 2.35; 95%CI, 1.25 to 4.42) women with a high WC compared with overweight and obese women with a low WC, respectively. On the other hand, WC was not predictive of the metabolic syndrome or component risk factors in men, within BMI categories. DISCUSSION: In women already at increased health risk because of an elevated BMI, the additional measurement of WC may help identify cardiovascular risk.     

成人腰围、体重指数与高三酰甘油血症的关系

目的探讨体重指数（BMI）、腰围（WC）与三酰甘油水平之间的关系,并用受试者工作特征（ROC）凹线评价BMI和WC对诊断高三酰甘油血症的价值。方法以2008年7至9月在我院进行常规体检的1093人（男性707人、女性386人）为研究对象,检测身高、体重、腰围和血三酰甘油水平。比较三酰甘油正常组与异常组BMI和WC的差异。建立BMI和WC的ROC曲线,获得曲线下面积及曲线上各界值点的灵敏度和特异度。结果男女性三酰甘油异常率分别为33．5％和8．3％。三酰甘油异常者的BMI和WC明显大于三酰甘油正常者（P〈0．01）。以BMI诊断高三酰甘油血症的ROC曲线下面积：男性为0．728±0．041、女性为0．708±0．021,最佳界值点：男性为24．5、女性为22．5;以WC诊断高三酰甘油血症的ROC曲线下面积：男性为0．790±0．042,女性为0．714±0．020,最佳界值点：男性为86cm,女性为77cm。结论BMI和WC与三酰甘油水平均相关。BMI和WC是预测高三酰甘油血症较为理想的指标。     

体质指数、腰围、腰臀比与高血压、高血糖的关系及三者对高血压、高血糖的预测价值

目的探讨体质指数（BMI）、腰围（WC）、腰臀比（WHR）与高血压、高血糖的关系及三者对高血压高血糖的预防价值。方法2006年4-9月整群抽取黑龙江省电力医院健康检查中心体检的1751人,测量身高、体重、腰围、臀围、血压和空腹血糖。结果①BMI、WC与血压的相关性比WHR好;WHR、WC与血糖的相关性比BMI好;②logistic回归分析表明3个指标中BMI是高血压重要的预测因子,而WC是高血糖及二者聚集重要的预测因子;③BMI、WC与WHR三者之间两两指标同时存在时对高血糖、高血压及二者聚集都存在交互作用;④当BMI≥25kg/m2时,其OR值在3.02-4.01之间,ARP在58.13%-69.21%之间,PARP在43.79%-55.77%之间;当WC≥85cm（男性）、WC≥80cm（女性）时,其OR值在4.04-6.70之间,PARP在56.47%-75.52%之间;敏感度和特异度均较好,正确指数高,具有较高的公共卫生价值。结论BMI、WC分别是高血压、高血糖重要的预测因子,以BMI≥25kg/m2或WC≥85cm（男性）、WC≥80cm（女性）为超重肥胖切点时,诊断价值最高,建议以此为诊断界值。     

Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men

BACKGROUND: Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. OBJECTIVE: The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. DESIGN: A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. RESULTS: During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend < 0.0001 for all). Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs. Adjustment for BMI substantially attenuated RRs for both WC and WHR. The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes. The cumulative proportions of type 2 diabetes cases identified according to medians of BMI (>/=24.8), WC (>/=94 cm), and WHR (>/=0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. CONCLUSIONS: Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.     

Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds

BACKGROUND: Waist circumference (WC) is strongly linked to obesity-associated risks. However, currently proposed WC risk thresholds are not based on associations with obesity-related risk factors but rather with body mass index (BMI; in kg/m(2)). OBJECTIVE: The objective was to determine the relations of WC to obesity-associated risk factors in a representative sample of US whites and to derive comparable risk thresholds for WC and BMI. DESIGN: Data on 9019 white participants of the third National Health and Nutrition Examination Survey were divided into 2 groups according to the presence of >or= 1 of 4 obesity-associated risk factors: low HDL cholesterol, high LDL cholesterol, high blood pressure, and high glucose. Odds ratio (OR) equations were derived from logistic regression models for WC and BMI with the use of the 25th percentile in the study population as the reference. Receiver operating characteristic curves for identifying risk factors were computed for WC and BMI. RESULTS: At BMIs of 25 and 30, ORs were 1.19 (95% CI: 1.06, 1.35) and 2.37 (95% CI: 1.33, 4.22) for men and 1.56 (95% CI: 1.29, 1.91) and 3.16 (95% CI: 1.94, 5.28) for women, respectively. The corresponding ORs for WC were at 90 and 100 cm for men and at 83 and 93 cm for women. Minima on the receiver operating characteristic curves for men were at 96 cm for WC and at 26 for BMI and for women were at 86 cm for WC and 25 for BMI. CONCLUSION: WC is more closely linked to cardiovascular disease risk factors than is BMI.     

Body mass index, body composition and the chronic energy deficiency classification of rural adult populations in Guatemala.

The present study tested the hypotheses that: (a) individual body composition estimates obtained with the Durnin-Womersley (D-W) equations have low validity in certain populations in developing countries; (b) there exists a poor relationship between the body mass index (BMI) and body composition estimates (fat mass (BFM) and fat-free mass (FFM)), and (c) BMI cut-off estimates (fat mass (BFM) and fat-free mass (FFM)), and (c) BMI cut-off points provide an invalid classification of chronic energy deficiency (CED) in adults. The study involved four samples of rural men and women in Guatemala, who had mean BMI of approximately 21 kg/m2. Body composition estimates were obtained by densitometry in three of the samples. Mean body fat (%) and mean FFM (kg) were: men: 11.6 (+/- 4.7) and 47.7 (+/- 4.9); and women: 21.6 (+/- 5.3) and 35.8 (+/- 3.5), respectively. The D-W equations based on various combinations of skinfold measurements consistently overestimated body fat content with low precision and validity. The BMI was more related to BFM and FFM than to fat proportion, but explained little of the variation in both body components, particularly at low BMI levels. A small number of men and women had BMI values below 18.5 kg/m2, and only one woman fell below 16 kg/m2. The power coefficients of height in the weight/height ratio which provided the strongest correlations with BFM and FFM were: BFM: women: 1.0; men: 1.5; FFM: 0.5 for both women and men. We conclude that the Quetelet index should not be recommended as a universally valid indicator to classify CED in adult groups similar to the study population.     

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.