Waist circumference and waist-to-hip ratio in Turkish adults: interrelation with other risk factors and association with cardiovascular disease

Indicators of hypertriglyceridemia from anthropometric measures based on data mining

BACKGROUND

The best indicator for the prediction of hypertriglyceridemia derived from anthropometric measures of body shape remains a matter of debate. The objectives are to determine the strongest predictor of hypertriglyceridemia from anthropometric measures and to investigate whether a combination of measures can improve the prediction accuracy compared with individual measures.

METHODS

A total of 5517 subjects aged 20-90 years participated in this study. The numbers of normal and hypertriglyceridemia subjects were 3022 and 653 females, respectively, and 1306 and 536 males, respectively. We evaluated 33 anthropometric measures for the prediction of hypertriglyceridemia using statistical analysis and data mining.

RESULTS

In the 20-90-year-old groups, age in women was the variable that exhibited the highest predictive power; however, this was not the case in men in all age groups. Of the anthropometric measures, the waist-to-height ratio (WHtR) was the best predictor of hypertriglyceridemia in women. In men, the rib-to-forehead circumference ratio (RFcR) was the strongest indicator. The use of a combination of measures provides better predictive power compared with individual measures in both women and men. However, in the subgroups of ages 20-50 and 51-90 years, the strongest indicators for hypertriglyceridemia were rib circumference in the 20-50-year-old group and WHtR in the 51-90-year-old group in women and RFcR in the 20-50-year-old group and BMI in the 51-90-year-old group in men.

CONCLUSIONS

Our results demonstrated that the best predictor of hypertriglyceridemia may differ according to gender and age.

Cutoff point of waist circumference for the diagnosis of metabolic syndrome in an Iranian population

SUMMARY

BACKGROUND

Proposed cutoffs for waist circumference (WC) in western populations may be not appropriate for Asian populations. The published data among Iranians are insufficient to address this issue. This study was designed to identify cutoffs for WC that confer increased risk of metabolic syndrome in Iranian adults living in Zanjan, a province located in the west of Tehran.

MATERIALS AND METHODS

Data of a cross-sectional sample of 3277 Iranian adults aged more than 20 years were analyzed. In the original study individual body weight, height, WC, and blood pressure were assessed and fasting plasma glucose, triglycerides, total cholesterol, low- and high-density lipoprotein cholesterol were measured. After excluding WC, existence of two or more of the remaining four risk factors of the modified NCEP III criteria for metabolic syndrome were defined as multiple risk factors. Receiver operating characteristic (ROC) analysis was used to find out the optimal cutoff values of WC to predict metabolic syndrome.

RESULTS

The cutoff level yielding the maximal sensitivity and specificity for predicting the presence of metabolic syndrome (multiple risk factors) was 87 cm in men and 82 cm in women. Cutoffs corresponding to body mass index (BMI) 25 and 30 kg/m(2) to predict metabolic syndrome were 84 and 97 cm in men and 78 and 91 cm in women, respectively.

CONCLUSIONS

Lower cutoffs for WC should be considered in the identification of Iranian population at high risk of metabolic syndrome.

The alarm and action levels of waist circumference in overweight and obese Turkish women

SUMMARY

OBJECTIVE

To determine 'alarm and action levels' of waist circumference (WC) in overweight and obese Turkish women and investigate the relationship with cardiovascular risk factors.Research subjects and methods: Four thousand three hundred and seventy-five women aged 18-81 years selected from Istanbul Faculty of Medicine Obesity outpatient clinic. WC, waist-to-hip ratio (WHR), body mass index [(BMI) (weight (kg)/height (m(2)))], blood pressure, and biochemical parameters were analyzed.

RESULTS

There was strong correlation between BMI and WC levels (r: 0.852). The regression equation which describes this correlation [WC = 1.68 × BMI (kg/m(2)) + 39.2 ± 1.6] was applied to 500 random samples in order to define alarm and action levels for WC. Our results indicated that alarm level of WC at BMI 25 kg/m(2) is 81 cm and action level of WC at BMI 30 kg/m(2) is 90 cm. Validating samples were divided into three groups: group I (WC levels below 81 cm, n: 421), group II (WC levels between 81 and 90 cm, n: 718), group III (WC levels above 90 cm, n: 2736) and further correlative analyses were performed. Strong differences within alarm and action groups in terms of cardiovascular risk factors were identified. The prevalence and mean values of cardiovascular risk factors significantly increased with WC. In group 1 one or more risk factor prevalence was 64.8%, whereas in groups 2 and 3 prevalence was increased to 76.8 and 89%, respectively.

CONCLUSION

Turkish women with WC greater than 81 cm should gain no further weight and those greater than 90 cm should reduce their weight.

Exploring risk factors in Latino cardiovascular disease: the role of education, nativity, and gender

OBJECTIVES

We examined 3 cardiovascular disease risk factors by nativity and gender, evaluating evidence for education and health behaviors in explaining the "Hispanic Health Paradox."

METHODS

We analyzed 2001-2008 National Health and Nutrition Examination Survey data for adults (n = 6032) to compare hypertension, high waist circumference, and diabetes for US- and foreign-born Mexican men and women. We controlled for age, depression, and health insurance.

RESULTS

Cardiovascular disease risk factors differed by education, nativity, and gender. Higher education was associated with higher odds of hypertension and high waist circumference for men and women regardless of nativity. As education increased, the odds of diabetes increased for US-born women, showing a gradient for this population. Finally, foreign-born Mexican women with 5 to 19 years in the United States conferred the highest odds of having diabetes, whereas foreign-born men with less than 5 years in the United States had the lowest odds for high waist circumference and presence of diabetes.

CONCLUSIONS

Results contest assumptions of the Hispanic Health Paradox and suggest new approaches. New research can yield accurate information to ensure the development of appropriate interventions, decreasing health disparities endemic to a subgroup of Latinos.

Protocol variations in arm position influence the magnitude of waist girth

Waist girth is recognised as a better predictor of obesity, particularly abdominal obesity, compared to other measures. Although several protocols for waist girth exist, arm position is either ignored, or not specified in unambiguous terms. Therefore, the purpose of this study was to determine if arm position influenced anthropometric waist girth measurement. Waist girth was measured in 92 adults (19 males, 73 females) with arms relaxed, abducted, horizontal, folded across the chest (three variations) and raised vertically. Duplicate measures, in all positions, were recorded by a single International Society for the Advancement of Kinanthropometry (ISAK)-trained technician to a precision of 0.2% technical error of measurement (TEM). Arm position had a significant effect (P < 0.001) on waist girth. Male participants had greater waist girth than females (P < 0.001) and the waist girth differences across the varying arm positions exhibited a significant position-by-gender interaction (P < 0.001). The arm position-by-body mass index (BMI) category interaction was also significant (P = 0.016) with greater differences observed at higher BMI. These findings suggest caution in comparing results of different studies where arm position is not specified and indicate that the arm position corresponding to the ISAK protocol has the lowest error and is therefore recommended.

Anthropometric studies on the Turkish population--a historical review

A historical review of anthropometric studies conducted on Turkish children and adults is presented. In view of observed differences in growth status between children of different societies, the need for local reference standards and the methodology to be used for such studies have been stressed. The importance of local studies in reflecting the state of health and nutrition both in children and adults has also been mentioned. While a number of studies in children cited in this paper are designed to compare the growth of children from different socioeconomic levels, other studies aim to establish local reference data for Turkish children. While the historical studies in adults aim to define racial characteristics, the more recent studies aim to bring out nutritional characteristics with emphasis on increasing frequency of obesity.

Relation of anthropometric variables to coronary artery disease risk factors

BACKGROUND AND OBJECTIVES

Anthropometric variables and their relation to conventional coronary artery disease (CAD) risk factors in railway employees have been inadequately studied in India. This cross-sectional survey was carried out in the Solapur division of the Central railway in the year 2004, to assess the anthropometric variables in railway employees and their relation to conventional CAD risk factors.

MATERIALS AND METHODS

A total of 995 railway employees, with 872 males and 123 females participated in this cross-sectional study. All subjects underwent anthropometric measurements, fasting lipid profile, and blood sugar level. Various anthropometric indices were calculated for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and abdominal volume index (AVI). Statistical analysis was done by EPI Info 6 statistical software.

RESULTS

Compared to all other obesity indices, WHtR was most prevalent in both genders. High WHtR was present in 699 (80.16%) males and 103 (83.73%) females. Age ≥45 years, high systolic BP, high diastolic BP, low HDL, high triglyceride, and diabetes mellitus were positively correlated with high BMI, high WC, high WHR, high WHtR, and high AVI. High BMI, high WC, high WHR, high WHtR, and high AVI were negatively associated with physical inactivity.

CONCLUSIONS

Over all, anthropometric variables in both genders were significantly deranged in subjects with coronary risk factors. Compared to all other anthropometric variables, WHtR was statistically significantly associated with a majority of coronary artery risk factors. Hence we recommend inclusion of WHtR as a parameter of obesity to predict coronary artery disease risk factor along with WC, WHR, and BMI in epidemiologic studies.

Use of knee height for the estimation of stature in elderly Turkish people and their relationship with cardiometabolic risk factors

The determination of the approximately truest value in height measurement is important in many fields, but it is difficult to perform true measurements, especially in the elderly individuals. We planned to investigate the following items in geriatric Turkish population: to calculate the decrease in height with advancing age by using the standing height measurement and estimated height derived from the knee height; to evaluate the significance of difference between the two measurement methods in the calculation of body mass index (BMI) and waist/height ratio (WHtR); to determine the cut-off value of WHtR according to estimated height in elderly individuals. We studied 551 cases aged between 19 and 97 years. Knee height was measured using a sliding caliper in a sitting position. Linear regression analysis was carried out to derive predictive equations for the estimation of stature with adults (≤ 50 years of age) according to the gender. This equation was then used to estimate height among elderly subjects. Of the cases, 60.3% were <60 years (mean: 48.75 ± 7.50); 39.7% of the cases were >60 years (mean: 69.51 ± 7.12). Estimated BMI (EBMI) measurements in the females and males >60 years were in average 1.23 kg/m(2) and 0.92 kg/m(2) higher than their real BMIs, respectively. EBMI measurements in the females <60 years were 0.32 kg/m(2) higher than their real BMIs (p<0.01). There is a statistically significant difference between WHtR in the females of both age groups, and in the males >60 years, as compared to our estimated WHtR (EWHtR) measurements (p<0.01). The cut-off point of WHtR was 0.61 and 0.58 in the female and male cases of >60 years in our study, respectively. WHtR seemed to be a better anthropometric index that could predict most cardiometabolic risk factors in our study. EWHtR emerged to be a better cardiometabolic risk index especially in the elderly group.

Body mass index, waist-to-hip ratio and waist/height in adult population from Backa and Banat - the Republic of Serbia

BACKGROUND

Nutritional status is vital in the assessment of physical fitness and health status of populations.

AIM

This study aimed to describe relationships between BMI, waist-to-hip ratio (WHR) and waist/height (W/Ht) and factors such as education, residence, origin and ethnic belonging among adults in Backa and Banat.

SUBJECTS AND METHODS

The study was conducted in 47 villages in the north of Serbia. The tested group consisted of 4247 individuals, aged 20+.

RESULTS

The problem of overweight and obesity was more common among men (66%) than women (49.71%). In the group with normal BMI, the majority of men and women were characterized by normal WHR and W/Ht values, but among them there were also groups with incorrect WHR (males >or= 0.95, females >or= 0.8) and W/Ht (>or= 0.5). Socio-demographic factors had a little impact on BMI, WHR and W/Ht in men in certain age groups while their impact was higher in women. These factors, especially education and origin, had a significant impact on nutritional status in young and middle-aged women, whereas they were not significant in older female participants (> 60).

CONCLUSION

Despite the fact that this part of the country has undergone intensive social changes since the last decade of 20th century, the nutritional status of the population has not significantly changed.

Social relationships and negative emotional traits are associated with central adiposity and arterial stiffness in healthy adolescents

OBJECTIVE

We examined the role of social relationships and negative emotional traits in the development of central adiposity and arterial stiffness in healthy adolescents.

DESIGN

A prospective, longitudinal study examined 213 Black and White adolescents (50% Black, 51% female); 160 returned for a second assessment approximately 3 years later.

MAIN OUTCOME MEASURES

Psychosocial variables at both assessments were measured with the Measurement of Attachment Qualities (Carver, 1997), Social Relationships Index (study entry only; Uchino, Holt-Lunstad, Uno, & Flinders, 2001), Spielberger Trait Anger and Anxiety (Spielberger et al., 1979), and the Cook-Medley Hostility Scale (Cook & Medley, 1954). Central adiposity was assessed by waist-to-hip ratio (WHR) at both assessments and arterial stiffness by pulse wave velocity (PWV) at the second assessment only.

RESULTS

Linear regression models controlled for demographic variables and body mass index showed that adolescents with less Supportive Relationships (beta = -.121, p = .05) and higher Trait Anger (beta = .117, p = .05) had increased WHR over time, adjusted for initial WHR. Those with higher Attachment Anxiety (beta = .211, p = .01) and Total Hostility (beta = .234, p < .01) had greater PWV. Psychosocial associations for PWV were more apparent among Blacks.

CONCLUSION

Psychosocial variables may be important in the development of central adiposity and arterial stiffness in adolescence.

Determination of the Leading Central Obesity Index among Cardiovascular Risk Factors in Iranian Women

Background

It is unknown whether the waist circumference (WC) or the waist-to-hip ratio (WHR) is a better predictor of cardiovascular risk factors at different ages.

Objective

To compare WC and WHR as predictors of cardiovascular risk factors and to determine the prevalence of some cardiovascular risk factors in overweight and obese adult women at different ages.

Methods

In this clinical cross-sectional study, 714 overweight and obese women aged 20 to 70 years who were referred to two nutrition clinics in Sistan and Baluchestan province, Islamic Republic of Iran, were studied. The subjects were classified into three groups, 20 to < 35, 35 to < 50, and > or = 50 years of age. Anthropometric indices were measured according to the standard protocol. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and TC/HDL-C ratios were enzymatically determined.

Results

Older subjects (> or = 50 years old) had significantly higher values of body mass index (BMI), WC, TC, TG, and LDL-C than those in the two younger age classes. The prevalence rates of obesity, high WC, high WHR, high TC, high TG, high LDL-C, and high TC/HDL-C ratios were higher in the older subjects. After adjustment for age and BMI, multiple linear regression showed that WC was significantly related to TC and TG in the 20- to < 35-year-old group and to TG in the 35- to < 50-year-old group. In the older participants, WHR was significantly related to TG.

Conclusions

The prevalence of cardiovascular risk factors increases with age. In clinical practice, WC is a better index for predicting some cardiovascular risk factors in younger and middle-aged women; however, for older women, WHR is better.

Age, body composition, and reproductive indices as predictors of radiographic hand osteoarthritis in Chuvashian women

OBJECTIVES

In our observational cross-section population-based study, we evaluated the predictors (age, body composition indices, age at menarche, and age at menopause) of radiographic hand osteoarthritis (OA) from a sample of women of European origin, who were not receiving any medication for prevention or treatment of OA.

METHODS

Our population consisted of 745 Chuvashian females with a mean age of 48.65 years (range 18-84 years) residing in peripheral villages of the Russian Federation. OA was evaluated using the Kellgren and Lawrence grading scheme. To evaluate the relationship between age, age at menarche, age at menopause, body composition indices [body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), somatotypes (ectomorphy, mesomorphy, and endomorphy)], and an individual's osteoarthritis score (Tot28) as the dependent variable, we used multiple linear regression analysis (stepwise method).

RESULTS AND CONCLUSIONS

Statistically significant predictors of hand OA in women were found to be the following: age (beta = 0.748, p = 0.000), mesomorphy (beta = 0.120, p = 0.000), WHR (beta = 0.117, p = 0.001), endomorphy (beta = -0.089, p = 0.006), and age at menarche (beta = -0.066, p = 0.012). Age was the most powerful factor in determining hand OA. Mesomorphy, the measure of muscular development was a significant predictor of hand OA. Endomorphy showed a very small, but significant, negative association with hand OA. However, BMI and WC showed no association, leading us to conclude that obesity is a mechanical rather than a systematic risk factor for OA. Age at menarche was negatively associated with hand OA, possibly because early menarche is associated with an increased rate of the general ageing process.

Effects of postmenopausal hormone replacement therapy on body fat composition

AIM

To evaluate the effects of different types, regimens and administration routes of hormone replacement therapy (HRT) on body fat composition indices in postmenopausal women at increased risk of anthropometry-related cardiovascular disease (CVD).

METHODS

Fifty-nine postmenopausal women (aged 41-57 years, mean +/- standard deviation: 49.9 +/- 3.8 years) with body mass index (BMI) > or =25 kg/m(2) participated in this 6-month, prospective, randomized single-blind study. Subjects were assigned into three groups and received transdermal estradiol (E2)/norethisterone acetate (NETA) (50 microg E2 daily for 14 days followed by 50 microg E2/0.25 microg NETA daily for 14 days; transdermal group, n = 19), transdermal continuous E2/oral medroxyprogesterone acetate (MPA) (50 microg E2/5 mg MPA daily; transdermal/oral group, n = 19) or oral continuous E2/NETA (1 mg E2/0.5 mg NETA daily; oral group, n = 21). Anthropometric indices (body weight, height, and hip and waist circumferences) were measured, and BMI and waist-to-hip ratio (WHR) were calculated, before and after treatment. Also, the thickness of subcutaneous abdominal fat was measured by ultrasound. Depending on waist circumference (WC), the subjects were divided into two risk groups: increased-risk group with WC <88 cm (n = 32) and high-risk group with WC > or =88 cm (n = 27). Also, the effects of HRT were evaluated separately in subjects with median subcutaneous fat of <33 mm (n = 29) and those with median subcutaneous fat of > or =33 mm (n = 30).

RESULTS

Overall, all three types of HRT caused a significant decrease in both WC and subcutaneous fat (p < 0.001), and also in WHR (p < 0.05). There was no significant difference in baseline (p > 0.05) and final values (p > 0.05) between HRT groups. In each group, all types of HRT significantly decreased WC and subcutaneous fat (transdermal group: p < 0.001 and p < 0.05; transdermal/oral group: p < 0.001 and p < 0.01; oral group: p < 0.001 and p < 0.001, respectively), while body weight, BMI and WHR changed only insignificantly (p > 0.05). In the increased-risk group, body weight increased significantly (p < 0.05) while WC and subcutaneous fat decreased significantly (p < 0.001 and p < 0.001). As for the high-risk group, there was a significant decrease in WC and subcutaneous fat (p < 0.001, p < 0.001) while the remaining parameters did not change significantly. However, BMI showed a tendency to increase in the increased-risk group, while there was a decrease in all measurements in the high-risk group. Regardless of the drugs used and baseline subcutaneous fat, WC and subcutaneous fat decreased significantly at the end of the treatment (subcutaneous fat <33 mm: p < 0.001 and p < 0.01; subcutaneous fat > or =33 mm: p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

The three different types of HRT have comparable effects on central fat tissue in women at increased risk of anthropometry-related CVD. Indeed, the three combinations of HRT reduced fat tissue in the central part of the body. However, the overall effect of HRT was more marked in women with WC > or =88 cm and subcutaneous fat > or =33 cm. Whether HRT increases body weight depends on the body composition indices of individuals before treatment.

Anthropometric measures and nutritional status in a healthy elderly population

Background

Anthropometric evaluation is an essential feature of geriatric nutritional evaluation for determining malnutrition, being overweight, obesity, muscular mass loss, fat mass gain and adipose tissue redistribution. Anthropometric indicators are used to evaluate the prognosis of chronic and acute diseases, and to guide medical intervention in the elderly. We evaluated anthropometric measurements and nutritional status as they relate to age and gender in healthy elderly people.

Methods

The study analyzed data from the national survey "Health needs and health service use by older-than-60-year-old beneficiaries of the Mexican Institute of Social Security (IMSS)". The present study included only individuals who reported no chronic disease in the last 20 years and had no hospital admission in the two months prior to the survey. Anthropometric measurements included weight, height, body mass index (BMI), body circumference (arm, waist, hip and calf), waist to hip ratio (WHR), elbow amplitude and knee-heel length.

Results

Application of the inclusion criteria resulted in a study population elderly of 1,968, representing 12.2% of the original number in the national survey in urban areas beneficiaries of the IMSS. The study population comprised 870 women and 1,098 men, with a mean age of 68.6 years. The average weights were 62.7 kg for women and 70.3 kg for men (p < 0.05), and the mean heights were 1.52 m for women and 1.63 m for men (p < 0.05). Age related changes in anthropometric values were identified. BMI values indicated that 62.3% of the population was overweight, and 73.6% of women and 16.5% of men had high fat tissue distribution.

Conclusion

Our findings suggest that applying the BMI thresholds that identify being overweight in the general adult population may lead to an overestimation in the number of overweight elderly Similar problems appear to exist when assessing waist circumference and WHR values. Prospective studies are required to determine the associations between health and BMI, waist circumference and WHR in the elderly.

Association of Calcium Intake, Dairy Product Consumption with Overweight Status in Young Adults (1995–1996): The Bogalusa Heart Study

OBJECTIVE

To examine the association between calcium intake and dairy product consumption with overweight and obesity in young adults.

METHODS

The sample used in this study consisted of 1306 young adults, ages 19-38 years, who participated in the 1995-1996 young adult survey. Analysis was performed with analysis of covariance (ANCOVA) for ethnicity-gender groups separately.

RESULTS

No significant association was found between dairy product consumption, calcium intake and overweight, defined by body mass index or waist circumference. However, there was a significant inverse association between calcium intake, low-fat dairy product consumption and waist-to-hip ratio in white males.

CONCLUSION

Increasing intake of calcium and low-fat dairy products may be associated with lower abdominal adiposity, particularly in young adult white males.

Prospective epidemiologic evidence of a "protective" effect of smoking on metabolic syndrome and diabetes among Turkish women--without associated overall health benefit

Sex-specific effects of cigarette smoking on the development of metabolic syndrome (MS) and diabetes (DM), concomitant with its clinical impact on CHD, were prospectively evaluated in a cohort of 3385 participants (mean age 48 years), representative of Turks. Heavy smoking denoted smoking 11 or more cigarettes daily. During a mean 5.9-year follow-up, 485 incident cases of MS and 216 of DM were diagnosed. Among women, baseline characteristics as a whole were similar. Smoking status was inversely associated with waist circumference (p=0.004) and predicted in women hyperinsulinemia (p=0.045) after adjustment for age and body mass index. In the prediction of MS, heavy smoking was significantly "protective" (RR 0.50 [95% CI 0.26; 0.94]) in women and in both genders combined, after adjustment for age, baseline family income bracket and physical activity grade. As predictor of new DM, heavy smoking was significantly "protective" (RR 0.54 [95% CI 0.35; 0.83]) in all adults and in women (RR 0.13 [95% CI 0.02; 0.97]), after similar adjustment. Additional adjustment for insulin and CRP levels hardly modified in women the RRs, though attenuated to borderline significance risk for MS and DM due to smaller sample size. Risks of incident CHD and overall mortality were significantly elevated in smoking men, but not in women, when adjusted for age, serum total cholesterol, elevated BP, DM and physical activity grade.

CONCLUSIONS

Heavy cigarette smoking is "protective" of future MS and DM in Turkish women, mainly via protection from obesity. A separate modest effect on central obesity appeared independent of plasma insulin concentrations. Evidence of a translated beneficial effect on subsequent CHD or all-cause mortality did not emerge.

Indices of body composition and chronic morbidity: a cross-sectional study of a rural population in central Russia

Our objective was to clarify how different groups of chronic morbidities are associated with indices of body composition, such as body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), skinfold index (SF), and fat-free mass index (FFMI). Our sample comprised Chuvasha residing in numerous villages in a rural area of the Russian Federation. The investigated cohort included 787 males aged 18-89 years, and 716 females aged 18-90 years. We performed a cross-sectional, community-based study of a large sample of individuals not receiving any medications for treatment or prevention of chronic morbidities. To elucidate the association between morbidity and age-adjusted anthropometrical indices, we used one-way analysis of variance, wherein the above indices were the dependent variables, while individuals affected vs. nonaffected for a specific disease were the grouping variables. Individuals with ischemic heart disease, diabetes mellitus, hypertension, and peptic ulcer showed significant differences in their BMI, WC, WHR, and SF. In the first diseases, mean values of anthropometric indices were higher in affected individuals, whereas in the peptic ulcer group, mean values were higher in the nonaffected. Skin diseases and gynecological diseases showed significant differences in WHR. Mean values in affected individuals were lower than in the nonaffected. The group afflicted with local forms of arthritis showed significant differences in FFMI, suggesting that arthritis is not linked to obesity, but is linked to high lean mass. Rheumatic diseases positively correlated with WC and FFMI.

Prevalence of obesity in Kuwait and its relation to sociocultural variables

This study ascertains the prevalence of obesity and its relationship with some sociocultural characteristics in Kuwaiti society. The sample involved 212 men and 212 women, most of whom are overweight and obese. Grades 1 (body mass index [BMI] > 25-30 kg m(-2)), 2 (BMI > 30-40) and 3 (BMI > 40) of obesity characterize 71.2% of the sample. Most individuals are in grade 2 obesity, 37.2%. Grade 1 obesity is seen in 31.4% of the sample. Obesity increases with age, especially in women. The heaviest women are aged 60 years or older (mean BMI of 33.8), about the same mean as in the 50-59-year-old age group. The highest frequency of grades 1 and 2 obesity occur in women 30-39 years old. Fifty per cent of the underweight women are 20-29 years old or are over 60 years old. Most women of normal weight are 20-29 years old. For the men, 60% of the underweight sample are 50-60 years old. Male respondents between 30 and 39 years old are the heaviest; 42.7% of the sample are within grade 1 obesity and 40.7% of the sample within grade 2 obesity. The smallest percentage of men in grades 1 and 2 obesity are those 50-59 years old. An association was found between some sociocultural variables and obesity. Data show an increasing prevalence of obesity in Kuwait compared with some previous studies.

Central adiposity is associated with cardiovascular reactivity to stress in adolescents

The current study examined the association between central adiposity, measured by waist circumference, and cardiovascular reactivity to stress among 106 White and 105 Black adolescents, approximately 50% of whom were girls. Participants engaged in 4 laboratory tasks while cardiovascular reactivity measures were taken. Independent of body mass index, race, and gender, participants with a greater waist circumference exhibited greater systolic blood pressure reactivity and diastolic blood pressure reactivity (boys only). Race did not affect the results. Results from the present study suggest that central adiposity is associated with blood pressure reactivity early in life, especially in adolescent boys.

Which anthropometric measurements is most closely related to elevated blood pressure?

BACKGROUND

Epidemiological studies find a progressive increase in the prevalence of elevated blood pressure with increasing adipose tissue. But there is no common opinion about which effectiveness of the anthropometric measurement tools indicating general or android obesity are most important to follow up in patients with elevated blood pressures.

OBJECTIVES

To identify which anthropometric measurements are most closely related to blood pressure elevation.

METHODS

A cross-sectional descriptive study of 1727 subjects [894 (50.6%) men and 833 (48.2%) women, aged 18-65 years old] was held in Edirne, Turkey. Each subject's weight, height, waist and hip circumference, triceps skin fold and blood pressures was measured; waist to hip ratio and body mass index were calculated. The relations between blood pressure and different anthropometric variables in both genders were investigated in linear regression models.

RESULTS

The mean systolic and diastolic blood pressures were 123.49 +/- 17.60 and 78.79 +/- 10.37 mmHg. According to body mass index 23.7% of the subjects were obese (.29.9 kg/m(2)). When waist circumference cut-off points were compared with waist to hip ratio the android obesity ratio was doubled (32.3% versus 16.6%). 119 subjects (6.8%) were not obese according to body mass index but nonetheless had waist circumference measurements above the cut-off points suggesting a high cardiovascular risk. In the linear regression models waist circumference was found to be an independent risk factor for blood pressure in men; however body mass was more important index and waist circumference somewhat less so for women.

CONCLUSION

In primary care waist circumference should be a useful tool screening for and following android obesity in patients with elevated blood pressure.

Waist circumference and waist-to-hip ratio as predictors of serum concentration of lipids in Brazilian men

OBJECTIVE

It is unknown whether waist circumference can predict a lipid profile beyond that predicted by body fatness alone, after adjustment for important confounding variables such as smoking, alcohol intake, and physical activity. The purpose of this non-clinical, healthy-subject study was to test this hypothesis.

METHODS

Data refer to 416 men, ages 20 to 58 y with a body mass index between 18.5 and 29.9 kg/m(2), who were blood donors living in a Brazilian city. Alcohol consumption, smoking, and physical activity were evaluated by interview; body fat was measured by electrical bioimpedance, and weight, height, and waist and hip circumferences were measured by trained anthropometrists. Multiple linear regression analysis was performed to quantify the association between measurements of fat distribution (waist circumference and waist-to-hip ratio) and the ratio of total cholesterol to high-density lipoprotein cholesterol and triacylglycerols independently of measurements of fatness and potentially confounding factors.

RESULTS

Waist circumference was strongly correlated with percentage of body fat (r = 0.90), whereas waist-to-hip ratio was less correlated (r = 0.55). After adjustment for age, percentage of body fat, smoking, alcohol intake, and physical activity, waist circumference was not significantly related to the ratio of total cholesterol high-density lipoprotein cholesterol, whereas the waist-to-hip ratio was strongly associated among the youngest subjects (beta = 3.51, P = 0.005).

CONCLUSION

Although several studies have analyzed the association between serum lipids with anthropometric markers, few, including the present one, support waist circumference as a good predictor of lipid profile.

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.

Waist-to-hip ratio is a better screening measure for cardiovascular risk factors than other anthropometric indicators in Tehranian adult men

BACKGROUND

It is essential to identify the best anthropometric index in any population to predict chronic disease risk.

OBJECTIVE

To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian men.

DESIGN

Population-based cross-sectional study.

SUBJECTS

A representative sample of 4,449 men aged 18-74 y, participants of the Tehran Lipid and Glucose Study

METHODS

Demographic data were collected; anthropometric indices and blood pressure were measured according to standard protocol. In the 18-34 y age category, cutoff points for BMI, WHpR, WHtR and WC were 24 kg/m(2), 0.86, 0.47 and 81 cm, respectively. In the 35-54 y age category these cut points were 26 kg/m(2), 0.91, 0.52 and 89 cm, and in the 55-74 y age category 26 kg/m(2), 0.95, 0.54 and 91 cm, respectively. Hypertension was defined based on JNC VI. Biochemical analysis was conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose > or =126 mg/dl or 2hPG > or =200 mg/dl and dyslipidemia based on ATP III. The presence of 'at least one risk factor' from the three major cardiovascular risk factors (hypertension, dyslipidemia and diabetes) was also evaluated.

RESULTS

Mean age of men was 41.8+/-15.4 y. Mean BMI, WHpR, WC and WHtR for subjects were 25.6+/-4.2 kg/m(2), 0.91+/-0.07, 87.7+/-11.7 cm and 0.51+/-0.02, respectively. Dyslipidemia and 'at least one risk factor' are more prevalent risk categories. Although all anthropometric indicators had a significant association to cardiovascular risk factors, WHpR had the highest correlation coefficients compared to other anthropometric measures. For all risk factors in all age categories, the highest odds ratios were pertained to WHpR. Of the four individual indicators, WHpR had the highest sensitivity, specificity and accuracy to predict cardiovascular risk factors. Cutoff points for WHpR were seen to have a higher percentage of correct prediction than BMI, WC and WHtR in all age categories.

CONCLUSION

It is concluded that WHpR is a better predictor for cardiovascular risk factors than BMI, WC and WHtR in Tehranian adult men.

Relationship of adiposity to the population distribution of plasma triglyceride concentrations in vigorously active men and women

Although it is known that triglyceride concentrations increase with adiposity, whether the same increase applies for different percentiles of the triglyceride distribution has not been reported. Therefore, physician-supplied triglyceride concentrations from 7288 male and 2326 female runners were divided into strata according to the body mass index (BMI) and circumferences of the waist, hip and chest. The percentiles of the triglyceride distribution within each stratum were used to determine the cross-sectional regression slope between adiposity and triglyceride levels at each triglyceride percentile. Compared to the 5th percentile of the triglyceride distribution, the rise in men's triglycerides at the 95th percentile per unit of adiposity was 14-fold greater for BMI, 7.8-fold greater for waist circumference, 3.6-fold greater for hip circumference, and 4.4-fold greater for chest circumference. The rise in women's triglyceride concentrations at the 95th percentile was 8-fold greater than at the 5th percentile for each kg/m(2) increase in BMI. These results suggest that the metabolic effects of adiposity on plasma triglycerides depend upon whether the concentrations are high or low. This contradicts statistical assumptions upon which prior studies of adiposity have based their analyses. We speculate that the reported greater increases in triglycerides per unit of adiposity in whites than blacks, in men than women, and in low-density lipoprotein (LDL) pattern B than A are all consistent with the relationships we observe. It remains to be verified whether these relationship also apply to less active populations.

Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites

OBJECTIVE

BMI (kilograms per meters squared) and waist circumference (WC) (measured in centimeters) are each associated with the risk of developing cardiovascular disease (CVD). Therefore, a combination of the two may be more effective in identifying subjects at risk than either alone. The present study sought to identify the combination of BMI and WC that has the strongest association with CVD risk factors in whites.

RESEARCH METHODS AND PROCEDURES

Subjects were 8712 white men and women from the Third National Health and Nutrition Examination Survey. The optimal combination of BMI and WC was developed using logistic regression models with BMI and WC as predictors and CVD risk factors as outcomes. The combined measure of BMI and WC using current cut-off points was also examined. Sensitivity, specificity, and receiver operating characteristics curves were compared between the combined measures and BMI alone.

RESULTS

For white men, the optimal combination of BMI and WC for identifying CVD risk factors was 0.68 x BMI + 0.32 x WC. This combination generated a score that better estimated the odds of having CVD risk factors than either alone. For white women, WC alone largely determined the likelihood of having CVD risks. The combination of BMI and WC using current cut-off points may provide an improved measure of CVD risk. Combined measures showed a higher sensitivity or a shorter distance in receiver operating characteristic curves in the identification of CVD risk factors.

DISCUSSION

Combined measures of BMI and WC may provide a higher overall test performance for CVD risk factors and may be useful in some ethnic groups as an improved means of screening subjects for further evaluation in the clinical setting.

Effects of Greek Orthodox Christian Church fasting on serum lipids and obesity

BACKGROUND

No study to date has focused on the impact of Greek Orthodox Christian fasting on serum lipoproteins and obesity yet.

METHODS

120 Greek adults were followed longitudinally for one year. Sixty fasted regularly in all fasting periods (fasters) and 60 did not fast at all (controls). The three major fasting periods under study were: Christmas (40 days), Lent (48 days) and Assumption (August, 15 days). A total of 6 measurements were made during one year including pre- and end-fasting blood collection, serum lipoprotein analyses and anthropometric measurements.

RESULTS

Statistically significant end-fasting total and LDL cholesterol differences were found in fasters. Fasters compared to controls presented 12.5% lower end-total cholesterol (p < 0.001), 15.9% lower end-LDL cholesterol (p < 0.001) and 1.5% lower end-BMI (p < 0.001). The end- LDL/HDL ratio was lower in fasters (6.5%, p < 0.05) while the change in end- HDL cholesterol in fasters (4.6% decline) was not significant. Similar results were found when the pre- and end-fasting values of fasters were compared. No change was found in control subjects.

CONCLUSIONS

Adherence to Greek Orthodox fasting periods contributes to a reduction in the blood lipid profile including a non-significant reduction in HDL cholesterol and possible impact on obesity.

Relationships of resting energy expenditure with body fat distribution and abdominal fatness in Japanese population

Body fat distribution and abdominal fatness are indicators of risks for coronary heart disease. However, the relationships between resting energy expenditure (REE) and the body fat distribution or the abdominal fatness are unclear. We examined the relationships of REE with whole-body fat distribution (waist, hip and waist-to-hip ratio: WHR) and abdominal fatness (intra-abdominal fat: IF and subcutaneous fat: SF) after adjustment for body composition. 451 men and 471 women were subdivided into two groups, 40-59 years: middle-aged group and 60-79 years: elderly group. REE was measured by an indirect calorimetry system. Percentage of fat mass (%FM), fat mass (FM) and fat-free mass (FFM) were assessed by a dual-energy x-ray absorptiometry method. The IF area (IFA) and SF area (SFA) at the level of the umbilicus were measured using computed tomography. Circumference of waist and hip were measured in a standing position. The WHR, waist circumference and SFA did not significantly (p>0.05) associate with the REE after adjusting for FM, FFM and age in any of the groups. The adjusted REE was significantly and inversely correlated with hip (r=-0.159, p<0.05) and IFA (r=-0.131, p<0.05) in the elderly men. These results suggest that lower REE may contribute to greater hip and IFA rather than WHR and waist in elderly men.

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.

Segregation analysis of waist circumference, hip circumference and waist-to-hip ratio in the Korean Nationwide Family Study

AIM

A central distribution of adipose tissue is frequently associated with cardiovascular disease and its risk factors. In this study, we investigated environmental, familial and genetic influences on waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) in 2507 members of 435 families who had participated in the Korean Nationwide Health Examination Survey.

METHOD

Maximum likelihood methods were used to fit several genetic and nongenetic models of inheritance to these data to determine whether an unobserved Mendelian major gene could explain the familial distribution of WC, HC and WHR. Adjustments for age, age(2), body mass index, smoking, alcohol consumption and exercise were carried out separately for males and females by multiple regression procedures for WC, HC and WHR phenotypes prior to segregation analysis. Regression models were used to test genetic and non-genetic models in these 435 families.

RESULTS

Segregation analysis did not provide statistical evidence of a major gene controlling either HC or WHR. Mendelian single-locus models with two underlying genotypic distributions were best supported by these data on WC, and this putative major gene explained the 22.4% of variance in adjusted WC.

CONCLUSION

Future linkage studies may be worthwhile to further clarify the mechanisms controlling WC.

Risk factors and cardiovascular disease in Turkey

Cardiovascular risk factors as well as morbidity and mortality from coronary heart disease among Turkish adults are herein reviewed. Lipids and lipoproteins are in focus, but other relevant risk factors are also discussed. Turks have distinctively low levels of total and high-density lipoprotein (HDL)-cholesterol, associated with high levels of hepatic lipase and fasting triglycerides. In addition, physical inactivity is common in both genders; close to 60% of men have the smoking habit, while obesity is common among Turkish women leading to a high prevalence of hypertension and diabetes in them. These factors probably account for the unanticipated fact that Turkish adults have the pattern of causes of death similar to a developed population, although the process of industrialization is ongoing, the structure of its population is young and overall cholesterol levels are comparatively low. The age-standardized coronary heart disease death rate is estimated to rank among the highest in Europe. The leading independent predictors of coronary events and death [systolic blood pressure, total/HDL-cholesterol ratio, followed by diabetes and (central) obesity] are related to the metabolic syndrome, estimated to prevail in 3-4% of adults aged 30 or over, and to underlie one-eighth of cases of coronary disease. Since several adverse factors exhibit a rising trend, primary and secondary prevention of cardiovascular disease must assume a much higher priority in various issues in Turkey than it currently does.