Waist-to-height ratio and coronary artery disease in Taiwanese type 2 diabetic patients

Waist-to-height ratio has a stronger association with cardiovascular risks than waist circumference, waist-hip ratio and body mass index in type 2 diabetes

AIMS

To compare the associations between four anthropometric indices including waist-to-height ratio (WHtR), waist circumference (WC), waist-hip-ratio (WHR) and body mass index (BMI) and cardio-cerebrovascular events (CCBVEs) in Chinese T2DM patients.

METHODS

The associations of four anthropometric measures with CCBVEs and metabolic syndrome (MetS) were compared by multiple regression model in 3108 T2DM patients. CCBVEs was defined as a history of myocardial infarction, angina, angioplasty, coronary artery bypass surgery, transient ischemic attack, ischemic or hemorrhagic stroke.

RESULTS

After controlling for age, sex and diabetes duration, the prevalence of CCBVEs and MetS significantly increased across the WHtR, WC, WHR and BMI quartiles in T2DM patients, respectively. However, when controlling for these four anthropometric measurements together, although four anthropometric measures were closely associated with MetS prevalence, only WHtR quartile was significantly associated with CCBVEs prevalence (6.5%, 13.8%, 16.9% and 21.3%, p < 0.001 for trend). After adjusting for multiple confounders including four anthropometric parameters, a regression analysis revealed that only WHtR was independently and positively associated with the presence of CCBVEs (p = 0.029).

CONCLUSIONS

Compared with WC, WHR and BMI, WHtR have a stronger association with CCBVEs in T2DM subjects. WHtR maybe a better indicator than other anthropometric measurements for evaluating cardiovascular risks in T2DM.

Waist-To-Height Ratio Is a More Accurate Tool for Predicting Hypertension Than Waist-To-Hip Circumference and BMI in Patients With Type 2 Diabetes: A Prospective Study

Background: Anthropometric measures [i.e., body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)] have been used as prediction factors for incident hypertension. However, whether any of these measures is superior to another in the matter of accuracy in predicting hypertension in diabetic patients has been controversial. The present prospective study aimed to determine whether WHtR is a more accurate tool for predicting hypertension than WHR and BMI in patients with type 2 diabetes.

Methods: The study population consisted of 1,685 normotensive patients with type 2 diabetes. BMI, WHR, and WHtR were assessed at baseline and followed up for hypertension incidence for a mean of 4.8 years. A cox regression analysis was performed to assess the association between anthropometric measures (i.e., BMI, WHR, and WHtR) and incident hypertension during the follow-up period. The area under the ROC curve analysis was performed and optimal cutoff values were calculated for each anthropometric measure for hypertension prediction.

Results: WHtR and BMI were significantly associated with an increased incidence of hypertension (HR = 3.296 (0.936–12.857), P < 0.001, and HR = 1.050 (1.030–1.070), P < 0.001, respectively). The discriminative powers for each anthropometric index for hypertension were 0.571 (0.540–0.602) for BMI, 0.518 (0.486–0.550) for WHR, and 0.609 (0.578–0.639) for WHtR. The optimal cutoff points for predicting hypertension in patients with type 2 diabetes were 26.94 (sensitivity = 0.739, specificity = 0.380) for BMI, 0.90 (sensitivity = 0.718, specificity = 0.279) for WHR, and 0.59 (sensitivity = 0.676, specificity = 0.517) for WHtR.

Conclusion: WHtR was a more accurate tool for predicting hypertension compared to WHR and BMI in patients with type 2 diabetes.

Faktor yang Berhubungan dengan Konsumsi Energi Ibu Menyusui di Kecamatan Cipayung, Kota Depok, Indonesia

Latar Belakang: Untuk mendukung kebutuhan gizi yang tinggi saat menyusui, ibu menyusui membutuhkan lebih banyak energi dibandingkan ibu hamil. Namun, berbagai studi melaporkan bahwa konsumsi energi ibu menyusui justru lebih rendah dibandingkan ibu hamil.Tujuan: Mengetahui faktor yang berhubungan dengan konsumsi energi ibu menyusui yang rendah di Kecamatan Cipayung Kota Depok Tahun 2016.Metode: Penelitian ini menganalisis data sekunder dari penelitian eksperimental semu dengan pendekatan kohort prospektif di Kota Depok. Total sampel berjumlah 169 responden. Analisis data pada penelitian ini menggunakan uji chi-square dan uji regresi logistik ganda.Hasil:  Konsumsi energi ibu saat hamil merupakan faktor dominan yang berhubungan dengan konsumsi energi ibu saat menyusui setelah dikontrol dengan paritas dan usia ibu. Ibu yang mengonsumsi energi dalam jumlah kurang saat hamil berisiko 3,5 kali lebih besar untuk mengonsumsi energi dalam jumlah kurang saat menyusui.Kesimpulan: Konsumsi energi ibu hamil sangat penting diperhatikan karena selain diperlukan untuk pertumbuhan dan perkembangan janin, sebagai cadangan lemak yang akan digunakan saat menyusui, juga untuk menjamin agar ibu mengonsumsi energi dalam jumlah cukup saat menyusui. 

Prevalence and Risk Factors of Sensory Symptoms in Diabetes Patients in Taiwan

BACKGROUND

Diabetic sensory neuropathy has rarely been studied in the Asian populations. This study investigated the prevalence and risk factors of sensory symptoms (SS) in the Taiwanese diabetes patients.

METHODS

A total of 1,400 diabetes patients received a health examination together with a structured questionnaire interview for three categories of abnormal sensation of numbness or tingling pain, electric shock, and skin thickness sensation on seven anatomical sites on upper limbs and six sites on lower limbs. Prevalence of SS was defined using nine different criteria, with the least stringent criterion of "any positive symptom on at least 1 site" and the most stringent criterion of "any positive symptom on at least bilateral and symmetrical 2 sites involving the lower limb." Logistic regression was used to estimate the odds ratios and their 95% confidence interval for SS by the different definitions. Fasting plasma glucose and hemoglobin A_1c were entered in separate models to avoid hypercollinearity.

RESULTS

The prevalence of SS was 14.4 and 54.0% when using the most stringent and least stringent criterion, respectively. Women consistently had a significantly higher prevalence than men did. Among the three categories of symptoms, numbness or tingling pain was the most common, and fingers and toes were the most commonly involved anatomical sites. For any symptoms, 37.1% of the patients had any symptoms on the upper limbs and 41.7% had any symptoms on the lower limbs. Female sex, diabetes duration, hemoglobin A_1c, and hypertension were associated with SS in all models.

CONCLUSIONS

Taiwanese diabetes patients may have a high prevalence of SS if a structured questionnaire is used for screening. Female sex, diabetes duration, hemoglobin A_1c, and hypertension are associated with SS.

Possible association between obesity and periodontitis in patients with Down syndrome

BACKGROUND

The present study was carried out to evaluate the possible association between obesity and periodontitis in patients with DS, and to explore which measure of obesity is most closely correlated to periodontitis.

MATERIAL AND METHODS

A prospective observational study was made to determine whether obesity is related to periodontal disease in patients with DS. The anthropometric variables were body height and weight, which were used to calculate BMI and stratify the patients into three categories: < 25(normal weight), 25-29.9 (overweight) and ≥ 30.0 kg/m2 (obese). Waist circumference and hip circumference in turn was recorded as the greatest circumference at the level of the buttocks, while the waist/hip ratio (WHR) was calculated. Periodontal evaluation was made of all teeth recording the plaque index (PI), pocket depth (PD), clinical attachment level (CAL) and the gingival index. We generated a multivariate linear regression model to examine the relationship between PD and the frequency of tooth brushing, gender, BMI, WHI, WHR, age and PI.

RESULTS

Significant positive correlations were observed among the anthropometric parameters BMI, WHR, WHI and among the periodontal parameters PI, PD, CAL and GI. The only positive correlation between the anthropometric and periodontal parameters corresponded to WHR. Upon closer examination, the distribution of WHR was seen to differ according to gender. Among the women, the correlation between WHR and the periodontal variables decreased to nonsignificant levels. In contrast, among the males the correlation remained significant and even increased. In a multivariate linear regression model, the coefficients relating PD to PI, WHR and age were positive and significant in all cases.

CONCLUSIONS

Our results suggest that there may indeed be an association between obesity and periodontitis in male patients with DS. Also, we found a clear correlation with WHR, which was considered to be the ideal adiposity indicator in this context.

Prevalence of colorectal neoplasm in Chinese patients with high-risk coronary artery disease classified by the Asia-Pacific Colorectal Screening score

OBJECTIVE

The aim of this study was to investigate the prevalence of colorectal neoplasms in patients coronary artery disease (CAD) with or without a family history of colorectal cancer (CRC).

METHODS

In this cross-sectional study, individuals with suspected CAD in the absence of cancer-related symptoms underwent coronary angiography for the first time, and were divided into CAD and non-CAD groups. Colonoscopy was performed in individuals at high-risk tier based on their Asia-Pacific colorectal screening (APCS) score. Their waist circumference (WC), height and body weight were measured.

RESULTS

There were 634 of 1157 individuals at a high risk of developing advanced colorectal neoplasms, 91.0% (577/634) of whom were male smokers. The proportion of CAD patients in the high-risk tier was 81.5% (517/634), while the prevalences of adenomas (32.1% vs 22.2%, P < 0.05) and advanced adenomas (14.7% vs 8.5%, P < 0.05) were significantly higher in the CAD group than in the non-CAD group. After 83 individuals with a family history of CRC were excluded, only the prevalence of adenomas was still significantly higher in the CAD group than in the non-CAD group (25.5% vs 16.0%, P < 0.01). Body mass index (BMI) ≥ 25 kg/m(2) was correlated with the occurrence of adenomas (OR 2.133, 95% CI 1.219-3.730, P = 0.008) in CAD patients.

CONCLUSIONS

Even in the absence of family history of CRC, CAD patients at a high risk of developing advanced colorectal neoplasms classified by the APCS score still showed a remarkably high prevalence of colorectal adenomas. Moreover, the association between the occurrence of adenomas and CAD was stronger in overweight (BMI ≥ 25 kg/m(2)) individuals.

Comparison of anthropometric and body composition measures as predictors of components of the metabolic syndrome in a clinical setting

PROBLEM

The use of body mass index (BMI) to assess obesity and health risks has been criticized in scientific and lay publications because of its failure to account for body shape and inability to distinguish fat mass from lean mass. We sought to determine whether other anthropometric measures (waist circumference (WC), waist-to-height ratio (WtH), percent body fat (%BF), fat mass index (FMI), or fat-free mass index (FFMI)) were consistently better predictors of components of the metabolic syndrome than BMI is.

METHODS

Cross-sectional measurements of height, weight, waist circumference and percent body fat were obtained from 12,294 adults who took part in annual physical exams provided by EHE International, Inc. Blood pressure was measured during the exam and HDL, LDL, and fasting glucose were measured from blood samples. Pearson correlations, linear regression, and adjusted Receiver Operator Characteristic (ROC) curves were used to relate each anthropometric measure to each metabolic risk factor.

RESULTS

None of the measures was consistently the strongest predictor. BMI was the strongest predictor of blood pressure, measures related to central adiposity (WC and WtH) performed better at predicting fasting glucose, and all measures were roughly comparable at predicting cholesterol levels. In all, differences in areas under ROC curves were 0.03 or less for all measure/outcome pairs that performed better than BMI.

CONCLUSION

Body mass index is an adequate measure of adiposity for clinical purposes. In the context of lay press critiques of BMI and recommendations for alternative body-size measures, these data support clinicians making recommendations to patients based on BMI measurements.

Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

Objective:

Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact.

Methods and patients:

One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded.

Results:

We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic patients compared to 4.8±2.3 in normal subjects (P=0.03).

Conclusion:

Reversible defects are commonly seen in myocardial perfusion SPECT in asymptomatic diabetic patients and are mild in severity and not associated with adverse cardiac events. Routine approach for detection of CAD beginning with ETT seems to be appropriate in these patients.

Intensive blood pressure treatment does not improve cardiovascular outcomes in centrally obese hypertensive individuals with diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial

OBJECTIVE

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Blood Pressure Trial reported no differences in most cardiovascular disease (CVD) outcomes between intensive and standard blood pressure therapy in individuals with diabetes mellitus (DM) and hypertension. Many such individuals are centrally obese. Here we evaluate whether the trial outcomes varied by the level of central obesity.

RESEARCH DESIGN AND METHODS

The cohort included 4,687 people (47.7% women) with DM and hypertension. Mean age was 62.2, and mean follow-up was 4.7 years. Participants were randomly assigned to one of two blood pressure treatment strategies: intensive (systolic <120 mmHg) or standard (systolic <140 mmHg). Sex-specific quartiles of waist-to-height ratio were used as the measure of central obesity. The primary ACCORD outcome (a composite of nonfatal myocardial infarction [MI], nonfatal stroke, or CVD death) and three secondary outcomes (nonfatal MI, fatal or nonfatal stroke, and CVD death) were examined using proportional hazard models.

RESULTS

There was no evidence that the effect of intensively lowering blood pressure differed by quartile of waist-to-height ratio for any of the four outcomes (P > 0.25 in all cases). Controlling for waist-to-height quartile had no significant impact on previously published results for intensive blood pressure therapy. Waist-to-height ratio was significantly related to CVD mortality (hazard ratio 2.32 [95% CI 1.40-3.83], P = 0.0009 comparing the heaviest to lightest quartiles), but not to the other outcomes (P > 0.09 in all cases).

CONCLUSIONS

Intensive lowering of blood pressure versus standard treatment does not ameliorate CVD risk in individuals with DM and hypertension. These results did not vary by quartile of waist-to-height ratio.

Prediction of cardiovascular events with consideration of general and central obesity measures in diabetic adults: results of the 8.4-year follow-up

BACKGROUND

Obesity is one of the most important cardiovascular disease (CVD) risk factors among diabetic populations. We evaluated the ability of different anthropometric measures for predicting CVD among type 2 diabetic patients.

METHODS

The study consisted of 411 men and 599 women, aged ≥30 years, free of CVD at baseline with a median follow-up of 8.4 years. The adjusted hazard ratios (HRs) for CVD were calculated for a 1 standard deviation change in body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) using Cox proportional regression analysis.

RESULTS

A total of 188 CVD events occurred (men, 90; women, 98). In women, in confounder-adjusted analysis [age, fasting plasma glucose (instead of glycosylated hemoglobin), and positive family history of CVD], WHR was associated with incident CVD [1.32 (1.06-1.65)], followed by WC and WHtR, which were marginally significant (P=0.06 and 0.08, respectively); after adjustment for hypertension and hypercholesterolemia, only WHR predicted CVD significantly. In men, the confounder-adjusted (age, fasting plasma glucose, and aspirin use) HR to predict CVD was significant only for WHR [HR 1.21(1.00-1.48)].

CONCLUSION

This study showed WHR was the most powerful predictor of CVD among anthropometric measures, followed by WHtR, in diabetic population.

Overweight and obesity predict time to periodontal disease progression in men

AIMS

To examine whether overweight and obesity indicators - body mass index (BMI), waist circumference (WC), and WC-to-height ratio - predict progression of periodontal disease in men.

MATERIAL AND METHODS

Participants were 1038 medically healthy, non-Hispanic, white males in the VA Dental Longitudinal Study who were monitored with triennial oral and medical examinations between 1969 and 1996. Periodontal disease progression in an individual was defined as having two or more teeth advance to levels of alveolar bone loss ≥40%, probing pocket depth ≥5 mm, or clinical attachment loss ≥5 mm after baseline. Extended Cox regression analyses estimated hazards of experiencing periodontal disease progression events due to overweight/obesity status, controlling for age, smoking, education, diabetes, recent periodontal treatment, recent prophylaxis, and number of filled/decayed surfaces.

RESULTS

Body mass index and WC-to-height ratio were significantly associated with hazards of experiencing periodontal disease progression events regardless of periodontal disease indicator. Adjusted hazard ratios for periodontal disease progression were 41-72% higher in obese men (BMI ≥30 kg/m(2)) relative to men with both normal weight and WC-to-height ratio (≤50%).

CONCLUSION

Both overall obesity and central adiposity are associated with an increased hazards of periodontal disease progression events in men.

Validity of self-reported abdominal obesity in Thai adults: a comparison of waist circumference, waist-to-hip ratio and waist-to-stature ratio

BACKGROUND AND AIMS

Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio (WSR), being common proxy measures of abdominal obesity, are useful tools in epidemiologic studies, but little is known about their validity when the indices are derived from self-reported measurements. We determine and compare the validity of self-reported WC, WHR and WSR in order to identify the optimal index for use in epidemiologic surveys.

METHODS AND RESULTS

Technician- and self-reported measurements of height, waist and hip circumference were obtained from 613 Thai adults (mean age 35 years). Regarding technician-reported measurements as reference, diagnostic test properties were derived and performances of the indices compared using receiver-operator-characteristic curves and the area-under-the-curve (AUC) analyses. There was good agreement between technician- and self-reported measurements for WC and WSR (concordance correlation coefficients ranged from 0.84 to 0.90) but not for WHR (0.50 in men, 0.45 in women). The sensitivity and specificity of self-reported WC and self-reported WSR as measures of abdominal obesity were superior to those of self-reported WHR in both sexes. AUCs for WC and WSR were comparable (0.93 and 0.92, respectively, in men; 0.88 and 0.87 in women) and significantly higher than for WHR (0.80 in men; 0.76 in women; p<0.0001).

CONCLUSION

WC and WSR derived from self-reported waist and height measurements are valid methods for determining abdominal obesity. Self-reported measurements should not be used to derive the WHR. In Asian populations, WSR may be the optimal index of abdominal obesity when measurements are derived from self-reports in epidemiologic surveys.

Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus

Individuals with diabetes mellitus are advised to achieve a healthy weight to prevent complications. However, fat mass distribution has hardly been investigated as a risk factor for diabetes complications. The authors studied associations between body mass index, waist circumference, waist/hip ratio, and waist/height ratio and mortality among individuals with diabetes mellitus. Within the European Prospective Investigation into Cancer and Nutrition, a subcohort was defined as 5,435 individuals with a confirmed self-report of diabetes mellitus at baseline in 1992-2000. Participants were aged 57.3 (standard deviation, 6.3) years, 54% were men, the median diabetes duration was 4.6 (interquartile range, 2.0-9.8) years, and 22% of the participants used insulin. Body mass index, as indicator of general obesity, was not associated with higher mortality, whereas all measurements of abdominal obesity showed a positive association. Associations generally were slightly weaker in women. The strongest association was observed for waist/height ratio: In the fifth quintile, the hazard rate ratio was 1.88 (95% confidence interval: 1.33, 2.65) for men and 2.46 (95% confidence interval: 1.46, 4.14) for women. Measurements of abdominal, but not general, adiposity were associated with higher mortality in diabetic individuals. The waist/height ratio showed the strongest association. Respective indicators might be investigated in risk prediction models.

Betel nut chewing and subclinical ischemic heart disease in diabetic patients

Background. This study investigated the association between betel nut chewing and subclinical ischemic heart disease (IHD) in Taiwanese type 2 diabetic patients. Methods. A total of 394 male patients aging ≥45 years and without previous heart disease were studied. Among them 349 had no habit of chewing betel nut and 45 possessed the habit for ≥5 years. Subclinical IHD was diagnosed by a Minnesota-coded resting electrocardiogram and was present in 71 cases. Statistical analyses were performed considering confounding effects of age, diabetic duration, smoking, body mass index, blood pressure, dyslipidemia, and metabolic control status. Results. Betel nut chewers were younger and had higher prevalence of smoking (86.7% versus 60.5%), higher body mass index, poorer glycemic control, and higher prevalence of subclinical IHD (28.9% versus 16.6%). Patients with subclinical IHD were older and had higher prevalence of betel nut chewing (18.0% versus 9.9%). The multivariate-adjusted odds ratio for subclinical IHD for chewers versus nonchewers was 4.640 (1.958–10.999). The adjusted odds ratios in younger or older patients divided by the median age of 63 years were similar: 4.724 (1.346–16.581) and 4.666 (1.278–17.028), respectively. Conclusions. Betel nut chewing is significantly associated with increased risk of subclinical IHD.

A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value

This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from cross-sectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being stronger than, and independent of, BMI. To make firmer statistical comparison, a meta-analysis is required. The AUROC analyses indicate that WHtR may be a more useful global clinical screening tool than WC, with a weighted mean boundary value of 0·5, supporting the simple public health message 'keep your waist circumference to less than half your height'.

Urgency of reassessment of role of obesity indices for metabolic risks

The definition of metabolic syndrome places emphasis on health care for persons at risk. However, whether an obesity index should be a mandatory component of the definition and whether obesity indices can identify metabolic risks satisfactorily require further exploration. Therefore, we investigated the effectiveness of various anthropometric obesity indices in identifying the clustering of 2 or more American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI)/International Diabetes Federation (IDF)-defined metabolic risk factors (hypertension, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol) for metabolic syndrome and those of other metabolic risk factors (high low-density lipoprotein cholesterol, hyperuricemia, high gamma-glutamyltransferase, fatty liver) in 6141 men and 2137 women. The anthropometric indices were the following: (1) for both sexes--various levels of waist-to-height ratio (WHtR) including 0.5 and body mass index (BMI) of 23 and 25 kg/m(2); (2) for men and women individually--waist circumference (W) 90/80 cm (AHA/NHLBI/IDF for ethnic groups), W 85/90 cm (Japan Society for the Study of Obesity), and combined W and BMI: W 85/90 cm and/or BMI 25 kg/m(2) (Japanese government). The results showed the following: (1) The optimal value for WHtR was 0.5 for AHA/NHLBI/IDF-defined risk factors and approximately 0.5 for other risk factors in both sexes. (2) The sensitivities of various proposed obesity indices for identifying clustering of defined and other risk factors varied between 74.4% (WHtR 0.5) and 36.3% (BMI 25) and between 80.5% (WHtR 0.5) and 43.7% (BMI 25) in men, and varied between 65.6% (WHtR 0.5) and 16.8% (W 90 cm) and between 82.3% (WHtR 0.5) and 28.2% (W 90 cm) in women. Because the sensitivities of many anthropometric indices were very low, a reassessment of the effectiveness of obesity indices in evaluating metabolic risks and especially their suitability as a single mandatory component of metabolic syndrome is urgently needed. However, WHtR 0.5 provides a very useful algorithm for screening persons at risk.

Clustering of other metabolic risk factors in subjects with metabolic syndrome

Various anthropometric indices have been proposed for metabolic syndrome. We investigated the clustering of metabolic risk factors other than components of metabolic syndrome and physical activity in subjects with and without metabolic syndrome as defined by different anthropometric indices. The subjects comprised 6141 men and 2137 women who underwent routine health examinations in Tokyo. We compared metabolic risk factors (high low-density lipoprotein cholesterol, hyperuricemia, high gamma-glutamyltransferase, fatty liver) and sedentary history in subjects with and without metabolic syndrome as defined by the American Heart Association by substituting various proposed anthropometric indices of abdominal obesity (waist circumference >or=85, >or=90, or >or=102 cm for men and >or=90, >or=80, or >or=88 cm for women; waist-to-height ratio >or=0.5 for both men and women). Irrespective of the anthropometric index or sex, the age-adjusted odds ratios for risk factors and sedentary history were all significantly greater in subjects with metabolic syndrome (men and women: 1.26 approximately 1.35 and 2.06 approximately 2.63 for high low-density lipoprotein cholesterol, 2.36 approximately 2.60 and 3.88 approximately 7.20 for hyperuricemia, 2.54 approximately 3.02 and 2.92 approximately 4.05 for high gamma-glutamyltransferase, 4.42 approximately 4.87 and 9.43 approximately 12.27 for fatty liver, and 1.37 approximately 1.50 and 1.43 approximately 1.72 for sedentary history). Findings still persisted in those not receiving medication for diabetes mellitus or coronary heart disease. Therefore, attention should be paid to other metabolic risk factors in subjects with metabolic syndrome, irrespective of the anthropometric index or sex. Further study is also needed to clarify the most appropriate definition of metabolic syndrome so as to include the spectrum of risk factors that best represents the future risk of cardiovascular and other diseases.