Prevalence of normal weight central obesity among Thai healthcare providers and their association with CVD risk: a cross-sectional study

Determining the best method for evaluating obesity and the risk for non-communicable diseases in women of childbearing age by measuring the body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, A Body Shape Index, and hip index

OBJECTIVE

Non-communicable diseases (NCDs) are linked to excessive adiposity and anthropometric indices can be used to identify those at risk. The aim of this study was to evaluate the precision of anthropometric indices in identifying obesity and risk factors for NCDs and to investigate the emergence of obesity-related NCDs in young women in Sri Lanka.

METHODS

We recruited 282 women 18 to 35 y of age from suburban and rural areas in Sri Lanka. We measured the women's height, weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), A Body Shape Index(ABSI), hip circumference (HC), hip index (HI), anthropometric risk index (ARI), fasting serum glucose, fasting serum insulin, homeostatic model assessment for insulin resistance, cholesterol, high-density lipoprotein, low-density lipoprotein, triacylglycerols, and ovulatory gonadal hormones (progesterone, testosterone). Comparisons were made between women with normal BMI and those who were overweight or obese using anthropometric and biochemical characteristics.

RESULTS

The prevalence of obesity was highest in WC and in receiver operating characteristic analysis, BMI, WC, and WHtR showed higher sensitivity and lower 1-specificity as indicators of obesity. BMI had an area under the curve (AUC) of 1.000 with 100% sensitivity and 0% 1-specificity. WC had an AUC of 0.941 with 80% sensitivity and 13.4% 1-specificity. Additionally, WHtR showed a 0.974 AUC, 92.1% sensitivity, and 4.9% 1-specificity. The correlations between body size and shapes were assessed among the study participants using Pearson's correlation. More than other measures, WC and WHtR showed a significant correlation with BMI with P < 0.05 (r = 0.888 and 0.737, respectively). Although ABSI and BMI showed only a weak correlation (P = 0.006, r = 0.162), WHR and BMI showed a moderate correlation (P = 0.001, r = 0.477). Although HI demonstrated a negative association with BMI (P = 0.618, r = -0.030), HC exhibited a strong association (P = 0.001, r = 0.749). A significant association with higher odds ratios was found for obesity-related NCD risk factors such as hypertension, homeostatic model assessment for insulin resistance, hypercholesterolemia, altered ovulatory hormones with these (BMI, WC, WHR, WHtR, ABSI, HI) obesity-assessing criteria (P < 0.05). A significant correlation between WC and hypertriacylglycerolmia (P = 0.001, r = 0.781, odds ratio, >16) was identified. A positive correlation was observed between all MS components and ARI, indicating that ARI may serve as a potential indicator of cardiometabolic risk.

CONCLUSION

BMI, WC, WHtR, and HC are intercorrelated anthropometric measurements that can be used either alone or in combination to define obesity and detect the risk for NCDs, including diabetes mellitus, cardiovascular disease, and infertility. On the other hand, BMI, ABSI, and HI are designed to be mutually independent indices and have the advantage of combining the separate risks to generate an overall ARI. Furthermore, ARI appears to be a highly effective predictor of cardiovascular disease.

Status and transition of normal-weight central obesity and the risk of cardiovascular diseases: A population-based cohort study in China

BACKGROUND AND AIMS

Cardiovascular disease (CVD) has become a growing public health concern. Normal weight central obesity (NWCO) has emerged as a potential risk factor for cardiometabolic dysregulation. To date, the association between NWCO and new-onset CVDs remains unclear. We aimed to evaluate the associations of NWCO and its longitudinal transitions with cardiovascular risks in middle-aged and older Chinese.

METHODS AND RESULTS

Data were from the China Health and Retirement Longitudinal Study 2011-2018. NWCO was defined as the combination of a body mass index (BMI) of <24.0 kg/m² and a waist circumference (WC) of >85 cm in males or >80 cm in females. CVDs included heart diseases and stroke. Cause-specific hazard models and subdistribution hazard models with all-cause death as the competing event were applied. In 2011, 9856 participants without prior CVDs were included, of whom 1814 developed CVDs during a 7-year follow-up. Compared to normal weight and non-central obesity (NWNCO), NWCO was significantly associated with new-onset CVDs, with cause-specific hazard ratios (cHRs) and 95% confidence intervals (CIs) of 1.21 (1.04-1.41) for heart diseases and 1.40 (1.11-1.76) for stroke. From 2011 to 2013, 571 NWNCO participants developed NWCO who subsequently demonstrated a 45% higher risk of CVDs than those with maintained NWNCO.

CONCLUSION

NWCO and transition from NWNCO to NWCO are associated with higher risks of CVDs. Identification and prevention of NWCO may be useful in the management of CVDs.

Relationship of normal-weight central obesity with the risk for heart failure and atrial fibrillation: analysis of a nationwide health check-up and claims database

Aims

There have been scarce data on the relationship of normal-weight central obesity (NWCO) with the subsequent risk for heart failure (HF) and atrial fibrillation (AF). Using a nationwide health check-up and administrative claims database, we sought to clarify whether NWCO would be associated with the incidence of HF and AF.

Methods and results

Medical records of 1 697 903 participants without prior history of cardiovascular disease (CVD) and normal-weight (body mass index of 18.5-23.0 kg/m2) were extracted from the JMDC Claims Database, which is a health check-up and claims database. We defined NWCO as normal-weight and CO (waist circumference ≥ 90 cm for men or ≥ 80 cm for women). The median age was 44.0 (37.0-52.0) years and 872 578 (51.4%) participants were men. Overall, 154 778 individuals (9.1%) had CO. The mean follow-up period was 3.3 ± 2.6 years. Participants with NWCO were older and more likely to be women than those without. HF and AF occurred in 26 936 (1.6%) and 6554 (0.4%) participants, respectively. People having NWCO were associated with a greater risk for HF [hazard ratio (HR): 1.072, 95% confidence interval (CI) 1.026-1.119] and AF (HR: 1.202, 95% CI: 1.083-1.333) compared with those having normal-weight without CO.

Conclusion

Our analysis of a nationwide health check-up and administrative claims database including ∼1.7 million participants without prevalent CVD history demonstrated the potential impact of NWCO on the risk for HF and AF, suggesting the importance of abdominal obesity in the developing HF and AF even in normal-weight individuals.

Combined consideration of body mass index and waist circumference identifies obesity patterns associated with risk of stroke in a Chinese prospective cohort study

Background

In China, few studies have examined the relationship between the combination of body mass index and waist circumference and the risk of stroke. Moreover, the relationship may also be different in different genders. Thus, we investigated the association between the combination of body mass index and waist circumference and the risk of stroke in Chinese.

Methods

This prospective cohort study included 36 632 participants aged 18 to 90 years. Participants were recruited from 60 surveillance sites (25 urban sites and 35 rural sites) across China in 2010 China Chronic Disease Risk Factor Surveillance, and followed up in 2016-2017. Incident cases of stroke were identified through questionnaires (including the basis of clinical diagnosis, imaging tests, time of diagnosis, diagnosis unit) and Cardiovascular Event Report System. Risk factors for stroke were collected at baseline using questionnaire, physical measurements and laboratory tests. Cox proportional hazards regression models were used to generate adjusted hazard ratios and 95%CI. All analyses were duplicated by gender stratification.

Results

During 6.42 ± 0.50 years of follow-up, 1 333 (597 males, 736 females) stroke events were observed among the 27 112 participants who did not have cardiovascular diseases at baseline. Compared with the general population who have normal weight or underweight with normal WC, those who have normal weight or underweight with abdominal obesity (adjusted hazard ratios 1.45, 95%CI 1.07-1.97 in males; 0.98, 95%CI 0.78-1.24 in females), overweight with abdominal obesity (1.41, 95%CI 1.14-1.75 in males; 1.33, 95%CI 1.10-1.61 in females), obesity with abdominal obesity (1.46, 95%CI 1.11-1.91 in males; 1.46, 95%CI 1.17-1.81 in females). Overweight with normal WC was found to be not statistically significant for both males and females (all P>0.05). Subgroup analysis found a multiplicative interaction between age and anthropometric group in females (P for interaction <0.05). Sensitivity analysis results did not change. In the subjects with CVD risk factors, we found a similar relationship as in the general population .

Conclusions

Combined assessment of body mass index and waist circumference identifies obesity patterns associated with stroke risk.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12756-2.

Prevalence and Risk Factors of Central Obesity among Adults with Normal BMI in Shaanxi, China: A Cross-Sectional Study

(1) Background: The study aims to estimate the prevalence of normal weight with central obesity (NWCO) and to examine the relationship between NWCO and cardiovascular disease risk factors in adults of the province of Shaanxi. (2) Methods: A population-based cross-sectional survey was conducted among residents who were aged 18–80 years and had been living in Zhenba County, Shaanxi Province, for over six months in 2018. Descriptive data analysis and prevalence/frequency were conducted. Logistic regression analyses were used to detect the corresponding factors associated with central obesity. (3) Results: A total of 2312 participants (936 men and 1376 women) were analyzed. The prevalence of NWCO was 58.3%. NWCO was significantly associated with hypertension and dyslipidemia. Compared with normal weight non-central obesity (NWNO), the adjusted odds ratios (ORs) for hypertension were 1.47 (95% CI 1.10–1.98) in men and 1.55 (1.14–2.10) in women, and the corresponding odds ratios for dyslipidemia were 2.71 (1.77–4.13) in men and 1.84 (1.29–2.61) in women. Female sex, age over 58 years, and lower education level were also significantly predictors of abdominal obesity. (4) Conclusions: Body mass index alone as a measure of obesity is not sufficient for assessing health risks. Central obesity index should be used together for clinical assessment.

Association Between Obesity and Blood Pressure in Common Korean People

Purpose

The aim of this study was to investigate the associations of high blood pressure (BP) and wide pulse pressure (PP) with obesity among common Korean people.

Materials and Methods

This study analyzed data from the Seventh Korean National Health and Nutrition Examination Survey (2017). The associations of BP with body mass index (BMI) and waist-to-height ratio (WHT2R) were investigated using their lump mean values.

Results

The BPs of males and females increased with BMI, the PP of females increased with BMI and then decreased, and the PP of males is nearly independent of BMI. The BPs of males and females increased to their maximum values with WHT2R and then decreased. The PPs of males and females increased with WHT2R.

Conclusion

BMI can be used as a useful predictor for high BP, and WHT2R can be used as a useful predictor for wide PP.

Contribution of Different Phenotypes of Obesity to Metabolic Abnormalities from a Cross-Sectional Study in the Northwest China

BACKGROUND

This study has been conducted to explore the correlation between phenotypes of obesity and metabolic comorbidities.

METHODS

This cross-sectional study recruited 14,724 adults aged ≥18 years with a randomized stratified sampling strategy. Obesity was classified into four types according to body mass index (BMI) and waist-to-height ratio (WHtR): normal weight with central obesity (NWCO) and without (NW) CO, and obese or overweight with (OBCO) and without (OB) central obesity. Uric acid (UA), fasting blood glucose (FBG), and lipid profile were measured.

RESULTS

The prevalence of hyperuricemia in the 4 groups (NW, NWCO, OB and OBCO) was 3.7%, 5.6%, 8.7% and 12.4%, whilst the prevalence of hypertriglyceridemia was 13.4%, 27.4%, 30.3% and 43.7%, separately. The prevalence of hypo-high-density lipoprotein cholesterolemia (hypo-HDL emia) was 20.1%, 21.4%, 30.8% and 27.9%, while the prevalence of hyper-low-density lipoprotein cholesterolemia (hyper-LDL emia) was 9.8%, 24.4%, 12.3% and 27.9%. The prevalence of hypercholesterolemia was 11.2%, 23.5%, 14.7%, 28.5% and the prevalence of hyperglycemia was 9.7%, 22.6%, 18.5%, and 27.0%, respectively. The prevalence of hypertension was 6.9%, 13.1%, 14.7%, and 20.6%. For various metabolic abnormalities, OBCO have the highest risks compared with NW (hyperuricemia: adjusted OR (aOR)= 2.60; hypertriglyceridemia: aOR= 3.19; hypercholesterolemia: aOR= 1.48; hyper LDLemia: aOR= 2.21; hypo HDLemia: aOR= 1.42; hyperglycemia: aOR= 1.95; hypertension: aOR= 2.16). The risk of hyper LDLemia, hypercholesterolemia and hyperglycemia in the NWCO group was higher than that in the OB group (hyperLDLemia: aOR: 1.69 vs 0.97; hypercholesterolemia: aOR: 1.27 vs 1.24; hyperglycemia: aOR: 1.62 vs 1.28).

CONCLUSION

Different phenotypes of obesity are significantly associated with metabolic abnormalities. NWCO is more closely associated with hypercholesterolemia, hyperglycemia and hyper LDLemia. General obesity and central obesity have a synergistic effect on the diseases.

Prevalence and correlates of normal body mass index central obesity among people with cardiovascular diseases in Australia

OBJECTIVE

Obesity is one of the most common risk factors for cardiometabolic diseases in Australia and worldwide. Recent studies show that people with normal body mass index (BMI) but with central obesity are at increased risk of morbidity and mortality from cardiometabolic diseases. This risk has not been explained well. The aim of this study was to examine the magnitude, correlates and effects of normal BMI central obesity in the Australian adult population.

STUDY DESIGN

Longitudinal study with data linkage.

METHODS

We used the Baker Biobank, which contains sociodemographic, behavioural, clinical and mortality data. Data were collected between 2000 and 2011 from 6530 adults who were between 18 and 69 years of age. Biobank data were linked to the National Death Index. A matrix of BMI and waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) were used to create adiposity categories. For analysis, we used descriptive statistics, logistic regression and cox regression models.

RESULTS

The overall prevalence of normal BMI central obesity was 13.4% by WHtR and 14.4% by WHR. Gender, age, BMI and physical activity were associated with normal BMI central obesity. Higher odds of multimorbidity and increased hazards of all-cause and cardiovascular mortality were associated with WHR.

CONCLUSION

WHtR and WHR, when each used with BMI, provided similar estimates of prevalence of normal BMI central obesity. However, WHR is a better predictor of all-cause and cardiovascular mortality.

Cross-sectional study of associations between normal body weight with central obesity and hyperuricemia in Japan

BACKGROUND

Several studies have shown that normal weight with central obesity (NWCO) is associated with cardiovascular disease risk factors such as hypertension, dyslipidemia and diabetes. However, the relationship between NWCO and hyperuricemia has not been studied in detail.

METHODS

We investigated the association between NWCO and hyperuricemia among Japanese adults aged 40-64 years who had undergone periodic health examinations between April 2013 and March 2014. Obesity was defined as a body mass index (BMI) ≥25 kg/m² and central obesity was determined as a waist-to-height ratio (WHtR) ≥0.5. We classified the participants into the following groups based according to having obesity and central obesity: normal weight (BMI 18.5-24.9 kg/m²) without (NW; WHtR < 0.5) and with (NWCO) central obesity, and obesity without (OB) and with (OBCO) central obesity. Hyperuricemia was defined as serum uric acid > 7.0 and ≥ 6.0 mg/dL in men and women, respectively, or under medical treatment for hyperuricemia. Alcohol intake was classified as yes (daily and occasional consumption) and none (no alcohol consumption). Odds ratios (OR) and 95% confidence intervals (CI) for hyperuricemia were calculated using a logistic regression model.

RESULTS

We analyzed data derived from 96,863 participants (69,241 men and 27,622 women). The prevalences of hyperuricemia in men and women were respectively, 21.4 and 11.0%, and of participants with NWCO respectively 15.6 and 30.0%. The adjusted OR for hyperuricemia was significantly increased in OBCO compared with NW, regardless of sex (men: OR, 2.12; 95%CI; 2.03-2.21; women: OR, 3.54; 95%CI, 3.21-3.90) and were statistically significant in NWCO compared with NW (men: OR, 1.44; 95%CI, 1.36-1.52; women: OR, 1.41; 95%CI, 1.27-1.57). The results were similar regardless of alcohol consumption.

CONCLUSIONS

We found that NWCO and OBCO were associated with hyperuricemia in middle-aged Japanese men and women. Middle-aged Japanese adults with normal weight but having central obesity should be screened using a combination of BMI and WHtR and educated about how to prevent hyperuricemia.

Assessment of Nutritional Status and Dietary Pattern of a Rural Adult Population in Dry Zone, Sri Lanka

The objective of this work was to describe average dietary intake, physical activity (PA) and nutritional status of the adult population of Girandurukotte, Sri Lanka. A cross-sectional survey, including one 24-h dietary recall, international physical activity questionnaire and anthropometric measurements was conducted in a representative sample of 120 adults. Mean (SD) for body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist to height ratio (WHtR) were 23.06(4.20) kg/m2, 85.6(9.5) cm, 0.95(0.05) and 0.55(0.07), respectively. Significant differences were observed in height, body fat %, body muscle %, hip circumference, WHR, WHtR, fat mass index and hand grip strength between men and women (p < 0.05). Among the study group, 35.8% were overweight, 13.3% were obese and 11.7% were underweight. Central obesity was observed in 59.2%, 97.5% and 74.2% of adults by WC, WHR and WHtR, respectively. Mean (SD) dietary diversity score and dietary diversity score with portions were 4.77(1.28) and 4.09(1.32), respectively. Mean daily intake of protein, fruits, vegetables and dairy were well below the national recommendations. Despite the higher PA level, nearly half the population was overweight and obese and the majority was centrally obese. None of the dietary diversity scores met the optimal levels, suggesting poor quality and quantity of the diet.

Associations between normal weight central obesity and cardiovascular disease risk factors in Japanese middle-aged adults: a cross-sectional study

BACKGROUND

Several studies have shown that normal weight central obesity (NWCO) is associated with cardiovascular disease (CVD) risk factors. However, studies conducted in the Japanese population have been very limited. Thus, the relationships between normal weight central obesity, classified using body mass index (BMI), the waist-to-height ratio (WHtR), and CVD risk factors in middle-aged Japanese adults were investigated.

METHODS

The participants were Japanese adults aged 40-64 years who had undergone periodic health examinations in Japan during the period from April 2013 to March 2014. The participants were categorized into the following four groups: normal weight (BMI 18.5-24.9 kg/m²) and no central obesity (WHtR < 0.5) (NW); normal weight and central obesity (WHtR ≥ 0.5) (NWCO); obesity (BMI ≥ 25 kg/m²) and no central obesity (OB); and obesity and central obesity (OBCO). Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or taking medication for hypertension. Dyslipidemia was defined as LDL-C ≥ 140 mg/dl, HDL-C < 40 mg/dl, triglyceride ≥ 150 mg/dl, or taking medication for dyslipidemia. Diabetes was defined as fasting plasma glucose ≥ 126 mg/dl, random plasma glucose ≥ 200 mg/dl, HbA1c ≥ 6.5%, or receiving medical treatment for diabetes mellitus. A logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for hypertension, dyslipidemia, and diabetes.

RESULTS

A total of 117,163 participants (82,487 men and 34,676 women) were analyzed. The prevalence of NWCO was 15.6% in men and 30.2% in women. With reference to NW, the ORs for hypertension (adjusted OR 1.22, 95% CI 1.17-1.27 in men, 1.23, 1.16-1.31 in women), dyslipidemia (1.81, 1.74-1.89 in men, 1.60, 1.52-1.69 in women), and diabetes (1.35, 1.25-1.46 in men, 1.60, 1.35-1.90 in women) were significantly higher in NWCO.

CONCLUSIONS

Normal weight with central obesity was associated with CVD risk factors, such as hypertension, dyslipidemia, and diabetes, compared with normal weight without central obesity, regardless of sex. It is important to focus on normal weight with central obesity for the prevention of CVD in Japanese middle-aged adults.

A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England

The National Institute for Health and Care Excellence (NICE) has acknowledged the value of waist-to-height ratio (WHtR) as an indicator for ‘early health risk’. We used recent UK data to explore whether classification based on WHtR identifies more adults at cardiometabolic risk than the ‘matrix’ based on BMI and waist circumference, currently used for screening. Data from the Health Survey for England (4112 adults aged 18+ years) were used to identify cardiometabolic risk, indicated by raised glycated Hb, dyslipidaemia and hypertension. HbA1c, total/HDL-cholesterol and systolic blood pressure (BP) were more strongly associated with WHtR than the ‘matrix’. In logistic regression models for HbA1c ≥ 48 mmol/mol, total/HDL-cholesterol > 4 and hypertension (BP > 140/90 mmHg or on medication), WHtR had a higher predictive value than the ‘matrix’. AUC was significantly greater for WHtR than the ‘matrix’ for raised HbA1c and hypertension. Of adults with raised HbA1c, 15 % would be judged as ‘no increased risk’ using the ‘matrix’ in contrast to 3 % using WHtR < 0·5. For hypertension, comparative values were 23 and 9 %, and for total/HDL-cholesterol > 4, 26 and 13 %. Nearly one-third of the ‘no increased risk’ group in the ‘matrix’ had WHtR ≥ 0·5 and hence could be underdiagnosed for cardiometabolic risk. WHtR has the potential to be a better indicator of cardiometabolic risks associated with central obesity than the current NICE ‘matrix’. The cut-off WHtR 0·5 in early screening translates to a simple message, ‘your waist should be less than half your height’, that allows individuals to be aware of their health risks.

Disparity in Adiposity among Adults with Normal Body Mass Index and Waist-to-Height Ratio

Body mass index (BMI) is commonly used to define obesity. However, concerns about its accuracy in predicting adiposity have been raised. The feasibility of using BMI as well as waist-height ratio (WHtR) in assessing adiposity was examined in relation to a more direct measurement of percent body fat (%BF). We analyzed the relation between dual-energy X-ray absorptiometry (DXA)-measured fat mass and BMI and WHtR using the US 1999-2004 National Health and Nutrition Examination Survey (NHANES) data. A considerable proportion of subjects in the healthy BMI range 20-25 were found to have excess adiposity, including 33.1% of males and 51.9% of females. The use of WHtR also supports the notion of normal-weight central obesity (NWCO), which increases with age. These findings have important implications not only for clinical practice but also for many comparative studies where control subjects are usually selected based on age, sex, and BMI.

Abdominal obesity increases metabolic risk factors in non-obese adults: a Hungarian cross-sectional study

BACKGROUND

The prevalence of abdominal obesity is increasing worldwide. Adults with abdominal obesity have been reported to have increased risk of cardiometabolic disorders. The aim of this study was to examine whether non-obese subjects (body mass index (BMI) < 25 kg/m2) with abdominal obesity examined in the framework of the Swiss-Hungarian Cooperation Programme had increased metabolic risk compared to participants without abdominal obesity.

METHODS

A cross-sectional study was carried out in 5228 non-obese individuals. Data were collected between July 2012 and February 2016. Descriptive statistics, Pearson's correlation analysis and multiple logistic regression models were applied, odds ratios (OR) with 95% confidence interval (CI) being the outcomes.

RESULTS

607 (11.6%) out of the 5228 non-obese individuals had abdominal obesity. The correlation analysis indicated that the correlation coefficients between BMI and waist circumference (WC) were 0.610 in males and 0.526 in females. In this subgroup, the prevalence of high systolic blood pressure, high fasting blood glucose, and high total cholesterol and triglyceride levels were significantly higher. The logistic regression model based on these data showed significantly higher risk for developing high systolic blood pressure (OR = 1.53; 95% CI = 1.20-1.94), low HDL cholesterol (OR = 2.06; 95% CI = 1.09-3.89), and high trygliceride level (OR = 1.65; 95% CI = 1.27-2.16).

CONCLUSIONS

There was a very high, significant, positive correlation between WC and BMI. Abdominal obesity was found to be strongly related to certain metabolic risk factors among non-obese subjects. Hence, measuring waist circumference could be recommended as a simple and efficient tool for screening abdominal obesity and related metabolic risk even in non-obese individuals.

[Not Available]

Objectif

Étudier le risque de mortalité présenté par l’obésité centrale chez les personnes de poids normal, déterminer une mesure clinique pour aider à dépister ce phénotype et examiner les moyens de réduire ce risque.

Qualité des données

La recherche n’a relevé que des études de cohorte prospectives (niveau II) ayant comparé des participants qui présentaient une obésité centrale et un poids normal à des participants dont l’indice de masse corporelle (IMC) était élevé. Des études de niveau I de bonne qualité ont démontré l’effet des interventions liées à l’alimentation et à l’exercice sur l’obésité centrale et la mortalité.

Message principal

Les participants centralement obèses malgré un IMC normal et qui sont atteints de dyslipidémie athérogène présentent un risque comparable, sinon supérieur, de mortalité que les participants qui sont centralement obèses en plus d’être en surpoids ou obèses selon l’IMC. Le rapport entre le tour de taille et la taille^* serait la mesure clinique la plus pragmatique de l’obésité centrale. Le régime méditerranéen est une intervention efficace pour stopper la prise pondérale tout en réduisant la ceinture abdominale. Un faible niveau d’exercice réduit aussi le tour de taille. La perte pondérale ne doit pas constituer l’objectif.

Conclusion

Un rapport entre le tour de taille et la taille de plus de 0,5 malgré un IMC normal indique un risque élevé de mortalité par atteinte cardiométabolique. Ce risque serait équivalent, voire supérieur, au risque présenté par les patients centralement obèses en plus d’être en surpoids ou obèses. De légères interventions liées à l’alimentation et à l’exercice sont efficaces pour réduire ce risque.

Normal-weight central obesity: Unique hazard of the toxic waist

OBJECTIVE

To examine the mortality risk presented by normal-weight central obesity, to identify a clinical measure to aid in the identification of this phenotype, and to explore the means for mitigation of this risk.

QUALITY OF EVIDENCE

Only prospective cohort studies (level II) comparing participants with central obesity at normal weight with those at higher levels of body mass index (BMI) were found. Good level I studies were available to demonstrate the effect of diet and exercise interventions on central obesity and mortality.

MAIN MESSAGE

Participants with atherogenic dyslipidemia who are centrally obese at normal BMI are at similar, and possibly higher, mortality risk compared with those who are centrally obese and overweight or obese according to their BMI. Waist-to-height ratio might be the most pragmatic clinical measure of central obesity. The Mediterranean diet is an effective intervention to prevent ongoing weight gain while reducing abdominal girth. Low levels of exercise can also reduce waist circumference. Weight loss need not be an objective.

CONCLUSION

A waist-to-height ratio exceeding 0.5 at normal BMI identifies elevated mortality risk for cardiometabolic disease. This risk might equal or exceed that of centrally obese patients who are overweight or obese. Modest dietary and exercise interventions can be effective in mitigation of this risk.

Temporal trends in normal weight central obesity and its associations with cardiometabolic risk among Chinese adults

Normal weight central obesity (NWCO), a distinct phenotype of obesity that is associated with a higher risk of cardiometabolic dysregulation, has received growing attention in the scientific literature. In this study, we aimed to report the prevalence of NWCO in the general Chinese adults and its secular trend from 1993 to 2011. The comorbid cardiometabolic risk of NWCO was also explored. Data from the China Health and Nutrition Survey (CHNS) 1993-2011 were obtained. NWCO was defined as the combination of a BMI of 18.5-23.9 kg/m2 and 1) a waist circumference (WC) of >85 cm in males or >80 cm in females (NWCO by WC); 2) a waist to height ratio (WHtR) of ≥0.5 (NWCO by WHtR); 3) a waist to hip ratio (WHR) of ≥0.9 in males or ≥0.85 in females (NWCO by WHR). We assessed the trend of NWCO prevalence with the generalized estimating equation method. The demographic, socioeconomic, geographic, behavioural and cardiometabolic predictors of NWCO were explored with multivariable logistic regression. From 1993 to 2011, the age-standardized prevalence of NWCO by WC increased from 6.65% (95% CI: 6.09-7.26) to 13.24% (95% CI: 12.58-13.93), and that of NWCO by WHtR and NWCO by WHR rose from 13.18% (95% CI: 12.41-13.98) to 17.06% (95% CI: 16.35-17.79) and from 16.14% (95% CI: 15.3-17.01) to 19.04% (95% CI: 18.25-19.85) respectively. The associated cardiometabolic factors of NWCO (by WC, WHtR and WHR) were hypertension, diabetes, insulin resistance, decreased insulin sensitivity, low high-density lipoprotein and elevated triglyceride. Moreover, NWCO by WC and NWCO by WHtR were associated with a decreased risk of impaired insulin secretion, and NWCO by WC was additionally linked to elevated total cholesterol. The prevalence of NWCO in the general Chinese adults increased significantly from 1993 to 2011. Effective strategies are needed to combat this epidemic and reduce its deleterious health outcomes.

Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial

Background/Objectives

There have been no studies examining the efficacy of meal replacement (MR) on weight loss and metabolic syndrome (MS) improvement in Southeast Asians. Thus, we undertook a 12-week randomised trial to evaluate the effect of a lifestyle education intervention alone (LEI) or with partial MR (LEI + MR) in obese Thai adults with MS.

Subjects/Methods

A total of 110 patients were randomised to receive either LEI or LEI + MR. Both groups received LEI to achieve weight loss. LEI + MR group additionally received two MR daily to replace either breakfast, lunch or dinner. Mean ± SE body mass index of all participants was 34.6 ± 0.6 kg/m², mean ± SE age was 42.5 ± 1.1 years and 83% of patients were female. Both groups were compared for anthropometric and cardiometabolic indices at 12-week. Body weight was also compared at weeks 38 and 64.

Results

At 12 weeks, both groups exhibited statistically significant percentage weight loss (%WL) compared to initial weight but greater %WL was observed in LEI + MR compared to LEI, 2.9% vs. 1.5%, respectively (p < 0.05). MS criteria such as waist circumference and blood pressure improved significantly in both groups compared to baseline. However, improvement in fasting plasma glucose (FPG) was only significant in LEI + MR, and more participants with impaired FPG at baseline in LEI + MR (42.9%) than LEI (19%) returned to normal FPG at 12 weeks (p < 0.05). HbA_1c, fasting insulin and HOMA-IR in LEI + MR were significantly lower than with LEI. At the end of the 12-week intervention period, 16% of participants no longer fulfilled MS criteria. A statistically significant weight loss from baseline persisted until 38 weeks but no longer reached statistically significant difference between groups

Conclusions

LEI and LEI + MR were acceptable and led to improvement in weight and MS. LEI + MR group exhibited additional weight reduction and glycemic benefits at 12 weeks.

Central obesity and normal-weight central obesity among adults attending healthcare facilities in Buffalo City Metropolitan Municipality, South Africa: a cross-sectional study

BACKGROUND

Central obesity (CO) confers a significant threat on the cardio-metabolic health of individuals, independently of overall obesity. Disparities in the measures of fat distribution lead to misclassification of individuals who are at risk of cardio-metabolic diseases. This study sought to determine the prevalence and correlates of central obesity and normal-weight central obesity among adults attending selected healthcare facilities in Buffalo City Metropolitan Municipality (BCMM), South Africa, assess their health risk and examine the association between central obesity and cardio-metabolic diseases among adults with normal weight, measured by body mass index (BMI).

METHODS

A cross-sectional survey of 998 adults was carried out at the three largest outpatient clinics in BCMM. Overall and central obesity were assessed using BMI, waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHTR). The WHO STEPwise questionnaire was used for data collection. Blood pressure and blood glucose were measured. Normal-weight central obesity was defined as CO among individuals with normal weight, as assessed by BMI. Health risk levels were assessed using the National Institute for Health and Clinical Excellence (NICE) BMI-WC composite index. Bivariate and multivariate analyses were used to determine the prevalence of CO, normal-weight central obesity and the predictors of CO.

RESULTS

The mean age of participants was 42.6 (± 16.5) years. The prevalence of CO was 67.0, 58.0 and 71.0% by WC, WHR and WHTR, respectively. The prevalence of normal-weight central obesity was 26.9, 36.9 and 29.5% by WC, WHR and WHTR, respectively. About 41% of the participants had a very high health risk, 13% had increased risk or high risk and 33% had no health risk. Central obesity was significantly associated with hypertension but not associated with diabetes among those with normal weight (by BMI). Female sex, age over 30 years, marriage, secondary or tertiary level of education, non-smoking status, diabetes and hypertension significantly predicted central obesity among the study participants.

CONCLUSION

The prevalence of central obesity among the study participants is high, irrespective of the defining criteria. One in three adults of normal weight had central obesity. Body mass index should therefore not be used alone for clinical assessment by healthcare workers in the study setting.

Waist-to-height ratio is better than body mass index and waist circumference as a screening criterion for metabolic syndrome in Han Chinese adults

Metabolic syndrome (MetS) is a major public health concern. Efficient screening requires criteria that are economical, easily accessible, and applicable for all populations. We aimed to compare the discriminating ability of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) for the diagnosis of MetS in a Han Chinese population.Demographic information, obesity indices, and results of biochemical tests were collected from a cross-sectional sample of 8084 individuals (3619 men and 4465 women, 18-79 years old) from Changping District, Beijing, China. Areas under receiver operating characteristic curves (AUCs) and adjusted odd ratios of 3 obesity indices were analyzed and their optimal cutoffs were determined.For women, the AUCs demonstrated that WHtR was significantly more powerful than BMI and WC (both P < .05) for predicting MetS [WHtR, 0.857 (0.846-0.868); WC, 0.849 (0.837-0.860); BMI, 0.808 (0.795-0.821)]. For men, WHtR was significantly better than BMI [P < .05; WHtR, 0.859 (0.846-0.871); WC, 0.855 (0.843-0.868); BMI, 0.815 (0.802-0.829)]. The optimal cutoffs for WHtR for discriminating MetS were 0.51 in both genders. Multiple logistic regression confirmed the positive association between WHtR and the risk of MetS. In the nonobese subgroup, WHtR was also superior to BMI and WC for predicting MetS in men (P < .05) and better than BMI in women (P < .05).Among the obesity indices analyzed here, WHtR was the best for predicting MetS in Han Chinese adults, especially in nonobese adults.