Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

Abstract Objective: To determine the frequency of cardiovascular risk factors in people categorised by previously defined “action g126 levels” of waist circumference. Design: Prevalence study in a random population sample. Setting: Netherlands. Subjects: 2183 men and 2698 women aged 20-59 years selected at random from the civil registry of Amsterdam and Maastricht. Main outcome measures: Waist circumference, waist to hip ratio, body mass index (weight (kg)/height (m2)), total plasma cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle. Results: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of >/=25 and waist to hip ratios >/=0.95 in men and >/=0.80 in women with a sensitivity and specificity of >/=96%. Men and women with at least one cardiovascular risk factor (total cholesterol >/=6.5 mmol/l, high density lipoprotein cholesterol </=0.9 mmol/l, systolic blood pressure >/=160 mm Hg, diastolic blood pressure >/=95 mm Hg) were identified with sensitivities of 57% and 67% and specificities of 72% and 62% respectively. Compared with those with waist measurements below action levels, age and lifestyle adjusted odds ratios for having at least one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1) in women with a waist measurement of 80-88 cm. In men and women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively. Conclusions: Larger waist circumference identifies people at increased cardiovascular risks.

[1]  A. Angel.  Progress in Obesity Research: 7 , 1996 .

[2]  J. Vandenbroucke.  Postmenopausal oestrogen and cardioprotection , 1991, The Lancet.

[3]  A Tremblay,et al.  Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. , 1994, The American journal of cardiology.

[4]  J. Coope,et al.  Can we improve compliance with long-term HRT? , 1992, Maturitas.

[5]  E. Barrett-Connor,et al.  Postmenopausal estrogen use and heart disease risk factors in the 1980s. Rancho Bernardo, Calif, revisited. , 1989, JAMA.

[6]  J H Ruijs,et al.  Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. , 1988, European journal of clinical nutrition.

[7]  G A Colditz,et al.  Obesity, Fat Distribution, and Weight Gain as Risk Factors for Clinical Diabetes in Men , 1994, Diabetes Care.

[8]  W. Kannel,et al.  Regional obesity and risk of cardiovascular disease; the Framingham Study. , 1991, Journal of clinical epidemiology.

[9]  K. McPherson,et al.  Long‐term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy , 1988, British journal of obstetrics and gynaecology.

[10]  G A Colditz,et al.  Physical Activity, Obesity, and Risk for Colon Cancer and Adenoma in Men , 1995, Annals of Internal Medicine.

[11]  Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society. , 1987, European heart journal.

[12]  R. Ross,et al.  Adipose tissue distribution measured by magnetic resonance imaging in obese women. , 1993, The American journal of clinical nutrition.

[13]  J. Bunker,et al.  The physician-patient as an informed consumer of surgical services. , 1974, The New England journal of medicine.

[14]  R Guardo,et al.  Quantification of adipose tissue by MRI: relationship with anthropometric variables. , 1992, Journal of applied physiology.

[15]  G. Möller,et al.  Multicentre Study of a New Enzymatic Method of Cholesterol Determination , 1984, Journal of clinical chemistry and clinical biochemistry. Zeitschrift fur klinische Chemie und klinische Biochemie.

[16]  A. King,et al.  Are women using postmenopausal estrogens? A community survey. , 1990, American journal of public health.

[17]  A. Gray,et al.  HRT: an analysis of benefits, risks and costs. , 1992, British medical bulletin.

[18]  A. Folsom,et al.  Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. , 1992, The American journal of clinical nutrition.

[19]  A. Hamsten,et al.  Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors. , 1993, Atherosclerosis.

[20]  W. Creasman,et al.  Effects of long-term estrogen replacement therapy. II. Neoplasia. , 1979, American journal of obstetrics and gynecology.

[21]  W. W. Muir,et al.  Regression Diagnostics: Identifying Influential Data and Sources of Collinearity , 1980 .

[22]  R. Sitruk-Ware.  STROKE PREVENTION AND OESTROGEN REPLACEMENT THERAPY , 1989, The Lancet.

[23]  R. Hahn.  Compliance considerations with estrogen replacement: withdrawal bleeding and other factors. , 1989, American journal of obstetrics and gynecology.

[24]  C. D. Beaumont,et al.  Regression Diagnostics — Identifying Influential Data and Sources of Collinearity , 1981 .

[25]  M. Lopes-Virella,et al.  Cholesterol determination in high-density lipoproteins separated by three different methods. , 1977, Clinical chemistry.

[26]  V. Ravnikar.  Compliance with hormone therapy. , 1987, American journal of obstetrics and gynecology.

[27]  A. Sönnichsen,et al.  Benefit from hypocaloric diet in obese men depends on the extent of weight-loss regarding cholesterol, and on a simultaneous change in body fat distribution regarding insulin sensitivity and glucose tolerance. , 1992, Metabolism: clinical and experimental.

[28]  J. Tuomilehto,et al.  Geographical variation in the major risk factors of coronary heart disease in men and women aged 35-64 years , 1988 .

[29]  Michael J. Campbell,et al.  Statistics at Square One , 1976, British medical journal.

[30]  B. Chern-Hughes.  The use of estrogens and progestins and the risk of breast cancer in postmenopausal women , 1996 .

[31]  C. Morrison,et al.  Waist circumference as a measure for indicating need for weight management , 1995, BMJ.

[32]  R. Doll,et al.  Mortality in relation to smoking: 22 years' observations on female British doctors. , 1980, British medical journal.

[33]  C. Dugowson,et al.  Physicians as patients--the use of obstetric technology in physician families. , 1987, The Western journal of medicine.

[34]  R. Wing,et al.  Effect of modest weight loss on changes in cardiovascular risk factors: are there differences between men and women or between weight loss and maintenance? , 1995, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[35]  J. Deslypere,et al.  Fat distribution in European men: a comparison of anthropometric measurements in relation to cardiovascular risk factors. , 1992, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[36]  R. Krauss,et al.  Multivariate analysis of the insulin resistance syndrome in women. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.

[37]  W. Kannel,et al.  Hazards of obesity--the Framingham experience. , 2009, Acta medica Scandinavica. Supplementum.