Waist Circumference and Cardiometabolic Risk: A Consensus Statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association

Introduction Obesity is an important risk factor for cardiometabolic diseases, including diabetes, hypertension, dyslipidemia, and coronary heart disease (CHD). Several leading national and international institutions, including the World Health Organization and the National Institutes of Health, have provided guidelines for classifying weight status based on body mass index (BMI) (1,2). Data from epidemiological studies demonstrate a direct correlation between BMI and the risk of medical complications and mortality rate (e.g., 3,4). Men and women who have a BMI 30 kg/m are considered obese and are generally at higher risk for adverse health events than are those who are considered overweight (BMI between 25.0 and 29.9 kg/m) or lean (BMI between 18.5 and 24.9 kg/m). Therefore, BMI has become the ‘‘gold standard’’ for identifying patients at increased risk of adiposity-related adverse health outcomes. Body fat distribution is also an important risk factor for obesity-related diseases. Excess abdominal fat (also known as central or upper-body fat) is associated with an increased risk of cardiometabolic disease. However, precise measurement of abdominal fat content requires the use of expensive radiological imaging techniques. Therefore, waist circumference (WC) is often used as a surrogate marker of abdominal fat mass, because WC correlates with abdominal fat mass (subcutaneous and intra-abdominal) (5) and is associated with cardiometabolic disease risk (6). Men and women who have WCs greater than 40 inches (102 cm) and 35 inches (88 cm), respectively, are considered to be at increased risk for cardiometabolic disease (7). These cutpoints were derived from a regression curve that identified the WC values associated with a BMI 30 kg/m in primarily Caucasian men and women living in north Glasgow (8). An expert panel, organized by the National Heart, Lung and Blood Institute (NHLBI), has recommended that WC be measured as part of the initial assessment and be used to monitor the efficacy of weight loss therapy in overweight and obese patients who have a BMI 35 kg/m (7). HowThe costs of publication of this article were defrayed, in part, by the payment of page charges. This article must, therefore, be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. *Director, Center for Human Nutrition, Chief, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, Saint Louis, Missouri; †Director, Clinical Nutrition Research Unit, University of Alabama at Birmingham, Birmingham, Alabama; ‡Executive Director, Clinical Research, Metabolism, Merck Pharmaceutical Company, Rahway, New Jersey; §Director, Obesity and Nutrition Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania; ¶Professor of Pediatrics and Medicine, Naomi Berrie Diabetes Center, Columbia University, New York, New York; Director, Obesity and Diabetes Programs, North General Hospital, New York, New York; and **American Diabetes Association, Alexandria, Virginia. Address correspondence to Samuel Klein, MD, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8031, Saint Louis, Missouri 63110. E-mail: sklein@wustl.edu Copyright © 2007 NAASO and the American Diabetes Association 1 Nonstandard abbreviations: CHD, coronary heart disease; BMI, body mass index; WC, waist circumference; NHLBI, National Heart, Lung and Blood Institute; MRI, magnetic resonance imaging; CT, computed tomography; SAAT, subcutaneous abdominal adipose tissue; IAAT, intra-abdominal adipose tissue; NHANES III, National Health and Nutrition Examination Survey III.