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      Association between High Waist-to-Height Ratio and Cardiovascular Risk among Adults Sampled by the 2016 Half-Way National Health and Nutrition Survey in Mexico (ENSANUT MC 2016)

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          Abstract

          Little evidence exists regarding the association between waist-to-height ratio (WHtR) and cardiovascular risk (CVR) factors in Mexican adults. Our study pursued a twofold objective: To describe the association between a high WHtR and CVR indicators among Mexican adults canvassed by the 2016 Half-Way National Health and Nutrition Survey, and to examine the interaction of sex and age on this association. We analyzed data from the adult sample (≥20 years old) and classified in two groups using WHtRs ≥0.5 considered high and low otherwise. The following CVR factors were analyzed: High-total-cholesterol (≥200 mg/dL), low high-density-lipoprotein-cholesterol (HDL-c < 40 mg/dL), high low-density-lipoprotein-cholesterol (LDL-c ≥ 130 mg/dL), high triglycerides (≥150 mg/dL), insulin resistance (IR) (HOMA-IR) (≥2.6), and hypertension (HBP) (≥140/≥90 mmHg). We estimated prevalence ratios (PR) to analyze the association between high WHtRs and CVR indicators. Over 90% of participants had high WHtRs and were at greater risk for dyslipidemias, HBP, and IR compared to those that had low WHtRs. PR for men with high WHtRs were between 1.3 to 2.3 for dyslipidemias, 3.4 for HBP and 7.6 for IR; among women were between 1.8 to 2.4 for dyslipidemias and HBP and 5.9 for IR ( p < 0.05). A high WHtR is associated with CVR factors in Mexican adults.

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          Prevalence and prevention of cardiovascular disease and diabetes mellitus

          Noncommunicable diseases (NCDs) have become important causes of mortality on a global scale. According to the report of World Health Organization (WHO), NCDs killed 38 million people (out of 56 million deaths that occurred worldwide) during 2012. Cardiovascular diseases accounted for most NCD deaths (17.5 million NCD deaths), followed by cancers (8.2 million NCD deaths), respiratory diseases (4.0 million NCD deaths) and diabetes mellitus (1.5 million NCD deaths). Globally, the leading cause of death is cardiovascular diseases; their prevalence is incessantly progressing in both developed and developing nations. Diabetic patients with insulin resistance are even at a greater risk of cardiovascular disease. Obesity, high cholesterol, hypertriglyceridemia and elevated blood pressure are mainly considered as major risk factors for diabetic patients afflicted with cardiovascular disease. The present review sheds light on the global incidence of cardiovascular disease and diabetes mellitus. Additionally, measures to be taken to reduce the global encumbrance of cardiovascular disease and diabetes mellitus are highlighted.
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            Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference

            Objectives There is now good evidence that central obesity carries more health risks compared with total obesity assessed by body mass index (BMI). It has therefore been suggested that waist circumference (WC), a proxy for central obesity, should be included with BMI in a ‘matrix’ to categorise health risk. We wanted to compare how the adult UK population is classified using such a ‘matrix’ with that using another proxy for central obesity, waist-to-height ratio (WHtR), using a boundary value of 0.5. Further, we wished to compare cardiometabolic risk factors in adults with ‘healthy’ BMI divided according to whether they have WHtR below or above 0.5. Setting, participants and outcome measures Recent data from 4 years (2008–2012) of the UK National Diet and Nutrition Survey (NDNS) (n=1453 adults) were used to cross-classify respondents on anthropometric indices. Regression was used to examine differences in levels of risk factors (triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), TC: HDL, glycated haemoglobin (HbA1c), fasting glucose, systolic (SBP) and diastolic blood pressure (DBP)) according to WHtR below and above 0.5, with adjustment for confounders (age, sex and BMI). Results 35% of the group who were judged to be at ‘no increased risk’ using the ‘matrix’ had WHtR ≥0.5. The ‘matrix’ did not assign ‘increased risk’ to those with a ‘healthy’ BMI and ‘high’ waist circumference. However, our analysis showed that the group with ‘healthy’ BMI, and WHtR ≥0.5, had some significantly higher cardiometabolic risk factors compared to the group with ‘healthy’ BMI but WHtR below 0.5. Conclusions Use of a simple boundary value for WHtR (0.5) identifies more people at ‘early health risk’ than does a more complex ‘matrix’ using traditional boundary values for BMI and WC. WHtR may be a simpler and more predictive indicator of the ‘early heath risks’ associated with central obesity.
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              Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore

              Background Excess adiposity is associated with cardiovascular disease (CVD) risk factors such as hypertension, diabetes mellitus and dyslipidemia. Amongst the various measures of adiposity, the best one to help predict these risk factors remains contentious. A novel index of adiposity, the Body Adiposity Index (BAI) was proposed in 2011, and has not been extensively studied in all populations. Therefore, the purpose of this study is to compare the relationship between Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Body Adiposity Index (BAI) and CVD risk factors in the local adult population. Methods and Findings This is a cross sectional study involving 1,891 subjects (Chinese 59.1% Malay 22.2%, Indian 18.7%), aged 21–74 years, based on an employee health screening (2012) undertaken at a hospital in Singapore. Anthropometric indices and CVD risk factor variables were measured, and Spearman correlation, Receiver Operating Characteristic (ROC) curves and multiple logistic regressions were used. BAI consistently had the lower correlation, area under ROC and odd ratio values when compared with BMI, WC and WHtR, although differences were often small with overlapping 95% confidence intervals. After adjusting for BMI, BAI did not further increase the odds of CVD risk factors, unlike WC and WHtR (for all except hypertension and low high density lipoprotein cholesterol). When subjects with the various CVD risk factors were grouped according to established cut-offs, a BMI of ≥23.0 kg/m2 and/or WHtR ≥0.5 identified the highest proportion for all the CVD risk factors in both genders, even higher than a combination of BMI and WC. Conclusions BAI may function as a measure of overall adiposity but it is unlikely to be better than BMI. A combination of BMI and WHtR could have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                21 June 2019
                June 2019
                : 11
                : 6
                : 1402
                Affiliations
                [1 ]Evaluation and Surveys Research Center, National Public Health Institute, 62100 Cuernavaca, Mexico; erangelb@ 123456insp.mx (E.R.-B.); tshamah@ 123456insp.mx (T.S.-L.)
                [2 ]Center for Nutrition and Health Research, National Public Health Institute, 62100 Cuernavaca, Mexico; scrodrig@ 123456insp.mx
                [3 ]Center for Research in Mathematics, Aguascalientes Unit, 20259 Aguascalientes, Mexico; imendez@ 123456cimat.mx
                [4 ]General Director of the National Public Health Institute, 62100 Cuernavaca, Mexico; jrivera@ 123456insp.mx
                Author notes
                [* ]Correspondence: lcuevas@ 123456insp.mx ; Tel.: +01-7773293000 (ext. 7225)
                Author information
                https://orcid.org/0000-0002-5852-8284
                https://orcid.org/0000-0001-9890-3563
                https://orcid.org/0000-0002-1357-720X
                https://orcid.org/0000-0002-5439-4389
                https://orcid.org/0000-0002-3908-0867
                Article
                nutrients-11-01402
                10.3390/nu11061402
                6627816
                31234359
                c08f79de-5618-410e-8e0d-300c9260c1b8
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 09 May 2019
                : 14 June 2019
                Categories
                Article

                Nutrition & Dietetics
                waist-to-height ratio,abdominal obesity,cardiovascular risk,adults,surveys
                Nutrition & Dietetics
                waist-to-height ratio, abdominal obesity, cardiovascular risk, adults, surveys

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