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      Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults

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          Abstract

          Purpose

          We aimed to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cardiometabolic risk.

          Methods

          In this cross-sectional study, 21,038 men and 15,604 women who participated in a health check-up were included.

          Results

          In both men and women, the area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of diabetes, hypertension, high total cholesterol, high triglycerides, and low HDL-cholesterol ( P < 0.05 for all). The AUC for WHtR in the prediction of metabolic syndrome (MS) was also highest in the women ( P < 0.05). After adjustment for potential confounders, the odds ratios and 95% confidence intervals for MS for each standard deviation increase in BMI, WHtR, and WC were 1.47 (1.46–1.49), 1.32 (1.31–1.33), and 1.19 (1.18–1.19), respectively. Finally, patients of either sex with a normal BMI or WC level, but with an elevated WHtR, had higher levels of various cardiometabolic risk factors in comparison with their normal BMI or WC, but low WHtR, counterparts ( P < 0.05 for all).

          Conclusion

          Among Taiwanese adults, a WHtR greater than 0.5 is a simple, yet effective indicator of centralized obesity and associated cardiometabolic risk, even among individuals deemed ‘healthy’ according to BMI and WC.

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          Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults.

          Bei-Fan Zhou (2002)
          For prevention of obesity in Chinese population, it is necessary to define the optimal range of healthy weight and the appropriate cut-off points of BMI and waist circumference for Chinese adults. The Working Group on Obesity in China under the support of International Life Sciences Institute Focal point in China organized a meta-analysis on the relation between BMI, waist circumference and risk factors of related chronic diseases (e.g., high diabetes, diabetes mellitus, and lipoprotein disorders). 13 population studies in all met the criteria for enrollment, with data of 239,972 adults (20-70 year) surveyed in the 1990s. Data on waist circumference was available for 111,411 persons and data on serum lipids and glucose were available for more than 80,000. The study populations located in 21 provinces, municipalities and autonomous regions in mainland China as well as in Taiwan. Each enrolled study provided data according to a common protocol and uniform format. The Center for data management in Department of Epidemiology, Fu Wai Hospital was responsible for statistical analysis. The prevalence of hypertension, diabetes, dyslipidemia and clustering of risk factors all increased with increasing levels of BMI or waist circumference. BMI at 24 with best sensitivity and specificity for identification of the risk factors, was recommended as the cut-off point for overweight, BMI at 28 which may identify the risk factors with specificity around 90% was recommended as the cut-off point for obesity. Waist circumference beyond 85 cm for men and beyond 80 cm for women were recommended as the cut-off points for central obesity. Analysis of population attributable risk percent illustrated that reducing BMI to normal range ( or = 28) with drugs could prevent 15%-17% clustering of risk factors. The waist circumference controlled under 85 cm for men and under 80 cm for women, could prevent 47%-58% clustering of risk factors. According to these, a classification of overweight and obesity for Chinese adults is recommended.
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            Waist circumference and not body mass index explains obesity-related health risk.

            Ian Janssen, Peter Katzmarzyk, Robert Ross (2004)
            The addition of waist circumference (WC) to body mass index (BMI; in kg/m(2)) predicts a greater variance in health risk than does BMI alone; however, whether the reverse is true is not known. We evaluated whether BMI adds to the predictive power of WC in assessing obesity-related comorbidity. Subjects were 14 924 adult participants in the third National Health and Nutrition Examination Survey, grouped into categories of BMI and WC in accordance with the National Institutes of Health cutoffs. Odds ratios for hypertension, dyslipidemia, and the metabolic syndrome were compared for overweight and class I obese BMI categories and the normal-weight category before and after adjustment for WC. BMI and WC were also included in the same regression model as continuous variables for prediction of the metabolic disorders. With few exceptions, overweight and obese subjects were more likely to have hypertension, dyslipidemia, and the metabolic syndrome than were normal-weight subjects. After adjustment for WC category (normal or high), the odds of comorbidity, although attenuated, remained higher in overweight and obese subjects than in normal-weight subjects. However, after adjustment for WC as a continuous variable, the likelihood of hypertension, dyslipidemia, and the metabolic syndrome was similar in all groups. When WC and BMI were used as continuous variables in the same regression model, WC alone was a significant predictor of comorbidity. WC, and not BMI, explains obesity-related health risk. Thus, for a given WC value, overweight and obese persons and normal-weight persons have comparable health risks. However, when WC is dichotomized as normal or high, BMI remains a significant predictor of health risk.
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              Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.

              Ali Mokdad, Earl S. Ford, Barbara BOWMAN … (2003)
              Obesity and diabetes are increasing in the United States. To estimate the prevalence of obesity and diabetes among US adults in 2001. Random-digit telephone survey of 195 005 adults aged 18 years or older residing in all states participating in the Behavioral Risk Factor Surveillance System in 2001. Body mass index, based on self-reported weight and height and self-reported diabetes. In 2001 the prevalence of obesity (BMI > or =30) was 20.9% vs 19.8% in 2000, an increase of 5.6%. The prevalence of diabetes increased to 7.9% vs 7.3% in 2000, an increase of 8.2%. The prevalence of BMI of 40 or higher in 2001 was 2.3%. Overweight and obesity were significantly associated with diabetes, high blood pressure, high cholesterol, asthma, arthritis, and poor health status. Compared with adults with normal weight, adults with a BMI of 40 or higher had an odds ratio (OR) of 7.37 (95% confidence interval [CI], 6.39-8.50) for diagnosed diabetes, 6.38 (95% CI, 5.67-7.17) for high blood pressure, 1.88 (95% CI,1.67-2.13) for high cholesterol levels, 2.72 (95% CI, 2.38-3.12) for asthma, 4.41 (95% CI, 3.91-4.97) for arthritis, and 4.19 (95% CI, 3.68-4.76) for fair or poor health. Increases in obesity and diabetes among US adults continue in both sexes, all ages, all races, all educational levels, and all smoking levels. Obesity is strongly associated with several major health risk factors.
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                Author and article information

                Contributors
                : +886-3-3281200 , +886-3-3287715 , 620313@adm.cgmh.org.tw
                Journal
                Journal ID (nlm-ta): Eur J Nutr
                Journal ID (iso-abbrev): Eur J Nutr
                Title: European Journal of Nutrition
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 1436-6207
                ISSN (Electronic): 1436-6215
                Publication date (Electronic): 11 December 2011
                Publication date PMC-release: 11 December 2011
                Publication date (Print): February 2013
                Volume: 52
                Issue: 1
                Pages: 57-65
                Affiliations
                [ ]Department of Occupation Medicine, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Maijin Rd., Keelung, 200 Taiwan
                [ ]Department of Emergency Medicine, Chang-Gung Memorial Hospital, Chiayi Branch, No. 6, West Sec. Chia-Pu Rd, Put-Zu, Chiayi, 600 Taiwan
                [ ]Chang Gung Institute of Technology, Chiayi Branch, No. 2, West Sec. Chia-Pu Rd, Put-Zu, Chiayi, 600 Taiwan
                [ ]Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou Branch, No. 5, Fu-Hsing Street, Guei-Shan, Taoyuan, 333 Taiwan
                [ ]College of Medicine, Chang-Gung University, No. 259, Wen-Hwa 1st Rd., Guei-Shan, Taoyuan, 333 Taiwan
                [ ]Department of Family Medicine, Chang-Gung Memorial Hospital, Kaohsiung Branch, No. 123, Dapi Rd., Niaosong Township, Kaohsiung County, 833 Taiwan
                [ ]Department of Emergency Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 10449 Taiwan
                [ ]Institute of Environmental and Occupational Health Science, National Yang-Ming University, Taipei, 112 Taiwan
                [ ]Department of Occupation Medicine, Chang-Gung Memorial Hospital, No. 5, Fu-Hsing Street, Guei-Shan, Taoyuan, 333 Taiwan, ROC
                Article
                Publisher ID: 286
                DOI: 10.1007/s00394-011-0286-0
                PMC ID: 3549404
                PubMed ID: 22160169
                SO-VID: dcb3b285-5577-478f-a372-5591d99bb0a7
                Copyright © © The Author(s) 2011
                History
                Date received : 17 June 2011
                Date accepted : 18 November 2011
                Categories
                Subject: Original Contribution
                Custom metadata
                issue-copyright-statement © Springer-Verlag Berlin Heidelberg 2013

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: waist-to-height ratio,waist circumference,obesity,diabetes,body mass index,asian
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: waist-to-height ratio, waist circumference, obesity, diabetes, body mass index, asian

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