Does waist circumference predict disease risk beyond metabolic risk factors and body mass index?

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Does waist circumference predict disease risk beyond metabolic risk factors and body mass index?

  1. 1. Does waist circumference predict disease risk beyond metabolic risk factors and body mass index? <ul><li>Peter M. Janiszewski, Ian Janssen, and Robert Ross </li></ul>School of Kinesiology and Health Studies Queen’s University Ontario 2007 Obesity Society Annual Scientific Meeting October 21st
  2. 2. Relationship Between BMI and the Risk of Death Stevens et al., N Engl J Med 1998. Relative Risk Relative Risk Body Mass Index Body Mass Index Women Men <19.0 19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9 <19.0 19.0-21.9 22.0-24.9 25.0-26.9 27.0-28.9 29.0-31.9
  3. 3. Obesity: A heterogeneous condition ≠ Central Obesity Peripheral Obesity Vague 1956, AJCN
  4. 4. Men <102 cm ( < 40 in) >102 cm ( > 40 in) BMI (kg/m 2) Class Women < 88 cm ( < 35 in) > 88 cm ( > 35 in) Overweight 25.0 - 29.9 Increased High Obesity 30.0 - 34.9 I High Very High Obesity 35.0 - 39.9 II Very High Very High Extreme Obesity > 40 III Extremely High Health Risk NIH National Heart, Lung and Blood Institute, 1998, Obesity Research. Characterizing Obesity Related Health Risk Waist Circumference BMI + WC = HEALTH RISK
  5. 5. Obesity: A heterogeneous condition RR for CVD Low WC Mid WC High WC Low Mid High BMI Rexrode et al. 1998, JAMA RR for Diabetes Low WC Mid WC High WC Low Mid High BMI Wang et al. 2005, AJCN
  6. 6. Waist Circumference and Cardiometabolic Risk: A Consensus Statement <ul><li>“… there is not yet a compelling body of evidence demonstrating that WC provides…sufficient incremental value in predicting diabetes, CVD, and mortality above and beyond that offered by BMI and commonly evaluated cardiometabolic risk factors…” </li></ul><ul><li>“… WC should only be measured if it can provide additional information that influences patient management.” </li></ul>The Obesity Society, the American Society for Nutrition, and the American Diabetes Association (2007)
  7. 7. Current Investigation <ul><li>Objective: </li></ul><ul><ul><li>To determine whether WC predicts risk of diabetes and CVD beyond that explained by commonly evaluated cardiometabolic risk factors and BMI </li></ul></ul><ul><li>Research Design: </li></ul><ul><ul><li>Subjects: Men and women from the 1999-2004 National Health and Nutrition Surveys (NHANES) </li></ul></ul><ul><ul><li>Analysis: Logistic regression to calculate the odds of diabetes and CVD according to sex-specific WC tertiles </li></ul></ul><ul><ul><li>Cardiometabolic Risk Factors: blood pressure, triglycerides, LDL and HDL cholesterol, and fasting glucose levels </li></ul></ul>
  8. 8. Results: Subject Characteristics Variable Total ( n = 5882) Men ( n = 3001) Women ( n = 2881) Age, y 44.2 ± 0.5 43.3 ± 0.5 45.1 ± 0.5 Waist circumference, cm 95.3 ± 0.4 98.5 ± 0.4 92.1 ± 0.5 BMI, kg/m 2 27.7 ± 0.1 27.6 ± 0.1 27.8 ± 0.2 Impaired fasting glucose, % 24.6 (1.1) 30.3 (1.4) 19.0 (1.1) Diabetes, % 8.1 (0.5) 9.2 (0.7) 7.1 (0.5) Cardiovascular disease, % 7.0 (0.5) 8.0 (0.7) 6.0 (0.6) Hypertension, % 27.3 (0.9) 26.6 (1.2) 28.1 (1.0) High LDL-cholesterol, % 21.6 (0.8) 22.8 (0.9) 20.4 (0.1) Low HDL-cholesterol, % 19.9 (0.8) 27.8 (1.0) 12.0 (0.9) High triglycerides, % 14.7 (0.6) 17.0 (1.0) 12.4 (0.6)
  9. 9. Results: WC and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High Waist Circumference Low Med High Waist Circumference Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking
  10. 10. Results: WC and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High Waist Circumference Low Med High Waist Circumference Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking, metabolic risk factors and BMI Adjusted for sex, age, race, and smoking
  11. 11. Results: BMI and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High BMI Low Med High BMI Adjusted for sex, age, race, and smoking
  12. 12. Results: BMI and Risk of Diabetes and CVD Odds Ratio for Diabetes Odds Ratio for CVD Low Med High BMI Low Med High BMI Adjusted for sex, age, race, and smoking Adjusted for sex, age, race, and smoking, metabolic risk factors and WC Adjusted for sex, age, race, and smoking
  13. 13. Results: WC, Cardiometabolic Risk Factors and Diabetes Risk Number of Cardiometabolic Risk Factors Odds Ratio for Diabetes Low WC Moderate WC High WC P trend < 0.001 for both WC and risk factors
  14. 14. Results: WC, Cardiometabolic Risk Factors and CVD Risk Number of Cardiometabolic Risk Factors Odds Ratio for CVD Low WC Moderate WC High WC P trend < 0.001 for risk factors, not significant for WC
  15. 15. Results: WC, Cardiometabolic Risk Factors and CVD Risk Number of Cardiometabolic Risk Factors Odds Ratio for CVD Low WC Mod WC High WC Odds Ratio for CVD Low Med High Waist Circumference
  16. 16. Conclusions <ul><li>WC predicts risk of diabetes, but not CVD, beyond that explained by commonly obtained cardiometabolic risk factors and BMI </li></ul>
  17. 17. * p<0.05 vs Control Effects of Aerobic Exercise (4 mo) With or Without Weight Loss on Waist Circumference in Obese Men and Women Ross et al. Ann Intern Med (2000) ; Ross et al. Obesity Research (2004) Reduction in Waist Circumference (cm) 0 3 6 9 Obese Men * * Control Weight Loss No Weight Loss Exercise 0 2 4 6 8 * * Obese Women Control Weight Loss No Weight Loss Exercise No Change in BMI No Change in BMI
  18. 18. Conclusions <ul><li>WC predicts risk of diabetes, but not CVD, beyond that explained by commonly acquired cardiometabolic risk factors and BMI </li></ul><ul><li>Thus, WC should be a routine clinical measure for the identification and management of the high-risk, abdominally obese patient </li></ul>

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