Waistcircumference can be used as an indicator for chronic disease risk. A large WC can lead to higher diagnoses of chronic and vascular diseases. Dallongeville et al. found this to be the case among younger populations, Caucasians, and former smokers. The researchers also found that individuals with a large WC have a more difficult time achieving target blood pressure, triglyceride levels, and blood sugar. 32 Many researchers have found that a large WC is predictive for diabetes, CHD, MI, MetS, insulin resistance syndrome, cancer, hypertension (HTN), coronary artery disease, dyslipidemias, all-cause mortality and as a result, increased medical care costs. 4,5,33-36 The NHANES III study indicated that high WC with a normal BMI was found in 14% of women and 1% of men. The World Health
We compared our WC reference curves with those of other countries in an attempt to evaluate ethnic differ- ences in adolescent abdominal obesity. Because of differ- ent methods that have been used in published national reference values for adolescents, caution is needed when comparing WC percentile reference data between studies. Therefore, comparison was limited among studies that used the LMS method. To use contemporary data, only surveys conducted from the year 2000 onwards were included. The results of the Greek adolescents’ WC measurements were compared with those from coun- tries of diverse geographical location and ethnicity: Norway, Turkey, Poland, South India, Germany and Kuwait [17,22-26]. Percentile curves for these coun- tries were also based on cross-sectional data obtained from adolescents in the school setting. For the adoles- cents aged 12–17 years the reported mean BMIs ranged from 20.4 to 24.2 for boys and from 20.3 to 23.9 for girls [23,25,26]. Our study participants had mean BMI values of 21.7 for boys and 21.4 for girls (Table 1). Data about WC is of special interest at the 50th percentile (WC 50 ) because they reflect the majority
Data were entered and analyzed by manual and computer- ized checking using SPSS version 18.0 (SPSS Inc. Chicago IL, United States, 2009). Age was calculated to the precise day by subtracting the date of birth from the date of exam- ination. Smoothed age- and gender-specific percentile curves were constructed for WC, WHR and WHtR by the LMS method . Fiftieth percentile curves for WC were compared with the previous studies in Hong Kong, United Kingdom, Iran, Germany, Switzerland and China that measured WC at the same site. Cut-off of ≥90 th age- and gender-specific percentile for WC [15,17,18,24,33,34] and ≥0.5 for WHtR [15,35-37] had been suggested for defining central obesity. Central obesity was defined as having both age- and gender-specific WC percentile ≥ 90 th and WHtR ≥ 0.5. Bivariate analysis, using chi-square test as the test of trend, was conducted to compare the prevalence of central obesity among the study variables. Multivariate logistic regression was used to quantify the independent
In our results we show that 97 (39%) of women in the study group are overweight, 68 (27.5%) of them are clas- sified as obese. Increased waistcircumference was pres- ent in 172 (69.4%) while increased blood pressure was measured in 130 (53.0%) examinees. The previously di- agnosed high blood pressure was present in 74 (30%) women in our study group. Further, we considered other risk factors that could influence the development of high blood pressure such as dyslipidemias, increased blood glucose concentrations and some lifestyle habits such as sports and smoking. Table 1 presents the data regarding measured parameters. It can be seen that increased se- rum triglycerides were found in 55 (22.3%), increased to- tal serum cholesterol in 183 (73.8%), decreased values of HDL were present in 202 (81.5%), increased LDL choles- terol in 86 (35.5%) and increased blood glucose concen- trations was found in 41 (16.0%) examinees. According to questionnaire, 47 (19.0%) participants declared to be ac- tive cigarette smokers and 44 (18.0%) declared to be rec- reational physical activities. We analyzed participants di- vided in two groups: first with recorded high blood pres- sure and the second with previously diagnosed hyperten- sion. The analysis of predictors of age distribution revea- led an average age for both groups significantly higher than the average found in a total number of participants, especially those with normal blood pressure values. Aver- age values of anthropometric indicators (BMI, waist cir- cumference, waist-to-hip ratio) and of several biochemi- cal parameters (cholesterol, LDL, fasting glucose concen- tration) were higher in a category with previously diag- nosed hypertension compared to all other groups. The re- sults of invariant logistic regression for measured high blood pressure indicate statistical significance for the predictors age, BMI, waistcircumference, waist-to-hip ratio, smoking habits, sport activities, cholesterol and glucose concentration. For the previously diagnosed high blood pressure statistically significant predictors were
The present study is the first investigation of adiponectin and its correlates in subjects from sub-Saharan Africa. It confirms most of the current knowledge on adiponectin acquired from other populations with the exception of a less clear relation with adiposity and the surrogates of its topographic distribution, especially in women. In fact, no correlation existed between adiponectin levels and waistcircumference in sSA women in the present study. While the measure of insulin sensitivity has been vali- dated in the study group against the gold standard meas- ure which is the euglycaemic hyperinsulinaemic clamp, it can be questioned whether waistcircumference is an appropriate surrogate of intra abdominal fat. In fact, Love- joy et al. observed that, at similar levels of BMI and waist- to-hip ratio, African-American women had smaller vis- ceral fat compared to Caucasian women . In addition WHR was correlated with fasting insulin only in Cauca- sians . Similarly, the group of Albu found a lower vis- ceral/sub cutaneous tissue in obese black women compared to whites at comparable levels of WHR . These discrepancies between imaging techniques for the measurement of visceral adipose tissue and clinical surro- gates would explain at least partially the need for ethnic- specific cut points for waistcircumference in the defini- tion of risk and/or metabolic syndrome as attempted by IDF in 2005 .
The ideal classification system for obesity, interpreted as excessive fatness, would be based on direct measure- ment of body composition, such as PBF 41 . Therefore, we compared the value measures of BMI, WC and WHR with PBF, as determined by measuring skinfold thickness. BMI, WC and WHR displayed strong positive correla- tions with PBF measured by skinfold thickness in boys. The observed correlations were also significant in girls; however, they were slightly lower. In the evaluation of the diagnostic tests, the nature and extent of misclassifi- cations were described through the use of ROC curves 42 . We used the AUC from an ROC analysis as an indicator of the overall performance in anthropometric indices of obesity. Our results indicated that AUCs exceeded 0.72– 0.95 for all anthropometric indices of obesity. The AUCs for BMI and WC were higher than the AUCs for WHR in both girls and boys. Therefore, BMI and WC measure- ments are more important indicators of obesity in teen- agers relative to WHR.
in different ethnic groups amongst the Caucasians has been documented (Colin et al, 2002). In his study higher BMI was associated with a higher prevalence of hypertension in all ethnic groups. However, at BMI levels less than 25, prevalence difference figures suggested a stronger association between BMI and hyper tension in Chinese men and women but not in Filipino women, compared with non-Hispanic Whites. Non-Hispanic Blacks and Filipino women had a higher prevalence of hypertension at every level of BMI compared with non-Hispanic Whites and Mexican Americans. Valsamarkis (2003) in his heavily reach work on modest weight loss and reductions in waistcircumference after medical treatment are associated with favourable changes in serum adipocytokines. Concluded that modest weight loss (>5%) after medical treatment in a routine obesity hospital clinic is as Body mass
It is worth emphasizing that patients with a higher WC had a lower PFM pressure compared to the group with WC ≤80. According to the completeness theory proposed by Petros and Ulmsten, in order to have a properly functioning PFM, it is necessary to have completeness of PFM apart from other structures that compose this region such as nerves, fascia, and ligaments. 32 In this sense, the overload, that comes from
The purpose of this study is to compare three com- monly methods used for indexing waistcircumference by height (waist-to-height ratio, using the square root of height, and using height-squared) in male and female children and adults. Using data from the Fels Longitudi- nal Study, the three waistcircumference indices—as well as the optimal powers for indexing waistcircumference by height—are estimated for male and female children at each age between 2 and 18 years of age, and for male and female adults at ten-year intervals from the third through eighth decades. Correlative analyses are then used to de- termine 1) Whether each index remains correlated with the original waistcircumference measures not indexed by height; and 2) Whether each index is uncorrelated with the original height measure (i.e. has the index “factored out” the effect of height from waistcircumference).
Methods: One hundred forty-two female subjects were selected to participate in this study, and they were recruited by consultant physicians from the Clinic and Medical Out-Patient, King Abdulaziz Hospital, Kingdom of Saudi Arabia. The anthropometric characteristics were obtained from questionnaires by using standard methods. Blood samples were obtained for the deter- mination of glucose, triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein by using enzymatic methods. Total testosterone was determined by enzyme-linked immunosorbent assay for the quantitative measurement of testosterone in human serum. Results: Significantly higher concentrations of total testosterone, low-density lipoprotein, and glucose, but lower concentrations of high-density lipoprotein, were observed in subjects with MS compared with women without MS (P<0.05).
Based on these data, it can be estimated that the subjects who belong to the highest quintiles of WC or WHtR have a 40–60% increased likelihood of having teeth with peri- odontal pockets at least 4 mm deep compared with those belonging to the lowest quintiles of WC or WHtR. The typical number of teeth with deepened periodontal pockets at least 4 mm deep was two or three among lean persons, but if the person had a large waistcircumference, measured either absolutely (WC) or relatively (WHtR), he/she had approximately one tooth more with a deep- ened periodontal pocket. This excess of periodontally af- fected teeth, which can be attributed to central obesity, can be compared, for example, with the excess that can be attributed to daily smoking, which in these data was about 2–3 teeth with periodontal pocketing .
Weight was measured to the nearest 0.5 kg using electronic weighing scale, with the subjects wearing lightweight gown or underwear. Height was measured to the nearest 0.1 cm using wall mounted height board. Child stood straight with no shoes; heels, buttocks, shoulder blades and back of head touching the vertical wall surface and looking directly forwards with Frankfurt plane (the line joining floor of external auditory meatus to the lower margin of orbit) and the being horizontal. BMI was calculated using standard formula: weight (kilograms)/height (meters 2 ). According to BMI, children were categorized into 3 groups: normal weight, overweight and obese as per World Health Organization (WHO) child growth standards (BMI greater than 95th percentile obese; BMI between 85th and 95th percentile - overweight). Waistcircumference was measured to the nearest 0.1 cm with nonelastic flexible tape with child standing without clothes. The smallest circumference between the hip and chest was measured at the end of gentle expiration. The following anatomical landmarks were used: laterally, midway between the lowest portion of the rib cage and iliac crest, and anteriorly midway between the xiphoid process of the sternum and the umbilicus. According to WC, children were divided into
Digital scale weighing machine corrected to 0.5 Kg was used to measure body weight. Machine was checked for zero error prior to each measurement. BMI was calculated by dividing body weight in kg by height in meters squared. Waistcircumference in centimeter was measured in horizontal plane midway between the inferior margin of the ribs and the superior border of the iliac crest, using a standard inelastic measuring tape at the end of gentle expiration. Measurements were taken thrice and the median was taken in all cases. 12
According to the results of the ROC analysis in each BMI group, the most discriminative threshold of WC showed an approximately 10 cm difference between the groups. The BMI-specific WC cutoffs provided a more appropriate balance of sensitivity and specificity in all BMI groups, while the discriminatory ability of BMI-specific WC cutoffs in the total study group was lower than that of the single WC cutoffs obtained from this study. Only in the subjects without excess weight (the combined underweight and normal weight group), did the BMI-specific WC cut- offs provide a substantial improvement in sensitivity. Further studies are necessary to confirm these findings in other populations. However, it is worth noting that the BMI-specific WC cutoffs may have a potential for better identification of people without excess weight but with a clustering of cardiovascular risk factors. Based on the results of the 2008 National Health and Nutrition Survey, 71.4% of men and 79.4% of women aged C20 years are estimated to have a BMI \ 25.0 in Japan . The NIPPON DATA Research Group revealed that the prevalence of people without excess weight but with a clustering of cardiovascular risk factors is quite high and that their cardiovascular mortality risk is also high . A better identification of people without excess weight but with a clustering of cardiovascular risk factors would seem to be a valuable step in terms of improving public health in Japan. The findings of this study are insufficient to recommend the combined BMI–WC screening. Further studies are necessary to validate the BMI-specific WC cutoffs using representative samples of the general population. The dis- criminatory ability of BMI-specific WC cutoffs, compared with the existing (recommended) WC cutoffs, should be confirmed in several different populations. On the other hand, health professionals should take notice that because of a low prevalence of clustering of cardiovascular risk factors, the number of false-positive cases, indicated by a 1 - positive predictive value (PPV), is substantial in people without excess weight. This misclassification is not prevented by using BMI-specific cutoff; the PPV of BMI-
CAD risk factors can also be classified as conventional and emerging risk factors. Compared to other ethnic groups, Indians have a lower prevalence of H.T, hypercholesterolemia, obesity and smoking, but a higher prevalence of high triglycerides, low level of HDL, glucose intolerance and central obesity. Although the conventional risk factors do not fully explain the excess burden of CAD, these risk factors appears to be doubly important and remains the principal target for prevention and treatment.
All anthropometry was measure by trained author (KS) with standard technique. Body weight and height was mea- sure by standard equipment. Waistcircumference was mea- sure with plastic tape at midway between the lower costal margin and the iliac crest while women is standing with- out clothes at this region. Hipcircumference was measure at the hip level at the widest part of buttocks without ex- cess clothes. All parameters were then calculated such as BMI, WHR.
Receiver operating characteristics (ROC) curve analysis was employed to determine optimal cutoffs of waist cir- cumference in relation to insulin resistance defined by dif- ferent values of HOMA-IR, with and without allowance for the covariates. In the analysis without consideration to the covariates, the optimal cutoff point was obtained by the Youden index, i.e., maximum (sensitivity + specificity -1) . After logistic regression analysis controlling for the covariates, ROC curve was depicted and area under ROC curve (AUC) was calculated for each of the cutoffs of 80, 85, and 90 cm in waistcircumference. Statistical sig- nificance was declared if a two-sided P value was less than 0.05 or if the 95% confidence intervals did not include unity. All computations were mostly performed using the SAS version 8.2 (SAS Institute Inc., Cary, NC). The ROC curve analysis was done by using Stata SE version 8 (Stata, College Station, TX).