Risk of cardiovascular diseases increases in Asian adults within the normal limits of body mass index and waist circumference.
Objective
To determine a point of body mass index and waist circumference above which the chances of having cardiovascular risk factors increased.
Methods
Data on anthropometric indices, blood pressure and biochemical measures were collected in a cross-sectional study of 3447 participants (1781 males and 1666 females) with normal body mass index (19 to <25 kg/m2 for both sexes) and normal waist circumference (<102cm for men and <88cm for women). Metabolic abnormalities were defined on the basis of the standard published criteria.
Results
Individuals at the highest category of body mass index (24 to <25 kg/m2) had significantly higher odds for having metabolic risk factors (odds ratios ranging from 1.3 to 1.6 for men and 1.36 to 2.0 for women for different risk factors) compared with those at first category (19 to <20 kg/m2). Furthermore, individuals at the top category of waist circumference (95 to <102cm for men and 85–88 cm for women) had significantly higher chances of having metabolic abnormalities (odds ratios ranging from 2.6 to 4.5 for men and 2.1 to 2.6 for women for different risk factors) compared with those in the first category (62 to <70cm for men and 60 to <65cm for women) in both sexes.
Conclusion
We concluded that the cut-off points of body mass index and waist circumference suggested by the World Health Organization are inappropriate for the Tehranian urban population.
Sarraf-ZadeganNSayed-TabatabaeiFABashardoostNMalekiATotonchiMHabibiHR, et al. The prevalence of coronary artery disease in an urban population in Isfahan, Iran.Acta Cardiol1999; 54:257–263.
2.
AziziFEsmaillzadehAMirmiranP.Obesity and cardiovascular risk factors in Tehran adults: a population-based study.East Mediterr Health J2004; 10:887–897.
3.
StevensJCaiJPamukERWilliamsonDFThunMJWoodJL.The effect of age on the association between body-mass index and mortality.N Engl J Med1998; 338:1–7.
4.
WeiMGaskillSPHaffnerSMSternMP.Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans: a 7-year prospective study.Obes Res1997; 5:16–23.
5.
Pi-SunyerFX.Obesity: criteria and classification.Proc Nutr Soc2000; 59:505–509.
6.
DiPietroLKatzLDNadelER.Excess abdominal adiposity remains correlated with altered lipid concentrations in healthy older women.Int J Obes Relat Metab Disord1999; 23:432–436.
7.
DobbelsteynCJJoffresMRMacLeanDRFlowerdewG.A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys.Int J Obes Relat Metab Disord2001; 25:652–661.
8.
PouliotMCDespresJPLemieuxSMoorjaniSBouchardCTremblayA, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women.Am J Cardiol1994; 73:460–468.
9.
World Health Organization.Obesity: preventing and managing the global epidemic. Report of a WHO consultation.World Health Organ Tech Rep Ser2000; 894:1–253.
10.
MisraA.Redefining obesity in Asians: more definitive action is required from the WHO.Natl Med J India2004; 17:1–4.
11.
MirmiranPEsmaillzadehAAziziF.Detection of cardiovascular risk factors by anthropometric measures in Tehranian adults: receiver operating characteristic (ROC) curve analysis.Eur J Clin Nutr2004; 58:1110–1118.
12.
AziziFRahmaniMEmamiHMadjidM.Tehran Lipid and Glucose Study: rationale and design.CVD Prev2000; 3:242–247.
13.
WangJThorntonJCBariSWilliamsonBGallagherDHeymsfieldSB, et al. Comparisons of waist circumferences measured at 4 sites.Am J Clin Nutr2003; 77:379–384.
14.
MirmiranPMohammadiFAllahverdianSAziziF.Estimation of energy requirements for adults: Tehran lipid and glucose study.Int J Vitam Nutr Res2003; 73:193–200.
15.
AziziFRahmaniMMadjidMAllahverdianSGhanbiliJGhanbarianA, et al. Serum lipid levels in an Iranian population of children and adolescents: Tehran Lipid and Glucose Study.Eur J Epidemiol2003; 18:311–319.
16.
AziziFGhanbarianAMadjidMRahmaniM.Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999–2000.J Hum Hypertens2002; 16:305–312.
17.
National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.Circulation2002; 106:3143–3421.
18.
Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.Sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure.Arch Intern Med1997; 157:2413–2446.
19.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.Report of the expert committee on the diagnosis and classification of diabetes mellitus.Diabetes Care2003; 26:S5–S20.
20.
GreenlandS.Interpretation and choice of effect measures in epidemiologic surveys.Am J Epidemiol1987; 125:761–768.
21.
LeeJChiaKS.Estimation of prevalence rate ratios for cross-sectional data: an example in occupational epidemiology.Br J Industrial Med1993; 50:861–862.
22.
ZhangJYuKF.What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.JAMA1998; 280:1690–1691.
23.
Deurenberg-YapMChewSKDeurenbergP.Elevated body fat percentage and cardiovascular risks at low body mass index levels among Singaporean Chinese, Malays and Indians.Obes Rev2002; 3:209–215.
24.
SnehalathaCViswanathanVRamachandranA.Cutoff values for normal anthropometric variables in Asian Indian adults.Diabetes Care2003; 26:1380–1384.
25.
VikramNKPandeyRMMisraASharmaRDeviJRKhannaN.Non-obese (body mass index <25 kg/m2) Asian Indians with normal waist circumference have high cardiovascular risk.Nutrition2003; 19:503–509.
ItoHNakasugaKOhshimaASakaiYMaruyamaTKajiY, et al. Excess accumulation of body fat is related to dyslipidemia in normal-weight subjects.Int J Obes Relat Metab Disord2004; 28:242–247.
28.
TanakaSTogashiKRankinenTPerusseLLeonASRaoDC, et al. Is adiposity at normal body weight relevant for cardiovascular disease risk?Int J Obes Relat Metab Disord2002; 26:176–183.
29.
PihlEJurimaeT.Cardiovascular disease risk factors in males with normal body weight and high waist-to-hip ratio.J Cardiovasc Risk2001; 8:299–305.
30.
GoodpasterBHKrishnaswamiSHarrisTBKatsiarasAKritchevskySBSimonsickEM, et al. Obesity, regional body fat distribution, and the metabolic syndrome in older men and women.Arch Intern Med2005; 165:777–783.
31.
DvorakRVDeNinoWFAdesPAPoehlmanET.Phenotypic characteristics associated with insulin resistance in metabolically obese but normal-weight young women.Diabetes1999; 48:2210–2214.
32.
ChanJMRimmEBColditzGAStampferMJWillettWC.Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men.Diabetes Care1994; 17:961–969.
33.
WillettWCMansonJEStampferMJColditzGARosnerBSpeizerFE, et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range.JAMA1995; 273:461–465.
34.
MansonJEWillettWCStampferMJColditzGAHunterDJHankinsonSE, et al. Body weight and mortality among women.N Engl J Med1995; 333:677–685.
35.
HsiehSDYoshinagaHMutoTSakuraiYKosakaK.Health risks among Japanese men with moderate body mass index.Int J Obes Relat Metab Disord2000; 24:358–362.
36.
GyllenborgJRasmussenSLBorch-JohnsenKHeitmannBLSkakkebaekNEJuulA.Cardiovascular risk factors in men: The role of gonadal steroids and sex hormone-binding globulin.Metabolism2001; 50:882–888.
37.
CriquiMHBarrett-ConnorEHoldbrookMJAustinMTurnerJD.Clustering of cardiovascular disease risk factors.Prev Med1980; 9:525–533
