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Several organizations recommend the use of measures of abdominal obesity in conjunction with body mass index (BMI) to assess obesity-related health risk. Recent evidence suggests that waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) are increasing within BMI categories. This shift may have affected the usefulness of abdominal obesity measures.
Data and methods
Data are from respondents aged 18 to 79 to the 2007 to 2009 Canadian Health Measures Survey. Using logistic regression, this paper examines cardiovascular disease (CVD) risk factors in relation to WC, WHR and WHtR within BMI health-risk categories. CVD risk factors considered include components of the metabolic syndrome.
Among men in the normal and overweight BMI categories, WHR and WHtR were positively associated with having at least two CVD risk factors. All three abdominal obesity measures were associated with increased odds of having at least two CVD risk factors among normal-weight women. Abdominal obesity was not associated with CVD risk factors for people in obese class I.
Among men and women in the normal BMI category, measures of abdominal obesity are associated with increased odds of CVD risk factors. This underscores the importance of measuring and monitoring abdominal obesity in normal-weight men and women.
Body composition, central obesity, metabolic syndrome, waist circumference, waist-to-height ratio, waist-to-hip ratio
Elevated body mass index (BMI) is a well-established contributor to the aetiology of cardiovascular disease (CVD). But while BMI is widely used to monitor the prevalence of obesity, it provides no information about the distribution of body fat. Some studies, have found that measures of abdominal obesity, principally, waist circumference (WC), waist-to-hip ratio (WHR), and more recently, waist-to-height ratio (WHtR), are more closely related to CVD morbidity and mortality than is BMI. However, reviews of the literature conducted to assess which measure of adiposity is most strongly associated with CVD have yielded inconsistent conclusions. [Full Text]
Margot Shields (1-613-951-4177, email@example.com) is with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6. Mark S. Tremblay is with the Children's Hospital of Eastern Ontario Research Institute and the University of Ottawa, Ottawa, Ontario. Sarah Connor Gorber is with the Public Health Agency of Canada, Ottawa, Ontario. Ian Janssen is with Queen's University, Kingston, Ontario.
What is already known on this subject?
- Elevated body mass index (BMI) and abdominal obesity are associated with increased risk of cardiovascular disease.
- Several health organizations recommend the use of measures of waist circumference within BMI categories to assess obesity-related health risk, but reviews of the literature to determine which adiposity measure is most strongly associated with CVD have yielded inconsistent conclusions.
- A Canadian study based on data collected 20 years ago found that higher waist circumference (WC) was associated with increased prevalence of CVD risk factors among women in the overweight and obese class I categories; among men, WC was not associated with increased prevalence of CVD risk factors in any BMI category.
- For a given BMI, Canadians have higher measures of abdominal obesity than they did 30 years ago.
What does this study add?
- Among men in the normal-weight and overweight categories, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were associated with increased odds of CVD risk factors.
- Among women in the normal-weight category, WC, WHR, and WHtR were associated with increased odds of CVD risk factors.
- For men and women in obese class I, measures of abdominal obesity were not associated with increased odds of CVD risk factors.
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