Comparison of waist circumference with body mass index for predicting abdominal adipose tissue☆
Introduction
Waist circumference (WC) has been widely used as a simple anthropometric index to measure the degree of central obesity in clinical practice [1], [2]. Several organizations advocate for the measurement of WC and adopt it as a component of the criteria for metabolic syndrome [3], [4]. However, evidence for the clinical significance of WC has not been fully accumulated and its clinical utility is still under question in Asian populations [5], [6], [7], [8], [9]. It has been reported that WC and BMI were equally associated with cardiovascular risk factors in Japanese [5] and Korean [6] populations. Some investigators have reported that WC is the most useful anthropometric predictor of cardiovascular risk factors for men, while for women, BMI is comparable [7] or even better than WC [8]. Very recently, the results of a meta-analysis conducted by the DECODA study (Diabetes Epidemiology: Collaborative Analysis of Diagnostic criteria in Asia) were reported [9], which failed to show a significant superiority of WC to BMI as an anthropometric index for diabetes and hypertension in Asians.
WC is often used in clinical settings as a surrogate indicator of abdominal adipose tissue, in particular, visceral adipose tissue (VAT), which is directly measured by radiological imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI). VAT has been reported to pose a greater risk for developing obesity-related disorders than subcutaneous adipose tissue (SAT) [10], [11], [12], [13], [14]. Also, recent recognition that VAT is an endocrine organ that secretes an unfavorable pattern of adipocytokines suggests that it may be involved in the pathophysiology of metabolic syndrome [15]. To date, large population-based studies in Western countries have demonstrated that WC is indeed a better predictor of VAT than BMI in Caucasians and African–Americans [14], [16], [17]. However, for Asian populations there have been only two reports with a relatively small number of participants, including hospital patients [18], [19]. Since Japanese men have a larger VAT than Caucasian men with the same level of WC [20], the relationship between VAT and WC may be different in Asians from Caucasians.
Therefore, the objective of this study was to compare WC with BMI for predicting VAT, SAT, and total adipose tissue (TAT) as measured by CT scans in the general Japanese population. The influences of gender and age were also analyzed as part of the study.
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Study subjects
Hokuriku Central Hospital has a special department, where public school employees may receive routine medical checkups—a service sponsored by their mutual aid association. Of the 6338 employees who received a regular medical checkup in 2006–2007, 2511 persons who voluntarily chose to be examined for VAT values using a CT scan were included in this study. All of the subjects were healthy, fully employed Japanese adults aged 38–60 years; 98% of them were teachers. After the exclusion of 28
Results
Clinical characteristics of the subjects are presented in Table 1. On average, men were taller and heavier than women and characterized by a higher mean BMI and WC than women (p < 0.001). Although total adipose tissue did not significantly differ between men and women, VAT was greater in men than in women (p < 0.001) and SAT values were the opposite. In women, SAT was approximately twice as large as VAT whereas in men SAT was as large as VAT. From the medical histories, the frequency of subjects
Discussion
In the present study, we compared WC with BMI for utility in predicting abdominal adipose tissues as measured by CT scans in middle-aged Japanese adults. The strength of this study is its large number of participants, who were all asymptomatic and apparently healthy men and women. Knowledge of prediction accuracy may provide valuable information for clinicians and epidemiologists in assessing central obesity using WC.
Consistent with previous reports, gender differences in the distribution of
Conflict of interest
There are no conflicts of interest.
Acknowledgements
This work was supported by Grant-in-Aid from Toyama medical Association. We thank all the staff of Hokuriku Central Hospital for their assistance with performing the study.
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Grant support: A Grant-in-Aid from Toyama Medical Funding.