Original articleComparison of waist circumference, body mass index, percent body fat and other measure of adiposity in identifying cardiovascular disease risks among Thai adults
Introduction
Obesity has reached epidemic levels with at least 400 million adults classified as being obese in 2005 [1]. Cardiovascular diseases (CVD) have been the leading cause of death in Thailand since 1987. Between 1985 and 1997 the prevalence of heart disease in Thailand tripled to 168 per 100,000 population [2]. Obesity has been proven to be a strong and consistent risk factor for CVD, though the best way to measure obesity in the context of clinical and population-based studies has become increasingly controversial [3], [4], [5]. Current worldwide guidelines suggest that overweight be defined as a body mass index (BMI) of 25–29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or more [1]. This classification has been recommended for people of all races, genders and ages. Waist circumference (WC), waist–hip ratio (WHR) and waist–height ratio (WHtR) are used as measures of central obesity, while BMI and %BF are generally used as measures of overall obesity.
Although BMI is the most commonly used anthropometric measure in epidemiologic studies, the specificity and predictive value of this measure has been questioned [3]. BMI has proven in numerous studies not to be the most accurate indicator for predicting obesity-related diseases among all groups [6], [7], [8]. Increasingly, investigators have identified limitations of employing measures and thresholds of obesity from studies of Caucasian population to studies of Asians [9], [10], [11], [12]. For instance, a WHO expert panel concluded that the BMI cut-off point for observed risk of CVD and type 2 diabetes in different Asian populations varies from 22 to 25 kg/m2 while for high risk it varies from 26 to 31 kg/m2 [4]. Notably, Asians tend to have higher %BF for a given level of BMI [8], [12], in part, because of their smaller body frames [13], [14].
Elevations in measures of overall obesity and central fat distribution, including BMI, waist circumference (WC), percentage body fat (%BF), waist–hip ratio (WHR), and waist–height ratio (WHtR) are known to be positively associated with the prevalence [6], [7], [15] and incidence [16], [17] of CVD and type 2 diabetes. There has been considerable heterogeneity in results from studies that compare associations of CVD and CVD risk factors with measures of overall obesity and central obesity [3], [18], [19], [20], [21]. In their study of 1010 African–American and Caucasian participants in the CARDIA study, Shen et al. reported that WC was more strongly associated with health risk indicators than BMI and %BF. Likewise Aekplakorn et al., in their study of 5305 Thai adults, reported that measures of central obesity (i.e., WC, WHR and WHtR) were slightly more strongly associated with CVD risk factors than the overall adiposity measure, BMI [18]. Conversely, Zhu et al reported that WC is a better indicator of CVD risk than BMI in their study of 10,969 participants from three different race-ethnicity groups [22].
Heterogeneity in study findings may be attributable to differences in race/ethnicity, age and gender distributions of participants across study populations. A number of investigators have now reported differences in the predictive value of obesity indicators according to ethnicity [8], [11], [23]. In a meta-analysis of 32 published reports, investigators noted that central obesity was a stronger predictor of incident type 2 diabetes than were measures of total body fat [3]. However, measures of overall obesity were better predictor of type 2 diabetes in US and European Caucasian [24].
In light of the heterogeneity in previous study findings and potential contraindications of generalizing results across populations, we sought to examine the relationship of measures of overall obesity (BMI and %BF) and central obesity (WC, WHR and WHtR) with CVD risk factors among Thai adults.
Section snippets
Study population
The study population comprised 1608 people (536 men and 1072 women) who participated in annual health examinations at the Mobile Health Checkup Unit of King Chulalongkorn Memorial Hospital in Bangkok, Thailand during the period of December 2006 through February 2007. Each year, Chulalongkorn Memorial Hospital provides on-site annual health examinations for professional and office workers of approximately 45 private companies and governmental agencies in and around Bangkok. Given that blood
Results
The socio-demographics and clinical characteristics of the study population are presented in Table 1. Results are summarized separately for men and women. The correlations among the individual anthropometric variables and metabolic parameters (fasting plasma glucose, triglyceride, HDL–C and blood pressure) are presented in Table 2. Overall, among men, three of the metabolic parameters (i.e., triglyceride (r = 0.374), HDL–C (r = −0.377) and SBP (r = 0.318)) were most strongly correlated with %BF.
Discussion
A number of cross-sectional studies have investigated the relationship between CVD risk factors according to multiple measures of adiposity [22], [27], [28], [29]. However, there has yet to be consensus as to which anthropometric measure best predicts obesity-related disorders, particularly among Asians. In our study we observed that BMI was slightly more strongly associated with CVD risk factors in women, and that %BF and WHR were slightly more strongly associated with CVD risk factors in men.
Acknowledgments
This research was supported by the Rachadapiseksompoj Faculty of Medicine Research Fund, Chulalongkorn University. This research was completed while Ms. Linda Paniagua was a research-training fellow in the Multidisciplinary International Research Training (MIRT) Program of the University of Washington, School of Public Health and Community Medicine. The MIRT Program is supported by an award from the National Institutes of Health, National Center on Minority Health and Health Disparities
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