Preventive cardiology
Comparison of Waist Circumference Versus Body Mass Index in Diagnosing Metabolic Syndrome and Identifying Apparently Healthy Subjects at Increased Risk of Cardiovascular Disease

https://doi.org/10.1016/j.amjcard.2008.02.096Get rights and content

The goal of this study was to compare the impact of differences in waist circumference (WC) defined according to the International Diabetes Federation (IDF) and the Adult Treatment Panel III (ATP III) and body mass index (BMI) on cardiovascular disease risk factors in 402 apparently healthy volunteers of European ancestry. Consequently, measurements were made of the WC, BMI, blood pressure, glucose, and lipid components of metabolic syndrome (MS) and insulin-mediated glucose uptake. Subjects were divided according to WC (IDF and ATP III criteria) and by normal weight, overweight, or obesity using BMI, and comparisons were made of the effect of these different indexes of adiposity on cardiovascular disease risk factors. The results indicated that WC and BMI significantly correlated (p <0.001) and were associated with differences in insulin-mediated glucose uptake to a similar degree in men (r = 0.57 and r = 0.59) and women (r = 0.53 and r = 0.52). Prevalences of MS were essentially identical irrespective of the measure of WC used (ATP III vs IDF), as were metabolic characteristics of those classified using IDF or ATP III criteria. Cardiovascular disease risk factor status did not vary substantially when subjects were divided on the basis of WC or BMI. In conclusion, prevalences of MS or cardiovascular disease risk factors did not vary as a function of differences in IDF and ATP III criteria for WC. BMI identified individuals at increased cardiovascular disease risk as effectively as determination of WC.

Section snippets

Methods

The study population consisted of 402 volunteers of European ancestry (227 women, 175 men) who had responded to advertisements for studies describing our research interest in the role of insulin resistance in human disease. The studies were performed at the General Clinical Research Center at Stanford University Hospital, Stanford, California. All subjects gave informed consent, and the protocols had been approved by the Stanford Human Subjects Committee.

Subjects were in apparent good health,

Results

Table 1 lists criteria for the diagnosis of MS according to the ATP III and IDF. Measurements of WC and BMI significantly (p <0.001) correlated in both men (r = 0.83) and women (r = 0.82). In addition, as shown in Figure 1, the relation between each index of adiposity and steady-state plasma glucose was very similar in men and women and was statistically significant (p <0.001).

To further evaluate the relation between insulin-mediated glucose uptake and BMI and WC, we performed logistic

Discussion

The existence of multiple definitions of MS led to several reports comparing the relative ability of these to determine the prevalence of the syndrome in various populations and/or the utility of each of the diagnoses to predict cardiovascular disease.11, 12, 13 However, little attention was given to comparing metabolic characteristics that result from classifying patients based on differences in the criteria for abdominal obesity used by the ATP III and IDF or the relation between abdominal

References (29)

  • M.S. Greenfield et al.

    Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp

    Diabetes

    (1981)
  • J. Yip et al.

    Resistance to insulin-mediated glucose disposal as a predictor of cardiovascular disease

    J Clin Endocrinol Metab

    (1998)
  • F.S. Facchini et al.

    Insulin resistance as a predictor of age-related diseases

    J Clin Endocrinol Metab

    (2001)
  • C. Lorenzo et al.

    Geographic variations of the International Diabetes Federation and the National Cholesterol Education Program-Adult Treatment Panel III definitions of the metabolic syndrome in nondiabetic subjects

    Diabetes Care

    (2006)
  • Cited by (64)

    • National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 - Full report

      2015, Journal of Clinical Lipidology
      Citation Excerpt :

      However, members of the NLA Expert Panel recognized that waist is not always measured in clinical practice, whereas weight and height data for the calculation of BMI are usually available. Thus, although not the preferred indicator, BMI may be used as an alternative to waist circumference when the latter is not available.232–234 Using National Health and Nutrition Examination Survey data, the cut points for BMI that produced the same population prevalence rates as the waist criteria were 25.0 kg/m2 for women and 29.0 kg/m2 in men.232,233

    View all citing articles on Scopus

    This work was supported in part by research grants from the National Institutes of Health, Bethesda, Maryland (RR000070), and Stanford University School of Medicine Dean's Fellowship (MCR), Stanford, California.

    View full text