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Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study

Published online by Cambridge University Press:  02 January 2007

MTA Olinto ,
LC Nacul ,
DP Gigante ,
JSD Costa ,
AMB Menezes  and
S Macedo
MTA Olinto*
Affiliation:
Master Program of Population Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, RS, CEP 93022-000, Brazil PhD Program of Epidemiology, Universidade Federal de Pelotas, RS, Brazil
LC Nacul
Affiliation:
London School of Hygiene and Tropical Medicine, London, UK
DP Gigante
Affiliation:
PhD Program of Epidemiology, Universidade Federal de Pelotas, RS, Brazil
JSD Costa
Affiliation:
Master Program of Population Health, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, RS, CEP 93022-000, Brazil PhD Program of Epidemiology, Universidade Federal de Pelotas, RS, Brazil
AMB Menezes
Affiliation:
PhD Program of Epidemiology, Universidade Federal de Pelotas, RS, Brazil
S Macedo
Affiliation:
PhD Program of Epidemiology, Universidade Federal de Pelotas, RS, Brazil
*
*Corresponding author: Email [email protected]
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Abstract

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Objective:

To evaluate the role of central adiposity, as evaluated by the measurement of waist circumference (WC), as an independent risk factor for hypertension and type 2 diabetes mellitus in the setting of a developing country.

Design:

Population-based, cross-sectional study.

Setting:

A medium-sized town in southern Brazil.

Participants:

One thousand and ninety-five non-pregnant women, 20 to 69 years old, recruited by cluster random sampling between 1999 and 2000. Their mean WC was 85.3 cm (standard deviation 13.9 cm) and 23.3% (n = 255) were obese (body mass index >30 kg m−2). The prevalence of hypertension and diabetes was 25.6% (n = 280) and 6.2% (n = 68), respectively.

Results:

The risks of hypertension and diabetes were directly related to WC measurement. Women with WC > 80 cm had increased risk of hypertension (odds ratio (OR) = 6.2, P < 0.001). The association remained significant (OR = 1.04 per cm increase in WC, P = 0.02) after adjusting for confounders. The effect of WC on diabetes was modified by age. The effect was stronger in women younger than 40 years old (OR = 12.7, P = 0.016) than in those over 40 years old (OR = 2.8, P = 0.013). In the multivariate analysis, the odds ratio was 5.7 (P = 0.12) in those under 40 years old and 2.8 (P = 0.008) in older women.

Conclusions:

Waist circumference is an independent determinant for hypertension and diabetes in women in this population. The stronger association between WC and diabetes in younger women suggests that the validity of this indicator to assess abdominal adiposity is age-specific. Further studies should validate the usefulness of WC measurement in different age groups.

Keywords

Waist circumferenceHypertensionDiabetes mellitusPopulation-based study
Type
Research Article
Information
Public Health Nutrition , Volume 7 , Issue 5 , August 2004 , pp. 629 - 635
Copyright
Copyright © The Authors 2004

References

1World Health Organization (WHO). Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1998.Google Scholar
2Michels, KB, Greeland, S, Rosner, BA. Does body mass index adequately capture the relation of body composition and body size to health outcomes? American Journal of Epidemiology 1998; 147(2): 167–72.Google Scholar
3Mollarius, A, Seidell, JC, Sans, S, Tuomilheto, J, Kuulasmaa, K. Waist and hip circumferences, and waist-hip ratio in 19 populations of the WHO MONICA Project. International Journal of Obesity and Related Metabolic Disorders 1999; 23(2): 116–25.Google Scholar
4Seidell, JC, Pérusse, L, Després, JP, Bouchard, C. Waist and hip circumference have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. American Journal of Clinical Nutrition 2001; 74(3): 315–21.CrossRefGoogle ScholarPubMed
5Lean, MEJ, Han, TS, Morrison, CE. Waist circumference as a measure for indicating need for weight management. British Medical Journal 1995; 311: 158–61.Google Scholar
6Seidell, JC. Are abdominal diameters abominable indicators? In: Progress in Obesity Research. London: John Libbey & Co Ltd, 1995, 303–6.Google Scholar
7Jansen, I, Heymsfield, SB, Allison, DB, Kotler, DP, Ross, R. Body mass index and waist circumference independently contribute to the prediction of nonabdominal, abdominal subcutaneous, and visceral fat. American Journal of Clinical Nutrition 2002; 75: 683–8.Google Scholar
8Lemieux, S, Prud'homme, D, Bouchard, C, Tremblay, A, Despres, JP. A single threshold value of waist girth identifies normal-weight and overweight subjects with excess visceral adipose tissue. American Journal of Clinical Nutrition 1996; 64(5): 685–93.CrossRefGoogle ScholarPubMed
9Conway, JM, Chanetsa, FF, Wang, P. Intraabdominal adipose tissue and anthropometric surrogates in African American women with upper- and lower-body obesity. American Journal of Clinical Nutrition 1997; 66(6): 1345–51.CrossRefGoogle ScholarPubMed
10Taylor, RW, Keil, D, Gold, EJ, Williams, SM, Goulding, A. Body mass index, waist girth, and waist-to-hip ratio as indexes of total and regional adiposity in women: evaluating using receiver operating characteristic curves. American Journal of Clinical Nutrition 1998; 67(1): 44–9.CrossRefGoogle ScholarPubMed
11Sönmez, K, Akçakoyun, M, Akçay, A, Demir, D, Duran, NE, Gençbay, M, et al. Which method should be used to determine the obesity, in patients with coronary artery disease? (body index mass, waist circumference or waist-to-hip ratio). International Journal of Obesity and Related Metabolic Disorders 2003; 27(3): 341–6.CrossRefGoogle ScholarPubMed
12Han, TS, Van Leer, EM, Seidell, JC, Lean, MEJ. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. British Medical Journal 1995; 311: 1401–5.CrossRefGoogle ScholarPubMed
13Rexrode, KM, Carey, VJ, Hennekens, CH, Walters, EE, Colditz, GA, Stampfer, MJ, et al. Abdominal adiposity and coronary heart disease in women. Journal of the American Medical Association 1998; 280: 1843–8.CrossRefGoogle ScholarPubMed
14Lean, MEJ, Han, TS, Seidell, JC. Impairment of health and quality of life in people with large waist circumference. Lancet 1998; 351: 853–6.CrossRefGoogle ScholarPubMed
15Ezenwaka, CE, Offiah, NV. Abdominal obesity in type 2 diabetic patients visiting primary healthcare clinics in Trinidad, West Indies. Scandinavian Journal of Primary Health Care 2002; 20(3): 177–82.CrossRefGoogle ScholarPubMed
16Rheeder, P, Stolk, RP, Veenhouwer, JF, Grobbee, DE. The metabolic syndrome in black hypertensive women – waist circumference more strongly related than body mass index. South African Medical Journal 2002; 92(8): 637–41.Google ScholarPubMed
17Jansen, I, Katzmarzyk, PT, Ross, R. Body mass index, waist circumference, and health risk. Archives of Internal Medicine 2002; 162: 2074–9.CrossRefGoogle Scholar
18Sundquist, J, Winkleby, M. Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men. International Journal of Epidemiology 2000; 29: 470–7.Google Scholar
19Hughes, K, Aw, TC, Kuperan, P, Choo, M. Central obesity, insulin resistance, syndrome X, lipoprotein(a), and cardiovascular risk in Indians, Malays, and Chinese in Singapore. Journal of Epidemiology and Community Health 1997; 51(4): 394–9.CrossRefGoogle ScholarPubMed
20Victora, CG, Huttly, S, Fuchs, SC, Olinto, MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology 1997; 26(1): 224–7.Google Scholar
21Brazilian Institute of Geography and Statistics (IBGE). Demographic Census 1991. Rio de Janeiro: IBGE, 1991.Google Scholar
22World Health Organization (WHO). Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Geneva: WHO, 1995.Google Scholar
23Hosmer, DW, Lemeshow, S. Applied Logistic Regression Analysis. New York: Wiley Interscience, 1989.Google Scholar
24Lakka, HM, Lakka, TA, Tuomilheto, J, Salonen, JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European Heart Journal 2002; 23(9): 706–13.Google Scholar
25Folsom, AR, Kushi, LH, Anderson, KE, Mink, PJ, Olson, JE, Hong, CP, et al. Associations of general and abdominal obesity with multiple health outcomes in older women. Archives of Internal Medicine 2000; 160(14): 2117–28.CrossRefGoogle ScholarPubMed
26Siani, A, Cappuccio, FP, Barba, G, Trevisan, M, Farinaro, E, Lancone, R, et al. The relation of waist circumference to blood pressure: the Olivetti Heart Study. American Journal of Hypertension 2002; 15(9): 780–6.Google Scholar
27Zhu, S, Wang, Z, Heshka, S, Heo, S, Faith, MS, Heymsfield, SB. Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. American Journal of Clinical Nutrition 2002; 76(4): 699–748.CrossRefGoogle ScholarPubMed
28Han, TS, Feskens, EJ, Lean, MEJ, Seidell, JC. Association of body composition with type 2 diabetes mellitus. Diabetic Medicine 1998; 15: 129–35.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
29International Diabetes Federation (IDF). Diabetes Atlas 2000. Brussels: IDF, 2000.Google Scholar
30Piccini, RX, Victora, CG. Systemic arterial hypertension in an urban area of southern Brazil: prevalence and risk factors. Revista de Saude Publica 1994; 28: 262–7.Google Scholar
31Malerbi, D, Franco, LJ. The Brazilian Cooperative Group on the Study of Diabetes Prevalence multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69. yr. Diabetes Care 1992; 15: 1509–16.Google Scholar
32Kac, G, Velásquez-Meléndez, G, Coelho, MA. Factors associated with abdominal obesity among childbearing-age women. Revista de Saude Publica 2001; 35(1): 46–51.CrossRefGoogle ScholarPubMed
33McNeely, MJ, Boyko, EJ, Shofer, JB, Newell-Morris, L. Standard definitions of overweight and central adiposity for determining diabetes risk in Japanese Americans. American Journal of Clinical Nutrition 2001; 74(1): 101–7.CrossRefGoogle ScholarPubMed
34Pablos-Velasco, PL, Martinez-Martin, FJ, Rodrigues-Perez, F. Prevalence of obesity in a Canadian community. Association with type 2 diabetes mellitus: the Guia Study. European Journal of Clinical Nutrition 2002; 56(6): 557–60.CrossRefGoogle Scholar
35Must, A, Spadano, J, Coakley, EH, Field, AE, Colditz, G, Dietz, W. The disease burden associated with overweight and obesity. Journal of the American Medical Association 1999; 282: 1523–9.CrossRefGoogle ScholarPubMed
36Rankinen, T, Kim, SY, Perusse, L, Despres, JP, Bouchard, C. The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. International Journal of Obesity and Related Metabolic Disorders 1999; 23(8): 801–9.CrossRefGoogle ScholarPubMed
37Molarius, A, Seidell, JC, Visscher, TL, Hofman, A. Misclassification of high-risk older subjects using waist action levels established for young and middle-aged adults: results from the Rotterdam study. Journal of the American Geriatrics Society 2000; 48(12): 1638–45.Google Scholar
38Martin, BC, Warram, JH, Krolewski, AS, Bergman, RN, Soeldner, JS, Kahn, CR. Role of glucose and insulin resistance in development of type 2 diabetes mellitus: results of a 25-year follow-up study. Lancet 1992; 340: 925–9.Google Scholar
39Leite, CC, Wajchenberg, BL, Radominski, R, Matsuda, D, Cerri, GG, Halpern, A. Intra-abdominal thickness by ultrasonography to predict risk factors for cardiovascular disease and its correlation with anthropometric measurements. Metabolism 2002; 51(8): 1034–40.Google Scholar