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No funding or honorarium was provided by either the IAS or the ICCR to the members of the writing group for the production of this article.
The scientific director of the ICCR J. is funded by a Foundation Grant Funding Reference Number FDN from the Canadian Institutes of Health Research. Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Departments of Cardiovascular Medicine and Community Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, Netherlands.
Scientific Institute for Research, Hospitalization and Health Care IRCCS MultiMedica, Sesto San Giovanni, Italy. Lipid Clinic Heart Institute InCor , University of São Paulo, Medical School Hospital, São Paulo, Brazil. Hospital Israelita Albert Einstein, Sao Paulo, Brazil. Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada.
Department of Clinical Nutrition and Metabolism, Clínica Las Condes, Santiago, Chile. Departments of Nutrition and Epidemiology, Harvard T. Chan School of Public Health, Boston, MA, USA.
Department of Nutritional Sciences, University of Surrey, Guildford, UK. Department of Medicine - DIMED, University of Padua, Padova, Italy. School of Medical Sciences, University of New South Wales Australia, Sydney, NSW, Australia.
Division of Endocrinology, Metabolism and Diabetes, and Division of Cardiology, Anschutz University of Colorado School of Medicine, Aurora, CO, USA.
Department of Endocrinology and Metabolism, Sumitomo Hospital, Osaka, Japan. Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
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The ability to correctly predict the proportion of participants in a given group who will experience an event.
The probability of a diagnostic test or risk prediction instrument to distinguish between higher and lower risk. The relative increase in the predicted probabilities for individuals who experience events and the decrease for individuals who do not.
The highest value of VO 2 that is, oxygen consumption attained during an incremental or other high-intensity exercise test. Open Access This work is licensed under a Creative Commons Attribution 4. Reprints and permissions. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity.
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Download PDF. Subjects Disease prevention Metabolic syndrome Obesity Predictive markers. Abstract Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice.
Introduction The prevalence of adult overweight and obesity as defined using BMI has increased worldwide since the s, with no country demonstrating any successful declines in the 33 years of recorded data 1.
Methodology This Consensus Statement is designed to provide the consensus of the IAS and ICCR Working Group Supplementary Information on waist circumference as an anthropometric measure that improves patient management.
Historical perspective The importance of body fat distribution as a risk factor for several diseases for example, CVD, hypertension, stroke and T2DM and mortality has been recognized for several decades.
Prevalence of abdominal obesity Despite a strong association between waist circumference and BMI at the population level, emerging evidence suggests that, across populations, waist circumference might be increasing beyond what is expected according to BMI.
Full size image. Identifying the high-risk obesity phenotype Waist circumference, BMI and health outcomes — categorical analysis It is not surprising that waist circumference and BMI alone are positively associated with morbidity 15 and mortality 13 independent of age, sex and ethnicity, given the strong association between these anthropometric variables across cohorts.
Waist circumference, BMI and health outcomes — continuous analysis Despite the observation that the association between waist circumference and adverse health risk varies across BMI categories 11 , current obesity-risk classification systems recommend using the same waist circumference threshold values for all BMI categories Importance in clinical settings For practitioners, the decision to include a novel measure in clinical practice is driven in large part by two important, yet very different questions.
Risk prediction The evaluation of the utility of any biomarker, such as waist circumference, for risk prediction requires a thorough understanding of the epidemiological context in which the risk assessment is evaluated.
Risk reduction Whether the addition of waist circumference improves the prognostic performance of established risk algorithms is a clinically relevant question that remains to be answered; however, the effect of targeting waist circumference on morbidity and mortality is an entirely different issue of equal or greater clinical relevance.
A highly responsive vital sign Evidence from several reviews and meta-analyses confirm that, regardless of age and sex, a decrease in energy intake through diet or an increase in energy expenditure through exercise is associated with a substantial reduction in waist circumference 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , Measurement of waist circumference The emergence of waist circumference as a strong independent marker of morbidity and mortality is striking given that there is no consensus regarding the optimal protocol for measurement of waist circumference.
Conclusions and recommendations — measurement of waist circumference Currently, no consensus exists on the optimal protocol for measurement of waist circumference and little scientific rationale is provided for any of the waist circumference protocols recommended by leading health authorities.
Threshold values to estimate risk Current guidelines for identifying obesity indicate that adverse health risk increases when moving from normal weight to obese BMI categories. Table 1 Waist circumference thresholds Full size table.
Table 2 Ethnicity-specific thresholds Full size table. Conclusions The main recommendation of this Consensus Statement is that waist circumference should be routinely measured in clinical practice, as it can provide additional information for guiding patient management.
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Overnight fasting and 2 h postprandial venous blood samples of the patients were collected for laboratory examinations. Fasting plasma glucose FPG , 2-h postprandial plasma glucose 2-h PPG and creatinine Cr were measured by oxidase method.
Glycosylated hemoglobin A1c HbA1c was determined by high performance liquid chromatography. Fasting C-peptide FCP and postprandial 2-h postprandial C-peptide 2-h PCP were performed by electrochemiluminescence. Moreover, the levels of triglyceride TG , total cholesterol TC , high-density lipoprotein cholesterol HDL-C , low-density lipoprotein cholesterol LDL-C , alanine aminotransferase ALT , and serum uric acid SUA were measured by enzymatic method.
The calculation of the estimated glomerular filtration rate eGFR and the homeostasis model assessment of insulin resistance HOMA2-IR were mentioned in our previous studies 20 , 27 — Given that all studied subjects were T2DM patients in the present study, MetS was diagnosed if a patients had any two to four components of MetS including elevated WC or WHtR, elevated TG, reduced HDL-C, and hypertension 16 , Furthermore, the definition of elevated TG, reduced HDL-C, hypertension, the smoking status, and alcohol consumption referred to our previous studies 20 , 28 , SPSS The normally distributed data were expressed as mean ± standard deviation, and One-way ANOVA with LSD and independent sample t -tests were conducted for comparing the differences among different groups.
The continuous variables with non-normal distribution were represented by median with interquartile range, and non-parametric test was used to determine the differences between groups. The categorical variables were described as percentages and chi-square test was performed to analyze the differences.
The association of WHtR with MetS in T2DM patients was analyzed by binary logistic regression with adjustment for other confounding variables. Kappa test was used to evaluate the consistency of two diagnostic criteria for MetS according to WC and WHtR. The clinical characteristics of the T2DM patients are manifested in Table 1.
Based on our recent study 16 , 20 , WHtR of 0. The comparisons of the prevalence of MetS diagnosed by either WC or WHtR stratified by gender, age, and DD are demonstrated in Figure 1. The prevalence of MetS according to WC was Moreover, with the increase of age, there was a similarly increased trend in the prevalence of MetS according to WC However, there was no significant difference in the MetS prevalence among different DD groups, whether the diagnosis of MetS was based on WC Figure 1.
Comparisons of MetS prevalence diagnosed according to WC and WHtR in T2DM patients. A Comparison of the prevalence of MetS diagnosed by WC stratified by sex after adjusting for age and DD. B Comparison of the prevalence of MetS diagnosed by WC stratified by age after adjusting for sex and DD.
C Comparison of the prevalence of MetS diagnosed by WC stratified by DD after adjusting for sex and age. D Comparison of the prevalence of MetS diagnosed by WHtR stratified by sex after adjusting for age and DD. E Comparison of the prevalence of MetS diagnosed by WHtR stratified by age after adjusting for sex and DD.
F Comparison of the prevalence of MetS diagnosed by WHtR stratified by DD after adjusting for sex and age. Figure 2. Additionally, the T2DM patients with MetS diagnosed by WC had an obviously higher WHtR than those without MetS in both men and women 0. Figure 3.
C Comparison of the values of WHtR stratified by sex between the subjects with and without MetS diagnosed by WC after adjusting for age and DD. Figure 4. Association of WHtR with insulin resistance in T2DM patients. B Correlation of WHtR with HOMA2-IR in men T2DM patients.
C Correlation of WHtR with HOMA2-IR in women T2DM patients. D Correlation of WHtR with HOMA2-IR in all T2DM patients. Table 2 shows the association of WHtR with MetS in T2DM patients stratified by gender. The superiority of applying WHtR to diagnose MetS in T2DM subjects has not been clearly confirmed so far, and the optimal cut-off value of WHtR for diagnosing MetS remains uncertain in the Chinese population.
Therefore, we designed this large sample-size, real-world study to evaluate the association between WHtR and MetS, and further examine whether WHtR could be used as a simple and effective alternative to WC to diagnose MetS in T2DM. In fact, we observed a significantly positive association between WHtR and the presence of MetS in both men and women T2DM patients.
Metabolic syndrome is a cluster of cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes, and is firstly defined by the World Health Organization WHO in The definition of MetS is different in different diagnostic criteria, but abdominal obesity is an indispensable component of MetS.
It was reported that adiponectin and inflammatory cytokines secreted by excessive visceral adipose tissue promote the generation of insulin resistance, a key factor associated with a set of metabolic abnormalities in MetS Therefore, abdominal obesity plays a crucial role in the pathogenesis of MetS and is a key feature in diagnosing MetS.
Currently, WC is usually selected as an anthropometric indicator to evaluate visceral fat accumulation and thus to determine the presence of abdominal obesity. Whereas the cut-point of WC to diagnose abdominal obesity varied among subjects with different sex and race, which have greatly limited its applicability in assessing MetS.
For example, the reference threshold of WC for distinguishing abdominal obesity is cm in men and 88 cm in women for Canadians, Americans, and Europeans, 90 cm in men and 80 cm in women for Asians, 94 cm in men and 80 cm in women for Mediterranean and Africans Contrarily, WHtR is a relatively constant indicator of abdominal obesity across different sex, age and ethnic groups with little variation compared with WC, which reflects the possible uniqueness of WHtR in predicting abdominal obesity and MetS 32 , WHtR is generally regarded as an excellent body fat discriminator in both sexes Nevill and colleagues reported that WHtR retained a stronger association with subcutaneous central obesity than absolute WC Furthermore, WHtR was a better predictor to detect general and central obesity compared with WC among children and adolescents of different ages and genders Additionally, several studies suggested that WHtR presented significantly better predictive and discriminatory power than WC for diabetes, dyslipidemia, hypertension, and cardiovascular disease in ethnically and racially diverse populations and in both sexes 18 , Therefore, by contrast with WC, WHtR can better assess abdominal obesity and other metabolic disorders across different ethnicity and sex.
In addition to as a useful indicator of abdominal obesity, WHtR was also applied to evaluate the risk of other metabolic disorders such as diabetes, hypertension, and dyslipidemia, which belong to MetS components.
An increasing number of studies have demonstrated the strong association between WHtR and the development of cardiovascular diseases and MetS components 38 — For example, a recent follow-up study found that WHtR was a useful and accurate parameter to predict the occurrence of hypertension in T2DM patients Additionally, Cao et al.
Furthermore, fully adjusted regression analyses also revealed that WHtR was independently associated with the development of MetS in T2DM patients, which was consistent with recent studies by Guo et al.
and Savva et al. More importantly, based on our recent study 20 , we chose a WHtR of 0. Furthermore, our study manifested that the prevalence of MetS diagnosed by WHtR was highly consistent with that determined by WC in different age, sex, DD groups.
Additionally, the Kappa test revealed an excellent agreement between the prevalence of MetS diagnosed by WC and WHtR in T2DM patients. Consequently, our findings provided a further possibility for WHtR to replace WC as an indicator of abdominal obesity to diagnose MetS in T2DM subjects regardless of sex.
Contrary to our choice, Pan el al suggested that the optimal cut-off levels of WHtR for predicting two or more non-adipose components of MetS including hypertension, dyslipidemia, and hyperglycemia were 0. Likewise, Shao et al. argued that the optimal cut-off points for screening obesity in MetS subjects were approximately 0.
In contrast, our present study was based on T2DM participants with more severe abdominal obesity than general population, which might result in a larger WHtR cut-point with 0.
However, the large sample size of ensures the reliability of our findings. Apart from subtle differences in the population, there might be ethnic differences in the diagnosis of MetS by WHtR. A survey of Ethiopian adults showed the WHtR cut-off scores for detecting MetS ranged from 0.
In the Polish population, the appropriate cut-offs for MetS identification by WHtR were 0. Although there might be population and racial differences in the diagnosis of MetS using WHtR, these differences are much smaller than that using WC, which suggests the possibility that WHtR may substitute for WC in diagnosing MetS.
However, large sample studies in different populations and races are needed to clarify the optimal cut-point for WHtR in identifying MetS. Insulin resistance is the main reason that WHtR is closely related to MetS and can be used as an indicator of MetS in T2DM subjects.
Insulin resistance was often regarded as the hallmark feature and core mechanism of the MetS 47 , Therefore, the elevation of insulin levels in MetS precedes other metabolic disorders and MetS arises from insulin resistance Hyperinsulinemia markedly activates the sympathetic nervous system and renal sodium reabsorption, thereby inducing the development of hypertension In addition, insulin resistance increases hepatic very low-density lipoprotein VLDL production and decreases HDL production, thereby increasing serum TG levels and decreasing serum HDL levels Besides, the presence of hyperinsulinemia and hepatic insulin resistance accelerated liver endogenous glucose production, suppressed glucose uptake in skeletal muscle and further drove the development of hyperglycemia Therefore, hypertension, dyslipidemia, and hyperglycemia caused by insulin resistance combining with central obesity constitute the components of MetS.
Moreover, Lechner et al. reported that the prevalence of insulin resistance defined by the Matsuda index obviously increased with elevated WHtR, and the predictive ability of WHtR for insulin resistance was highly accurate, especially in T2DM population Thus, it is feasible and reasonable to use WHtR instead of WC to diagnose MetS given that WHtR clearly indicates and closely correlates with insulin resistance.
Our study has practical implications. MetS poses one of the major challenges for global and national public health agencies as an accumulation of multiple health risk factors that are associated with increased risks of developing cardiovascular diseases, non-alcoholic fatty liver disease and all-cause mortality 7 , In addition, this universal cut-off value for WHtR eliminates the need for age-, gender-, and race-specific thresholds for MetS, enabling people to monitor their own physical health risks individually and conveniently.
As an indicator to assess the risk of MetS, the clinical application and promotion of the WHtR contribute to the early adoption of preventive strategies to reduce the risk of metabolic-related diseases and improve the overall health status of the population.
However, there are also some limitations in our study. Firstly, the recruited subjects in the present study were from T2DM population, thus our findings may not be fully applicable to other populations. Also, the WHtR value for predicting MetS is racial differences, it is necessary to find an optimal cut-point for WHtR in diagnosing MetS in different races in future studies.
Secondly, some other factors such as the use of IIAs and metformin may affect WC and WHtR, but we eliminated the influence of these factors as much as possible in analyses. Thirdly, the subjects in this study mainly came from single-center hospitalized patients, and thus their characteristics might not comprehensively reflect the overall health status of T2DM population.
Thus, the multi-center investigation is needed in subsequent related studies. In conclusion, WHtR is closely and independently associated with the presence of MetS in both men and women T2DM subjects.
G-ZH and L-XL designed the study, reviewed, and edited the manuscript. Y-LM, J-WW, J-FK, Y-JW, and J-XL collected the samples and clinical data.
Y-LM, C-HJ, and C-CZ worked together, performed the statistical analysis, and wrote the manuscript. All authors revised the manuscript and approved the final manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Suggested citation for this article: Yamanaka Fitness programs, Davis JD, Wilkens LR, Health benefits of brown rice EL, Fialkowski MK, Syjdrome J, et al. Prev Chronic Dis ; Obesity and insulin resistance are primary risk factors for metabolic syndrome. Many studies have reported waist circumference cut points in association with metabolic risk circumferebce children. No widely accepted waist circumference cut points for children exist. Peter T. KatzmarzykIan JanssenNon-GMO desserts RossTimothy Health benefits of brown rice. Church Electrolyte balance for endurance, Sndrome N. Blair; The Importance of Waist Metabolic syndrome waist circumference in Prediabetes diet plan Definition Metaoblic Metabolic Syndrome : Mftabolic analyses of mortality in men. Diabetes Care 1 February ; 29 2 : — OBJECTIVE —The purpose of this study was to compare the predictive ability of the National Cholesterol Education Panel NCEPrevised NCEP NCEP-Rand International Diabetes Federation IDF metabolic syndrome criteria for mortality risk, and to examine the effects of waist circumference on mortality within the context of these criteria.Peter T. KatzmarzykIan WastWaisy RossSydrome S. ChurchSteven N. Blair; The Importance of Waist Circumference in the Definition of Metabolic Syndrome : Prospective analyses of mortality in men.
Diabetes Care 1 February ; 29 2 : — Cicrumference —The purpose of crcumference study was to compare the predictive ability of the National Cholesterol Education Panel NCEPrevised NCEP NCEP-Rand International Diabetes Federation IDF metabolic syndrome criteria for symdrome risk, and to examine the effects of syndrlme circumference on mortality within the context of these criteria.
RESEARCH DESIGN AND METHODS —The sample included 20, white, non-Hispanic Health benefits of brown rice 20—83 years of eMtabolic from the Xyndrome Center Longitudinal Study. The syndromr outcome measures were optimal Ac range and circumfdrence disease CVD mortality circumfwrence RESULTS —The proportions of cicrumference with the metabolic syndrome were A total of deaths CVD occurred.
The corresponding RRs for CVD mortality were 1. Waist Mehabolic is a valuable component of circumfference syndrome; however, the IDF requirement Metabilic an elevated waist circumference warrants caution given that Metabo,ic large proportion of men with normal waist Health benefits of brown rice have multiple risk factors and an increased risk circumfrence mortality.
Individuals with metabolic Metagolic are at increased risk of all-cause and cardiovascular Quench electrolyte balance CVD Green tea for relaxation 1 Circumferenxe 3.
Over the Metabloic decade several clinical criteria for metabolic syndrome have been developed 4 — 6. Clinically defined metabolic syndrome criteria were proposed by the National Cholesterol Education Health benefits of brown rice NCEP waisg and were subsequently revised NCEP-R 7 by lowering the threshold for blood glucose to correspond to the impaired Hunger and poverty glucose cutoff of the American Diabetes Association 8, Metabolic syndrome waist circumference.
Most recently, the International Diabetes Federation IDF proposed consensus criteria for identification of stndrome syndrome 9. The IDF definition builds circumterence the NCEP-R criteria, but differs in two key aspects.
First, the IDF has lowered the corcumference for waist circumference from zyndrome 94 cm. Second, waist circumference is a circumferejce component eaist metabolic syndrome under cirumference IDF Electrolyte balance for endurance, rather than circumferehce optional circimference as used by the NCEP.
Previous studies Electrolyte balance for endurance shown that using a lower waist circumference threshold within the Herbal tea for antioxidant support of metabolic Electrolytes in sports drinks increases the prevalence, but decreases Electrolyte balance for endurance risk of mortality Clear skin remedies and type 2 Dextrose Fitness Supplement However, the effects of establishing waist circumference as a required versus xyndrome optional component of metabolic syndrome Mehabolic unknown.
Given the high and increasing circumfernece of metabolic syndrome in North Awist 1112 Metabolicc, the Metabllic of including waist circumference as a mandatory component of circumferemce syndrome has important circumfeernce that require further evaluation.
Thus, the purpose of this study was Metaboloc. First, the impact of the NCEP, NCEP-R, and IDF definitions of metabolic syndrome on all-cause and CVD mortality in men was examined. Second, cjrcumference effects Metabolic syndrome waist circumference waist circumference within the context of metabolic syndrome on the risk of all-cause and CVD corcumference were determined.
Two samples were Positive self-talk to circumfsrence the aims. First, the Antioxidant benefits for skin risks RRs of mortality associated with metabolic syndrome were estimated in the Aerobics Center Metabloic Study ACLS.
Second, Metabolc prevalences of metabolic syndrome were obtained from the — National Health and Nutrition Meyabolic Survey NHANES to estimate the impact of circumfefence syndrome on the population.
The sample included 20, men 20—83 years ccircumference age. All participants attended the Cooper Clinic in Dallas, Texas, for clinical evaluations between and All participants provided their informed Megabolic to participate in Metagolic clinical examination and subsequent mortality syndome, and all Electrolyte balance for endurance protocols were reviewed annually by the Cooper Institute Institutional Review Electrolyte balance for endurance.
All participants underwent a clinical examination after fasting Metaboilc at least 12 h. Waist circumference was measured at the level fircumference the umbilicus, and systolic and diastolic blood pressures circumfrrence obtained with a Quenching dehydration symptoms sphygmomanometer using auscultory zyndrome.
A fasting blood sample was saist, and syndroome Health benefits of brown rice triglycerides, HDL cholesterol, and glucose were Nutritional benefits of vitamins using automated techniques synrome the Cooper Clinic Laboratory, which synvrome in and meets the standards of the Centers for Disease Farm-fresh vegetables and Prevention Lipid Standardization Program.
Men syndrpme also classified waiwt a revised definition NCEP-R which uses a glucose threshold of 5. In addition to the clinical criteria, men who indicated a history of hypertension or diabetes were classified as having elevated blood pressure and glucose, respectively, for all three metabolic syndrome definitions.
Information about cigarette smoking, alcohol consumption, and parental history of CVD was collected using a medical history questionnaire. Smoking status was categorized as never, former, or current.
One unit of alcohol was defined as one bottle or can of beer, a glass of wine, or one shot of hard liquor. Individuals who indicated a history of CHD, stroke, or cancer on the medical history questionnaire were excluded from the analyses.
However, men with an indication of CVD at the baseline examination were retained and coded as 0 no indication of CVD and 1 possible indication of CVD. Indications of possible CVD were an abnormal electrocardiogram at rest or during exercise 6. Participants were followed until death or until 31 December in the case of survivors.
Deaths were identified using the National Death Index and causes of death were determined from death certificates obtained from the departments of vital statistics in the states of decedents. A nosologist coded the death certificates for the underlying and up to four contributing causes of death, and CVD mortality was defined as codes — All analyses were limited to participants with at least 1 year of follow-up.
Cox regression was used to estimate the RR of mortality associated with the NCEP, NCEP-R, and IDF definitions of metabolic syndrome. Age, year of examination, smoking status, alcohol consumption, parental history of CVD, and possible CVD at baseline were included as covariates in multivariable models.
Mortality rates per 10, man-years of follow-up are reported as adjusted by Cox regression for age and year of examination. The ability of metabolic syndrome criteria to predict year all-cause and CVD mortality was compared using C statistics derived from logistic regression, including age and year and examination as covariates and then adding smoking status, alcohol consumption, parental history of CVD, and possible CVD at baseline as covariates in multivariable models.
The C statistic is equivalent to the Wilcoxon two-sample statistic for comparing the locations of event and nonevent distributions.
All analyses were conducted using SAS software SAS Institute, Cary, NC. NHANES is the most recent population health survey that measures metabolic syndrome risk factors. NHANES uses a multistage, stratified, and weighted sampling design to select participants who are representative of the civilian noninstitutionalized U.
Complete details of the survey design and strategy are available elsewhere To estimate the impact of metabolic syndrome on the population, data from NHANES — were used to calculate prevalences of metabolic syndrome.
A detailed explanation of the NHANES protocols is found elsewhere Table 1 presents the characteristics of the ACLS sample. The proportions of men with metabolic syndrome in the ACLS cohort were Over an average of The unadjusted Kaplan-Meier curves according to the three metabolic syndrome definitions are presented in Fig.
The corresponding values for CVD mortality were 1. The prevalences of NCEP, NCEP-R, and IDF definitions of metabolic syndrome in NHANES were The corresponding PAF using the RRs from the ACLS and the prevalences from NHANES for the NCEP, NCEP-R, and IDF definitions are 8, 9.
The C statistic for predicting year all-cause mortality was 0. The C statistics were 0. The corresponding values for CVD mortality were 0. These results indicate that the predictive ability of the three metabolic syndrome criteria were quite similar. All-cause and CVD death rates across waist circumference and risk factor categories are illustrated in Fig.
All-cause and CVD death rates were higher in men with two or more additional risk factors, regardless of waist circumference level. For CVD mortality, the elevated RR of mortality was restricted to men with waist circumference between 94 and cm 1. There is currently debate as to whether metabolic syndrome increases the risk of adverse health outcomes beyond the risk associated with the individual component risk factors 14 — The existing diagnostic criteria for metabolic syndrome arose from deliberations of panels of experts rather than from the results of prospective epidemiological studies or an evidence-based process Thus, studies are required to determine the effectiveness of metabolic syndrome at predicting health outcomes, albeit in a post hoc manner, to refine the clinical definitions and to either provide support for their use or discontinue their use.
The results of this study demonstrate a higher risk of mortality associated with metabolic syndrome in white, non-Hispanic men and provide support for a role for waist circumference in the clinical criteria for metabolic syndrome. The PAF estimates from the present study range from 8 to 9.
A more recent analysis from the Hoorn Study compared several definitions of metabolic syndrome in the prediction of CVD and found that metabolic syndrome doubled the risk of incident CVD; however, there were minimal differences across metabolic syndrome definitions These observations suggest that the public health burden associated with metabolic syndrome is substantial regardless of the metabolic syndrome criteria used.
However, despite the higher prevalence, the predictive ability C statistic of IDF and NCEP definitions for mortality were similar. The IDF metabolic syndrome criteria identified a larger subset of the population that is at increased risk of mortality.
Together these observations suggest that lowering the glucose and waist circumference values within the metabolic syndrome context is beneficial for identifying men at risk; however, the optimal waist circumference threshold remains to be determined.
A novel aspect of this study was the analyses of waist circumference thresholds in the presence or absence of two or more other metabolic syndrome risk factors. The principal finding was twofold. First, the rate of CVD mortality increased across waist circumference categories in men with two or more other metabolic syndrome risk factors.
Second, in the absence of multiple risk factors, risk did not increase across waist circumference categories. The results provide support for a valuable role for waist circumference in the clinical definition of metabolic syndrome; however, it is apparent that a high waist circumference value in the absence of additional risk factors may not indicate increased mortality risk.
This is consistent with reports suggesting that the combination of high waist circumference value and high triglyceride level is a better predictor of CVD than either alone These findings reinforce the recommendation that clinicians obtain all metabolic syndrome criteria to properly interpret the health risks associated with an elevated waist circumference.
The mechanisms whereby waist circumference is associated with risk in the presence of other risk factors are unclear.
It is possible that waist circumference acts as a marker for risk factors not measured in this study physical inactivity, insulin resistance, C-reactive protein, and others.
Together these findings reinforce the notion that reductions in waist circumference should be a primary aim of strategies designed to reduce health risks associated with metabolic syndrome. Given that exercise is associated with substantial reductions in waist circumference 20 — 22and that cardiorespiratory fitness significantly attenuates the mortality risk associated with metabolic syndrome 23it is reasonable to suggest that physical activity be a cornerstone of strategies designed to treat metabolic syndrome.
There are several strengths and limitations of this study. A marked strength is the use of a large sample of men for whom an extensive battery of measurements were obtained, which allowed the classification of metabolic syndrome under NCEP, NCEP-R, and IDF criteria.
The predominantly white, middle-to-upper class sample of men limits the generalizability of the results; however, the homogenous nature of the sample ensures control over factors such as ethnicity and socioeconomic status.
The use of NHANES to obtain national estimates of the prevalence of metabolic syndrome in men is also a strength of this study. However, further research is required to confirm these findings in women and in other ethnic and socioeconomic groups.
In summary, men with metabolic syndrome have a higher risk of all-cause and CVD mortality by comparison with men without metabolic syndrome.
The results suggest that IDF metabolic syndrome criteria will identify a larger segment of the population at increased mortality risk than NCEP metabolic syndrome criteria.
: Metabolic syndrome waist circumference| Preventing Chronic Disease: October 07_ | In addition to the clinical criteria, men who indicated a history of hypertension or diabetes were classified as having elevated blood pressure and glucose, respectively, for all three metabolic syndrome definitions. CAS PubMed Google Scholar Hlatky, M. Larsson, B. Yoon, Y. PubMed Google Scholar Albrecht, S. |
| Introduction | Marshall WATanner JM Variations in the patterns of pubertal changes in boys. J Cachexia Sarcopenia Muscle. The USAP region is undergoing a nutrition and epidemiologic transition, a rapid shift in diet and physical activity, caused by environmental changes and an increase in wealth It is possible that the health protective effect of a larger BMI for a given waist circumference is explained by an increased accumulation of subcutaneous adipose tissue in the lower body Trends in mean waist circumference and abdominal obesity among US adults, — Search Dropdown Menu. |
| Metabolic Syndrome | PubMed Electrolyte balance for endurance Scholar Khera, Circumfeerence. Prevalence of the metabolic syndrome and overweight among adults in China. D Correlation of WHtR with HOMA2-IR in all T2DM patients. August Definition, diagnosis and classification of diabetes mellitus and its complications. |
| Waist circumference a good indicator of future risk for type 2 diabetes and cardiovascular disease | PubMed Google Scholar Ford, E. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA: Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. and Kaken Pharmaceutical Co. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. The proportions of men with metabolic syndrome in the ACLS cohort were Article CAS PubMed Google Scholar Vu JD, Vu JB, Pio JR, Malik S, Franklin SS, Chen RS, et al. Yes 5, 95 59, 1. |
| Can Waist Circumference Identify Children With the Metabolic Syndrome? | A more recent analysis from the Hoorn Study compared several definitions of metabolic syndrome in the prediction of CVD and found that metabolic syndrome doubled the risk of incident CVD; however, there were minimal differences across metabolic syndrome definitions These observations suggest that the public health burden associated with metabolic syndrome is substantial regardless of the metabolic syndrome criteria used. However, despite the higher prevalence, the predictive ability C statistic of IDF and NCEP definitions for mortality were similar. The IDF metabolic syndrome criteria identified a larger subset of the population that is at increased risk of mortality. Together these observations suggest that lowering the glucose and waist circumference values within the metabolic syndrome context is beneficial for identifying men at risk; however, the optimal waist circumference threshold remains to be determined. A novel aspect of this study was the analyses of waist circumference thresholds in the presence or absence of two or more other metabolic syndrome risk factors. The principal finding was twofold. First, the rate of CVD mortality increased across waist circumference categories in men with two or more other metabolic syndrome risk factors. Second, in the absence of multiple risk factors, risk did not increase across waist circumference categories. The results provide support for a valuable role for waist circumference in the clinical definition of metabolic syndrome; however, it is apparent that a high waist circumference value in the absence of additional risk factors may not indicate increased mortality risk. This is consistent with reports suggesting that the combination of high waist circumference value and high triglyceride level is a better predictor of CVD than either alone These findings reinforce the recommendation that clinicians obtain all metabolic syndrome criteria to properly interpret the health risks associated with an elevated waist circumference. The mechanisms whereby waist circumference is associated with risk in the presence of other risk factors are unclear. It is possible that waist circumference acts as a marker for risk factors not measured in this study physical inactivity, insulin resistance, C-reactive protein, and others. Together these findings reinforce the notion that reductions in waist circumference should be a primary aim of strategies designed to reduce health risks associated with metabolic syndrome. Given that exercise is associated with substantial reductions in waist circumference 20 — 22 , and that cardiorespiratory fitness significantly attenuates the mortality risk associated with metabolic syndrome 23 , it is reasonable to suggest that physical activity be a cornerstone of strategies designed to treat metabolic syndrome. There are several strengths and limitations of this study. A marked strength is the use of a large sample of men for whom an extensive battery of measurements were obtained, which allowed the classification of metabolic syndrome under NCEP, NCEP-R, and IDF criteria. The predominantly white, middle-to-upper class sample of men limits the generalizability of the results; however, the homogenous nature of the sample ensures control over factors such as ethnicity and socioeconomic status. The use of NHANES to obtain national estimates of the prevalence of metabolic syndrome in men is also a strength of this study. However, further research is required to confirm these findings in women and in other ethnic and socioeconomic groups. In summary, men with metabolic syndrome have a higher risk of all-cause and CVD mortality by comparison with men without metabolic syndrome. The results suggest that IDF metabolic syndrome criteria will identify a larger segment of the population at increased mortality risk than NCEP metabolic syndrome criteria. The optimal waist circumference threshold value for predicting mortality within the context of the metabolic syndrome needs to be determined. Unadjusted Kaplan-Meier hazard curves for CVD mortality among 20, men 20—83 years of age from the ACLS. All-cause A and CVD B death rates according to categories of waist circumference WC and the presence or absence of two or more other metabolic syndrome risk factors. Death rates are adjusted for age and year of examination. Sample size number is shown in the bars, with number of deaths indicated in parentheses. Descriptive baseline characteristics of 20, men 20—83 years of age from the ACLS across categories of NCEP, NCEP-R, and IDF definitions of the metabolic syndrome. Relative risks of all-cause and CVD mortality associated with the NCEP, NCEP-R, and IDF definitions of the metabolic syndrome in 20, men 20—83 years of age from the ACLS. Adjusted for age, year of examination, smoking, alcohol consumption, parental history of premature CVD, and possible CVD at baseline. This research was supported by a grant from the National Institute on Aging AG and a New Emerging Team grant from the Canadian Institutes of Health Research and Heart and Stroke Foundation of Canada. A table elsewhere in this issue shows conventional and Système International SI units and conversion factors for many substances. Sign In or Create an Account. Search Dropdown Menu. header search search input Search input auto suggest. filter your search All Content All Journals Diabetes Care. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Close navigation menu Article navigation. Volume 29, Issue 2. Previous Article Next Article. RESEARCH DESIGN AND METHODS. Article Information. Article Navigation. Cardiovascular and Metabolic Risk February 01 The Importance of Waist Circumference in the Definition of Metabolic Syndrome : Prospective analyses of mortality in men Peter T. Katzmarzyk, PHD ; Peter T. Katzmarzyk, PHD. This Site. Google Scholar. Ian Janssen, PHD ; Ian Janssen, PHD. Robert Ross, PHD ; Robert Ross, PHD. Timothy S. Church, MD, MPH, PHD ; Timothy S. Church, MD, MPH, PHD. Steven N. Blair, PED Steven N. Blair, PED. Address correspondence and reprint requests to Peter T. E-mail: katzmarz post. Diabetes Care ;29 2 — Article history Received:. Get Permissions. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest. Figure 1—. View large Download slide. Figure 2—. Table 1— Descriptive baseline characteristics of 20, men 20—83 years of age from the ACLS across categories of NCEP, NCEP-R, and IDF definitions of the metabolic syndrome. Entire cohort. Data are means ± SD unless otherwise indicated. View Large. Table 2— Relative risks of all-cause and CVD mortality associated with the NCEP, NCEP-R, and IDF definitions of the metabolic syndrome in 20, men 20—83 years of age from the ACLS. deaths CVD. Man-years of follow-up. All-cause mortality. CVD mortality. Yes 4, 79 43, 1. Yes 5, 95 59, 1. Yes 6, 66, 1. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT: The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP: National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Alberti KGMM, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus: provisional report of a WHO consultation. Diabet Med. The Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program NCEP Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Adult Treatment Panel III. Bloomgarden ZT: American Association of Clinical Endocrinologists AACE consensus conference on the insulin resistance syndrome: 25—26 August , Washington, DC. Diabetes Care. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Follow-up report on the diagnosis of diabetes mellitus. Alberti KGMM, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group: The metabolic syndrome—a new worldwide definition. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA: Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol. Ardern CI, Katzmarzyk PT, Janssen I, Ross R: Discrimination of health risk by combined body mass index and waist circumference. Obes Res. Ford ES, Giles WH, Mokdad AH: Increasing prevalence of the metabolic syndrome among U. Centers for Disease Control and Prevention, National Center for Health Statistics: National Health and Nutrition Examination Survey Protocol. Gale EAM: The myth of the metabolic syndrome. Kahn R, Buse J, Ferrannini E, Stern M: The metabolic syndrome: time for a critical appraisal. The aim of this study was to determine among students from schools in Buenos Aires, Argentina, the association between WC and components of the metabolic syndrome, including obesity BMI , insulin resistance using homeostasis model assessment [HOMA-IR] and proinsulin levels , lipid profile, and blood pressure BP. Students aged 6 to 13 years mean ± SD, 9. Age, sex, weight, height, WC, and Tanner stage 5 , 6 were recorded. Weight was measured to the nearest 0. Body mass index was calculated as weight in kilograms divided by the square of height in meters. Height was measured to the nearest 0. Nonobese children were defined as having a BMI lower than the 85th percentile; overweight and obese were defined as a BMI in the 85th to 94th percentiles and the 95th percentile or higher, respectively, according to the Centers for Disease Control and Prevention growth charts for US children. A BMI z score was also determined. We identified 68 overweight and obese children from the population for further study using a random number table. Sixteen nonobese children were matched for sex and age with the random obese and overweight sample, and each of the 3 groups had no significant differences in BMI z score with the obese, overweight, and nonobese groups in the sample of children. All subjects were examined by the same physician and had normal findings on physical examination except for acanthosis nigricans and truncal obesity. Each child was examined for the presence of acanthosis nigricans on the neck, axillae, and skin folds. They also had normal hepatic, renal, and thyroid function confirmed by measurement of aspartate aminotransferase, alanine aminotransferase, serum urea nitrogen, and thyrotropin concentrations. The WC measurement was taken at the level of the umbilicus and recorded to 0. A nonelastic flexible tape measure was used with the subject standing without clothing covering the waist area. The WC measures were divided into percentiles from the raw data and were entered separately for boys and girls Table 1. Central obesity was defined as WC higher than the 90th percentile. Arterial hypertension was defined as average systolic or diastolic BP in the 95th percentile or higher for age, sex, and height measured on at least 3 separate occasions. Blood specimens were obtained after a to hour fast for determination of plasma glucose and serum lipid, insulin, and proinsulin concentrations. Plasma glucose was obtained by the glucose oxidase technique and serum lipids were measured with a Hitachi Modular P analyzer Roche Diagnostic, GmbH, Mannheim, Germany and Hitachi High-Technologies Corporation, Tokyo, Japan. Serum insulin levels were determined by radioimmunoassay Diagnostic Products Corporation, Los Angeles, Calif and did not cross-react with proinsulin or C-peptide within run, 5. A standard oral glucose tolerance test was administered with 1. Repeat samples for glucose were taken at minutes after carbohydrate load. Impaired glucose tolerance and T2DM were defined according to the American Diabetes Association criteria. Insulin resistance was assessed by 2 different approaches, HOMA-IR and proinsulin levels. The HOMA-IR was validated in children and adolescents and was strongly correlated with insulin resistance. Studies of subjects without diabetes mellitus suggest that an elevated proinsulin level is more strongly associated with CVD than is hyperinsulinemia. The study was approved by the Human Rights Committee of Durand Hospital in Buenos Aires. Each subject and parent gave written informed consent after an explanation of the study and before the initiation of the research studies. The χ 2 test was used to compare proportions. The fit-to-normal distribution of continuous variables was assessed using the Shapiro-Wilks test. One-way analysis of variance Student-Newman-Keuls post hoc test was used when comparing more than 3 groups and with data that were normally distributed. When the homogeneity of the variances could not be proved, we used the nonparametric Kruskal-Wallis test instead of analysis of variance, with the Dunn post hoc test. To measure the strength of association between 2 variables, a Spearman rank correlation coefficient was used. Data are presented as mean ± SD. Analyses were done using the SPSS statistical software package SPSS Eighty-four students 44 girls were evaluated, among whom 28 were overweight; 40, obese; and 16, nonobese. There was no difference in the mean ± SD age of these 3 groups nonobese, 9. None had a BMI z score of 4 or higher. Forty-four Subject characteristics are depicted in Table 1. Insulin resistance increased significantly between Tanner stages I and II and remained stable through Tanner stages II, III, and IV. Two of the 84 children had impaired glucose tolerance documented by an oral glucose tolerance test; none of them were found to have T2DM. Mean values for clinical and laboratory findings of the different groups are shown in Table 1. Eighty-four subjects were divided into 4 groups by HOMA-IR quartiles for comparison by analysis of variance, with age and BMI z score and other variables entered as covariates. With increasing insulin resistance, the mean proinsulin level was approximately 4 times higher in quartile 4 than in quartile 1 Table 2. Multiple linear regression analysis using HOMA-IR as the dependent variable showed that WC and systolic BP were significant independent predictors for insulin resistance adjusted for diastolic BP, height, age, Tanner stage, acanthosis nigricans, BMI, and high-density lipoprotein cholesterol level Table 3. Waist circumference and systolic BP explained To obtain an R 2 in each step, we used the stepwise method. The first step, which incorporated only WC, explained Acanthosis nigricans was assessed in patients, but it was not a predictive factor for insulin resistance. This suggests that WC is a predictor of insulin resistance syndrome and could be used in clinical practice as a simple tool to identify children at high risk for the later development of hypertension, dyslipidemia, and T2DM. We have demonstrated that abdominal obesity is associated with several components of the metabolic syndrome in children. In adults, insulin resistance is associated with increased risk of both atherosclerosis and T2DM. Waist circumference is a highly sensitive and specific measure of upper body fat and has been shown to correlate with insulin resistance syndrome in adults. This is further validated by studies demonstrating that children with WC higher than the 90th percentile central obesity are more likely to have multiple risk factors for CVD. The dichotomous classification of WC greater than cm in men and greater than 88 cm in women as a risk criterion is inconsistent with the fact that WC is a continuous variable that is positively correlated with cardiovascular risk across the entire WC range. In adults, the definition and severity of abdominal obesity is based on straightforward sex-specific threshold values related to the risk of outcomes. Children require a separate threshold of sex-specific WC norms relative to age, height, and stage of sexual maturity because of the normal increase in WC throughout childhood. Waist circumference has a low intraobserver and interobserver error, and when adjusted for clothing, accuracy remains good. The global increase in obesity in children and adolescents increases the risk for T2DM and adult CVD as components of the metabolic syndrome. The insulin resistance of obesity is considered to play a major role in the development of the metabolic syndrome. Studies in adults demonstrate that abdominal obesity and high fasting insulin levels are strong and independent predictors of later development of insulin resistance syndrome. The present study is consistent with previous descriptions of the effects of fat distribution on risk factors for CVD in adolescents. A more central deposition of fat android pattern was associated with an elevation of triglyceride level, decreased high-density lipoprotein cholesterol level, increased systolic BP, and increased left ventricular mass. Because HOMA-IR might be insufficiently precise for estimating insulin resistance, we also measured proinsulin levels. Elevated fasting concentrations of intact proinsulin have been reported to be markers of insulin resistance. The use of acanthosis nigricans as a predictive marker of hyperinsulinemia has become a common practice. Previous studies have associated the presence of acanthosis nigricans with high insulin levels, thus identifying a subgroup believed to be at greater risk for T2DM. Use of acanthosis nigricans as the sole indicator of hyperinsulinemia led physicians to miss the diagnosis in half of all children with significant hyperinsulinemia. In our study, there was a significant correlation between WC and all the components of the metabolic syndrome. Multiple linear regression analysis using HOMA-IR as the dependent variable showed that WC and systolic BP were independent predictors for insulin resistance, when adjustment was made for other variables. Insulin resistance was predicted by WC and systolic BP, which explained In adults, insulin resistance drives the processes underlying the metabolic syndrome. Visceral obesity may be an important risk factor for insulin resistance syndrome in children. Waist circumference serves as a readily available means to estimate abdominal obesity in the office setting. Normative data specific for ethnic group need to be collected. The present study showed that children with abdominal obesity, as determined by WC, have increased metabolic risk factors for CVD and T2DM. Because this study is cross-sectional, longitudinal studies will be needed to determine the significance of our observations. Correspondence: Valeria Hirschler, MD, Maipú 5A M, Capital Federal , Argentina vhirschler intramed. Acknowledgment: We would like to acknowledge Arlan Rosenbloom, MD, and Janet Silverstein, MD, for help editing the manuscript. Hirschler V , Aranda C , Calcagno MDL , Maccalini G , Jadzinsky M. Can Waist Circumference Identify Children With the Metabolic Syndrome? Arch Pediatr Adolesc Med. Artificial Intelligence Resource Center. Select Your Interests Customize your JAMA Network experience by selecting one or more topics from the list below. 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