Waist circumference as a predictor of cardiovascular risk in Canadian adults

by Dobbelsteyn, Cindy

Buckground. Individuals with excess accumulation of fat in the abdominal region are at increased risk of developing cardiovascular disease (CVD) or conditions associated with CVD such as high blood pressure. abnomal cholesterol levels. and NIDDM. While for many years the waist hip ratio (WHR) was accepted as the optimal mesure of abdominal obesity. recent evidence suggests that waist circumference (WC) alone may be a better indicator of abdominal visceral adipose tissue and CVD risk. ïhere is limited research with respect to the use of WC as a screening tool for CVD risk in the Canadian population. In addition. little information is available regarding CVD risk factors. weight dissatisfaction or weight loss attempts associated with having a high WC in the absence of being overweight. Objectives. The purpose of this study was to comparatively evaluate cut-off points of WC. BMI and WHR with respect to their ability to predict other individual and multiple CVD risk factors. A hirther purpose was to investigate cardiovascular risk factors and weight-related attitudes and behaviors in individuals who have a high WC in the absence of being considered overweight. Methods. Data was obtained from the Canadian Heart Health Surveys ( 1986- 1992). ROC curves and analysis of sensitivity, specificity and positive and negative predictive values were used to comparatively evaluate cut-off points of WC. BMI and WHR. Cross tabulation of individuals based on their BMI and WC was completed to examine differences in ~veight-related attitudes and behaviors and CVD nsk factors. Reszrlts. Results indicate that WC is the best single indicator of other individual and multiple cardiovascular risk factors. Optimal cut-off points for al1 anthropometric measures are dependent on age. sex and the prevalence of the risk factor(s) being considered. For WC. cut-off points of 2 90 cm in men and 1 80 cm in women may be most applicable for prediction of individual and multiple nsk factors. Individuals with a high waist circumference in the absence of overweight have a high prevalence of individual and multiple cardiovascular risk factors. and a relatively low prevalence of weight dissatisfaction. They also have a lower prevalence of current or previous attempts at weight Ioss than individuals who are classified as ovenveight. C'onc/zrsions. Canadian standards for measurement of overweight need to be updated. Waist circumference measurernents should be incorporated into routine clinical esamination of Canadian adults. Health professionals and the public need to be fùrther educated regarding the potential cardiovascular health risks associated with abdominal adiposity even in the absence of general adiposity, and the need for increased efforts in prevention. detection. and management.