Abstract
The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.
Highlights
It is very well documented that the prevalence of overweight and obesity in England and other high-income countries is increasing at all ages: almost two-thirds of adults and a third of children are so classified [1]
There was evidence that sex modified the relation of National Institute for Health and Clinical Excellence (NICE) categories with body mass index (BMI) and waist circumference (WC) (p,0.05) with the biomarkers; as such, we present gender-specific results
There was a graded linear relationship between risk categories of NICE and cardiovascular disease (CVD) risk factors such that the beta coefficients or the odds ratios of CVD risk factors increased in a step-wise manner with the increase in the risk category
Summary
It is very well documented that the prevalence of overweight and obesity in England and other high-income countries is increasing at all ages: almost two-thirds of adults and a third of children are so classified [1]. The National Institute for Health and Clinical Excellence (NICE), a UK agency established in 1999 to assist health care professionals in providing the best care based on current scientific evidence, has endorsed using combined measures of general and central adiposity in estimating the ‘health’ risks associated with overweight and obesity [26]. We examined the predictive utility of these guidelines by relating them to both CVD risk factors and a CVD risk score (the Framingham index) using data from the Health Survey of England, a large, representative sample of that country’s population
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