Impact of Waist Circumference and Body Mass Index on Risk of Cardiometabolic Disorder and Cardiovascular Disease in Chinese Adults: A National Diabetes and Metabolic Disorders Survey

Xuhong Hou,Guangliang Shan,Jiapu Ge,Zhigang Zhao,Zhiguang Zhou,Juming Lu,Jie Liu,Jianping Weng,Dalong Zhu,Weiping Jia,Wenying Yang,Li Chen,Qiang Li,Zhongyan Shan,Linong Ji,Qiuhe Ji,Zhaojun Yang,Huayu Tian ,Lin Li ,Guo X

doi:10.1371/journal.pone.0057319

Abstract

BackgroundWe updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults.Methods and Findings46,024 participants aged ≥20 years, a nationally representative sample surveyed in 2007–2008, were included in this analysis. Taking the cutoffs recommended by the Chinese Joint Committee for Developing Chinese Guidelines (JCDCG) and the Working Group on Obesity in China (WGOC) into account, the participants were divided into four WC and four BMI groups in 0.5-SD increments around the mean, and 16 cross-tabulated combination groups of WC and BMI. 27.1%, 31.4%, and 12.2% of Chinese adults are centrally obese, overweight, or obese according to JCDCG and WGOC criteria. After adjustment for confounders, after a 1-SD increment, WC is associated with a 1.7-fold or 2.2-fold greater risk of having DM or DM plus dyslipidemia than BMI, while BMI was associated with a 2.3-fold or 1.7-fold higher hypertension or hypertension plus dyslipidemia risk than WC. The combination of WC and BMI categories had stronger association with CMD risk, i.e., the adjusted ORs (95% CI) of having DM, hypertension, and dyslipidemia for the combined and separate highest WC and BMI categories were 2.19 (1.96–2.44) vs 1.88 (1.67–2.12) and 1.12 (0.99–1.26); 5.70 (5.24–6.19) vs 1.51 (1.39–1.65) and 1.69 (1.57–1.82); and 3.73 (3.42–4.07) vs 2.16 (1.98–2.35) and 1.33 (1.25–1.40), respectively. The combination of WC and BMI categories was more likely to identify individuals with lower WC and lower BMI at CVD risk, even after the effects of CMD were controlled (all P<0.05).ConclusionCentral obesity, overweight, and obesity are epidemic in Chinese adults. The combination of WC and BMI measures is superior to the separate indices in identifying CMD and CVD risk.

Highlights

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world [1] and is the most prevalent disease affecting the health of the Chinese population [2]
Central obesity, overweight, and obesity are epidemic in Chinese adults
The combination of waist circumference (WC) and body mass index (BMI) measures is superior to the separate indices in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk

Summary

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world [1] and is the most prevalent disease affecting the health of the Chinese population [2]. It is anticipated that cardiometabolic disorder (CMD) and CVD together will become an even more serious public health burden as the prevalence of obesity, the most important cardiometabolic risk factor [3,4,5,6], continues to rise rapidly in China, as it has over the past two decades [7,8]. They are not perfect measures of body fat, body mass index (BMI) and waist circumference (WC) are the most practical indices for identifying obesity in clinical practice and epidemiologic research. We updated the prevalence of obesity and evaluated the clinical utility of separate and combined waist circumference (WC) or body mass index (BMI) category increments in identifying cardiometabolic disorder (CMD) and cardiovascular disease (CVD) risk in Chinese adults

Methods

Results

Discussion

Conclusion