High Waist Circumference Group Research Articles

The Association of Body Mass Index and Waist Circumference with Sepsis-Related Mortality in South Korea.

Obesity is a major public health problem worldwide and is associated with increased morbidity and mortality. However, studies have shown that obesity has sepsis-related mortality benefits. We aimed to determine whether there is an improved sepsis-related survival rate in patients with obesity in South Korea. We included data from 77,810 adults with sepsis between 1 January 2013 and 31 December 2020, extracted from the National Health Insurance Service database in South Korea. The patients underwent standard health examinations within a year before sepsis, and body mass index (BMI) and waist circumference (WC) were used to reflect obesity. Lower 30-day and 1-year mortality rates were observed in the overweight and obesity groups after adjusting for confounders, including WC. However, there was no difference in mortality between the patients with severe obesity and those with normal BMI. Underweight was associated with higher 30-day and 1-year mortality. Higher 30-day and 1-year mortality was found in the high and very high WC groups. In conclusion, patients with abdominal obesity and overweight and obesity and with sepsis showed reduced mortality, whereas underweight patients with sepsis showed increased mortality in South Korea.

Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)

BackgroundThe association of changes in waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted-waist index (WWI) with subsequent risk of multimorbidity remains unclear among older Chinese adults. Therefore, we aimed to assess this association by utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).MethodsOur study was based on the 2011/2012 wave of the CLHLS whose follow-up surveys were conducted in 2014 and 2017/2018. A total of 2900 participants aged 65 and above at baseline were enrolled. WC, WHtR, and WWI were calculated from measured height, weight, and waist circumference. Multimorbidity refers to the coexistence of two or more of 18 chronic diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) to evaluate the effect of three-year changes in WC, WHtR, and WWI on the risk of multimorbidity.ResultsDuring a mean follow-up time of 4.2 (2.0) years, 906 multimorbidity cases were identified. Compared to participants in the persistently low WC group, those in the WC gain group and the persistently high WC group had a higher multimorbidity risk with adjusted HRs (95%CI) of 1.23 (1.01–1.50) and 1.34(1.14–1.58), respectively. Participants in the WHtR gain group and the persistently high WHtR group also had higher risks of multimorbidity with HRs (95%CI) of 1.35 (1.08–1.67) and 1.27 (1.05–1.53), respectively, relative to the persistently low WHtR group. Compared to the persistently low WWI group, those in the WWI loss group had a lower risk of multimorbidity with HRs (95%CI) of 0.80 (0.66–0.98). For every standard deviation increase in WC, WHtR, and WWI over three years, the risk of multimorbidity was higher by 12% (95%CI: 1.05–1.19), 13% (95%CI: 1.06–1.20), and 12% (95%CI: 1.05–1.20), respectively.ConclusionsAssociations of changes in WC, WHtR and WWI with multimorbidity are significant among older Chinese adults. The findings highlight the importance of evaluating changes in WC, WHtR, and WWI in screening and prevention of multimorbidity in older adults.

Relation between waist circumference and the renal hemodynamic in healthy individuals

Background and aimsObesity has been shown to be an independent risk factor for the development of CKD. Little is known about pathways of interaction of visceral fat mass estimated by waist circumference (WC) and metabolic factors with the renal and intraglomerular hemodynamic profile in healthy, non-obese individuals. Methods and resultsThe study population of this post-hoc analysis in 80 healthy individuals, who participated in a randomized, controlled clinical trial (www.clinicaltrials.gov: NCT02783456) was divided into two groups based on median of WC (high WC and low WC group). Renal hemodynamic profiles were analyzed using steady state input clearance (infusion of para-amino-hippuric acid and inulin). Intraglomerular pressure (IGP) and resistances of the afferent (RA) and efferent (RE) arterioles were calculated (Gomez equation). The analysis included healthy, non-smoking individuals, aged 27 ± 9 years with median WC of 84.75 ± 9 cm. Glomerular filtration rate (GFR) (110 ± 15 vs. 127 ± 16 ml/min/m2, p < 0.001), renal plasma flow (RPF) (620 ± 109 vs. 700 ± 104 ml/min, p = 0.001) and IGP (36.7 ± 2.3 vs. 38.5 ± 3.1 mmHg, p = 0.003) were lower in the high WC compared to the low WC group. Patients in the high WC group showed higher renal vascular resistance (RVR) (85 ± 19 vs. 70 ± 12 mmHg/(ml/min), p < 0.001), higher RA (4034 ± 1177 vs. 3069 ± 786 dyn∗s/cm5, p < 0.001) and higher RE (2283 ± 339 vs. 2118 ± 280 dyn∗s/cm5, p = 0.021) compared to the low WC group. Individuals in the high WC group showed higher leptin levels (p = 0.003) and higher HOMA-IR (p = 0.024) compared to the low WC group. ConclusionIncreased WC in healthy young individuals was associated with reduced GFR and RPF likely mediated by increased RVR.

RELATION BETWEEN WAIST CIRCUMFERENCE AND THE RENAL HEMODYNAMIC IN PATIENTS WITH UNCOMPLICATED HYPERTENSION GRADE 1-2

Objective: Abdominal adiposity, measured by waist circumference (WC), is associated with increased mortality in patients with hypertension. Little is known about the impact of abdominal obesity on the renal perfusion and function in patients with hypertension. We analyzed whether abdominal adiposity changes renal hemodynamics in 36 patients with uncomplicated hypertension grade 1-2 without other cardiovascular (CV) disease. Design and method: We analysed the renal hemodynamic using steady state input clearance with infusion of para-aminohippuric acid and inulin, respectively. Intraglomerular pressure and resistances of the afferent (RA) and efferent (RE) arterioles were calculated according to the Gomez equation. The study population was divided in into two groups based on median of WC of the total study population. Results: The study cohort consisted of 36 male, non-smoking individuals, aged 36 ± 10 years with mean WC of 96.1 ± 10.4 cm and mean BMI of 27 ± 3.8 kg/m2. True hypertension was confirmed using 24-hour ambulatory blood pressure (BP) measurement. Patients in the high WC group (19 patients) showed mean office BP of 145/ 90 mmHg and mean 24-hour ambulatory BP of 139/ 86 mmHg, whereas patients in the low WC group (17 patients) showed mean office BP of 144/ 88 mmHg and mean 24-hour-ambulatory BP of 140/ 86 mmHg (office BP: p = 0.895/ p = 0.662, 24-hour-ambulatory BP: p = 0.645/ p = 0.918). Renal vascular resistance and RA were higher in the high WC compared to the low WC group, whereas glomerular filtration rate and renal plasma flow were lower in the high WC compared to the low WC group (table 1). Conclusions: Higher WC in young, male patients with hypertension grade 1-2 without other cardiovascular disease was associated with increased renal vascular resistance predominantly at the afferent site leading to reduced glomerular filtration rate.

Association of high body mass index, waist circumference, and body fat percentage with sarcopenia in older women

BackgroundAge-related obesity and body composition changes include loss of muscle mass and increased body fat. This study aimed to investigate sex differences in the impact of sarcopenia, defined by the Asian Working Group for Sarcopenia (AWGS), on obesity in Korean older adults.MethodsIn this 2-year longitudinal study, 3014 participants were excluded based on AWGS sarcopenia parameters (if any one of the sarcopenic parameter criteria was satisfied), including low handgrip strength (HGS), low appendicular skeletal muscle mass index (ASMI), and low short physical performance battery (SPPB). A total of 926 non-sarcopenic participants were recruited for the study. The obese and non-obese groups were compared according to the sarcopenia parameters. The following variables were selected for obesity analysis: body mass index (BMI), waist circumference (WC), and body fat percentage. Unadjusted and fully adjusted logistic regression analyses were performed for each variable to predict sarcopenia and sarcopenic obesity according to sex.ResultsAmong the sarcopenia parameters, reduction in ASMI was significantly lower in the obese group with high WC and percentage of body fat (PBF) in both men and women (P < 0.01). Multivariable analysis revealed that different obesity parameters were associated with AWGS criteria: women in the high BMI group presented significantly lower ASMI and sarcopenia (ASMI, OR = 0.289, 95% CI = 0.174-0.480; sarcopenia, OR = 0.152, 95% CI = 0.048-0.483). Women in the high WC group had significantly lower ASMI and sarcopenia (ASMI, OR = 0.307, 95% CI = 0.189-0.500; sarcopenia, OR = 0.262, 95% CI = 0.106-0.649). Women in the high PBF group had a lower incidence of sarcopenia (OR = 0.214, 95% CI = 0.068-0.278).ConclusionsOur study identified that high BMI had a protective effect on the reduction of muscle mass in men and women. However, obesity parameters including BMI, WC, and PBF were positively correlated with a lower incidence of sarcopenia only in women. Obesity in older women may have a protective effect in reducing ASMI and the incidence of sarcopenia.

Relationship between waist circumference and cardiorespiratory fitness in Chinese children and adolescents: Results from a cross-sectional survey

BackgroundThis article assessed the relationship between waist circumference (WC) and cardiorespiratory fitness (CRF) of children and adolescents aged 7–18 years. MethodsUsing a stratified cluster random sampling method, 92,574 children and adolescents (47,364 males and 45,210 females) were extracted. CRF was measured by performance in the 20 m shuttle run test (20mSRT) and the subsequent estimation of maximal oxygen consumption (V˙O2max) using the Léger equations. Participants were divided into five groups of WC percentiles and three groups of CRF percentiles by the Lambda Mu Sigma (LMS). The correlation between WC and CRF was examined by one-way ANOVA and curvilinear regression analysis. ResultsWC increased with age, while V˙O2max showed an age-related decline. Controlling for gender, urban, and rural factors, for children and adolescents aged 10–12, 13–15, and 16–18 years, the V˙O2max Z-score of the normal WC group was significantly higher than the very low WC group (P < 0.05). Controlling for gender, urban, and rural factors, for participants aged 7–18 years, the V˙O2max Z-score of the normal WC group was significantly higher than the high WC group and the very high WC group (P < 0.05). ConclusionsIt generally shows a “parabolic” trend between WC-Z and V˙O2max-Z. The CRF among children and adolescents in the normal WC group is significantly higher than that in the low and the high WC groups.

Pre-pregnancy metabolic syndrome and insulin administration in gestational diabetes: A nationwide population-based cohort study

BackgroundThe present study aimed to evaluate whether mothers with obesity/central obesity and metabolic syndrome before gestation are at higher risk of insulin administration in gestational diabetes mellitus (GDM) to diminish the burden of insulin use during pregnancy. MethodsThis was a population-based retrospective cohort study conducted using data from the National Health Information Database of Korea. We identified all deliveries from January 1, 2011 to December 31, 2015 (N = 1,214,655). Among the deliveries, we identified mothers with pre-pregnancy health checkup records and without previous diabetes history (N = 325,208). Hazards of insulin use in GDM were calculated based on pre-pregnancy obesity/central obesity and metabolic syndrome. ResultsHazards of insulin use in GDM increased proportionately with an increase in the pre-pregnancy body mass index (BMI) and waist circumference (WC). After the adjustment for clinical factors, high BMI group (≥30 kg/m2) and high WC group (≥100 cm) were significantly associated with higher hazard ratios (HRs) (HR 4.161, 95% Confidence interval [CI] 3.381–5.121, P < 0.001 and HR 2.563, 95% CI 1.769–3.712, P < 0.001, respectively). The presence of pre-pregnancy metabolic syndrome significantly increased the hazard of insulin use in GDM (0.54% vs. 5.04%). In the presence of obesity (BMI ≥ 25 kg/m2) or central obesity (WC ≥ 85 cm), HRs of insulin use in GDM were 2.637 (95% CI 2.275–3.056) and 1.603 (95% CI 1.023–2.511), respectively, after adjustment for clinical factors. ConclusionsThe presence of pre-pregnancy obesity/central obesity and metabolic syndrome in Korean mothers is associated with increased risk of insulin use in GDM.

Higher risk of dementia in English older individuals who are overweight or obese.

BackgroundSeveral risk factors contribute to dementia, but the role of obesity remains unclear. This study investigated whether increased body weight or central obesity were associated with a higher risk of developing dementia in a representative sample of older English adults.MethodsWe studied 6582 participants from the English Longitudinal Study of Ageing (ELSA) who were aged ≥50 years and were dementia-free at baseline, that being either wave 1 (2002–2003) for study members who started at wave 1, or at either wave 2 (2004–2005) or 4 (2008–2009) for those who began the study as refreshment samples. Body mass index (BMI) was measured at baseline and categorized into normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Central obesity was defined as a waist circumference (WC) >88 cm for women and >102 cm for men. Cumulative incidence of dementia was ascertained based on physician-diagnosed dementia, an overall score >3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Hospital Episodes Statistics (HES) data at every ELSA wave from baseline until wave 8 (2016–2017). Cox proportional hazards models were used to assess the association between baseline BMI levels or abdominal obesity in relation to dementia incidence during the mean follow-up period of 11 years.ResultsFrom the overall sample, 6.9% (n = 453) of participants developed dementia during the follow-up period of maximum 15 years (2002–2017). Compared with participants with normal weight, those who were obese at baseline had an elevated risk of dementia incidence [hazard ratio (HR) = 1.34, 95% confidence interval (CI) 1.07–1.61] independent of sex, baseline age, apolipoprotein E-ε4 (APOE-ε4), education, physical activity, smoking and marital status. The relationship was slightly accentuated after additionally controlling for hypertension and diabetes (HR = 1.31, 95% CI 1.03–1.59). Women with central obesity had a 39% greater risk of dementia compared with non-central obese women (HR = 1.39, 95% CI 1.12–1.66). When compared with a normal BMI and WC group, the obese and high WC group had 28% (HR = 1.28, 95% CI 1.03–1.53) higher risk of dementia.ConclusionsOur results suggest that having an increased body weight or abdominal obesity are associated with increased dementia incidence. These findings have significant implications for dementia prevention and overall public health.

Predictive Factors of Early Weight Loss after Laparoscopic Sleeve Gastrectomy

Objective To explore the clinical factors that can be used to predict the early weight loss after laparoscopic sleeve gastrectomy(LSG).Methods The clinical data of 64 obese patients undergoing LSG in Peking Union Medical College Hospital from August 2015 to January 2018 were retrospectively analyzed.We analyzed the relationship between different clinical factors and early weight loss,determined the independent predictors based on Logistic models,and estimated their test power by using the receiver operating characteristic(ROC)curves.Results Correlation analysis indicated that preoperative body mass index(P=0.000,P=0.000,P=0.000),waist circumference(WC)(P=0.000,P=0.000,P=0.000),whole body fat volume(P=0.000,P=0.006,P=0.003),homeostatic model assessment for insulin resistance(HOMA-IR)(P=0.000,P=0.000,P=0.002),and hypersensitive C-reactive protein(hsCRP)(P=0.004,P=0.002,P=0.025)were negatively correlated with excess weight loss percentage(EWL %) after 3,6 and 12 months.Also,hsCRP after 6 months showed negative correlation with EWL % after 1 year(P=0.029).Binary Logistic regression analysis showed that WC was an independent predictor of early weight loss(P=0.018).ROC analysis showed that when the optimal cutoff value is 142.5 cm for WC,Youden index was highest,with a sensitivity of 80% and a specificity of 87%.Patients were further divided into low WC group and high WC group based on this optimal cutoff value.The low WC group had significantly higher EWL% than the high WC group 3 months(t=6.677,P=0.000),6 months(t=6.157,P=0.000),and 1 year(t=4.006,P=0.000)after surgery.The low WC group also had significantly lower hsCRP than high WC group 6 months after surgery(z=-3.510,P=0.000).HOMA-IR showed no significant difference between these two groups(z=-0.821,P=0.412).Conclusions WC is an independent predictor of weight loss early after LSG.The patients with low WC have better weight loss effectiveness.

Contribution of birth weight and adult waist circumference to cardiovascular disease risk in a longitudinal study

To determine the association of birth weight (BW) and waist circumference (WC) on cardiovascular disease (CVD). The longitudinal cohort study consisted of 745 participants who were able to provide their birth weight information and were followed from 2002 to 2014. During the follow-up, 83 events of CVD were confirmed. After adjusting for confounding factors, subjects with birth weight <2500 g were at a significantly increased CVD risk when compared to subjects with birth weight between 2500–3999 g (OR 2·47, 95%CI, 1·07–5·71). When high waist circumference (HWC), a measurement of adult obesity, was incorporated into stratifying factors according to presence or absence of low birth weight (LBW, birth weight <2500 g), adjusted CVD risk was significantly elevated in -LBW/+ HWC group (OR 1·94, 95%CI, 1·10–3·43) and marginally significantly increased in +LBW/-HWC group (OR 2·94, 95%CI, 1·00–8·64). CVD risk was highest in subjects with LBW and HWC (+LBW/+HWC), OR 4·74 (95%CI, 1·48–15·21). Higher waist circumference in adulthood is an especially strong risk factor for cardiovascular disease among those small at birth. In this cohort, birth size and adiposity in adulthood interact to predict events of cardiovascular disease.

Compensatory Structural and Functional Adaptation After Nephrectomy in Obese Patients According to Waist Circumference

To investigate whether the postnephrectomy renal adaptation mechanism, focused on functional hyperfiltration as well as structural hypertrophy, was affected by abdominal obesity. We retrospectively evaluated 358 patients who underwent simple or radical nephrectomy and nephroureterectomy between 2009 and 2013. Patients were classified according to waist circumference (WC), with values >102 cm in men and >88 cm in women considered high (obesity). Functional renal volume (FRV) was measured using computed tomography performed preoperatively and 6 months postoperatively to evaluate the degree of remnant kidney hypertrophy. The degree of hyperfiltration was calculated from the difference between the preoperative and postoperative glomerular filtration rate (GFR)/FRV. The mean preoperative GFR, FRV, and GFR/FRV were 72.1 mL/min/1.73 m2, 282.8 cm3, and 0.25 mL/min/1.73 m2/cm3, respectively. The percent GFR reduction was significantly greater in the high WC group (high, 25.9% vs normal, 16.0%, P = .036), although the degree of hypertrophic volume in the remnant kidney showed no difference. The change in GFR/FRV was statistically lower in the high WC group (high, 25.7% vs normal, 40.2%, P = .009). The factors associated with postoperative increased GFR/FRV were low preoperative GFR, proteinuria, high predictive preserved functional parenchymal volume ratio, absence of hypertension, increased levels of high-density lipoprotein cholesterol, and normal WC (all P < .05). Patients with high WC might have a large reduction in postoperative renal function, owing to a lower degree of functional hyperfiltration.

Waist Circumference, Physical Activity, and Functional Impairments in Older U.S. Adults: Results from the NHANES 2005-2010.

Physical activity (PA) improves function in older obese adults. However, body mass index is an unreliable adiposity indicator better reflected by waist circumference (WC). The impact of PA on physical impairment and mobility with high WC is unclear. We performed a secondary data analysis of 4,976 adults ≥ 60 years of age using the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Physical limitations (PL), activities of daily living (ADL) impairments, and PA (low = < 1 day/week or high = > 1 day/week) were self-reported. WC was dichotomized (females: 88 cm; males: 102 cm). Mean age was 70.1 years and 55.1% were female. Prevalence of PL and ADL impairment in the high WC group were 57.7% and 18.8%, respectively, and high PA was present in 53.9%. Among those with high WC, high PA vs. low PA participants were at lower risk of PL (OR 0.58 [0.48-0.70]) and ADL impairment (OR 0.46 [0.32-0.65]). Those with high WC had higher odds of PL irrespective of PA (high PA: OR 1.57 [1.30-1.88]; low PA: OR 1.52 [1.29-1.79]) and ADL impairment (high PA: OR 1.27 [1.02-1.57] and low PA: OR 1.24 [0.99-1.54]). High PA in viscerally obese individuals is associated with impairments.

The emergence of cardiometabolic disease risk in Chinese children and adults: consequences of changes in diet, physical activity and obesity.

Strong secular declines in physical activity, increased fat and salt intake, and increased obesity, especially abdominal obesity, mark China's recent nutrition transition. The China Health and Nutrition 2009 Survey collected anthropometry, blood pressure and fasting blood samples from more than 9,000 individuals ≥ 7 years of age. We focus on elevated blood pressure and plasma markers of diabetes, inflammation and dyslipidemia. We used international definitions of cardiometabolic risk and estimated age- and sex-specific prevalence ratios for each outcome for high waist circumference or overweight. We used logistic regression to assess each risk factor's association with diet, physical activity, overweight and abdominal obesity. Cardiometabolic risk prevalence was high in all age groups Prevalence ratios for most risk factors were nearly doubled for overweight or high waist circumference groups. Prevalence ratios were higher in younger than older adults. Low physical activity consistently predicted higher cardiometabolic risk across most outcomes and age-sex groups. The co-occurrence of overweight and high waist circumference was highly predictive of dyslipidemia, elevated glycated haemoglobin and diabetes. High prevalence of cardiometabolic risk factors and their strong association with weight status and abdominal obesity in young adults portend increases in cardiometabolic morbidity and mortality. Early interventions will be required to reverse trends.

Association of waist circumference with perception of own health in urban African males and females: the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study

Background: Current waist circumference (WC) cut-points of the Joint Statement Consensus (JSC) (male ≥ 94 cm, female ≥ 80 cm) were compared with a recently proposed WC cut-point (RPWC) (male ≥ 90 cm, female ≥ 98 cm). In this study, we aimed to compare the two cut-points to assess the association between central obesity and perception of own health. Method: We determined blood pressure and fasting bloods [glucose, high-density lipoprotein (HDL) and triglycerides] as metabolic syndrome markers for 171 urban teachers. Perception of own health was determined via the General Health Questionnaire-28 (GHQ-28) to indicate probable psychological distress or a psychiatric disorder or caseness (≥ 4). Results: The RPWC was an improved discrimination between the WC groups on perception of own health as reflected in the GHQ-28 subscales. In the male group, higher scores were found in the RPWC high WC group (≥ 90 cm) with regard to somatic symptoms, social dysfunction and GHQ-28 caseness, compared to those of the low WC groups (< 90 cm). Compared to the RPWC high WC females (≥ 98 cm), the low WC (< 98 cm) reflected significantly higher anxiety and sleeplessness subscale scores. Conclusion: Our results suggest that the RPWC (men 90 cm, women 98 cm), (determined in this African cohort when adding GHQ-28 caseness as a discriminatory variable between WC cut-point), distinguished better between WC groups based on their perception of own health than the JSC cut-point.

Sixteen‐year longitudinal trends in waist circumference and their impact on blood pressure in China Cohort

To evaluate the association among waist circumference (WC), changes in waist circumference (ΔWC) and changes in blood pressure, we used prospective data from the China Health and Nutrition Survey of 3077 subjects aged 18–45 years old, whose blood pressure was normal at baseline and who did not take anti‐hypertension drugs and was reexamined at least one more time in follow‐up years. Controlled for age, BMI, blood pressure at baseline and changes in BMI, we used multivariate analysis of variance for longitudinal, repeated‐measures and random effects linear model to analyze changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) among WC and ΔWC groups. SBP increased 8.9 mmHg in low WC group compared with 14.9 mmHg in high WC group (P&lt;0.001) in men and 11.3 mmHg and 20.6 mmHg, respectively (P&lt;0.001) in women. For DBP, the same results showed an increase of 5.9 mmHg in low WC group vs. 9.9 mmHg in high WC group (P&lt;0.001) in men and 5.8 mmHg vs. 11.1mmHg in women, respectively. SBP and DBP increased higher in both high and low ΔWC gain groups than in WC stable or decrease groups. Association between WC or ΔWC and blood pressure was statistically significant. Independent of BMI, among Chinese adults central distributed body fat at baseline and an increase in central body fat can independently increase SBP and DBP in both men and women.Supported by NIH (R01‐HD30880) and Fogarty International Center, NIH (5D43TW007709).

The Joint Effects of Cardiorespiratory Fitness and Waist Circumference on All-Cause Mortality in Women

When examined separately, cardiorespiratory fitness (CRF) and waist circumference (WC) are independently associated with all-cause mortality. However, the joint effect of CRF and WC on mortality in women is unclear. PURPOSE: To examine the relation between CRF and WC, together in the same model, and all-cause mortality in a large cohort of women. METHODS: Participants were 8383 women (age = 44±10 years; WC = 74±11 cm) who completed a preventive medical examination between 1979 and 2002. CRF was quantified as duration of a symptom-limited maximal treadmill test. CRF categories were based on age- and sex-specific distributions of exercise duration defined as low (lowest 20%), moderate (middle 40%) and high (highest 40%) fitness. WC was measured at the umbilicus and tertiles of the WC distribution were as follows: low (< 67 cm), moderate (67-74.5 cm) and high (>74.5 cm). We conducted mortality follow up through 2004 primarily using the National Death Index. RESULTS: After an average follow-up period of 11.5 years, mortality was confirmed in 2.2% (n=186) of women. Age-adjusted mortality rates per 10,000 person-years of follow up across low, moderate and high CRF categories were 42.9, 17.6 and 13.7 for women in the high WC group, 27.9, 15.0 and 22.7 for the moderate WC group and 24.9, 24.0 and 6.9 for the low WC group. Results from a proportional hazards regression model that included age, health and smoking status, showed CRF was inversely related to the risk of all-cause mortality regardless of WC. In this model, women in the moderate and high CRF groups had a 40-50% lower mortality risk compared to low fit women. Hazard ratios (95% CI) for mortality were 0.56 (0.39-0.80) and 0.46 (0.31-0.68) among moderately and highly fit women, respectively. Based on this analysis, there was no statistically significant relation between WC and mortality. CONCLUSIONS: Reduced risk for all-cause mortality in women is associated with moderate and high level CRF independent of WC.

Does Waist Circumference Predict Diabetes and Cardiovascular Disease Beyond Commonly Evaluated Cardiometabolic Risk Factors?

While the measurement of waist circumference (WC) is recommended in current clinical guidelines, its clinical utility was questioned in a recent consensus statement. In response, we sought to determine whether WC predicts diabetes and cardiovascular disease (CVD) beyond that explained by BMI and commonly obtained cardiometabolic risk factors including blood pressure, lipoproteins, and glucose. Subjects consisted of 5,882 adults from the 1999-2004 National Health and Nutrition Examination Survey, which is nationally representative and cross-sectional. Subjects were grouped into sex-specific WC and BMI tertiles. Blood pressure, triglycerides, LDL and HDL cholesterol, and glucose were categorized using standard clinical thresholds. Logistic regression analyses were used to calculate the odds for diabetes and CVD according to WC tertiles. After controlling for basic confounders, the medium and high WC tertiles were more likely to have diabetes and CVD compared with the low WC tertile (P < 0.05). After inclusion of BMI and cardiometabolic risk factors in the regression models, the magnitude of the odds ratios were attenuated (i.e., for diabetes the magnitude decreased from 6.54 to 5.03 for the high WC group) but remained significant in the medium and high WC tertiles for the prediction of diabetes, though not for CVD. WC predicted diabetes, but not CVD, beyond that explained by traditional cardiometabolic risk factors and BMI. The findings lend critical support for the recommendation that WC be a routine measure for identification of the high-risk, abdominally obese patient.