Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

BMJ 1995;311:1401-1405 (25 November)

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Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample

T S Han, PhD student,^a E M van Leer, epidemiologist,^b J C Seidell, head of department,^b M E J Lean, Rank professor of human nutrition ^a

^a Department of Human Nutrition, University of Glasgow, Royal Infirmary, Queen Elizabeth Building, Glasgow G31 2ER, ^b Department of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, Netherlands

Correspondence to: Professor Lean.

Abstract

Objective: To determine the frequency of cardiovascular riskfactors in people categorised by previously defined "actionlevels" of waist circumference.
Design: Prevalence study in a random population sample.
Setting: Netherlands.
Subjects: 2183 men and 2698 women aged 20-59 years selectedat random from the civil registry of Amsterdam and Maastricht.
Main outcome measures: Waist circumference, waist to hip ratio,body mass index (weight (kg)/height (m²)), total plasma cholesterolconcentration, high density lipoprotein cholesterol concentration,blood pressure, age, and lifestyle.
Results: A waist circumference exceeding 94 cm in men and 80cm in women correctly identified subjects with body mass indexof >/=25 and waist to hip ratios >/=0.95 in men and >/=0.80in women with a sensitivity and specificity of >/=96%. Menand women with at least one cardiovascular risk factor (totalcholesterol >/=6.5 mmol/l, high density lipoprotein cholesterol</=0.9 mmol/l, systolic blood pressure >/=160 mm Hg, diastolicblood pressure >/=95 mm Hg) were identified with sensitivitiesof 57% and 67% and specificities of 72% and 62% respectively.Compared with those with waist measurements below action levels,age and lifestyle adjusted odds ratios for having at least onerisk factor were 2.2 (95% confidence interval 1.8 to 2.8) inmen with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1)in women with a waist measurement of 80-88 cm. In men and womenwith larger waist measurements these age and lifestyle adjustedodds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively.
Conclusions: Larger waist circumference identifies people atincreased cardiovascular risks.

Key messages

Key messages
Both overweight and central fat distribution relate to preventable ill health
Compared with people with waist circumferences below "action level" 1 (94 cm in men, 80 cm in women) those with waist circumferences between action levels 1 and 2 (94-101 cm in men, 80-87 cm in women) are one and a half times to twice as likely to have one or more major cardiovascular risk factors; people with waist circumferences above action level 2 are two and a half to four and a half times as likely to have one or more major cardiovascular risk factors
A waist circumference above action level 1 should be a signal to avoid weight gain or lose weight, to maintain increased physical activity, and to give up smoking in order to reduce the risk of cardiovascular disease
Patients with a waist circumference above action level 2 should seek advice from health professionals for weight management

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