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 risk factors in people categorised by previously defined "action levels" of waist circumference.
Design: Prevalence study in a random population sample.
Setting: Netherlands.
Subjects: 2183 men and 2698 women aged 20-59 years selected at 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 cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle.
Results: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of >/=25 and waist to hip ratios >/=0.95 in men and >/=0.80 in women with a sensitivity and specificity of >/=96%. Men and women with at least one cardiovascular risk factor (total cholesterol >/=6.5 mmol/l, high density lipoprotein cholesterol </=0.9 mmol/l, systolic blood pressure >/=160 mm Hg, diastolic blood pressure >/=95 mm Hg) were identified with sensitivities of 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 one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men 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 women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively.
Conclusions: Larger waist circumference identifies people at increased 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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