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

BMJ 1995; 311 doi: (Published 25 November 1995) Cite this as: BMJ 1995;311:1401
  1. T S Han, PhD studenta,
  2. E M van Leer, epidemiologistb,
  3. J C Seidell, head of departmentb,
  4. M E J Lean, Rank professor of human nutritiona
  1. aDepartment of Human Nutrition, University of Glasgow, Royal Infirmary, Queen Elizabeth Building, Glasgow G31 2ER
  2. bDepartment of Chronic Diseases and Environmental Epidemiology, National Institute of Public Health and Environmental Protection, Bilthoven, Netherlands
  1. aCorrespondence to: Professor Lean.
  • Accepted 5 October 1995


Objective: To determine the frequency of cardiovascular risk factors in people categorised by previously defined “action g126 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.


  • Funding Department of Human Nutrition discretionary funds, University of Glasgow (TSH); Netherlands Ministry of Health, Welfare, and Sport (EMVL and JCS); Rank Foundation and Rank prize funds (MEJL).

  • Conflict of interest None.

  • Accepted 5 October 1995
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