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Waist Circumference and Cardiometabolic Risk

A Consensus Statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, The Obesity Society; the American Society for Nutrition; and the American Diabetes Association

¹ Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri
² Clinical Nutrition Research Unit, University of Alabama at Birmingham, Birmingham, Alabama
³ Clinical Research Department, Metabolism, Merck Pharmaceutical Company, Rahway, New Jersey
⁴ Obesity and Nutrition Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania
⁵ Naomi Berrie Diabetes Center, Columbia University, New York, New York
⁶ Obesity and Diabetes Programs, North General Hospital, New York, New York
⁷ American Diabetes Association, Alexandria, Virginia

Address correspondence and reprint requests to Samuel Klein, MD, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8031, St. Louis, MO 63110. E-mail: sklein@wustl.edu

Abbreviations: CHD, coronary heart disease • CT, computed tomography • IAAT, intra-abdominal adipose tissue • MRI, magnetic resonance imaging • NHANES III, National Health and Nutrition Examination Survey III • SAAT, subcutaneous abdominal adipose tissue • WC, waist circumference • WHO, World Health Organization

The first 300 words of the full text of this article appear below.

	INTRODUCTION

 
Obesity is an important risk factor for cardiometabolic diseases, including diabetes, hypertension, dyslipidemia, and coronary heart disease (CHD). Several leading national and international institutions, including the World Health Organization (WHO) and the National Institutes of Health, have provided guidelines for classifying weight status based on BMI (1,2). Data from epidemiological studies demonstrate a direct correlation between BMI and the risk of medical complications and mortality rate (e.g., 3,4). Men and women who have a BMI 30 kg/m² are considered obese and are generally at higher risk for adverse health events than are those who are considered overweight (BMI between 25.0 and 29.9 kg/m²) or lean (BMI between 18.5 and 24.9 kg/m²). Therefore, BMI has become the "gold standard" for identifying patients at increased risk for adiposity-related adverse health outcomes.

Body fat distribution is also an important risk factor for obesity-related diseases. Excess abdominal fat (also known as central or upper-body fat) is associated with an increased risk of cardiometabolic disease. However, precise measurement of abdominal fat content requires the use of expensive radiological imaging techniques. Therefore, waist circumference (WC) is often used as a surrogate marker of abdominal fat mass, because WC correlates with abdominal fat mass (subcutaneous and intra-abdominal) (5) and is associated with cardiometabolic disease risk (6). Men and women who have waist circumferences greater than 40 inches (102 cm) and 35 inches (88 cm), respectively, are considered to be at increased risk for cardiometabolic disease (7). These cut points were derived from a regression curve that identified the waist circumference values associated with a BMI 30 kg/m² in primarily Caucasian men and women living in north Glasgow (8).

An expert panel, organized by the National Heart, Lung and Blood Institute, . . . [Full Text of this Article]

	QUESTION 1: What does waist circumference measure?

 
Measurement technique.
Anatomical relationships.

	QUESTION 2: What are the biological mechanisms responsible for the association between waist circumference and metabolic and cardiometabolic risk?

 

	QUESTION 3: What is the power of waist circumference to predict adverse cardiometabolic outcomes? How does the predictive power of waist circumference compare with that of BMI? Does waist circumference measurement in addition to BMI improve predictability?

 

	QUESTION 4: Should waist circumference be measured in clinical practice?

 

	CONCLUSIONS

 

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