A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

Abstract

Study design: Literature review. Background: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m 2 )) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. Objective: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. Setting: Ontario, Canada. Methods: Literature review. Results: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. Conclusions: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia. Body mass index (BMI) as a marker of obesity in chronic SCIObesity is defined as an excess accumulation of fat mass. Able-bodied men and women p40 years are considered obese when fat mass exceeds 22-25 and 35% of body weight, respectively. 1,2 As individuals age, fat mass accrues at the expense of fat-free mass, so that at older ages percentage fat mass is higher, even in individuals who do not gain weight. 3 Thus, obesity in 41-60-yearold able-bodied men and women can be defined as a fat mass 425 and 438% of body weight, respectively. 2 Mean percent fat mass (measured by dual energy X-ray absorptiometry (DXA), isotope dilution or the threecompartment model) reported in cross-sectional studies of persons (mostly men) with chronic spinal cord injury (SCI) ranges from 23 to 35%. [4][5][6][7][8][9][10][11] The percentage of body weight as fat mass is 8-18% higher in SCI versus age-, height-and/or weight-matched able-bodied control subjects. These values are often consistent with the above definitions of obesity, and are summarized in Table 1. Accurate classification of an individual as normal weight, overweight or obese requires measurement of body composition. However, measuring fat mass can be difficult and expensive, and no accurate method is easily available for routine clinical use. Therefore, the body mass index (BMI) is widely used. Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal we...

Secondary complications and subjective well-being in individuals with chronic spinal cord injury: associations with self-reported adiposity

“…2 It is for this reason in part that the other non-significant relationships between BMI and secondary complications were expected. Therefore, these findings may have implications for the use of BMI in clinical settings.…”

“…1 Given the limitations of obesity-related measurement for persons with SCI, this statistic likely underestimates the true prevalence of overweight and obesity in the SCI population. 2 In both the able-bodied and the SCI populations, excess body fat has been associated with an elevated risk of many chronic diseases, including, but not limited to, cardiovascular disease and diabetes. 3 In addition to chronic diseases, individuals with SCI report myriad injury-related comorbidities and complications, including bladder problems, pressure sores, pain, spasticity and fatigue.…”

“…14,15 Furthermore, BMI seems to be an inadequate measure of adiposity in the SCI population. 2 Given these limitations, we also included a selfreport measure of overweight, whereby participants indicated whether they considered themselves to be overweight. These two measures were used to examine the relationships between adiposity, secondary complications and SWB.…”

Frequency of metabolic syndrome and the food intake patterns in adults living in a rural area of Brazil

“…16 According to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III), MetS is diagnosed when at least three of the following criteria exist: central obesity, assessed by waist circumference > 102cm in men and > 88cm in women; systolic blood pressure/diastolic blood pressure ≥ 130/85mmHg; fasting glucose ≥ 110mg/dL; serum triglycerides ≥ 150mg/dL; and HDL cholesterol<40mg/dL for men and <50mg/dL for women 11 .…”

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

“…Just as with other indicators of body composition, such as skinfolds and abdominal circumference, it is difficult to interpret the BMI after SCI. 43 In an early phase of recovery, a low BMI may be attributed to a catabolic state after injury, concurrent pathology, or complications. Therefore, a low BMI may be negatively associated with physical capacity.…”