Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study

Abstract

OBJECTIVE: Fat distribution as measured by waist-to-hip ratio has been shown to be an important independent predictor of glucose intolerance. Few studies, however, have considered the contributions of the waist and hip circumferences independently. The aim of this study was to investigate the independent associations of waist and hip circumference with diabetes in a large population-based study, and to investigate whether they also apply to other major components of the metabolic syndrome (hypertension and dyslipidemia). In addition, as previous studies were performed in older persons, we investigated whether these associations were present across adult age groups. METHODS: Weight, height, waist and hip circumferences were measured in 11 247 participants of the nationally representative Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. HDL-cholesterol, triglycerides, fasting and 2-h postload glucose were determined, and diastolic and systolic blood pressure was measured. After exclusion of persons already known to have diabetes, hypertension or dyslipidemia, logistic and linear regression were used to study cross-sectional associations of anthropometric variables with newly diagnosed diabetes, hypertension and dyslipidemia, and with continuous metabolic measures, all separately for men (n ¼ 3818) and women (n ¼ 4582). Analyses were repeated in the same population stratified for age. RESULTS: After adjustment for age, body mass index and waist, a larger hip circumference was associated with a lower prevalence of undiagnosed diabetes (odds ratio (OR) per one s.d. increase in hip circumference 0.55 (95% CI 0.41-0.73) in men and 0.42 (0.27-0.65) in women) and undiagnosed dyslipidemia (OR 0.58 (0.50-0.67) in men and 0.37 (0.30-0.45) in women). Associations with undiagnosed hypertension were weaker (OR 0.80 (0.69-0.93) in men and 0.88 (0.70-1.11) in women). As expected, larger waist circumference was associated with higher prevalence of these conditions. Similar associations were found using continuous metabolic variables as outcomes in linear regression analyses. Height partly explained the negative associations with hip circumference. When these analyses were performed stratified for age, associations became weaker or disappeared in the oldest age groups (age Z75 y in particular), except for HDL-cholesterol. CONCLUSION: We found independent and opposite associations of waist and hip circumference with diabetes, dyslipidemia and less strongly with hypertension in a large population-based survey. These results emphasize that waist and hip circumference are important predictors for the metabolic syndrome and should both be considered in epidemiological studies. The associations were consistent in all age groups, except in age Z75 y. Further research should be aimed at verifying hypotheses explaining the 'protective' effect of larger hips.

Anthropometric measures and glucose levels in a large multi-ethnic cohort of individuals at risk of developing type 2 diabetes

“…Waist and hip circumference have opposite relationships with cardiometabolic risk. However, due to their high correlation (r=0.76 in Epi-DREAM), these only become apparent after mutual adjustment [20][21][22][23][24]. Increased waist circumference is likely to be associated with cardiometabolic risk by the presence of visceral fat and is balanced by hip circumference, which is associated with leg muscularity, hip subcutaneous fat and oestrogen [23].…”

Association of waist and hip circumference with 12-year progression of carotid intima-media thickness in elderly women

“…Our results agree with those from a previous cross-sectional study in which the prevalence of atherosclerotic disease was highest among individuals with a large waist circumference and a small hip circumference. 22 There is limited evidence for the association of different measures of body adiposity with preclinical atherosclerosis, especially in the elderly. In a 4-year follow-up study in middle-aged men, WHR and waist circumference were associated with accelerated increase in carotid IMT independent of BMI, whereas BMI had no independent association with the increase in carotid IMT.…”

Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors

“…Second, height partly explained the inverse associations of hip circumference with diabetes, dyslipidemia or hypertension. 55 Third, at a given WC, mortality rate ratio was shown to decrease with increasing BMI. 19,20 This decrease was most pronounced at a lower WC and was weaker at higher WC.…”