Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease

Abstract

Background Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. Objective To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. Methods We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk ≥20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. Results WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m2). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. Conclusion WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

Measurement error and ethnic comparisons of measures of abdominal obesity

“…A recent report of a large cross-sectional study of Latin Americans, nonHispanics whites and blacks, and Hispanics claims WHR to be the most accurate of anthropometric indices in screening for high risk of CHD, with uniform cut points for women but ethnic specific WC and WHR cut points for men. However, there were different techniques employed for waist circumference measurement in the various populations, which could influence the analyses (Herrera et al, 2009). Similarly in the prospective multicentre study of total mortality in Europe, both general adiposity (BMI) and abdominal obesity were associated with the risk of death due to all causes with no clear preference for WHR.…”

Correlation of anthropometric indices with lipid profile in adult females

“…It was also seen that BMI was almost uninformative and WC was less reliable. [15] In a study done by Farrag et al, it was demonstrated that WHR had the best association with coronary artery disease severity. [16] Several factors may account for the discrepancy in findings.…”

Tratamento pós-menopausa reduz a atividade da catalase e atenua o risco cardiovascular

“…In contrast, it has been reported that while HT may prevent the development of atherosclerotic plaques in postmenopausal women 9 , there is no difference in the carotid IMT between women who had and had not used HT 11 . Lipid and lipoprotein metabolism is markedly altered after menopause [12][13][14] with a natural reduction in estrogen levels.…”