Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) Study

Hill, James O.; Sidney, Steve; Lewis, Cora E.; Tolan, Kim; Scherzinger, Ann; Stamm, Elizabeth R.

doi:10.1093/ajcn/69.3.381

Cited by 227 publications

(214 citation statements)

References 28 publications

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“…BMI as a measure of obesity cannot distinguish between fat and lean tissue, preventing a potential mechanistic explanation of race-related differences. Similarly, waist circumference may reflect varying levels of abdominal visceral fat, particularly among older populations (30,31). Next, whether age-, race-, or sex-specific thresholds for the individual criteria of the metabolic syndrome are more appropriate for defining the metabolic syndrome than the criteria used herein remains unclear and should be the focus of future studies.…”

Section: Discussionmentioning

confidence: 98%

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

Hanks

Tanner²,

Muntner³

et al. 2013

Clinical Journal of the American Society of Nephrology

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on behalf of the REGARDS Investigators Summary Background and objectives Higher body mass index (BMI) is paradoxically associated with lower mortality in persons with CKD, but whether cardiometabolic abnormalities modulate this association is unclear.Design, setting, participants, & measurements Participants with CKD from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=4374) were analyzed. The harmonized criteria for metabolic syndrome were used to define metabolic health, and participants were categorized into one of six mutually exclusive categories defined by combined measures of metabolic health (metabolically healthy, ,3 criteria for metabolic syndrome; metabolically unhealthy, $3 criteria) and weight status (normal weight, BMI 18.5-24.9 kg/m 2 ; overweight, BMI 25-29.9 kg/m 2 ; obese, BMI $30 kg/m 2 ). Cox models were used to estimate the hazard ratio (HR) of death as a function of each category.Results A total of 683 deaths were observed over a mean 4.5 years of follow-up. In analyses adjusted for age, race, sex, and geographic region of residence, compared with metabolically healthy normal weight persons, the HRs of mortality in metabolically healthy overweight and obese persons were 0.68 (95% confidence interval [95% CI], 0.53 to 0.87) and 0.71 (95% CI, 0.51 to 0.98), respectively, whereas there were no statistically significant differences in survival among metabolically unhealthy overweight or obese individuals. After further adjustment for lifestyle, clinical and laboratory factors including markers of kidney function, the HR of mortality remained lower in metabolically healthy overweight individuals compared with metabolically healthy normal weight individuals (HR, 0.74; 95% CI, 0.57 to 0.96).Conclusions Metabolic abnormalities may attenuate the magnitude and strength of survival benefits associated with higher BMI in individuals with CKD.

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Section: Discussionmentioning

confidence: 98%

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

Hanks

Tanner²,

Muntner³

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Studies included in the meta-analysis used different methods as the gold standard to assess for BF composition. Owing to their comparable accuracy, studies that used dual energy Xray absorptiometry, hydrostatic weighing, air-displacement plethysmography, and isotope dilution measurement of total body water were grouped together and the pooled estimates were reported and compared with those studies that used lower accuracy measures as their gold standard (bioelectrical impedance and skin fold).Owing to the reported ethnic and geographic differences on body composition, [14][15][16] studies were grouped based on their regional origin into either from North America, South-East Asia, or Europe. Finally, studies were grouped into two subgroups based on their quality assessment score described above.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis

Okorodudu

Jumean

Montori³

et al. 2010

Int J Obes

931

684

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Objective: We performed a systematic review and meta-analysis of studies that assessed the performance of body mass index (BMI) to detect body adiposity. Design: Data sources were MEDLINE, EMBASE, Cochrane, Database of Systematic Reviews, Cochrane CENTRAL, Web of Science, and SCOPUS. To be included, studies must have assessed the performance of BMI to measure body adiposity, provided standard values of diagnostic performance, and used a body composition technique as the reference standard for body fat percent (BF%) measurement. We obtained pooled summary statistics for sensitivity, specificity, positive and negative likelihood ratios (LRs), and diagnostic odds ratio (DOR). The inconsistency statistic (I2) assessed potential heterogeneity. Results: The search strategy yielded 3341 potentially relevant abstracts, and 25 articles met our predefined inclusion criteria. These studies evaluated 32 different samples totaling 31 968 patients. Commonly used BMI cutoffs to diagnose obesity showed a pooled sensitivity to detect high adiposity of 0.50 (95% confidence interval (CI): 0.43-0.57) and a pooled specificity of 0.90 (CI: 0.86-0.94). Positive LR was 5.88 (CI: 4.24-8.15), I 2 ¼ 97.8%; the negative LR was 0.43 (CI: 0.37-0.50), I 2 ¼ 98.5%; and the DOR was 17.91 (CI: 12.56-25.53), I 2 ¼ 91.7%. Analysis of studies that used BMI cutoffs X30 had a pooled sensitivity of 0.42 (CI: 0.31-0.43) and a pooled specificity of 0.97 (CI: 0.96-0.97). Cutoff values and regional origin of the studies can only partially explain the heterogeneity seen in pooled DOR estimates. Conclusion: Commonly used BMI cutoff values to diagnose obesity have high specificity, but low sensitivity to identify adiposity, as they fail to identify half of the people with excess BF%.

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“…Although this indicator reflects central fat distribution, it is not as strongly correlated to visceral fat accumulation among Caucasians and African Americans as is WC (Conway et al, 1997;Hill et al, 1999;Rankinen et al, 1999). As a ratio, waist to hip is difficult to interpret biologically because a change in body adiposity or weight does not necessarily result in a change of WHR.…”

Section: Discussionmentioning

confidence: 99%

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

et al. 2004

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Objectives: To evaluate waist circumference (WC) as a screening tool for obesity in a Caribbean population. To identify risk groups with a high prevalence of (central) obesity in a Caribbean population, and to evaluate associations between (central) obesity and self-reported hypertension and diabetes mellitus. Design: Cross-sectional. Setting: Population-based study. Subjects: A random sample of adults (18 y or older) was selected from the Population Registries of three islands of the Netherlands Antilles. Response was over 80%. Complete data were available for 2025 subjects. Intervention: A questionnaire and measurements of weight, height, waist and hip. Main outcome measurement: Central obesity indicator (WC Z102 cm men, Z88 cm women). Results: WC was positively associated with age (65-74 y vs 18-24 y) in men (OR ¼ 7.7, 95% CI 3.4-17.4) and women (OR ¼ 6.4, 95% CI 3.2-12.7). Women with a low education had a higher prevalence of central obesity than women with a high education (OR ¼ 0.5, 95% CI 0.3-0.7). However, men with a high income had a higher prevalence of a central obesity than men with a low income (OR ¼ 1.7, 95% CI ¼ 1.1-2.6). WC was the strongest independent obesity indicator associated with self-reported hypertension (OR ¼ 1.7, 95% CI 1.4-2.0) and diabetes mellitus (OR ¼ 1.6, 95% CI 1.3-1.9). Conclusions: The identified risk groups were women aged 55-74 y, women with a low educational level and men with a high income. WC appears to be the major obesity indicator associated with hypertension and diabetes mellitus.

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Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) Study

Abstract: Both waist circumference and sagittal diameter were good predictors of VAT in all groups. However, the nature of this relation differed such that race- and sex-specific equations will likely be required to estimate VAT from waist circumference or sagittal diameter.

Cited by 227 publications

References 28 publications

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

Metabolic Subtypes and Risk of Mortality in Normal Weight, Overweight, and Obese Individuals with CKD

Diagnostic performance of body mass index to identify obesity as defined by body adiposity: a systematic review and meta-analysis

Waist circumference as a measurement of obesity in the Netherlands Antilles; associations with hypertension and diabetes mellitus

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