Comparison of Measures of Adiposity and Cardiovascular Disease Risk Factors Among African American Adults: the Jackson Heart Study
Obesity, particularly central adiposity, is a well-established risk factor for cardiovascular disease (CVD). Waist circumference (WC) is measured in numerous epidemiologic studies as a relatively simple indicator of central adiposity. However, recently, investigators have considered a measure that takes height into consideration, waist-to-height ratio (WHtR) as a more sensitive predictor of CVD. A limited number of studies have examined the association between various measures of central adiposity and obesity with CVD, but there is a dearth of information on this topic focused specifically on African American adults. Given the high rates of cardiovascular disease and metabolic risk factors in this population, it is important to develop validated, easy-to-measure indicators of CVD risk for clinical use. Data from 4758 African American adults participating in the baseline visit of the Jackson Heart Study with available risk factor data were examined, with three measures of body habitus (body mass index (BMI), WC, and WHtR) and five CVD risk factors (HDL and LDL cholesterol, triglycerides, diabetes, and hypertension), the latter also categorized into multiple (2+) risk factors present. C-statistics for waist circumference (WC), BMI, and WHtR were computed and compared for each model to assess their discriminant abilities. WHtR was a stronger correlate of HDL cholesterol, triglycerides, diabetes, hypertension, and multiple risk factors compared to BMI, and was a stronger correlate of HDL cholesterol when compared to WC. These data indicate that, for African American adults, WHtR may be more appropriate measure to identify those at elevated risk for CVD.
KeywordsObesity Cardiovascular disease Waist circumference African Americans
The authors thank the participants and data collection staff of the Jackson Heart Study. The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Heart, Lung, and Blood Institute; the National Institutes of Health; or the US Department of Health and Human Services. Data from this analysis were presented in poster format at the 2016 Obesity Society’s Annual Scientific Conference, October 31–November 4, 2016.
Compliance with Ethical Standards
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Informed consent was obtained from all individual participants included in this study in accordance with the protocol of the parent study.
- 2.Smith SC Jr, Haslam D. Abdominal obesity, waist circumference and cardio-metabolic risk: awareness among primary care physicians, the general population and patients at risk—the Shape of the Nations survey. Curr Med Res Opin. 2007;23(1):29–47. https://doi.org/10.1185/030079906X159489.CrossRefPubMedGoogle Scholar
- 4.Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K. Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLoS One. 2017;12(5):e0177175. https://doi.org/10.1371/journal.pone.0177175.
- 8.Wohlfahrt P, Somers VK, Cifkova R, Filipovsky J, Seidlerova J, Krajcoviechova A, et al. Relationship between measures of central and general adiposity with aortic stiffness in the general population. Atherosclerosis. 2014;235(2):625–31. https://doi.org/10.1016/j.atherosclerosis.2014.05.958.CrossRefPubMedGoogle Scholar
- 9.Hori A, Nanri A, Sakamoto N, Kuwahara K, Nagahama S, Kato N, et al. Comparison of body mass index, waist circumference, and waist-to-height ratio for predicting the clustering of cardiometabolic risk factors by age in Japanese workers—Japan Epidemiology Collaboration on Occupational Health Study. Circ J. 2014;78(5):1160–8. https://doi.org/10.1253/circj.CJ-13-1067.CrossRefPubMedGoogle Scholar
- 12.Khalili S, Hatami M, Hadaegh F, Sheikholeslami F, Azizi F. Prediction of cardiovascular events with consideration of general and central obesity measures in diabetic adults: results of the 8.4-year follow-up. Metabol Syndrome Related Disord. 2012;10(3):218–24. https://doi.org/10.1089/met.2011.0070.CrossRefGoogle Scholar
- 13.World Health Organization. Waist circumference and waist-hip ratio: report of a WHO Expert Consultation. 2008. Available at: http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf.
- 19.Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23(02):247–69. https://doi.org/10.1017/S0954422410000144.CrossRefPubMedGoogle Scholar
- 20.Katzmarzyk PT, Mire E, Bray GA, Greenway FL, Heymsfield SB, Bouchard C. Anthropometric markers of obesity and mortality in white and African American adults: the pennington center longitudinal study. Obesity (Silver Spring). 2013;21(5):1070–5. https://doi.org/10.1002/oby.20151.CrossRefGoogle Scholar
- 21.Kazlauskaite R, Avery-Mamer EF, Li H, Chataut CP, Janssen I, Powell LH, et al. Race/ethnic comparisons of waist-to-height ratio for cardiometabolic screening: the study of women’s health across the nation. Am J Hum Biol. 2017;29 https://doi.org/10.1002/ajhb.22909. Epub 2016 Nov 1
- 22.McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message—‘keep your waist circumference to less than half your height’. Int J Obes (London). 2006;30(6):988–92. https://doi.org/10.1038/sj.ijo.0803226.CrossRefGoogle Scholar
- 23.Kabat GC, Heo M, Van Horn LV, Kazlauskaite R, Getaneh A, et al. Longitudinal association of anthropometric measures of adiposity with cardiometabolic risk factors in postmenopausal women. Ann Epidemiol. 2014;24(12):896–902. https://doi.org/10.1016/j.annepidem.2014.10.007.CrossRefPubMedPubMedCentralGoogle Scholar