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Obesity measure should be redefined to accurately assess heart attack risk
November 04, 2005HAMILTON, ONTARIO-Waist-to-hip ratio, not body mass index (BMI), is the best obesity measure for assessing a person's risk of heart attack, concludes a global study published in this week's issue of The Lancet.
If obesity is redefined using waist-to-hip ratio instead of BMI the proportion of people at risk of heart attack increases by threefold, calculate the authors.
Previous research has shown that obesity increases the risk of heart disease. However, these studies have mainly been done in populations of European and North American origin. The evidence for other populations is therefore sparse. In the latest study, Dr. Salim Yusuf, director of the Population Health Research Institute at McMaster University and Hamilton Health Sciences, and colleagues aimed to assess whether other markers for obesity, especially waist-to-hip ratio, would be a stronger predictor of heart attack than the conventional measure of BMI in different ethnic populations.
The investigators looked at BMI, waist-to-hip ratio, waist measure, and hip measure in more than 27,000 people from 52 countries. Half the participants had previously had a heart attack and half were age and sex-matched controls (individuals who had not had a heart attack and were the same age and sex as cases). The team found that BMI was only slightly higher in heart attack patients than in controls, with no difference in the Middle East and South Asia. By contrast, heart attack patients had a strikingly higher waist-to-hip ratio than controls, irrespective of other cardiovascular risk factors. The researchers found that this observation was consistent in men and women, across all ages, and in all regions of the world.
The authors' state that compared with BMI, waist-to-hip ratio is three times stronger than BMI in predicting the risk of a heart attack. Larger waist size (which reflects the amount of abdominal fat) was harmful, whereas larger hip size (which may indicate the amount of lower body muscle) was protective.
The waist-to-hip ratio is calculated by dividing the waist measure by the hip measure. The cut off point for cardiovascular risk factors is less than 0.85 for women and 0.90 for men. A higher number denotes more risk
Dr. Yusuf concludes: "Our findings suggest that substantial reassessment is needed of the importance of obesity for cardiovascular disease in most regions of the world."
Dr. Yusuf is a professor of medicine of the Michael G. DeGroote School of Medicine at McMaster University, a cardiologist at Hamilton Health Sciences. He also holds the Heart and Stroke Foundation of Ontario Chair in Cardiology at McMaster University. The study was funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario and 37 other funding sources, including unrestricted support from several pharmaceutical companies.
In an accompanying published comment Charlotte Krageland of the University of Oslo, Norway states: "The main message from the new report is that current practice with body mass index as the measure of obesity is obsolete. For the assessment of risk associated with obesity, the waist-to-hip ratio, and not the body mass index, is the preferred simple measure."
Dr. John Kelton, dean of the Michael G. DeGroote School of Medicine and dean and vice-president, Faculty of Health Sciences, McMaster University, said: "The results of this study will change, on an international scope, how we evaluate patients' risks for heart disease. Being able to easily identify the risk will have a beneficial effect on awareness and treatment."
Dr. Alan Bernstein, president of the Canadian Institutes of Health Research, said: "We've long been aware of the link of obesity and cardiovascular disease. Thanks to the research conducted by Dr. Yusuf, we now have a better understanding of the risk related to obesity which can lead to more effective health interventions.
Laura Syron, vice-president of research for the Heart and Stroke Foundation of Ontario, said: "For the Foundation it is immensely gratifying to see yet another in a series of successes by Dr. Yusuf and his team. We have supported this initiative from the beginning and it has been wonderful to follow the tale of the tape from Ontario to the world."
Murray Martin, President and CEO of Hamilton Health Sciences, said: "Part of our mission as a teaching hospital is to advance health care through education and research. Dr. Yusuf's commitment to finding answers to important heart health questions that affect people around the world exemplifies the leadership we embrace at Hamilton Health Sciences.\\\
McMaster University
The investigators looked at BMI, waist-to-hip ratio, waist measure, and hip measure in more than 27,000 people from 52 countries. Half the participants had previously had a heart attack and half were age and sex-matched controls (individuals who had not had a heart attack and were the same age and sex as cases). The team found that BMI was only slightly higher in heart attack patients than in controls, with no difference in the Middle East and South Asia. By contrast, heart attack patients had a strikingly higher waist-to-hip ratio than controls, irrespective of other cardiovascular risk factors. The researchers found that this observation was consistent in men and women, across all ages, and in all regions of the world.
The authors' state that compared with BMI, waist-to-hip ratio is three times stronger than BMI in predicting the risk of a heart attack. Larger waist size (which reflects the amount of abdominal fat) was harmful, whereas larger hip size (which may indicate the amount of lower body muscle) was protective.
The waist-to-hip ratio is calculated by dividing the waist measure by the hip measure. The cut off point for cardiovascular risk factors is less than 0.85 for women and 0.90 for men. A higher number denotes more risk
Dr. Yusuf concludes: "Our findings suggest that substantial reassessment is needed of the importance of obesity for cardiovascular disease in most regions of the world."
Dr. Yusuf is a professor of medicine of the Michael G. DeGroote School of Medicine at McMaster University, a cardiologist at Hamilton Health Sciences. He also holds the Heart and Stroke Foundation of Ontario Chair in Cardiology at McMaster University. The study was funded by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Ontario and 37 other funding sources, including unrestricted support from several pharmaceutical companies.
In an accompanying published comment Charlotte Krageland of the University of Oslo, Norway states: "The main message from the new report is that current practice with body mass index as the measure of obesity is obsolete. For the assessment of risk associated with obesity, the waist-to-hip ratio, and not the body mass index, is the preferred simple measure."
Dr. John Kelton, dean of the Michael G. DeGroote School of Medicine and dean and vice-president, Faculty of Health Sciences, McMaster University, said: "The results of this study will change, on an international scope, how we evaluate patients' risks for heart disease. Being able to easily identify the risk will have a beneficial effect on awareness and treatment."
Dr. Alan Bernstein, president of the Canadian Institutes of Health Research, said: "We've long been aware of the link of obesity and cardiovascular disease. Thanks to the research conducted by Dr. Yusuf, we now have a better understanding of the risk related to obesity which can lead to more effective health interventions.
Laura Syron, vice-president of research for the Heart and Stroke Foundation of Ontario, said: "For the Foundation it is immensely gratifying to see yet another in a series of successes by Dr. Yusuf and his team. We have supported this initiative from the beginning and it has been wonderful to follow the tale of the tape from Ontario to the world."
Murray Martin, President and CEO of Hamilton Health Sciences, said: "Part of our mission as a teaching hospital is to advance health care through education and research. Dr. Yusuf's commitment to finding answers to important heart health questions that affect people around the world exemplifies the leadership we embrace at Hamilton Health Sciences.\\\
McMaster University
Obesity Current Events and Obesity News RSSPhysical education key to improving health in low-income adolescents
School-based physical education plays a key role in curbing obesity and improving fitness among adolescents from low-income communities, according to a new study led by researchers at the University of California, San Francisco and UC Berkeley.
Energy gap useful tool for successful weight loss maintenance strategy
Americans continue to get heavier. Most weight control methods short of bariatric surgery are generally considered ineffective in preventing obesity or reducing weight.
TV bombards children with commercials for high-fat and high-sugar foods
Childhood obesity in the United States is reaching epidemic proportions. With more than one fourth of advertising on daytime and prime time television devoted to foods and beverages and continuing questions about the role television plays in obesity.
New scientific study indicates that eating quickly is associated with overeating
According to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM), eating a meal quickly, as compared to slowly, curtails the release of hormones in the gut that induce feelings of being full.
American Dietetic Association Releases Updated Position Paper Promoting and Supporting Breastfeeding
The American Dietetic Association has released an updated position paper on breastfeeding that details health benefits for both infants and mothers and encourages promotion of breastfeeding whenever possible.
Addressing obesity via the 'energy gap'
The November issue of the Journal of the American Dietetic Association features a commentary by James O. Hill, an honorary ADA member, professor of pediatrics and medicine and director of the Center for Human Nutrition at the University of Colorado-Denver.
MSU researcher: Obesity significantly cuts odds of successful pregnancy
Obese women are as much as 28 percent less likely to become pregnant and have a successful pregnancy, according to research that earned a Michigan State University professor a national award.
Study: Lap band surgery effective for morbidly obese children
A surgeon at Children's National Medical Center and his colleagues from New York University have found laparoscopic adjustable gastric banding (Lap band) to improve the health of morbidly obese adolescents.
Gastroenterology/hepatology societies release report evaluating fellowship training curriculum
Due to the increasing complexities of treating digestive diseases, allowing gastroenterological (GI) trainee physicians the opportunity to develop enhanced abilities and experiences in specific disease areas or procedures will be a great benefit to patients, according to a "Report of the Multisociety Task Force on GI Training."
Study finds link between childhood physical abuse and arthritis
Adults who had experienced physical abuse as children have 56 per cent higher odds of osteoarthritis compared to those who have not been abused, according to a new study by University of Toronto researchers.
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