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Three recent articles suggest there may be better measures than

#1 Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study

Salim Yusuf et al on behalf of the INTERHEART Study Investigators  The Lancet 2005; 366:1640-1649

Background: Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure.

Findings: Waist to Hip Ratio was a better predictor of heart attacks than BMI which is traditional measurement. 

Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups.

#2 Research Demonstrates Waist-to-Tallness Ratio Is Simple, Effective Indicator of Obesity and Cardiovascular Risk San Diego, CA, June 4, 2005 - Researchers at the 87th Annual Meeting of The Endocrine Society in San Diego will present the results of a study by the Max Planck Institute of Psychiatry in Munich and the University of Dresden, demonstrating that the simplest and most predictive standard for obesity and its related cardiovascular risks is the waist-to-tallness ratio. Obesity has been clearly associated with cardiovascular risk factors, and it is known that treatment of obesity reduces that risk. However, a number of different obesity standards have been used to predict cardiovascular risks. For years, the body mass index (BMI) was the standard measure. In recent years, waist circumference (WC) has been proposed as a more appropriate indicator for obesity and cardiovascular risk. To determine the most predictive obesity standard, an analysis of the DETECT study, was performed on 48,353 primary care patients by Dr. Harald Schneider of the Max Planck Institute of Psychiatry and colleagues. They tested the predictive value of BMI, WC, hip circumference, waist-to-hip ratio and waist-to-tallness ratio (WTR). The WTR was found to be most strongly associated with most risk factors in males and females. A cut-off for the WTR of 0.53 for women and of 0.55 for men revealed both highest specificity and sensitivity for overall-cardiovascular risk.“The study strongly suggests that the measurement of WTR is simple and the most reliable predictor of cardiovascular risk in primary care,” said Dr. Schneider.

#3 Midlife Body Mass Index and Hospitalization and Mortality in Older Age Lijing L. Yan, PhD, MPH; et al  JAMA. 2006;295:190-198.

Objective  To assess the relation of midlife body mass index with morbidity and mortality outcomes in older age among individuals without and with other major risk factors at baseline.

Setting and Participants  Participants were 17 643 men and women aged 31 through 64 years, recruited from Chicago-area companies or organizations and free of coronary heart disease (CHD), diabetes, or major electrocardiographic abnormalities at baseline.

Main Outcome Measures  Hospitalization and mortality from CHD, cardiovascular disease, or diabetes, beginning at age 65 years.

Results  In multivariable analyses that included adjustment for systolic blood pressure and total cholesterol level, the odds ratio (95% confidence interval) for CHD death for obese participants compared with those of normal weight in the same risk category was 1.43 (0.33-6.25) for low risk and 2.07 (1.29-3.31) for moderate risk; for CHD hospitalization, the corresponding results were 4.25 (1.57-11.5) for low risk and 2.04 (1.29-3.24) for moderate risk. Results were similar for other risk groups and for cardiovascular disease, but stronger for diabetes (eg, low risk: 11.0 [2.21-54.5] for mortality and 7.84 [3.95-15.6] for hospitalization).

Conclusion  For individuals with no cardiovascular risk factors as well as for those with 1 or more risk factors, those who are obese in middle age have a higher risk of hospitalization and mortality from CHD, cardiovascular disease, and diabetes in older age than those who are normal weight.

These three articles suggest there are several measures of assessing obesity; time will tell us which are best.  GLE

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