As per a prospective cohort study, waist circumference along with BMI modestly improves the prediction of which postmenopausal women are at a higher risk for premature death.
By using waist circumference along with BMI , modest gains were made in predicting which postmenopausal women were at a higher risk for premature death, a prospective cohortremains a pressing public health threat, prevention and treatment are made difficult by the limits of the BMI to accurately measure excess adiposity, according to the study’s authors.
“Waist circumference is a simple, inexpensive method to assess visceral adiposity and correlates well with visceral fat as assessed by imaging,”The problem, wrote Aragaki and his colleagues, is that waist circumference is not often measured in the clinical setting. Further, “Waist circumference would be especially valuable for staging of obesity risk if BMI-specific thresholds were available,” they wrote. The investigators said that the current recommended waist circumference thresholds do not complement BMI because most adults diagnosed with obesity are already beyond these thresholds. Currently accepted waist circumference thresholds for overweight are 88 cm or above for women and 102 cm or above for men.Society and the International Chair on Cardiometabolic Risk Working Group on Visceral Obesity. They have proposed thresholds in women of 80 cm or greater, 90 cm or greater, 105 cm or greater, 115 cm or greater, and 115 cm or greater to correlate, respectively, with BMI categories: normal weight to 61.3% , an improvement of 0.7% . The c-statistic is the agreement between the number of observed outcomes and predicted risk at 10 and 20 years, according to Aragaki and his colleagues. Discrimination was not significantly improved for Validation Cohort 2, however, with a difference in c-statistics of 0.3% . “Combining BMI and waist circumference assessments allows for more personalized decision making,” Aragaki and his colleagues wrote. “Patients with a large waist circumference in any BMI category are at elevated cardiometabolic and mortality risk and may benefit from more aggressive interventions than those with similar BMIs but lower waist circumferences. Conversely, those with a normal waist circumference may require less aggressive care.” The results of the study reinforce other data in favor of supplementing BMI with a second metric to more completely assess cardiometabolic health, a clinical obesity specialist told“BMI is a flawed criteria for diagnosis of obesity as it reflects total body mass but does not distinguish between fat and lean mass or where fat is distributed,” said Reema Hamid Dbouk, MD. “Waist circumference is a surrogate for visceral fat, which is more metabolically active and linked to cardiometabolic risk and mortality.” Dbouk is an assistant professor of obesity medicine at Emory School of Medicine and a Rollins Distinguished Clinician at the Emory Clinic, both in Atlanta. “Waist circumference measurement is inexpensive, quick, and requires minimal training. The paper notes that embarrassment or discomfort among patients is low, particularly among older adults. Integration into EMRs and vital sign protocols could normalize its use. Patients may understand waist size more intuitively than BMI. Tracking waist circumference over time may be more encouraging, especially if muscle gain masks fat loss on the scale,” said Dbouk.“Waist circumference-based thresholds may not fully account for differences in fat distribution by race/ethnicity or body habitus. For example, Asians may have higher metabolic risk at lower waist circumference. The thresholds are a step toward personalized risk assessment, but they may still require refinement to account for racial/ethnic differences in fat distribution and risk. More research is needed to validate waist circumference thresholds in broader populations, including men and younger individuals.” The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, through contracts 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005. Conflicts of interest are listed online with the published paper. Dbouk reported having no disclosures.Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our
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