Endocrinol Metab.  2016 Dec;31(4):559-566. 10.3803/EnM.2016.31.4.559.

Waist Circumference as a Marker of Obesity Is More Predictive of Coronary Artery Calcification than Body Mass Index in Apparently Healthy Korean Adults: The Kangbuk Samsung Health Study

Affiliations
  • 1Department of Endocrinology and Metabolism, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. hongsiri@hanmail.net

Abstract

BACKGROUND
We aimed to assess the risk for coronary artery calcification (CAC) according to groups subdivided by body mass index (BMI) and waist circumference (WC) in apparently healthy Korean adults.
METHODS
Thirty-three thousand four hundred and thirty-two participants (mean age, 42 years) in a health screening program were divided into three groups according to BMI: <23 kg/m² (normal), 23 to 25 kg/m² (overweight), and >25 kg/m² (obese). In addition, the participants were divided into two groups according to WC. Coronary artery calcium score (CACS) was measured with multi-detector computed tomography in all participants. Presence of CAC was defined as CACS >0.
RESULTS
When logistic regression analysis was performed with the presence of CAC as the dependent variable, the risk for CAC increased as BMI increased after adjusting for confounding variables (1.102 [95% confidence interval (CI), 1.000 to 1.216]; 1.284 [95% CI, 1.169 to 1.410]; in the overweight and obese groups vs. the normal weight group). When the participants were divided into six groups according to BMI and WC, the subjects with BMI and WC in the obese range showed the highest risk for CAC (1.321 [95% CI, 1.194 to 1.461]) and those with BMI in the overweight range and WC in the obese range showed the second highest risk for CAC (1.235 [95% CI, 1.194 to 1.461]).
CONCLUSION
Participants with obesity defined by both BMI and WC showed the highest risk for CAC. Those with BMIs in the overweight range but with WC in the obese range showed the second highest risk for CAC, suggesting that WC as a marker of obesity is more predictive of CAC than BMI.

Keyword

Body mass index; Coronary artery calcium score; Waist circumference

MeSH Terms

Adult*
Body Mass Index*
Calcium
Confounding Factors (Epidemiology)
Coronary Vessels*
Humans
Logistic Models
Mass Screening
Obesity*
Overweight
Waist Circumference*
Calcium

Figure

  • Fig. 1 Comparison of the (A) mean values of coronary artery calcium score (CACS) and (B) the proportion of subjects with CACS >0 among the groups divided by body mass index (BMI). ANOVA, analysis of variance.

  • Fig. 2 Comparison of the (A) mean values of coronary artery calcium score (CACS) and (B) the proportion of subjects with CACS >0 among the groups divided by body mass index (BMI) and waist circumference (WC). Group I: BMI <23 kg/m2 and WC <90 cm in men, <85 cm in women; Group II: BMI <23 kg/m2 and WC ≥90 cm in men, ≥85 cm in women; Group III: BMI 23 to 25 kg/m2 and WC <90 cm in men, <85 cm in women; Group IV: BMI 23 to 25 kg/m2 and WC ≥90 cm in men, ≥85 cm in women; Group V: BMI >25 kg/m2 and WC <90 cm in men, <85 cm in women; Group VI: BMI >25 kg/m2 and WC ≥90 cm in men, ≥85 cm in women. ANOVA, analysis of variance. a,b,cGroups with different letters denote significant differences between the groups in the post hoc analysis.


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Reference

1. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008; 32:1431–1437.
2. Yajnik CS, Yudkin JS. The Y-Y paradox. Lancet. 2004; 363:163.
3. Oh HG, Nallamshetty S, Rhee EJ. Increased risk of progression of coronary artery calcification in male subjects with high baseline waist-to-height ratio: the Kangbuk Samsung Health Study. Diabetes Metab J. 2016; 40:54–61.
4. Mathieu P, Pibarot P, Larose E, Poirier P, Marette A, Despres JP. Visceral obesity and the heart. Int J Biochem Cell Biol. 2008; 40:821–836.
5. Xu Z, Qi X, Dahl AK, Xu W. Waist-to-height ratio is the best indicator for undiagnosed type 2 diabetes. Diabet Med. 2013; 30:e201–e207.
6. 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; 23:247–269.
7. Yu JH, Yim SH, Yu SH, Lee JY, Kim JD, Seo MH, et al. The relationship of body composition and coronary artery calcification in apparently healthy Korean adults. Endocrinol Metab (Seoul). 2013; 28:33–40.
8. Peters SA, den Ruijter HM, Bots ML, Moons KG. Improvements in risk stratification for the occurrence of cardiovascular disease by imaging subclinical atherosclerosis: a systematic review. Heart. 2012; 98:177–184.
9. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004; 291:210–215.
10. Nasir K, Clouse M. Role of nonenhanced multidetector CT coronary artery calcium testing in asymptomatic and symptomatic individuals. Radiology. 2012; 264:637–649.
11. Moon BS, Park HJ, Lee MK, Jeon WS, Park SE, Park CY, et al. Increased association of coronary artery calcification in apparently healthy Korean adults with hypertriglyceridemic waist phenotype: the Kangbuk Samsung Health Study. Int J Cardiol. 2015; 194:78–82.
12. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005; 366:1059–1062.
13. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28:412–419.
14. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2016; 39:Suppl 1. S13–S22.
15. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014; 311:507–520.
16. Rumberger JA, Brundage BH, Rader DJ, Kondos G. Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc. 1999; 74:243–252.
17. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894:1–253.
18. Lee K, Song YM, Sung J. Which obesity indicators are better predictors of metabolic risk?: healthy twin study. Obesity (Silver Spring). 2008; 16:834–840.
19. Bosy-Westphal A, Geisler C, Onur S, Korth O, Selberg O, Schrezenmeir J, et al. Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors. Int J Obes (Lond). 2006; 30:475–483.
20. Schneider HJ, Glaesmer H, Klotsche J, Bohler S, Lehnert H, Zeiher AM, et al. Accuracy of anthropometric indicators of obesity to predict cardiovascular risk. J Clin Endocrinol Metab. 2007; 92:589–594.
21. Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Agudo-Conde C, Rodriguez-Sanchez E, Garcia-Ortiz L, et al. Abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive. BMC Cardiovasc Disord. 2012; 12:3.
22. Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008; 358:1336–1345.
23. Liu J, Musani SK, Bidulescu A, Carr JJ, Wilson JG, Taylor HA, et al. Fatty liver, abdominal adipose tissue and atherosclerotic calcification in African Americans: the Jackson Heart Study. Atherosclerosis. 2012; 224:521–525.
24. Ohashi N, Yamamoto H, Horiguchi J, Kitagawa T, Hirai N, Ito K, et al. Visceral fat accumulation as a predictor of coronary artery calcium as assessed by multislice computed tomography in Japanese patients. Atherosclerosis. 2009; 202:192–199.
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