Secular trends of obesity and cardiovascular risk factors in a Mediterranean population

Objective: To evaluate time trends of obesity, abdominal obesity, and cardiovascular risk factors (CRFs) according to BMI and waist circumference (WC) categories in a Mediterranean population. Research Methods and Procedures: Subjects were Spanish men (n = 2383) and women (n = 2525) 25 to 74 years old, examined in 1994 to 1995 and 1999 to 2000 in two independent population‐based cross‐sectional surveys in the northeast of Spain. Lifestyle measures, CRFs, and anthropometric variables were analyzed. Results: Over the 5 years of the study, mean age‐standardized BMI increased by 1.0 units in men and by 0.8 units in women. At the same time the prevalence of obesity increased from 15.4% to 21.9% in men and from 15.4% to 21.4% in women. An upward trend was observed for WC and abdominal obesity (WC > 102 cm in men and WC > 88 cm in women) only in men. The proportion of men and women with hypercholesterolemia, diabetes, and low high‐density lipoprotein‐cholesterol plasma concentration remained stable within BMI and WC categories. The proportion of hypertension and smoking in obese men significantly increased from 1995 to 2000. Discussion: The 5‐year increase in BMI and WC is of considerable magnitude in the present population, although several CRFs remained stable within BMI and WC categories.     

Associations of Fat Distribution and Obesity with Hypertension in a Bi‐ethnic Population: The ARIC Study

Objective: To examine associations of hypertension with obesity and fat distribution among African American and white men and women. Research Methods and Procedures: The analysis sample included 15,063 African American and white men and women between the ages of 45 and 64 years who were participants in the 1987 through 1989 examination of the Atherosclerosis Risk in Communities Study (ARIC). Odds ratios and adjusted prevalences of hypertension were calculated across sexspecific quintiles of body mass index (BMI), waist‐to‐hip ratio (WHR), waist circumference, and waist‐to‐height ratio (waist/height) and adjusted for age, research center, smoking, education, physical activity, alcohol consumption, hormone replacement therapy, and menopausal status. Results: The prevalence of hypertension was higher among African Americans than whites. In the lowest quintile of BMI, 41% of African American women and 43% of African American men had hypertension compared with 14% of white women and 19% of white men. Elevated BMI, WHR, waist circumference, and waist/height were associated with increased odds of hypertension in African American and white men and women. In women, but not in men, there were significant interactions between ethnicity and the anthropometric variables studied here. The direction of the interaction indicated larger odds ratios for hypertension with increasing levels of anthropometric indices in white compared with African American women. Discussion: Obesity and abdominal fat preponderance were associated with increased prevalence of hypertension in African American and white men and women. Associations were similar among African American and white men, but obesity and fat patterning were less strongly associated with hypertension in African American than in white women.     

Visceral adiposity and subclinical coronary artery disease in elderly adults: Rancho Bernardo Study

Objective: Despite growing attention to central obesity as a predictor of clinical coronary heart disease (CHD), there are few reports about the association between directly measured visceral obesity and subclinical coronary atherosclerosis in elderly adults. We examined this association in elderly, community‐dwelling adults without clinically recognized CHD. Methods and Procedures: Elderly adults (190 men, BMI 27.2 ± 3.6 kg/m²; 220 women, BMI 25.8 ± 4.6) aged 55–88 years (median 69 years) with no history of CHD or coronary revascularization had an electron beam computed tomography (EBCT) to measure coronary artery calcification score (CACS), an estimate of coronary plaque burden. Visceral and subcutaneous adiposity were assessed by a triple‐slice EBCT scan at the lumbar 4–5 disc level and height, weight, and waist and hip circumferences were measured. Results: In sex‐specific ordinal logistic regression analyses, no measure of obesity or body fat distribution, including BMI, waist‐to‐hip ratio, waist girth, and visceral and subcutaneous fat by EBCT, was significantly associated with CACS before or after adjusting for multiple covariates of CACS (age, smoking, alcohol intake, exercise, pulse pressure, low‐density lipoprotein (LDL)/high‐density lipoprotein (HDL)‐cholesterol ratio, and fasting plasma glucose). Discussion: In elderly adults without clinically recognized CHD, body weight and fat distribution do not predict coronary artery plaque burden. These results raise questions about the value of weight reduction diets for preventing heart disease in elderly survivors without clinical heart disease.     

Validation of DXA Body Composition Estimates in Obese Men and Women

The aim of this study was to determine the accuracy of dual‐energy X‐ray absorptiometry (DXA)‐derived percentage fat estimates in obese adults by using four‐compartment (4C) values as criterion measures. Differences between methods were also investigated in relation to the influence of fat‐free mass (FFM) hydration and various anthropometric measurements. Six women and eight men (age 22–54 years, BMI 28.7–39.9 kg/m², 4C percent body fat (%BF) 31.3–52.6%) had relative body fat (%BF) determined via DXA and a 4C method that incorporated measures of body density (BD), total body water (TBW), and bone mineral mass (BMM) via underwater weighing, deuterium dilution, and DXA, respectively. Anthropometric measurements were also undertaken: height, waist and gluteal girth, and anterior‐posterior (A‐P) chest depth. Values for both methods were significantly correlated (r² = 0.894) and no significant difference (P = 0.57) was detected between the means (DXA = 41.1%BF, 4C = 41.5%BF). The slope and intercept for the regression line were not significantly different (P > 0.05) from 1 and 0, respectively. Although both methods were significantly correlated, intraindividual differences between the methods were sizable (4C‐DXA, range = ?3.04 to 4.01%BF) and significantly correlated with tissue thickness (chest depth) or most surrogates of tissue thickness (body mass, BMI, waist girth) but not FFM hydration and gluteal girth. DXA provided cross‐sectional %BF data for obese adults without bias. However, individual data are associated with large prediction errors (±4.2%BF). This error appears to be associated with tissue thickness indicating that the DXA device used may not be able to accurately account for beam hardening in obese cohorts.     

First nationwide survey of prevalence of overweight, underweight, and abdominal obesity in Iranian adults

Objective: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. Research Methods and Procedures: A nationwide cross‐sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal‐weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and ≥40 (kg/m²), respectively. Abdominal obesity was defined as WC ≥102 cm in men and ≥88 cm in women. Results: The age‐adjusted means for BMI and WC were 24.6 kg/m² in men and 26.5 kg/m² in women and 86.6 cm in men and 89.6 cm in women, respectively. The age‐adjusted prevalence of overweight or obesity (BMI ≥25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI ≥30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. Discussion: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.     

The relationship between measures of obesity and incident heart failure: The multi‐ethnic study of atherosclerosis

Objective : To evaluate the strength of association of body mass index (BMI) and waist circumference (WC) with incident heart failure (HF), exploring our associations by ethnicity and age. Design and Methods : 6,809 participants, aged 45‐84 years old, without clinical cardiovascular disease (2000–2002), from the Multi‐Ethnic Study of Atherosclerosis were included. Cox‐Proportional hazards models were used to examine associations of BMI and WC with incident HF. The predictive abilities of BMI and WC were compared using receiver operating characteristic curves. Results : Over a median follow‐up of 7.6 years, there were 176 cases. BMI and WC were associated with incident HF in men (1.33 [1.10‐1.61] and 1.38 [1.18‐1.62], respectively] and women (1.70 [1.33‐2.17] and 1.64 [1.29‐2.08], respectively). These associations became non‐significant after adjusting for obesity‐related conditions (hypertension, dysglycemia, hypercholesterolemia, left ventricular hypertrophy, kidney disease, and inflammation). The associations of BMI and WC did not vary significantly by ethnicity or age‐group, but were inverse in Hispanic men. The area under the curve for BMI and WC was 0.749 and 0.750, respectively, in men and 0.782 and 0.777, respectively, in women. Conclusions : The association between obesity and incident HF is largely mediated by obesity‐related conditions. BMI and WC have similar predictive abilities for incident HF.     

Obesity indices and self-reported functional health in men and women in the EPIC-Norfolk

Objective: To investigate the association between two indices of obesity, BMI and waist‐to‐hip ratio (WHR), and self‐reported physical and mental functional health. Research Methods and Procedures: We examined the relationship between obesity indices and self‐reported physical and mental functional health measured by the Anglicized version of the Short‐Form 36‐item questionnaire in a population‐based cross sectional study of 16, 806 men and women 40 to 79 years old living in the general community in Norfolk, United Kingdom. Results: Higher BMI and WHR were both independently associated with poorer self‐reported physical functional health in men and women. The effect of BMI was greater in women compared with men, and the effect of WHR was greater in men compared with women, for poor physical functional health. Higher WHR but not BMI was associated with lower mental functional health in men and women. Discussion: High BMI and WHR seem to be adversely related to self‐perceived functional health in both men and women, although their relative impacts seem to differ by sex. Our findings also highlight the importance of using WHR in addition to BMI in assessing the impact of obesity on health outcome.     

Waist Circumference is an Independent Correlate of Errors in Self‐Reported BMI

Although there are issues of reporting bias surrounding the use of self‐reported BMI, it is frequently the method employed to establish the prevalence of obesity. The goal of this study was to assess whether, independently of measured BMI, waist circumference (WC) was associated with the magnitude of the difference between self‐reported and measured BMI within a large sample of European‐American (EA) and African‐American (AA) adults. Self‐reported height and weight, and measured height, weight, and WC were collected on 12,809 adults (61% women, 66% EA) aged 18–65 years. Mean negative BMI differences (self‐reported minus measured BMI) were identified in all race‐by‐sex groups (AA men: ?0.55; EA men: ?0.63; AA women: ?0.91; EA women: ?0.67). WC was negatively associated with the BMI difference such that a higher WC was associated with greater under‐reporting of BMI. However, after adjusting for age and measured BMI, WC was positively associated with the BMI difference in all race‐by‐sex groups. These results suggest that WC could be useful in gaining an insight into people's awareness of their own body size and fatness.     

Effects of Obesity and Body Fat Distribution on Lipids and Lipoproteins in Nondiabetic American Indians: The Strong Heart Study

Objectives: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. Research Methods and Procedures: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high‐density lipoprotei in (HDL) cholesterol, low‐density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/lipoproteins. Results: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m²) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m²), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = ?0.24, p < 0.001). There was a significant but weak relation with apoAI (r = ?0.14 p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14 p < 0.001) and negatively related to HDL cholesterol (r = ?0.23, p < 0.001) and apoAI (r = ?0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = ?0.35, p < 0.001) and apoAI (r = ?0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = ?0.36 p < 0.001). In both women and men there was an inverted U‐shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (?1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (?0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. Discussion: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.     

Association between Serum Leptin Levels and 24‐Hour Blood Pressure in Obese Women

Objective: To assess the relationship between serum leptin and 24‐hour blood pressure (BP) in obese women, according to body fat distribution. Research Methods and Procedures: A cross‐sectional study was carried out in a population of 70 nondiabetic, normotensive, obese women (40 with android and 30 with gynoid type of obesity) and 20 nonobese healthy women as a control group. All subjects underwent 24‐hour ambulatory BP monitoring. Blood samples were collected for serum leptin and plasma insulin measurements. Total cholesterol and high‐density lipoprotein cholesterol were also measured. Results: Serum leptin levels were significantly higher in obese subjects than in controls, and they were more elevated in android obese women than in gynoid ones. Leptin levels were positively related to body mass index (BMI), insulin, and waist and hip circumferences in the android group. Among gynoid subjects, leptin levels showed positive associations with BMI and insulin. In women with android obesity, strong positive correlations (p < 0.001) were found between leptin levels and 24‐hour systolic BP (SBP), daytime SBP, nighttime SBP, 24‐hour diastolic BP (DBP), and daytime DBP. Multiple regression analyses, including age, insulin and leptin concentrations, BMI, and waist and hip circumferences on 24‐hour and daytime SBP and DBP, showed that only leptin levels contributed to the variability of BP. Conclusions: Our study shows that serum leptin levels are directly related to 24‐hour BP levels in normotensive women with android fat distribution, independently of BMI.     

Obesity in South Africa: The South African Demographic and Health Survey

Objectives: To ascertain the anthropometric profile and determinants of obesity in South Africans who participated in the Demographic and Health Survey in 1998. Research Methods and Procedures: A sample of 13,089 men and women (age, ≥15 years) were randomly selected and then stratified by province and urban and nonurban areas. Height, weight, mid-upper arm circumference, and waist and hip circumference were measured. Body mass index (BMI) was used as an indicator of obesity, and the waist/hip ratio (WHR) was used as an indicator of abdominal obesity. Multivariate regression identified sociodemographic predictors of BMI and waist circumference in the data. Results: Mean BMI values for men and women were 22.9 kg/m² and 27.1 kg/m², respectively. For men, 29.2% were overweight or obese (≥25 kg/m²) and 9.2% had abdominal obesity (WHR ≥1.0), whereas 56.6% of women were overweight or obese and 42% had abdominal obesity (WHR >0.85). Underweight (BMI <18.5 kg/m²) was found in 12.2% of men and 5.6% of women. For men, 19% of the variation of BMI and 34% of the variation in waist circumference could be explained by age, level of education, population group, and area of residence. For women, these variables explained 16% of the variation of BMI and 24% of the variation in waist circumference. Obesity increased with age, and higher levels of obesity were found in urban African women. Discussion: Overnutrition is prevalent among adult South Africans, particularly women. Determinants of overnutrition include age, level of education, ethnicity, and area of residence.     

Body mass index,waist circumference and employment: Evidence from older Irish adults

Data from the first wave of the Irish Longitudinal Study on Ageing are used to examine the relationship between fatness and obesity and employment status among older Irish adults. Employment status is regressed on one of the following measures of fatness: BMI and waist circumference entered linearly as continuous variables and obesity as a categorical variable defined using both BMI and waist circumference. Controls for demographic and socioeconomic characteristics, socioeconomic characteristics in childhood and physical, mental and behavioural health are also included. The regression results for women indicate that all measures of fatness are negatively associated with the probability of being employed and that the employment elasticity associated with waist circumference is larger than the elasticity associated with BMI. The results for men indicate that employment is not significantly associated with BMI and waist circumference when these are entered linearly in the regression, but it is significantly and negatively associated with obesity defined either using BMI or waist circumference as categorical variables. The results also indicate that the negative association between obesity and employment status is larger among women. For example, the probability of being employed for the obese category defined using BMI is around 8 percentage points lower for women and 5 percentage points lower for men.     

Comparison of Overall Obesity and Body Fat Distribution in Predicting Risk of Mortality

Results of studies comparing overall obesity and abdominal adiposity or body fat distribution with risk of mortality have varied considerably. We compared the relative importance and joint association of overall obesity and body fat distribution in predicting risk of mortality. Participants included 5,799 men and 6,429 women aged 30–102 years enrolled in the third National Health and Nutrition Examination Survey who completed a baseline health examination during 1988–1994. During a 12‐year follow‐up (102,172 person‐years), 1,188 men and 925 women died. In multivariable‐adjusted analyses, waist‐to‐thigh ratio (WTR) in both sexes (P_trend <0.01 for both) and waist‐to‐hip ratio (WHR) in women (P_trend 0.001) were positively associated with mortality in middle‐aged adults (30–64 years), while BMI and waist circumference (WC) exhibited U‐ or J‐shaped associations. Risk of mortality increased with a higher WHR and WTR among normal weight (BMI 18.5–24.9 kg/m²) and obese (BMI ≥30.0 kg/m²) adults. In older adults (65–102 years), a higher BMI in both sexes (P_trend <0.05) and WC in men (P_trend 0.001) were associated with increased survival, while remaining measures of body fat distribution exhibited either no association or an inverse relation with mortality. In conclusion, ratio measures of body fat distribution are strongly and positively associated with mortality and offer additional prognostic information beyond BMI and WC in middle‐aged adults. A higher BMI in both sexes and WC in men were associated with increased survival in older adults, while a higher WHR or WTR either decreased or did not influence risk of death.     

Associations of leukocyte telomere length with body anthropometric indices and weight change in chinese women

Objective: This study evaluated associations of telomere length with various anthropometric indices of general and abdominal obesity, as well as weight change. Design and Methods: The study included 2,912 Chinese women aged 40‐70 years. Monochrome multiplex quantitative polymerase chain reaction was applied to measure relative telomere length. Results: Telomere length was inversely associated with body mass index (BMI), waist circumference, waist‐to‐height ratio, weight, and hip circumference (P_trend = 0.005, 0.004, 0.004, 0.010, and 0.026, respectively), but not waist‐to‐hip ratio (P_trend = 0.116) or height (P_trend = 0.675). Weight change since age 50 was further evaluated among women over age 55. Women who maintained their weight within ±5% since age 50, particularly within a normal range (BMI = 18.5‐24.9 kg/m²), or reduced their weight from overweight (BMI = 25‐29.9 kg/m²) or obesity (BMI ≥30 kg/m²) to normal range, had a longer mean of current telomere length than women who gained weight since age 50 (P_trend = 0.025), particularly those who stayed in obesity or gained weight from normal range or overweight to obesity (P = 0.023). Conclusion: Our findings show that telomere shortening is associated with obesity and that maintaining body weight within a normal range helps maintain telomere length.     

A Prospective Study of Adiposity and All‐Cause Mortality: The Malmö Diet and Cancer Study

Objective: This study aims to examine the association between various measures of adiposity and all‐cause mortality in Swedish middle‐aged and older men and women and, additionally, to describe the influences of age and sex on these associations. Research Methods and Procedures: A prospective analysis was performed in a cohort of 10,902 men and 16,814 women ages 45 to 73 years who participated in the Malmö Diet and Cancer Study in Sweden. Baseline examinations took place between 1991 and 1996, and 982 deaths were documented during an average follow‐up of 5.7 years. All‐cause mortality was related to the following variables measured at baseline: body mass index (BMI), percentage of body fat, lean body mass (LBM), and waist‐to‐hip ratio (WHR), with adjustment for age and selected covariates. Body composition data were derived from bioelectrical impedance analysis. Results: The association between percentage of body fat and mortality was modified by age, particularly in women. For instance, fatness was associated with excess mortality in the younger women but with reduced mortality in the older women. Weaker associations were seen for BMI than for percentage of body fat in both sexes. Placement in the top quintiles of waist‐to‐hip ratio, independent of overall body fat, was a stronger predictor of mortality in women than in men. The observed associations could not be explained by bias from early death or antecedent disease. Discussion: The findings reveal sex and age differences for the effects of adiposity and WHR on mortality and indicate the importance of considering direct measures of adiposity, as opposed to BMI, when describing obesity‐related mortality risks.     

Pedometer-determined physical activity and indicators of health in Japanese adults

Recently, many cross-sectional studies observed that body mass index (BMI) and percentage of body fat (%BF) were inversely associated with pedometer-determined physical activities, but studies on Asian populations, including the Japanese, are sparse. Height, weight, body fat percentage (%BF, bioelectrical impedance analyzer), and waist circumference were measured on 117 women (62.8+/-4.5 years, 22.2+/-2.2 kg/m(2)) and 62 men (64.0+/-4.6 years, 23.6+/-2.5 kg/m(2)). Pearson correlations and partial correlation coefficients after controlling for age were calculated between steps/day and variables. Furthermore, participants were classified into four groups as follows: <5,000, 5,000-7,499, 7,500-9,999, and >or=10,000 steps/day, and analyzed using ANOVA across activity groups. In women, a significant correlation was found between steps/day and BMI (r=-0.217, p=0.018), %BF (r=-0.292, p=0.0014), and the relationship was still significant after controlling for age. The relationship between steps/day and waist circumference was not significant. In men, a significant relationship was not observed between steps/day and obesity indices. The correlations between steps/day and both BMI and %BF were significant in Japanese women, but weak compared with Caucasian and African-American women as reported previously. A possible cause is racial difference in degree of obesity and body shape. The effects of physical activity on body shape and composition may differ according to race.     

Prevalence of obesity and the relationship between the body mass index and body fat: cross-sectional, population-based data

Background

Anthropometric measures such as the body mass index (BMI) and waist circumference are widely used as convenient indices of adiposity, yet there are limitations in their estimates of body fat. We aimed to determine the prevalence of obesity using criteria based on the BMI and waist circumference, and to examine the relationship between the BMI and body fat.

Methodology/Principal Findings

This population-based, cross-sectional study was conducted as part of the Geelong Osteoporosis Study. A random sample of 1,467 men and 1,076 women aged 20–96 years was assessed 2001–2008. Overweight and obesity were identified according to BMI (overweight 25.0–29.9 kg/m²; obesity ≥30.0 kg/m²) and waist circumference (overweight men 94.0–101.9 cm; women 80.0–87.9 cm; obesity men ≥102.0 cm, women ≥88.0 cm); body fat mass was assessed using dual energy X-ray absorptiometry; height and weight were measured and lifestyle factors documented by self-report. According to the BMI, 45.1% (95%CI 42.4–47.9) of men and 30.2% (95%CI 27.4–33.0) of women were overweight and a further 20.2% (95%CI 18.0–22.4) of men and 28.6% (95%CI 25.8–31.3) of women were obese. Using waist circumference, 27.5% (95%CI 25.1–30.0) of men and 23.3% (95%CI 20.8–25.9) of women were overweight, and 29.3% (95%CI 26.9–31.7) of men and 44.1% (95%CI 41.2–47.1) of women, obese. Both criteria indicate that approximately 60% of the population exceeded recommended thresholds for healthy body habitus. There was no consistent pattern apparent between BMI and energy intake. Compared with women, BMI overestimated adiposity in men, whose excess weight was largely attributable to muscular body builds and greater bone mass. BMI also underestimated adiposity in the elderly. Regression models including gender, age and BMI explained 0.825 of the variance in percent body fat.

Conclusions/Significance

As the BMI does not account for differences in body composition, we suggest that gender- and age-specific thresholds should be considered when the BMI is used to indicate adiposity.     

The Relationship between Body Weight and Health Care among German Women

Objective: To investigate the relationship between body weight and the use of health care services among women from southern Germany. Research Methods and Procedures: Data were drawn from the 1994 to 1995 Monitoring of Trends and Determinants in Cardiovascular Disease Augsburg survey, covering a population‐representative sample of women 25 to 74 years old (n = 2301). Logistic regression models were used to calculate odds ratios (ORs) for the use of medical services by women with overweight (BMI 25.0 to 29.9 kg/m²) or obesity (BMI ≥ 30 kg/m²) in comparison with normal‐weight women (BMI < 25.0 kg/m²). Results: In multivariable analysis, obese women 50 to 74 years old were more likely than normal‐weight women to delay cancer screening procedures, such as manual breast examination and Papanicolaou smear (OR 0.52, 95% confidence interval 0.37 to 0.74) in the previous 12 months. However, the relationship between obesity and cancer screening was not found to be significant in 25‐ to 49‐year‐old women (OR 0.92, 95% confidence interval 0.62 to 1.36). Neither in the 25‐ to 49‐year‐old age group nor in the 50‐ to 74‐year‐old age group were independent relationships between higher body weight and total physician visits, hospitalizations, or medication use observed. Discussion: Obese women tended to use medical services with greater frequency due to obesity‐related diseases. However, postmenopausal women with a BMI ≥ 30 kg/m² were more likely to delay routine cancer screening, putting them at a greater risk for death from breast, cervical, and endometrial cancer. Thus, obese postmenopausal women should be targeted for increased screening.     

Influence of Excess Fat on Cardiac Morphology and Function: Study in Uncomplicated Obesity

Objective: To evaluate whether or not “uncomplicated” obesity (without associated comorbidities) is really associated with cardiac abnormalities. Research Methods and Procedures: We evaluated cardiac parameters in obese subjects with long‐term obesity, normal glucose tolerance, normal blood pressure, and regular plasma lipids. We selected 75 obese patients [body mass index (BMI) >30 kg/m²], who included 58 women and 17 men (mean age, 33.7 ± 11.9 years; BMI, 37.8 ± 5.5 kg/m²) with a ≥10‐year history of excess fat, and 60 age‐matched normal‐weight controls, who included 47 women and 13 men (mean age, 32.7 ± 10.4 years; BMI, 23.1 ± 1.4 kg/m²). Each subject underwent an oral glucose tolerance test to exclude impaired glucose tolerance or diabetes mellitus, bioelectrical impedance analysis to calculate fat mass and fat‐free mass, and echocardiography. Results: Obese patients presented diastolic function impairment, hyperkinetic systole, and greater aortic root and left atrium compared with normal subjects. No statistically significant differences between obese subjects and normal subjects were found in indexed left ventricular mass (LVM/body surface area, LVM/height^2.7, and LVM/fat‐free mass_kg), and no changes in left ventricular geometry were observed. No statistically significant differences in cardiac parameters between extreme (BMI > 40 kg/m²) and mild obesity (BMI < 35 kg/m²) were observed. Discussion: In conclusion, our data showed that obesity, in the absence of glucose intolerance, hypertension, and dyslipidemia, seems to be associated only with an impairment of diastolic function and hyperkinetic systole, and not with left ventricular hypertrophy.     

A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study

Objective: Our goal was to examine five different measures of adiposity as predictors of all‐cause mortality. Research Methods and Procedures: Subjects were 16,969 men and 24,344 women enrolled between 1990 and 1994 in the Melbourne Collaborative Cohort Study (27 to 75 years of age). There were 2822 deaths over a median follow‐up period of 11 years. BMI, waist circumference, and waist‐to‐hip ratio were obtained from direct anthropometric measurements. Fat mass and percentage fat were estimated by bioelectric impedance analysis. Results: Comparing the top quintile with the second quintile, for men there was an increased risk of between 20% and 30% for all‐cause mortality associated with each of the anthropometric measures. For women, there was an increased risk of 30% (95% confidence interval for hazard ratio, 1.1–1.6) observed for waist circumference and 50% (1.2–1.8) for waist‐to‐hip ratio, but little or no increased risk for BMI, fat mass, and percentage fat. Waist‐to‐hip ratio was positively and monotonically associated with all‐cause mortality for both men and women. There was a linear association between waist circumference and all‐cause mortality for men, whereas a U‐shaped association was observed for women. Discussion: Measures of central adiposity were better predictors of mortality in women in the Melbourne Collaborative Cohort Study compared with measures of overall adiposity. We recommend measuring waist and hip circumferences in population studies investigating the risk of all‐cause mortality associated with obesity. The use of additional measures such as bioelectric impedance is not justified for this outcome.