Original Article

International Journal of Obesity (2009) 33, 239–248; doi:10.1038/ijo.2008.252; published online 9 December 2008

Abdominal obesity and the spectrum of global cardiometabolic risks in US adults

H Ghandehari1, V Le1, S Kamal-Bahl2, S L Bassin1 and N D Wong1

  1. 1Division of Cardiology, Heart Disease Prevention Program, University of California, Irvine, CA, USA
  2. 2Global Outcomes Research, Merck & Co. Inc., West Point, PA, USA

Correspondence: Dr ND Wong, Medicine, Heart Disease Prevention Program, C240 Medical Sciences, University of California, Irvine, CA 92697, USA. E-mail: ndwong@uci.edu

Received 12 March 2008; Revised 20 October 2008; Accepted 31 October 2008; Published online 9 December 2008.

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Abstract

Objective:

 

To compare the association of obesity and abdominal obesity with cardiometabolic risk factor burden and global estimated coronary heart disease (CHD) risk among multiethnic US adults.

Design:

 

Cross-sectional, survey study.

Subjects:

 

A total of 4456 participants (representing 194.9 million adults) aged 20–79 years in the 2003–2004 National Health and Nutrition Examination Survey (NHANES).

Measurements:

 

Body mass index (BMI) and waist circumference (WC) measures, CHD risk factors and a 10-year estimated CHD risk based on Framingham algorithms. Obesity was defined as a BMI greater than or equal to30 kg/m2 and abdominal obesity as a WC >88 cm in women and >102 cm in men. High CHD risk status included diabetes, cardiovascular disease (CVD) or a 10-year Framingham risk score of >20%.

Results:

 

Overall, abdominal obesity was present in 42.3% of men and 62.5% of women and in 53.6% of whites, 56.9% of blacks and 50.5% of Hispanics (P<0.001 between gender and ethnicity). However, using International Diabetes Federation (IDF)-recommended WC cut points for Hispanics, the prevalence of abdominal obesity was 78.3%. Mean levels of low-density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure, fasting glucose and C-reactive protein increased, and high-density lipoprotein cholesterol (HDL-C) decreased (P<0.001) according to BMI and WC categories, although these associations were attenuated in blacks for blood pressure, LDL-C, HDL-C and triglycerides. Of those with high WC, 25–35% had greater than or equal to3 cardiometabolic risk factors. High CHD risk among those with high WC was most common in men (27.9%) and non-Hispanic whites (23.9%). Persons with a high vs normal WC, adjusted for age, gender, ethnicity and BMI were more likely to have greater than or equal to3 cardiometabolic risk factors (odds ratio (OR)=5.1, 95% confidence interval (CI)=3.9–6.6) and were classified as high CHD risk (OR=1.5, 95% CI=1.1–2.0).

Conclusion:

 

The association of abdominal obesity with risk factors varies by ethnicity and is independently associated with high CHD risk status, further validating its clinical significance.

Keywords:

abdominal obesity, ethnic differences, coronary heart disease

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