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A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys


OBJECTIVE: To comparatively evaluate cut-off points of waist circumference, body mass index and waist to hip ratio with respect to their ability to predict other individual and multiple cardiovascular disease risk factors.

DESIGN: Population-based, cross-sectional surveys.

SUBJECTS: A total of 9913 men and women aged 18–74, selected using health insurance registries from five Canadian provinces.

MEASUREMENTS: Anthropometric measures, other cardiovascular risk factors, receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values.

RESULTS: Waist circumference may be the best single indicator of other individual and multiple cardiovascular risk factors. Optimal cut-off points of all anthropometric measures are dependent on age, sex and the prevalence of the risk factor(s) being considered. For waist circumference, cut-off points of ≥90 cm in men and ≥80 cm in women may be most appropriate for prediction of individual and multiple risk factors in Caucasian populations.

CONCLUSION: Health professionals should incorporate the use of waist circumference measurements in their routine clinical examination of adult patients.

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We wish to acknowledge other members of the Canadian Heart Health Research Group: Dr Christopher Balram from the Department of Health and Community Services, Fredericton NB; Lynne Blair from the BC Ministry of Health, Victoria; Dr David Butler-Jones from Saskatchewan Health, Regina, Saskatchewan; Dr Roy Cameron from the University of Waterloo, Waterloo; Dr Ruth Collins-Nakai from the University of Alberta, Edmonton; Dr Philip W Connelly from St Michael's Hospital and University of Toronto, Toronto; Dr Catherine Donovan, Alison C Edwards and Dr Kevin Hogan, from Memorial University of Newfoundland, St John's; Dr Ron Dyck from Alberta Health, Edmonton; Dale Gelskey and Dr Sharon Macdonald from the University of Manitoba, Winnipeg; Dr Richard Lessard from Public Health Directorate, Montreal; Ella MacLeod from the Prince Edward Island Heart Health Program, Charlottetown; Mukund Nargundkar from Satistics Canada, Ottawa; Dr Brian A O'Connor from the University of British Columbia, Vancouver; Dr Gilles Paradis from McGill University, Montreal; Dr Andres Petrasovits from the Cardiovascular Disease Prevention Unit, Health and Welfare Canada, Ottawa; Dr Bruce A Reeder from the University of Saskatchewan, Saskatoon; Dr Richard Schabas from the Ontario Ministry of Health; Dr Sylvie Stachenko from Health Canada, Ottawa; Dr Lamont Sweet from the PEI Department of Health and Social Services, Charlottetown; and Rosemary White from the Heart and Stroke Foundation of PEI, Charlottetown.

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Dobbelsteyn, C., Joffres, M., MacLean, D. et al. A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes 25, 652–661 (2001).

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