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Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study

Abstract

OBJECTIVE: Fat distribution as measured by waist-to-hip ratio has been shown to be an important independent predictor of glucose intolerance. Few studies, however, have considered the contributions of the waist and hip circumferences independently. The aim of this study was to investigate the independent associations of waist and hip circumference with diabetes in a large population-based study, and to investigate whether they also apply to other major components of the metabolic syndrome (hypertension and dyslipidemia). In addition, as previous studies were performed in older persons, we investigated whether these associations were present across adult age groups.

METHODS: Weight, height, waist and hip circumferences were measured in 11 247 participants of the nationally representative Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. HDL-cholesterol, triglycerides, fasting and 2-h postload glucose were determined, and diastolic and systolic blood pressure was measured. After exclusion of persons already known to have diabetes, hypertension or dyslipidemia, logistic and linear regression were used to study cross-sectional associations of anthropometric variables with newly diagnosed diabetes, hypertension and dyslipidemia, and with continuous metabolic measures, all separately for men (n=3818) and women (n=4582). Analyses were repeated in the same population stratified for age.

RESULTS: After adjustment for age, body mass index and waist, a larger hip circumference was associated with a lower prevalence of undiagnosed diabetes (odds ratio (OR) per one s.d. increase in hip circumference 0.55 (95% CI 0.41–0.73) in men and 0.42 (0.27–0.65) in women) and undiagnosed dyslipidemia (OR 0.58 (0.50–0.67) in men and 0.37 (0.30–0.45) in women). Associations with undiagnosed hypertension were weaker (OR 0.80 (0.69–0.93) in men and 0.88 (0.70–1.11) in women). As expected, larger waist circumference was associated with higher prevalence of these conditions. Similar associations were found using continuous metabolic variables as outcomes in linear regression analyses. Height partly explained the negative associations with hip circumference. When these analyses were performed stratified for age, associations became weaker or disappeared in the oldest age groups (age ≥75 y in particular), except for HDL-cholesterol.

CONCLUSION: We found independent and opposite associations of waist and hip circumference with diabetes, dyslipidemia and less strongly with hypertension in a large population-based survey. These results emphasize that waist and hip circumference are important predictors for the metabolic syndrome and should both be considered in epidemiological studies. The associations were consistent in all age groups, except in age ≥75 y. Further research should be aimed at verifying hypotheses explaining the ‘protective’ effect of larger hips.

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References

  1. de Vegt F, Dekker JM, Jager A, Hienkens E, Kostense PJ, Stehouwer CD, Nijpels G, Bouter LM, Heine RJ . Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 2001; 285: 2109–2113.

    CAS  Article  Google Scholar 

  2. Snijder MB, Dekker JM, Visser M, Bouter LM, Stehouwer CDA, Kostense PJ, Yudkin JS, Heine RJ, Nijpels G, Seidell JC . Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am J Clin Nutr 2003; 77: 1192–1197.

    CAS  Article  Google Scholar 

  3. Lakka HM, Lakka TA, Tuomilehto J, Salonen JT . Abdominal obesity is associated with increased risk of acute coronary events in men. Eur Heart J 2002; 23: 706–713.

    Article  Google Scholar 

  4. Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C . Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis 1990; 10: 497–511.

    CAS  Article  Google Scholar 

  5. Han TS, McNeill G, Seidell JC, Lean ME . Predicting intra-abdominal fatness from anthropometric measures: the influence of stature. Int J Obes Relat Metab Disord 1997; 21: 587–593.

    CAS  Article  Google Scholar 

  6. Bjorntorp P . Metabolic implications of body fat distribution. Diabetes Care 1991; 14: 1132–1143.

    CAS  Article  Google Scholar 

  7. Despres JP, Lemieux S, Lamarche B, Prud'homme D, Moorjani S, Brun LD, Gagne C, Lupien PJ . The insulin resistance-dyslipidemic syndrome: contribution of visceral obesity and therapeutic implications. Int J Obes Relat Metab Disord 1995; 19 (Suppl 1): S76–S86.

    PubMed  Google Scholar 

  8. Arner P . Insulin resistance in type 2 diabetes: role of fatty acids. Diabetes Metab Res Rev 2002; 18 (Suppl 2): S5–S9.

    CAS  Article  Google Scholar 

  9. Goodpaster BH, Thaete FL, Simoneau JA, Kelley DE . Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes 1997; 46: 1579–1585.

    CAS  Article  Google Scholar 

  10. Abate N, Garg A, Peshock RM, Stray-Gundersen J, Grundy SM . Relationships of generalized and regional adiposity to insulin sensitivity in men. J Clin Invest 1995; 96: 88–98.

    CAS  Article  Google Scholar 

  11. Seidell JC, Han TS, Feskens EJ, Lean ME . Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. J Intern Med 1997; 242: 401–406.

    CAS  Article  Google Scholar 

  12. Chowdhury B, Lantz H, Sjostrom L . Computed tomography-determined body composition in relation to cardiovascular risk factors in Indian and matched Swedish males. Metabolism 1996; 45: 634–644.

    CAS  Article  Google Scholar 

  13. Seidell JC, Perusse L, Despres JP, Bouchard C . Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. Am J Clin Nutr 2001; 74: 315–321.

    CAS  Article  Google Scholar 

  14. Lissner L, Bjorkelund C, Heitmann BL, Seidell JC, Bengtsson C . Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res 2001; 9: 644–646.

    CAS  Article  Google Scholar 

  15. Snijder MB, Dekker JM, Visser M, Yudkin JS, Stehouwer CD, Bouter LM, Heine RJ, Nijpels G, Seidell JC . Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn Study. Obes Res 2003; 11: 104–111.

    Article  Google Scholar 

  16. Dunstan DW, Zimmet PZ, Welborn TA, Cameron AJ, Shaw J, de Courten M, Jolley D, McCarty DJ . The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)—methods and response rates. Diabetes Res Clin Pract 2002; 57: 119–129.

    Article  Google Scholar 

  17. Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA, Dwyer T, Colagiuri S, Jolley D, Knuiman M, Atkins R, Shaw JE . The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2002; 25: 829–834.

    Article  Google Scholar 

  18. WHO. Definition, diagnosis and classification of diabetes mellitus and its complications. Department of Noncommunicable Disease Surveillance : Geneva; 1999.

  19. Best JD, Jerums G, Newnham HH, O'Brien RC . Diabetic dyslipidaemia. Australian Diabetes Society position statement. Med J Aust 1995; 162: 91–93.

    CAS  PubMed  Google Scholar 

  20. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines subcommittee. J Hypertens 1999; 17: 151–183.

  21. Gallagher D, Visser M, De Meersman RE, Sepulveda D, Baumgartner RN, Pierson RN, Harris T, Heymsfield SB . Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol 1997; 83: 229–239.

    CAS  Article  Google Scholar 

  22. Arner P . Differences in lipolysis between human subcutaneous and omental adipose tissues. Ann Med 1995; 27: 435–438.

    CAS  Article  Google Scholar 

  23. Rebuffe-Scrive M, Enk L, Crona N, Lonnroth P, Abrahamsson L, Smith U, Bjorntorp P . Fat cell metabolism in different regions in women. Effect of menstrual cycle, pregnancy, and lactation. J Clin Invest 1985; 75: 1973–1976.

    CAS  Article  Google Scholar 

  24. Frayn KN . Adipose tissue as a buffer for daily lipid flux. Diabetologia 2002; 45: 1201–1210.

    CAS  Article  Google Scholar 

  25. Ravussin E, Smith SR . Increased fat intake, impaired fat oxidation, and failure of fat cell proliferation result in ectopic fat storage, insulin resistance, and type 2 diabetes mellitus. Ann NY Acad Sci 2002; 967: 363–378.

    CAS  Article  Google Scholar 

  26. McGarry JD . Banting lecture 2001: dysregulation of fatty acid metabolism in the etiology of type 2 diabetes. Diabetes 2002; 51: 7–18.

    CAS  Article  Google Scholar 

  27. Goodpaster BH, Thaete FL, Kelley DE . Thigh adipose tissue distribution is associated with insulin resistance in obesity and in type 2 diabetes mellitus. Am J Clin Nutr 2000; 71: 885–892.

    CAS  Article  Google Scholar 

  28. Seppala-Lindroos A, Vehkavaara S, Hakkinen AM, Goto T, Westerbacka J, Sovijarvi A, Halavaara J, Yki-Jarvinen H . Fat accumulation in the liver is associated with defects in insulin suppression of glucose production and serum free fatty acids independent of obesity in normal men. J Clin Endocrinol Metab 2002; 87: 3023–3028.

    CAS  Article  Google Scholar 

  29. Tiikkainen M, Tamminen M, Hakkinen AM, Bergholm R, Vehkavaara S, Halavaara J, Teramo K, Rissanen A, Yki-Jarvinen H . Liver-fat accumulation and insulin resistance in obese women with previous gestational diabetes. Obes Res 2002; 10: 859–867.

    CAS  Article  Google Scholar 

  30. Williams MJ, Hunter GR, Kekes-Szabo T, Snyder S, Treuth MS . Regional fat distribution in women and risk of cardiovascular disease. Am J Clin Nutr 1997; 65: 855–860.

    CAS  Article  Google Scholar 

  31. Van Pelt RE, Evans EM, Schechtman KB, Ehsani AA, Kohrt WM . Contributions of total and regional fat mass to risk for cardiovascular disease in older women. Am J Physiol Endocrinol Metab 2002; 282: E1023–E1028.

    CAS  Article  Google Scholar 

  32. Pouliot MC, Despres JP, Nadeau A, Moorjani S, Prud'Homme D, Lupien PJ, Tremblay A, Bouchard C . Visceral obesity in men. Associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes 1992; 41: 826–834.

    CAS  Article  Google Scholar 

  33. Hunter GR, Kekes-Szabo T, Snyder SW, Nicholson C, Nyikos I, Berland L . Fat distribution, physical activity, and cardiovascular risk factors. Med Sci Sports Exerc 1997; 29: 362–369.

    CAS  Article  Google Scholar 

  34. Terry RB, Stefanick ML, Haskell WL, Wood PD . Contributions of regional adipose tissue depots to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh fat. Metabolism 1991; 40: 733–740.

    CAS  Article  Google Scholar 

  35. Tanko LB, Bagger YZ, Alexandersen P, Larsen PJ, Christiansen C . Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women. Circulation 2003; 107: 1626–1631.

    Article  Google Scholar 

  36. Kristjansson K, Sigurdsson JA, Lissner L, Sundh V, Bengtsson C . Blood pressure and pulse pressure development in a population sample of women with special reference to basal body mass and distribution of body fat and their changes during 24 years. Int J Obes Relat Metab Disord 2003; 27: 128–133.

    CAS  Article  Google Scholar 

  37. Goff Jr DC, Zaccaro DJ, Haffner SM, Saad MF . Insulin sensitivity and the risk of incident hypertension: insights from the Insulin Resistance Atherosclerosis Study. Diabetes Care 2003; 26: 805–809.

    Article  Google Scholar 

  38. Suter PM, Sierro C, Vetter W . Nutritional factors in the control of blood pressure and hypertension. Nutr Clin Care 2002; 5: 9–19.

    Article  Google Scholar 

  39. Ljung T, Holm G, Friberg P, Andersson B, Bengtsson BA, Svensson J, Dallman M, McEwen B, Bjorntorp P . The activity of the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system in relation to waist/hip circumference ratio in men. Obes Res 2000; 8: 487–495.

    CAS  Article  Google Scholar 

  40. Bjorntorp P . Body fat distribution, insulin resistance, and metabolic diseases. Nutrition 1997; 13: 795–803.

    CAS  Article  Google Scholar 

  41. Seidell JC, Bouchard C . Visceral fat in relation to health: is it a major culprit or simply an innocent bystander? Int J Obes 1997; 21: 626–631.

    CAS  Article  Google Scholar 

  42. Byrne CD, Phillips DI . Fetal origins of adult disease: epidemiology and mechanisms. J Clin Pathol 2000; 53: 822–828.

    CAS  Article  Google Scholar 

  43. Barker DJ . Fetal origins of coronary heart disease. BMJ 1995; 311: 171–174.

    CAS  Article  Google Scholar 

  44. Hill DJ, Duvillie B . Pancreatic development and adult diabetes. Pediatr Res 2000; 48: 269–274.

    CAS  Article  Google Scholar 

  45. Singhal A, Wells J, Cole TJ, Fewtrell M, Lucas A . Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease? Am J Clin Nutr 2003; 77: 726–730.

    CAS  Article  Google Scholar 

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Acknowledgements

MBS received grants from the European Foundation for the Study of Diabetes and Van Walree Fund, Royal Netherlands Academy of Arts and Sciences. We are most grateful to the following for their support of the AusDiab study: The Commonwealth Department of Health and Aged Care, Eli Lilly (Aust) Pty Ltd, Janssen—Cilag (Aust) Pty Ltd, Knoll Australia Pty Ltd, Merck Lipha s.a., Alphapharm Pty Ltd, Merck Sharp & Dohme (Aust), Roche Diagnostics, Servier Laboratories (Aust) Pty Ltd, SmithKline Beecham International, Pharmacia and Upjohn Pty Ltd, BioRad Laboratories Pty Ltd, HITECH Pathology Pty Ltd, the Australian Kidney Foundation, Diabetes Australia (Northern Territory), Queensland Health, South Australian Department of Human Services, Tasmanian Department of Health and Human Services, Territory Health Services, Victorian Department of Human Services and Health Department of Western Australia. For their invaluable contribution to the field activities of AusDiab, we are enormously grateful to Annie Allman, Marita Dalton, Adam Meehan, Claire Reid, Alison Stewart, Robyn Tapp and Fay Wilson.

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Correspondence to M B Snijder.

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Snijder, M., Zimmet, P., Visser, M. et al. Independent and opposite associations of waist and hip circumferences with diabetes, hypertension and dyslipidemia: the AusDiab Study. Int J Obes 28, 402–409 (2004). https://doi.org/10.1038/sj.ijo.0802567

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Keywords

  • body composition
  • fat distribution
  • type II diabetes
  • hypertension
  • dyslipidemia
  • anthropometry

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