Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Waist circumference and obesity-related abnormalities in French and Cameroonian adults: the role of urbanization and ethnicity

International Journal of Obesity volume 34, pages 446–453 (2010)Cite this article

Subjects

Abstract

Objectives:

To evaluate the effect of urbanization and ethnicity on correlations between waist circumference (WC) and obesity-related cardiovascular risk factors.

Methods:

1471 rural and urban Cameroonians, and 4185 French, from community-based studies, aged ⩾25 years, not treated for hypertension, diabetes and dyslipidemia participated in this study. Slopes of obesity-related abnormalities with WC were compared using an interaction term between place of residence and WC.

Results:

Women in urban Cameroon and men in France had significantly higher WC and BMI relative to their gender counterparts. Urban Cameroonians had higher abdominal adiposity, but lower BP and better metabolic profile than the French. WC was positively associated to all the obesity-related abnormalities in the three sites except to FPG (both genders) and blood lipids (women) in rural Cameroon. A 5 cm larger WC was associated with a higher increment among urban than rural Cameroonians for diastolic blood pressure (DBP) (women, 1.95/0.63 mm Hg; men, 2.56/1.44 mm Hg), HOMA-IR (women, 0.11/0.05), fasting plasma glucose (FPG) (men, 0.09/−0.01 mmol/l) and triglycerides (women, 0.06/0.01 mmol/l; men, 0.09/0.03 mmol/l), all P<0.05. A 5 cm larger WC was associated with a higher increment among urban Cameroon than French people for DBP (women, 1.95/1.28 mm Hg, P<0.01; men, 2.56/1.49 mm Hg, P<0.01), but with a lower increment for HOMA-IR (women, 0.11/0.14, P<0.05), FPG (women, 0.05/0.09 mmol/l), total cholesterol (women, 0.07/0.11 mmol/l; men, 0.10/0.13 mmol/l) and triglycerides (women, 0.06/0.11 mmol/l; men, 0.09/0.13 mmol/l) all P<0.05.

Conclusion:

Ethnicity and urbanization modify the association of WC with obesity-related metabolic abnormalities. WC cutoff points derived from Caucasians may not be appropriate for black Sub-Saharan Africans.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE . Adiposity as compared with physical activity in predicting mortality among women. New Engl J Med 2004; 351: 2694–2703.

    Article  CAS  Google Scholar 

  2. Solomon CG, Manson JE . Obesity and mortality: a review of the epidemiologic data. Am J Clin Nutr 1997; 66: 1044S–1050S.

    Article  CAS  Google Scholar 

  3. Wannamethee SG, Shaper AG, Walker M . Weight change, weight fluctuation, and mortality. Arch Int Med 2002; 162: 2575–2580.

    Article  Google Scholar 

  4. Wannamethee SG, Shaper AG, Walker M . Overweight and obesity and weight change in middle aged men: impact on cardiovascular disease and diabetes. J Epidemiol Community Health 2005; 59: 134–139.

    Article  Google Scholar 

  5. World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Report of WHO Consultation on Obesity, 3–5 June 1997. WHO/NUT/NCD/98.1: Geneva.

  6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

    Article  Google Scholar 

  7. Adams-Campbell LL, Nwankwo M, Ukoli F, Omene J, Haile GT, Kuller LH . Body fat distribution patterns and blood pressure in black and white women. J Natl Med Assoc 1990; 82: 573–576.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK et al. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metabol 1982; 54: 254–260.

    Article  CAS  Google Scholar 

  9. Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994; 73: 460–468.

    Article  CAS  Google Scholar 

  10. Seidell JC, Oosterlee A, Deurenberg P, Hautvast JG, Ruijs JH . Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Euro J Clin Nutr 1988; 42: 805–815.

    CAS  Google Scholar 

  11. Wei M, Gaskill SP, Haffner SM, Stern MP . Waist circumference as the best predictor of noninsulin dependent diabetes mellitus (NIDDM) compared to body mass index, waist/hip ratio and other anthropometric measurements in Mexican Americans—a 7-year prospective study. Obesity Res 1997; 5: 16–23.

    Article  CAS  Google Scholar 

  12. Bouchard C, Bray GA, Hubbard VS . Basic and clinical aspects of regional fat distribution. Am J Clin Nutr 1990; 52: 946–950.

    Article  CAS  Google Scholar 

  13. Molarius A, Seidell JC . Selection of anthropometric indicators for classification of abdominal fatness—a critical review. Int J Obes Relat Metab Disord 1998; 22: 719–727.

    Article  CAS  Google Scholar 

  14. Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K . Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project. J Clin Epidemiol 1999; 52: 1213–1224.

    Article  CAS  Google Scholar 

  15. Despres JP, Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC et al. Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study. Arterioscler, Thromb Vasc Biol 2000; 20: 1932–1938.

    Article  CAS  Google Scholar 

  16. Lemieux S, Prud’homme D, Bouchard C, Tremblay A, Despres JP . Sex differences in the relation of visceral adipose tissue accumulation to total body fatness. Am J Clin Nutr 1993; 58: 463–467.

    Article  CAS  Google Scholar 

  17. Razak F, Anand S, Vuksan V, Davis B, Jacobs R, Teo KK et al. Ethnic differences in the relationships between obesity and glucose-metabolic abnormalities: a cross-sectional population-based study. Int J Obes 2005; 29: 656–667.

    Article  CAS  Google Scholar 

  18. Fezeu L, Minkoulou E, Balkau B, Kengne AP, Awah P, Unwin N et al. Association between socioeconomic status and adiposity in urban Cameroon. Int J Epidemiol 2006; 35: 105–111.

    Article  Google Scholar 

  19. Kamadjeu RM, Edwards R, Atanga JS, Kiawi EC, Unwin N, Mbanya JC . Anthropometry measures and prevalence of obesity in the urban adult population of Cameroon: an update from the Cameroon Burden of Diabetes Baseline Survey. BMC Public Health 2006; 6: 228.

    Article  Google Scholar 

  20. Sobngwi E, Mbanya JC, Unwin NC, Kengne AP, Fezeu L, Minkoulou EM et al. Physical activity and its relationship with obesity, hypertension and diabetes in urban and rural Cameroon. Int J Obes Relat Metab Disord 2002; 26: 1009–1016.

    Article  CAS  Google Scholar 

  21. Fezeu L, Balkau B, Kengne AP, Sobngwi E, Mbanya JC . Metabolic syndrome in a sub-Saharan African setting: central obesity may be the key determinant. Atherosclerosis 2007; 193: 70–76.

    Article  CAS  Google Scholar 

  22. Mbanya JC, Minkoulou EM, Salah JN, Balkau B . The prevalence of hypertension in rural and urban Cameroon. Int J Epidemiol 1998; 27: 181–185.

    Article  CAS  Google Scholar 

  23. Mbanya JC, Ngogang J, Salah JN, Minkoulou E, Balkau B . Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon. Diabetologia 1997; 40: 824–829.

    Article  CAS  Google Scholar 

  24. Balkau B, Eschwege E, Tichet J, Marre M . Proposed criteria for the diagnosis of diabetes: evidence from a French epidemiological study (D.E.S.I.R.). Diabetes Metab 1997; 23: 428–434.

    CAS  Google Scholar 

  25. Balkau B, Vernay M, Mhamdi L, Novak M, Arondel D, Vol S et al. The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French D.E.S.I.R. study. Diabetes Metab 2003; 29: 526–532.

    Article  CAS  Google Scholar 

  26. McKeigue PM, Shah B, Marmot MG . Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991; 337: 382–386.

    Article  CAS  Google Scholar 

  27. Alberti KG, Zimmet P, Shaw J . The metabolic syndrome—a new worldwide definition. Lancet 2005; 366: 1059–1062.

    Article  Google Scholar 

  28. Janssen I, Katzmarzyk PT, Ross R . Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch Int Med 2002; 162: 2074–2079.

    Article  Google Scholar 

  29. Lear SA, Toma M, Birmingham CL, Frohlich JJ . Modification of the relationship between simple anthropometric indices and risk factors by ethnic background. Metabol: Clin Exp 2003; 52: 1295–1301.

    Article  CAS  Google Scholar 

  30. Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Charles MA, Bennett PH . A two-step model for development of non-insulin-dependent diabetes. Am J Med 1991; 90: 229–235.

    Article  CAS  Google Scholar 

  31. Wannamethee SG, Shaper AG . Physical activity and cardiovascular disease. Semin Vasc Med 2002; 2: 257–266.

    Article  Google Scholar 

  32. Harris MM, Stevens J, Thomas N, Schreiner P, Folsom AR . Associations of fat distribution and obesity with hypertension in a bi-ethnic population: the ARIC study. Atherosclerosis Risk in Communities Study. Obes Res 2000; 8: 516–524.

    Article  CAS  Google Scholar 

  33. Kramer H, Han C, Post W, Goff D, Diez-Roux A, Cooper R et al. Racial/ethnic differences in hypertension and hypertension treatment and control in the multi-ethnic study of atherosclerosis (MESA). Am J Hypertens 2004; 17: 963–970.

    Article  Google Scholar 

  34. Lloyd-Jones DM, Sutton-Tyrrell K, Patel AS, Matthews KA, Pasternak RC, Everson-Rose SA et al. Ethnic variation in hypertension among premenopausal and perimenopausal women: Study of Women's Health Across the Nation. Hypertension 2005; 46: 689–695.

    Article  CAS  Google Scholar 

  35. Mennen LI, Mbanya JC, Cade J, Balkau B, Sharma S, Chungong S et al. The habitual diet in rural and urban Cameroon. Euro J Clin Nutr 2000; 54: 150–154.

    Article  CAS  Google Scholar 

  36. Deurenberg P, Yap M, van Staveren WA . Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 1998; 22: 1164–1171.

    Article  CAS  Google Scholar 

  37. Lovejoy JC, de la Bretonne JA, Klemperer M, Tulley R . Abdominal fat distribution and metabolic risk factors: effects of race. Metabol Clin Exp 1996; 45: 1119–1124.

    Article  CAS  Google Scholar 

  38. Albu JB, Murphy L, Frager DH, Johnson JA, Pi-Sunyer FX . Visceral fat and race-dependent health risks in obese nondiabetic premenopausal women. Diabetes 1997; 46: 456–462.

    Article  CAS  Google Scholar 

  39. Conway JM . Ethnicity and energy stores. Am J Clin Nutr 1995; 62: 1067S–1071S.

    Article  CAS  Google Scholar 

  40. Conway JM, Chanetsa FF, Wang P . Intraabdominal adipose tissue and anthropometric surrogates in African American women with upper- and lower-body obesity. Am J Clin Nutr 1997; 66: 1345–1351.

    Article  CAS  Google Scholar 

  41. Heitmann BL, Frederiksen P, Lissner L . Hip circumference and cardiovascular morbidity and mortality in men and women. Obes Res 2004; 12: 482–487.

    Article  Google Scholar 

  42. 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.

    Article  CAS  Google Scholar 

  43. Snijder MB, Zimmet PZ, Visser M, Dekker JM, Seidell JC, Shaw JE . Independent association of hip circumference with metabolic profile in different ethnic groups. Obes Res 2004; 12: 1370–1374.

    Article  Google Scholar 

Download references

Acknowledgements

The 1994 Cameroon study was supported by a grant from the European Union, contract NO TS3* CT92-0142. The insulin assays were undertaken in the Department of Medicine, University of Newcastle upon Tyne thanks to a generous support from Professor George Alberti. The DESIR study has been supported by INSERM contracts with CNAMTS, Lilly, Novartis Pharma and Sanofi-Aventis; by INSERM (Réseaux en Santé Publique, Interactions entre les determinants de la santé), the Association Diabète Risque Vasculaire, the Fédération Française de Cardiologie, La Fondation de France, ALFEDIAM, ONIVINS, Ardix Medical, Bayer Diagnostics, Becton Dickinson, Cardionics, Merck Santé, Novo Nordisk, Pierre Fabre, Roche, Topcon. The DESIR Study Group. INSERM U780: B Balkau, P Ducimetière, E Eschwège; INSERM U367: F Alhenc-Gelas; CHU D’Angers: Y Gallois, A Girault; Bichat Hospital: F Fumeron, M Marre; Centres d’Examens de Santé: Alençon, Angers, Caen, Chateauroux, Cholet, Le Mans, Tours; Institute de Recherche Médecine Générale: J Cogneau; General practitioners of the region; Institute inter-Regional pour la Santé: C Born, E Caces, M Cailleau, JG Moreau, F Rakotozafy, J Tichet, S Vol.

Author information

Authors and Affiliations

  1. INSERM U780-IFR69, Epidemiological and Biostatistical Research, Villejuif, France

    L Fezeu, B Balkau & P Ducimetiere

  2. Univ Paris-Sud, Orsay, France

    L Fezeu, B Balkau & P Ducimetiere

  3. Health of Population in Transition Research Group, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon

    L Fezeu & J-C Mbanya

  4. Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

    E Sobngwi

  5. The George Institute for International Health, The University of Sydney, Sydney, Australia

    A-P Kengne

  6. Institut inter Régional pour la Santé, La Riche, France

    S Vol

Authors
  1. L Fezeu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B Balkau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E Sobngwi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A-P Kengne
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Vol
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P Ducimetiere
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J-C Mbanya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L Fezeu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fezeu, L., Balkau, B., Sobngwi, E. et al. Waist circumference and obesity-related abnormalities in French and Cameroonian adults: the role of urbanization and ethnicity. Int J Obes 34, 446–453 (2010). https://doi.org/10.1038/ijo.2009.256

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2009.256

Keywords

This article is cited by

Search

Advanced search

Quick links