Title: Waist circumference, hip circumference, body mass index (BMI) , and ratios: Which best predicts type 2 diabetes mellitus in men and women?
1Waist circumference, hip circumference, body mass
index (BMI) , and ratios Which best predicts
type 2 diabetes mellitus in men and women?
- Harold E. Bays, MD
- Kathleen M. Fox, PhD
- Susan Grandy, PhD
- for the SHIELD Study Group
NAASO The Obesity Society Annual Scientific
Meeting, New Orleans October 24, 2007
2Background
- Adiposopathy is defined as pathogenic adipose
tissue - Promoted by positive caloric balance and
sedentary lifestyle in genetically and
environmentally susceptible patients - Anatomically manifested by adipocyte hypertrophy,
adipose tissue accumulation (adiposity) in the
visceral region, as well as ectopic fat
(triglyceride) deposition in peripheral organs
such as liver, muscle, and pancreas - Whose adverse metabolic and immune consequences
result in clinical metabolic disease
Bays HE et al. Future Cardiology.
20051(1)39-59
Bays HE. Expert Rev Cardiovas Ther.
20053(3)395-404
3Background
Bays H, Ballantyne C. Future Lipidology.
20061(4)389-420
4Background
EFRMDexcessive fat-related metabolic diseases
Bays H, Ballantyne C. Future Lipidology.
20061(4)389-420
5Background
Bays H, Ballantyne C. Future Lipidology.
20061(4)389420
6Adiposopathy Visceral and Peripheral Adipose
Tissue
Bays H, Blonde L, Rosenson R. Expert Rev
Cardiovas Ther. 4(6), 871895 (2006)
7SHIELD
- Study to Help Improve Early evaluation and
management of risk factors Leading to Diabetes
(SHIELD) - 5-year, national, longitudinal survey of
diabetes, CVD, and cardiometabolic risk in US
adults - Purpose To better understand patterns of health
behavior, knowledge and attitudes of people
living with type 2 diabetes (T2DM) and those at
high risk for its development - This analysis assessed anthropometric measures in
predicting type 2 diabetes in men and women
8Objective
- To assess gender-specific associations between
type 2 diabetes and adipose tissue parameters
9Methods Identifying Cohorts
- Screening questionnaire mailed to 200,000
nationally representative US households - Part of the TNS (formerly National Family
Opinion) consumer panel - Responses for 211,097 adults from 127,420
households (64 response rate) - Used to identify individuals who self-reported
- T2DM and other metabolic diseases
- Varying numbers of risk factors (0-5) associated
with T2DM diagnosis - Follow up 64-item survey was sent to 22,001
people, along with tape measure and instructions
for use - Type 1 diabetes (n1000), T2DM (n5000), History
of gestational diabetes (n1000), Control/at risk
(n15,000, 2400 in each risk level) - Responses from 17,640 adults (80 response rate
10,466 women 6,686 men)
TNS Taylor Nelson Sofres
10Risk Factor Definitions
Risk Factor Definition Abdominal obesity Men
waist circumference gt 97cm Women waist
circumference gt89 cm BMI ?28 kg/m2
Dyslipidemia Diagnosed with cholesterol
problems of any type Hypertension Diagnosed with
high blood pressure CV event One or more CV
problems or events (heart disease/myocardial
infarction, narrow or blocked arteries,
stroke, coronary artery bypass graft surgery/an
gioplasty/stents/surgery to clear arteries)
BMI body mass index CVcardiovascular
11Adipose Tissue Measures
- Waist circumference (WC) assesses pathogenic
visceral adipose tissue - Body mass index (BMI) assesses overall obesity,
with most of total fat being protective
subcutaneous adipose tissue - Hip circumference protective gluteal
subcutaneous adipose tissue - WC-BMI ratio pathogenic / protective adipose
tissue ratio - WC-HC ratio pathogenic / protective adipose
tissue ratio
12Statistical Analyses
- Distribution of measured and reported adipose
tissue parameters by quintiles of all respondents - Analyses stratified by gender
13NHLBI Treatment Guidelines for Adult Obesity
Bays H, Dujovne C. Curr Atheroscler Rep.
20068(2)144-156
14Results T2DM Women
Quintile n10466 women BMI kg/m2 N () n2212 T2DM women Quintile n9707 WC cm N () n2013 T2DM women
1 n2093 lt24.4 162 (7.3) 1 n1942 lt83.8 173 (8.6)
2 n2093 24.4 to 28.3 361 (16.3) 2 n1941 83.8 to 94.0 264 (13.1)
3 n2094 28.4 to 32.3 425 (19.2) 3 n1941 94.1 to 104.1 354 (17.6)
4 n2093 32.4 to 37.8 536 (24.2) 4 n1942 104.2 to 116.8 529 (26.3)
5 n2093 37.8 728 (32.9) 5 n1941 116.8 693 (34.4)
The highest percent of women with T2DM occurred
at the highest BMI and at the highest WC.
15Results T2DM Women
Quintile n9623 women WCBMI ratio N () n1998 T2DM women Quintile n9558 WCHC ratio N () n1985 T2DM women
1 n1925 lt2.93 484 (24.2) 1 n1912 lt0.81 217 (10.9)
2 n1925 2.93 to 3.17 413 (20.7) 2 n1911 0.81 to 0.86 295 (14.9)
3 n1924 3.18 to 3.38 369 (18.5) 3 n1911 0.87 to 0.90 384 (19.3)
4 n1924 3.39 to 3.64 363 (18.2) 4 n1912 0.91 to 0.95 473 (23.8)
5 n1925 gt3.64 369 (18.5) 5 n1912 0.95 616 (31.0)
The highest percent of women with T2DM occurred
at the lowest WCBMI ratio, and the highest WCHC
ratio.
16Results T2DM Men
Quintile n6686 men BMI kg/m2 N () n1613 T2DM men Quintile n6418 WC cm N () n1565 T2DM men
1 n1337 lt25.1 161 (10.0) 1 n1284 lt91.4 42 (2.7)
2 n1337 25.1 to 28.2 408 (25.3) 2 n1284 91.4 to 101.6 208 (13.3)
3 n1338 28.3 to 30.8 399 (24.7) 3 n1283 101.7 to 109.2 394 (25.2)
4 n1338 30.9 to 34.7 366 (22.7) 4 n1283 109.3 to 119.4 461 (29.5)
5 n1337 34.7 279 (17.3) 5 n1284 119.4 460 (29.4)
The highest percent of men with T2DM occurred at
the highest WC.
17ATP III The Metabolic Syndrome
Diagnosis is established when ?3 of these risk
factors are present.
Risk Factor Defining Level
Abdominal obesity(Waist circumference) Men Women gt102 cm (gt40 in)gt88 cm (gt35 in)
TG ?150 mg/dL
HDL-C Men Women lt40 mg/dLlt50 mg/dL
Blood pressure ?130/?85 mm Hg
Fasting glucose ?110 mg/dL
Expert Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults.
JAMA 20012852486-2497.
18Results T2DM Men
Quintile n6357 men WCBMI ratio N () n1548 T2DM men Quintile n6031 WCHC ratio N () n1470 T2DM men
1 n1271 lt3.24 99 (6.4) 1 n1206 lt0.90 21 (1.4)
2 n1272 3.24 to 3.46 156 (10.1) 2 n1206 0.90 to 0.95 46 (3.1)
3 n1272 3.47 to 3.64 257 (16.6) 3 n1207 0.96 to 1.00 147 (10.0)
4 n1271 3.65 to 3.87 414 (26.7) 4 n1206 1.01 to 1.05 357 (24.3)
5 n1271 3.87 622 (40.2) 5 n1206 1.05 899 (61.2)
The highest percent of men with T2DM occurred at
the highest WCBMI ratio and the highest WCHC
ratio.
19Summary
- In univariate analyses of women, the number of
patients with T2DM gradually increased with
increasing BMI, WC, and WCHC ratio, but not
WCBMI, indicated that total peripheral,
subcutaneous adipose tissue may not always be
protective - In men, univariate analyses indicated that WCHC
ratio was a better predictor of T2DM than WCBMI,
WC, or BMI, possibly reflecting the pathogenic
effects of having both increased visceral adipose
tissue relative lack of protective gluteal
and peripheral, subcutaneous adipose tissue.
20Back up slides
21Six Faces of Adiposopathy
Bays H, Blonde L, Rosenson R. Expert Rev
Cardiovas Ther. 4(6), 871895 (2006)
22Adiposopathy Treatment
Finally, an emerging concept is that the
development of anti-obesity agents must not only
reduce fat mass (adiposity) but must also correct
fat dysfunction (adiposopathy)
Bays HE. Obesity Research 2004 Vol. 12 No.
81197-1211.
23Adiposopathy Treatment
Adiposopathy treatments and their effects upon
select parameters that promote type 2 diabetes
mellitus
Intervention Visceral fat Free fatty acids Leptin Adiponectin Tumor necrosis factor alpha
Diet/Exercise ? ? ? ? ?
PPAR gamma agonists ?/- ? ?/- ? ?
Orlistat ? ? ? ? ?
Sibutramine ? ? ? ?/- ?
Cannabinoid receptor antagonists ? ? ? ? ?
Bays H, Blonde L, Rosenson R. Expert Rev
Cardiovas Ther. 4(6), 871895 (2006)
24Adiposopathy Treatment
Adiposopathy treatments and their effects upon
select parameters that promote hypertension
Intervention Visceral fat Free fatty acids Leptin Adiponectin Renin-angiotensin-aldosterone enzymes
Diet/Exercise ? ? ? ? ?
PPAR gamma agonists ?/- ? ?/- ? -
Orlistat ? ? ? ? ?
Sibutramine ? ? ? ?/- ?
Cannabinoid receptor antagonists ? ? ? ? ?
Bays H, Blonde L, Rosenson R. Expert Rev
Cardiovas Ther. 4(6), 871895 (2006)
25Adiposopathy Treatment
Adiposopathy treatments and their effects upon
select parameters that promote dyslipidemia
Intervention Visceral fat Free fatty acids Leptin Adiponectin Androgens Estrogens
Diet/Exercise ? ? ? ? ? (women) ? (men) ?/- (men)
PPAR gamma agonists ?/- ? ?/- ? ? ?/- (men)
Orlistat ? ? ? ? ? (women) ?
Sibutramine ? ? ? ?/- ? (women) ?
Cannabinoid receptor antagonists ? ? ? ? ? ?
Bays H, Blonde L, Rosenson R. Expert Rev
Cardiovas Ther. 4(6), 871895 (2006)
26Bays H, Ballantyne C. Future Lipidology.
20061(4)389-420 Bays H et al. Expert Rev
Cardiovasc Ther. 20053(5)789-820
27Bays H, Ballantyne C. Future Lipidology.
20061(4)389-420