Obesity-Linked Disease Predictors in Middle-Aged Women

Posted by Lloyd on February 22, 2012
Women's Health

Physicians and scientists have long known that obesity, or excess body fat, can expose individuals to increased risk of conditions such as osteoarthritis, heart disease, diabetes and some types of cancer.

There are several measurements commonly used to determine if an individual should be considered obese, and thus at increased risk. It is not clear, however, which measure best predicts increased risk.

In an effort to determine which anthropometric, or body measurement, characteristics are best predictors of disease, researchers examined data from more than 30,000 middle-aged women in the Iowa Women’s Health Study. Their report, published in the July 24 issue of the Archives of Internal Medicine, suggests that two measurements — body mass index (BMI) and the waist-to-hip circumference ratio (WHR) — may be particularly useful.

BMI is calculated as the ratio of body weight divided by height squared. It is an index of general fatness for most individuals. However, the presence of obesity alone does not tell the whole story of disease risk — the distribution of the excess body fat is also important.

Obese people whose excess fat is mostly abdominal, which is characteristic for men, tend to have a higher risk of diabetes and heart disease than people whose fat is located more on hips and thighs. This peripheral distribution is most commonly seen in pre-menopausal women. Abdominal obesity may be inferred from waist circumference alone, or from the WHR.

The link between abdominal obesity and disease is based mostly on reports evaluating men and younger women. The current report both extends the description to older women, and looks at the roles of different obesity patterns in multiple diseases.

The investigators, led by Dr. A.R. Folsom of the University of Minnesota, followed the health status of 31,702 Iowa women for 11 to 12 years. The subjects were 55 to 69 years old when the study began. Participants reported the presence or absence of physician-diagnosed cancers, heart disease, high blood pressure or diabetes. They also reported their height, weight, and waist and hip circumferences. These measurements allowed the investigators to calculate the subjects’ BMIs and WHRs, and assess the strength of the association between these obesity measurements and disease occurrence or death.

The investigation indicated that while general obesity tended to be a poor predictor of total mortality in these older women, abdominal obesity, as measured by WHR, was associated with a significant (50 percent) increase in risk. Those women in the group with the highest WHR also had a 2.5-fold increased risk of coronary heart disease, compared to women with the lowest WHRs; the highest levels of BMI and waist circumference were also associated with significantly increased risk.

Each measure considered separately approximately doubled the risk of high blood pressure. When the group with highest BMI and WHR levels was examined, they had a 2.8-fold increased risk of high blood pressure.

The greatest impact of general and abdominal obesity in these women was on the risk of developing diabetes. A BMI in the highest one-fifth increased the risk of diabetes 13.8-fold; the group with the greatest waist circumference had a 16.5-fold increased risk; and the group with the greatest WHR had an 11.5-fold increased risk. The most impressive increase was found in the group that had the highest BMIs and WHRs: This group had a 29-fold increased risk of developing diabetes.

Folsom and colleagues concluded that “clinical guidelines using BMI and waist circumference indeed identify older women at risk of diabetes, hypertension [high blood pressure] and CVD [cardiovascular disease].” But they found that for prediction of increased risk of mortality, as well as increased risk of some diseases, WHR might be more useful than simple waist circumference.

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