Use of waist circumference to predict insulin resistance: retrospective study -- Wahrenberg et al. 330 (7504): 1363 -- BMJ
Use of waist circumference to predict insulin resistance: retrospective study -- Wahrenberg et al. 330 (7504): 1363 -- BMJ
A waist circumference of < 100 cm excludes individuals of both sexes from being at risk of being insulin resistant. Waist circumference is a strong independent risk factor for insulin resistance and the most powerful regressor in our model. It replaces body mass index, waist:hip ratio, and other measures of total body fat as a predictor of insulin resistance and explains more than 50% of the variation in insulin sensitivity alone.
Current guidelines suggest a cut-off of 102 cm in men and 88 cm in women, on the basis of the many metabolic risk factors after waist circumference is stratified in fifths.3 However, with 88 cm as a cut-off in women the specificity drops markedly. In the San Antonio heart study, twice as many women as men had a waist circumference above the level given in the current guidelines, whereas the prevalence of the metabolic syndrome was similar in both sexes, thus supporting the notion that abdominal obesity is overestimated in women.4 The coupling of insulin resistance with abdominal obesity suggests a biological link at the fat cell level. Hyperinsulinaemia activates 11{beta}-hydroxysteroid dehydrogenase in omental adipose tissue, thus generating active cortisol and promoting a cushingoid fat distribution.5 Waist circumference is a simple tool to exclude insulin resistance and to identify those at greatest risk (therefore those who would benefit most from lifestyle adjustments).
A waist circumference of < 100 cm excludes individuals of both sexes from being at risk of being insulin resistant. Waist circumference is a strong independent risk factor for insulin resistance and the most powerful regressor in our model. It replaces body mass index, waist:hip ratio, and other measures of total body fat as a predictor of insulin resistance and explains more than 50% of the variation in insulin sensitivity alone.
Current guidelines suggest a cut-off of 102 cm in men and 88 cm in women, on the basis of the many metabolic risk factors after waist circumference is stratified in fifths.3 However, with 88 cm as a cut-off in women the specificity drops markedly. In the San Antonio heart study, twice as many women as men had a waist circumference above the level given in the current guidelines, whereas the prevalence of the metabolic syndrome was similar in both sexes, thus supporting the notion that abdominal obesity is overestimated in women.4 The coupling of insulin resistance with abdominal obesity suggests a biological link at the fat cell level. Hyperinsulinaemia activates 11{beta}-hydroxysteroid dehydrogenase in omental adipose tissue, thus generating active cortisol and promoting a cushingoid fat distribution.5 Waist circumference is a simple tool to exclude insulin resistance and to identify those at greatest risk (therefore those who would benefit most from lifestyle adjustments).
posted by Aloyzio Achutti at 2:44 PM
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