title: Combination of BMI and Waist Circumference for Identifying Cardiovascular Risk Factors in Whites.
abstract: OBJECTIVE
  BMI (kilograms per meters squared) and waist circumference (WC) (measured in centimeters) are each associated with the risk of developing cardiovascular disease (CVD). Therefore, a combination of the two may be more effective in identifying subjects at risk than either alone. The present study sought to identify the combination of BMI and WC that has the strongest association with CVD risk factors in whites.
  
  
  METHODS
  Subjects were 8712 white men and women from the Third National Health and Nutrition Examination Survey. The optimal combination of BMI and WC was developed using logistic regression models with BMI and WC as predictors and CVD risk factors as outcomes. The combined measure of BMI and WC using current cut-off points was also examined. Sensitivity, specificity, and receiver operating characteristics curves were compared between the combined measures and BMI alone.
  
  
  RESULTS
  For white men, the optimal combination of BMI and WC for identifying CVD risk factors was 0.68 x BMI + 0.32 x WC. This combination generated a score that better estimated the odds of having CVD risk factors than either alone. For white women, WC alone largely determined the likelihood of having CVD risks. The combination of BMI and WC using current cut-off points may provide an improved measure of CVD risk. Combined measures showed a higher sensitivity or a shorter distance in receiver operating characteristic curves in the identification of CVD risk factors.
  
  
  CONCLUSIONS
  Combined measures of BMI and WC may provide a higher overall test performance for CVD risk factors and may be useful in some ethnic groups as an improved means of screening subjects for further evaluation in the clinical setting.
authors.affiliation: New York Obesity Research Center, St. Luke's-Roosevelt Hospital Center and Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, USA. szhu@mcw.edu
authors.forename: Shankuan
authors.initials: S
authors.lastname: Zhu
authors.forename: Stanley
authors.initials: S
authors.lastname: Heshka
authors.forename: ZiMian
authors.initials: Z
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Shen
authors.forename: David B
authors.initials: DB
authors.lastname: Allison
authors.forename: Robert
authors.initials: R
authors.lastname: Ross
authors.forename: Steven B
authors.initials: SB
authors.lastname: Heymsfield
mesh_terms: D001824:Body Constitution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D044465:White People