title: A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury.
abstract: METHODS
  Literature review.
  
  
  BACKGROUND
  Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m(2))) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations.
  
  
  OBJECTIVE
  To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population.
  
  
  CONCLUSIONS
  We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia.
authors.affiliation: Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada.
authors.forename: A C
authors.initials: AC
authors.lastname: Buchholz
authors.forename: J M
authors.initials: JM
authors.lastname: Bugaresti
mesh_terms: D015992:Body Mass Index; D049628:Body Size; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D013223:Statistics as Topic; D049629:Waist-Hip Ratio