title: Ethnic differences in the association between waist-to-height ratio and albumin-creatinine ratio: the observational SUNSET study.
abstract: BACKGROUND
  Ethnic differences in the association between central obesity and raised albumin-creatinine ratio (ACR) have not been investigated. Our aim was to determine whether the association between central obesity, defined by the waist-to-height ratio (WHtR), and ACR differed between subjects of Hindustani-Surinamese, African-Surinamese and Dutch origin.
  
  
  METHODS
  In total, 334 Hindustani-Surinamese (~South Asian), 589 African-Surinamese (~African), and 493 Dutch (~European) men and women, aged 35-60 years, randomly selected from the municipal register of Amsterdam, participated in an interview and physical examination.We calculated the WHtR by dividing the waist circumference by height and the log ACR (logACR, log mg/mmol) by log-transforming the albumin concentration by the creatinine concentration in urine. The association between WHtR and logACR was studied in the total population and stratified by ethnicity. We also tested for interaction.
  
  
  RESULTS
  In the total population, a higher WHtR was associated with a higher logACR, after adjustment for sex, age, and smoking, body mass index and the presence of type 2 diabetes or hypertension. Among the Hindustani-Surinamese, the adjusted association between WHtR and logACR appeared somewhat stronger than among the other ethnic groups: for every 0.1 increase in the WHtR, the log-ACR increased by 0.522 (0.096-0.949) log mg/mmol among the Hindustani-Surinamese, by 0.334 (0.047-0.622) among the African-Surinamese and by 0.356 (-0.010-0.721) among the Dutch. However, the interaction was not statistically significant.
  
  
  CONCLUSIONS
  WHtR was associated with a higher ACR among populations of Hindustani-Surinamese, African-Surinamese and Dutch origin. Our study seems to support global use of WHtR in relation to ACR across ethnic groups. However, although not significant, the association appeared slightly stronger among the Hindustani-Surinamese than among the other ethnic groups. If confirmed, this could have implications for use of the WHtR across ethnic groups.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. i.g.vanvalkengoed@amc.uva.nl
authors.forename: Irene G M
authors.initials: IG
authors.lastname: van Valkengoed
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.forename: Ray T
authors.initials: RT
authors.lastname: Krediet
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D000419:Albuminuria / Q000208:ethnology* / Q000652:urine*; D001208:Asia / Q000208:ethnology; D001827:Body Height; D015897:Comorbidity; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009765:Obesity / Q000208:ethnology* / Q000652:urine*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055105:Waist Circumference
chemical_list: D003404:Creatinine