title: Evidence of inappropriate cardiovascular risk assessment in middle-age women based on recommended cut-points for waist circumference.
abstract: OBJECTIVE
  Diverse waist circumference thresholds for assessment of metabolic and cardiovascular risk in Caucasians are recommended by different health professional organizations. We aimed to determine optimal sex-specific thresholds for anthropometric measures showing the strongest association with cardiovascular risk factors in a cohort of middle-aged Germans.
  
  
  RESULTS
  Statistical analyses are based on data from 426 mothers and 267 fathers of participants of the Ulm Birth Cohort Study undergoing a clinical follow-up examination in 2008 (median age 41 years) using logistic regression analyses. The prevalence of many cardiometabolic risk factors was significantly higher in men than in women; hypertension: 45%/17% (p < 0.0001), apolipoprotein ratio B/A1 > 0.72: 35%/9% (<0.0001), hyperglycemia: 11%/14% (p = 0.3), which is in contrast to the predicted cardiovascular risk of 52%/70% and 24%/36% based on thresholds for waist circumference proposed by International Diabetes Federation and American Heart Association, respectively. We determined optimal thresholds for waist circumference between 90 and 95 cm for men and women. Using a threshold of 92 cm the prevalence of abdominal obesity was 59% in men and 24% in women, which was in agreement with the higher prevalence of overweight and obesity in men than in women (Body Mass Index (BMI) > 25: 64%/35%). The prediction of cardiometabolic risk factors by waist circumference and waist-to-height ratio did not outperform the prediction by BMI. In contrast to BMI, waist circumference was correlated with body height independent of sex.
  
  
  CONCLUSIONS
  Currently proposed thresholds for waist circumference spuriously overestimate the cardiovascular risk in women, but not in men in a German population.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. Electronic address: i.florath@dkfz.de.
authors.forename: I
authors.initials: I
authors.lastname: Florath
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Brandt
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: M N
authors.initials: MN
authors.lastname: Weck
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Moss
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Gottmann
authors.affiliation: Institute of Epidemiology and Medical Biometry, Ulm University, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wabitsch
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D055105:Waist Circumference; D065927:Waist-Height Ratio
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D001786:Blood Glucose; D007328:Insulin
keywords: Assessment, risk; BMI; Cut-points; Syndrome, metabolic cardiovascular; Waist circumference