title: Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors.
abstract: OBJECTIVE
  This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors.
  
  
  METHODS
  The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO2 max) of the firefighters were also clinically assessed.
  
  
  RESULTS
  The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m(2) (vs. the standard definition of 25.0-29.9 kg/m(2)), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters.
  
  
  CONCLUSIONS
  BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m(2)) should be reported additionally for prevention of CVD among male firefighters.
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA. b.choi@uci.edu.
authors.forename: BongKyoo
authors.initials: B
authors.lastname: Choi
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Steiss
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Rivas
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Kojaku
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Schnall
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Marnie
authors.initials: M
authors.lastname: Dobson
authors.affiliation: Center for Occupational and Environmental Health, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, USA.
authors.forename: Dean
authors.initials: D
authors.lastname: Baker
mesh_terms: D050154:Adiposity; D000328:Adult; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D061388:Firefighters; D006801:Humans; D008297:Male; D009765:Obesity / Q000145:classification / Q000150:complications; D050177:Overweight / Q000145:classification / Q000150:complications; D012307:Risk Factors; D012885:Skinfold Thickness; D055105:Waist Circumference
keywords: California; Ethnicity; Gender; Obesity; Overweight; Professional firefighters