Snijder M B, Zimmet P Z, Visser M, Dekker J M, Seidell J C, Shaw J E
International Diabetes Institute, Caulfield, Victoria, Australia.
Int J Obes Relat Metab Disord. 2004 Mar;28(3):402-9. doi: 10.1038/sj.ijo.0802567.
Fat distribution as measured by waist-to-hip ratio has been shown to be an important independent predictor of glucose intolerance. Few studies, however, have considered the contributions of the waist and hip circumferences independently. The aim of this study was to investigate the independent associations of waist and hip circumference with diabetes in a large population-based study, and to investigate whether they also apply to other major components of the metabolic syndrome (hypertension and dyslipidemia). In addition, as previous studies were performed in older persons, we investigated whether these associations were present across adult age groups.
Weight, height, waist and hip circumferences were measured in 11 247 participants of the nationally representative Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. HDL-cholesterol, triglycerides, fasting and 2-h postload glucose were determined, and diastolic and systolic blood pressure was measured. After exclusion of persons already known to have diabetes, hypertension or dyslipidemia, logistic and linear regression were used to study cross-sectional associations of anthropometric variables with newly diagnosed diabetes, hypertension and dyslipidemia, and with continuous metabolic measures, all separately for men (n=3818) and women (n=4582). Analyses were repeated in the same population stratified for age.
After adjustment for age, body mass index and waist, a larger hip circumference was associated with a lower prevalence of undiagnosed diabetes (odds ratio (OR) per one s.d. increase in hip circumference 0.55 (95% CI 0.41-0.73) in men and 0.42 (0.27-0.65) in women) and undiagnosed dyslipidemia (OR 0.58 (0.50-0.67) in men and 0.37 (0.30-0.45) in women). Associations with undiagnosed hypertension were weaker (OR 0.80 (0.69-0.93) in men and 0.88 (0.70-1.11) in women). As expected, larger waist circumference was associated with higher prevalence of these conditions. Similar associations were found using continuous metabolic variables as outcomes in linear regression analyses. Height partly explained the negative associations with hip circumference. When these analyses were performed stratified for age, associations became weaker or disappeared in the oldest age groups (age > or =75 y in particular), except for HDL-cholesterol.
We found independent and opposite associations of waist and hip circumference with diabetes, dyslipidemia and less strongly with hypertension in a large population-based survey. These results emphasize that waist and hip circumference are important predictors for the metabolic syndrome and should both be considered in epidemiological studies. The associations were consistent in all age groups, except in age > or =75 y. Further research should be aimed at verifying hypotheses explaining the 'protective' effect of larger hips.
通过腰臀比测量的脂肪分布已被证明是葡萄糖不耐受的重要独立预测指标。然而，很少有研究单独考虑腰围和臀围的作用。本研究的目的是在一项大型基于人群的研究中调查腰围和臀围与糖尿病的独立关联，并研究它们是否也适用于代谢综合征的其他主要组成部分（高血压和血脂异常）。此外，由于先前的研究是在老年人中进行的，我们调查了这些关联在所有成年年龄组中是否都存在。
在具有全国代表性的澳大利亚糖尿病、肥胖与生活方式（AusDiab）研究的11247名参与者中测量了体重、身高、腰围和臀围。测定了高密度脂蛋白胆固醇、甘油三酯、空腹及餐后2小时血糖，并测量了舒张压和收缩压。在排除已知患有糖尿病、高血压或血脂异常的人群后，使用逻辑回归和线性回归分别研究人体测量变量与新诊断的糖尿病、高血压和血脂异常以及连续代谢指标之间的横断面关联，男性（n = 3818）和女性（n = 4582）分别进行分析。在按年龄分层的同一人群中重复进行分析。
在调整年龄、体重指数和腰围后，较大的臀围与未诊断糖尿病的患病率较低相关（男性臀围每增加一个标准差，比值比（OR）为0.55（95%可信区间0.41 - 0.73），女性为0.42（0.27 - 0.65））以及未诊断血脂异常的患病率较低相关（男性OR为0.58（0.50 - 0.67），女性为0.37（0.30 - 0.45））。与未诊断高血压的关联较弱（男性OR为0.80（0.69 - 0.93），女性为0.88（0.70 - 1.11））。正如预期的那样，较大的腰围与这些疾病的较高患病率相关。在线性回归分析中使用连续代谢变量作为结果时也发现了类似的关联。身高部分解释了与臀围的负相关。当按年龄分层进行这些分析时，除高密度脂蛋白胆固醇外，在最年长的年龄组（特别是年龄≥75岁）中，关联变得较弱或消失。
在一项大型基于人群的调查中，我们发现腰围和臀围与糖尿病、血脂异常存在独立且相反的关联，与高血压的关联较弱。这些结果强调腰围和臀围是代谢综合征的重要预测指标，在流行病学研究中都应予以考虑。除年龄≥75岁的人群外，这些关联在所有年龄组中都是一致的。进一步的研究应旨在验证解释较大臀部“保护”作用的假说。
