Nazare Julie-Anne, Smith Jessica, Borel Anne-Laure, Aschner Pablo, Barter Phil, Van Gaal Luc, Tan Chee Eng, Wittchen Hans-Ulrich, Matsuzawa Yuji, Kadowaki Takashi, Ross Robert, Brulle-Wohlhueter Claire, Alméras Natalie, Haffner Steven M, Balkau Beverley, Després Jean-Pierre
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; CENS, CARMEN Laboratory INSERM U1060-INRA 1235, Pierre-Bénite, France.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Harvard School of Public Health, Department of Nutrition, Boston, Massachusetts.
Am J Cardiol. 2015 Feb 1;115(3):307-15. doi: 10.1016/j.amjcard.2014.10.039. Epub 2014 Nov 13.
Despite its well-documented relation with visceral adiposity (VAT) and cardiometabolic risk (CMR), whether waist circumference (WC) should be measured in addition to body mass index (BMI) remains debated. This study tested the relevance of adding WC to BMI for the estimation of VAT and CMR. In the International Study of Prediction of Intra-abdominal Adiposity and Its Relationship with Cardiometabolic Risk/Intra-abdominal Adiposity, 297 physicians recruited 4,504 patients (29 countries). Both BMI and WC were measured, whereas VAT and liver fat were assessed by computed tomography. A composite CMR score was calculated. From the 4,109 patients included in the present analyses (20 ≤ BMI < 40 kg/m(2), 47% women), about 30% displayed discordant values for WC and BMI quintiles, despite a strong correlation between the 2 anthropometric variables (r = 0.87 and r = 0.84 for men and women, respectively, p <0.001). Within each single BMI unit, VAT and WC showed substantial variability between subjects (mean difference between 90th and 10th percentiles: 175 cm(2)/16 cm and 137 cm(2)/18 cm for VAT/WC in men and women, respectively). Within each BMI category, increasing gender-specific WC tertiles were associated with significantly higher VAT, liver fat, and with a more adverse CMR profile. In conclusion, this large international cardiometabolic study highlights the frequent discordance between BMI and WC, driven by the substantial variability in VAT for a given BMI. Within each BMI category, WC was cross-sectionally associated with VAT, liver fat, and CMR factors. Thus, WC allows a further refinement of the CMR related to any given BMI.
尽管腰围（WC）与内脏脂肪（VAT）和心脏代谢风险（CMR）之间的关系已有充分记录，但除体重指数（BMI）外是否应测量WC仍存在争议。本研究测试了在BMI基础上增加WC用于评估VAT和CMR的相关性。在国际腹部内脂肪预测及其与心脏代谢风险/腹部内脂肪关系研究中，297名医生招募了4504名患者（来自29个国家）。测量了BMI和WC，而VAT和肝脏脂肪通过计算机断层扫描进行评估。计算了综合CMR评分。在纳入本分析的4109名患者中（20≤BMI<40 kg/m²，47%为女性），尽管这两个人体测量变量之间存在很强的相关性（男性和女性的r分别为0.87和0.84，p<0.001），但约30%的患者WC和BMI五分位数的值不一致。在每个单一的BMI单位内，VAT和WC在受试者之间显示出很大的变异性（男性和女性VAT/WC的第90百分位数与第10百分位数之间的平均差异分别为175 cm²/16 cm和137 cm²/18 cm）。在每个BMI类别中，特定性别的WC三分位数增加与显著更高的VAT、肝脏脂肪以及更不利的CMR特征相关。总之，这项大型国际心脏代谢研究突出了BMI和WC之间频繁的不一致性，这是由给定BMI下VAT的显著变异性驱动的。在每个BMI类别中，WC与VAT、肝脏脂肪和CMR因素呈横断面相关。因此，WC可以进一步细化与任何给定BMI相关的CMR。
