Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK.
Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
Nutr Metab Cardiovasc Dis. 2022 Jul;32(7):1642-1650. doi: 10.1016/j.numecd.2022.04.003. Epub 2022 Apr 10.
There is growing evidence that Body Mass Index (BMI) is unfit for purpose. Waist circumference (WC) indices appear to be the preferred alternative, although it is not clear which WC index is optimal at predicting cardio-metabolic risk (CMR) and associated health outcomes.
We obtained a stratified random probability sample of 53,390 participants from the Health Survey for England (HSE), 2008-2018. The four available CMR factors were; high-density lipoproteins (HDL) cholesterol, glycated haemoglobin (HbA1c), systolic (SBP) and diastolic blood pressure (DBP). Strength of association between the four cardio-metabolic risk factors and competing anthropometric indicators of weight status [BMI, Waist-to-height ratio (WHTR), unadjusted WC, and a new WC index independent of height, WHT·5R = WC/height] was assessed separately, using simple correlations and ANCOVAs, and together (combined) using MANCOVA, controlling for age, sex and ethnicity. Centile curves for the new index WHT·5R = WC/heightwere also provided.
Waist-circumference indices were superior to BMI when explaining/predicting our CMR factors, before and after controlling for age, sex and ethnicity. No single WC index was consistently superior. Results suggest that WHTR is the strongest predictor of HbA1c, confirming that shorter individuals are at great risk of diabetes. The most appropriate WC index associated with blood pressure was WHT·5R for DBP, or unadjusted WC for SBP. Given HDL cholesterol is independent of height, the best predictor of HDL was WHT.5R. Clearly, "no one size fits all!". MANCOVA identified WHT·5R to be the best single WC index associated with a composite of all four CMR factors.
越来越多的证据表明，体重指数（BMI）并不适用。腰围（WC）指数似乎是更好的替代指标，尽管目前尚不清楚哪种 WC 指数在预测心血管代谢风险（CMR）和相关健康结果方面最为理想。
我们从 2008 年至 2018 年的英国健康调查（HSE）中获得了一个分层随机概率样本，其中包含 53390 名参与者。可用的四个 CMR 因素是：高密度脂蛋白（HDL）胆固醇、糖化血红蛋白（HbA1c）、收缩压（SBP）和舒张压（DBP）。使用简单相关和协方差分析，分别评估四个心血管代谢危险因素与体重状况的竞争人体测量指标（BMI、腰高比（WHTR）、未调整的 WC 以及一个与身高无关的新 WC 指数 WHT·5R=WC/height）之间的关联强度，并使用 MANCOVA 结合起来，同时控制年龄、性别和种族。还提供了新指数 WHT·5R=WC/height 的百分位数曲线。
在控制年龄、性别和种族后，WC 指数在解释/预测我们的 CMR 因素方面优于 BMI。没有一个单一的 WC 指数始终具有优势。结果表明，WHTR 是 HbA1c 的最强预测因子，这证实了个子较矮的人患糖尿病的风险很大。与血压最相关的最佳 WC 指数是 DBP 的 WHT·5R 或 SBP 的未调整 WC。由于 HDL 胆固醇与身高无关，HDL 的最佳预测因子是 WHT·5R。显然，“没有一刀切的解决方案！”。MANCOVA 确定 WHT·5R 是与所有四个 CMR 因素组成的复合因素最相关的最佳单一 WC 指数。
