Re: INTERHEART Paper

[Guest guest]

It's been in there from the start.

on 11/4/2005 2:13 PM, Rodney at perspect1111@... wrote:

Perhaps we should add waist/hip ratio to Francesca's table in the

database?

Rodney.

[Guest guest]

It's been in there from the start.

on 11/4/2005 2:13 PM, Rodney at perspect1111@... wrote:

Perhaps we should add waist/hip ratio to Francesca's table in the

database?

Rodney.

[Guest guest]

Hi Francesca:

I believe what is in there is waist to HEIGHT ratio. I sure hope so,

because otherwise there sure are some funny-shaped people around

here. So funny in fact I am not sure I'd want to be associated with

them, LOLOL.

Rodney.

>

> Perhaps we should add waist/hip ratio to Francesca's table in the

> database?

>

> Rodney.

>

[Guest guest]

Hi Francesca:

I believe what is in there is waist to HEIGHT ratio. I sure hope so,

because otherwise there sure are some funny-shaped people around

here. So funny in fact I am not sure I'd want to be associated with

them, LOLOL.

Rodney.

>

> Perhaps we should add waist/hip ratio to Francesca's table in the

> database?

>

> Rodney.

>

[Guest guest]

Well, there is one waist/hip in there.

Regards.

[ ] Re: INTERHEART Paper

Hi Francesca:I believe what is in there is waist to HEIGHT ratio. I sure hope so, because otherwise there sure are some funny-shaped people around here. So funny in fact I am not sure I'd want to be associated with them, LOLOL.Rodney.> > Perhaps we should add waist/hip ratio to Francesca's table in the> database?> > Rodney.>

[Guest guest]

Well, there is one waist/hip in there.

Regards.

[ ] Re: INTERHEART Paper

Hi Francesca:I believe what is in there is waist to HEIGHT ratio. I sure hope so, because otherwise there sure are some funny-shaped people around here. So funny in fact I am not sure I'd want to be associated with them, LOLOL.Rodney.> > Perhaps we should add waist/hip ratio to Francesca's table in the> database?> > Rodney.>

[Guest guest]

Hi All,

The pdf-available story for:

http://news.xinhuanet.com/english/2005-11/04/content_3731079.htm

is:

Hip, waist size predictor of heart risk

www.chinaview.cn 2005-11-04 14:15:39

BEIJING, Nov. 4 (Xinhuanet)

-- Scientists say they've found a better way of measuring obesity and a

person's

risk of getting a heart attack than the method used by doctors worldwide for

years.

It has long been thought that fat people are more at risk of a heart attack,

but

doctors say today that it is not as simple as that. It all depends on where the

fat

is. A large bottom and thighs could be positively healthy — a “beer belly”, on

the

other hand, spells trouble, no matter how skinny the person may be elsewhere.

Researchers reported in Friday’s issue of The Lancet medical journal that a

hip-to-waist ratio is a better predictor of the risk of heart attack for a

variety

of ethnic groups than body-mass index (BMI), the current standard.

BMI (based on a person's weight and height) takes no notice of where a

person's

fat lies or how muscular that person may be, says Dr. Arya Sharma, co-author of

the

study and a professor of medicine at McMaster University in Hamilton, Ont.

Therefore, a well-muscled athlete and an obese person could have similar BMI

scores.

A study of 27,000 people, including more than 14,000 heart disease patients,

has

found that waist-to-hip ratios can mark out those people more likely to suffer

heart

failure far more effectively than conventional tests.

....

A farewell to body-mass index?

Lancet, 2005 9497, 1589-1591

Charlotte Kragelund and Torbjørn Omland

In today's Lancet, the INTERHEART investigators report the results of a

well-conceived, well-executed, large-scale study on different measures of body

composition and risk of myocardial infarction in multiple populations from 52

countries across the world.1 Amid the dispute over whether or not the metabolic

syndrome, of which obesity is a central feature, exists as a sensible unity in

defining increased cardiovascular risk in populations,2 and 3 and whether or not

the

waist measure, as opposed to body-mass index, is the measure of choice in

assessing

obesity across multiple populations,4 the INTERHEART investigators place what

seems

to be the final nail in the casket for body-mass index as an independent

cardiovascular risk factor.

Last year, the INTERHEART investigators identified nine important risk factors

for

myocardial infarction, including abdominal obesity,5 which accounted for more

than

90% of the worldwide myocardial infarction risk. Today's article further

explores

the complex associations between different measures of obesity and myocardial

infarction risk. The INTERHEART study provides convincing evidence of the

relative

importance of several different measures of obesity in assessing risk of

myocardial

infarction. The investigators focus on four different measures of obesity,

namely

body-mass index, waist-to-hip ratio, waist measure, and hip measure, the last

three

measures serving as surrogate measures for abdominal obesity. The salient

finding of

INTERHEART is that waist-to-hip ratio is the obesity measure most strongly

associated with myocardial infarction. This finding is consistent across

populations

and across well-defined subgroups, and is evident regardless of analytic

approach.

Importantly, these findings were independent of other measures of body

composition

and other known risk factors previously identified in the INTERHEART study

population.5 Finally, the INTERHEART investigators show that the population risk

attributable to waist-to-hip ratio is much larger than the population risk

attributable to body-mass index. This result suggests that previous estimates of

the

impact of obesity as a cardiovascular risk factor have been too low.

The findings from INTERHEART are important in several ways. Previous studies of

the

general population have shown increased risk of cardiovascular disease and

mortality

in obese individuals,6 and 7 with an improved prognosis after weight loss.8

However,

most of these studies have included single well-defined populations, mainly of

European and north American origin, and the evidence for other population groups

is

sparse.9 By contrast, INTERHEART investigated individuals across all continents,

including large groups with different ethnic origins and ages. Increasing

evidence

in patients with established coronary heart disease suggests similar or

decreased

mortality in obese patients compared with patients of normal weight.10 and 11

The

mechanisms underlying this apparently paradoxical relation between obesity and

cardiovascular risk are unclear, but may relate to the definition of obesity

itself.

Traditionally, obesity has been defined by body-mass index, but increasing

evidence

suggests that measurement of abdominal obesity as waist circumference and

waist-to-hip ratio is more important. Other strengths of the current INTERHEART

report include novel information on the prevalence of abdominal obesity in

different

ethnic groups. By contrast with many other studies, body composition was

measured

instead of being self-reported.

Even though INTERHEART is an important contribution to the understanding of the

association between obesity and risk of myocardial infarction, some limitations

should be kept in mind. The cross-sectional case-control design does not allow

inferences to be drawn about causality between obesity and myocardial infarction

risk. The design is susceptible to bias from differential selection of cases and

controls, and so the results must be interpreted with caution. The study does

not

give evidence of the underlying biological causes of the association between

waist-to-hip ratio and risk of myocardial infarction. Waist-to-hip ratio is a

surrogate measure of abdominal obesity, even though previous studies have found

a

high correlation between waist measure and waist-to-hip ratio and amount of

intra-abdominal fat.12 Moreover, the finding that waist-to-hip ratio is a better

risk predictor than body-mass index is not entirely new. For instance, a recent

prospective study on the risk of death in patients with acute myocardial

infarction

identifies abdominal obesity as measured by the waist-to-hip ratio as a better

risk

indicator than body-mass index.11

The main message from the new INTERHEART report is that current practice with

body-mass index as the measure of obesity is obsolete, and results in

considerable

underestimation of the grave consequences of the overweight epidemic. A direct

consequence of these findings is that, for assessment of risk associated with

obesity, the waist-to-hip ratio, and not body-mass index, is the preferred

simple

measure. Future studies must validate the importance of the waist-to-hip ratio

by

assessment of the effect of weight loss and decreasing abdominal obesity on

prognosis.

Obesity and the risk of myocardial infarction in 27 000 participants from 52

countries: a case-control study

Lancet, 2005 9497, , 1640-1649

Salim Yusuf, Hawken, Ôunpuu, Leonelo Bautista, Grazia

Franzosi, Commerford, Chim C Lang, Zvonko Rumboldt, Churchill L Onen,

Liu

Lisheng et al.

.... Findings

BMI showed a modest and graded association with myocardial infarction (OR 1·44,

95%

CI 1·32–1·57 top quintile vs bottom quintile before adjustment), which was

substantially reduced after adjustment for waist-to-hip ratio (1·12, 1·03–1·22),

and

non-significant after adjustment for other risk factors (0·98, 0·88–1·09). For

waist-to-hip ratio, the odds ratios for every successive quintile were

significantly

greater than that of the previous one (2nd quintile: 1·15, 1·05–1·26; 3rd

quintile:

1·39; 1·28–1·52; 4th quintile: 1·90, 1·74–2·07; and 5th quintiles: 2·52,

2·31–2·74

[adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1·77;

1·59–1·97)

and hip (0·73; 0·66–0·80) circumferences were both highly significant after

adjustment for BMI (p<0·0001 top vs bottom quintiles). Waist-to-hip ratio and

waist

and hip circumferences were closely (p<0·0001) associated with risk of

myocardial

infarction even after adjustment for other risk factors (ORs for top quintile vs

lowest quintiles were 1·75, 1·33, and 0·76, respectively). The

population-attributable risks of myocardial infarction for increased

waist-to-hip

ratio in the top two quintiles was 24·3% (95% CI 22·5–26·2) compared with only

7·7%

(6·0–10·0) for the top two quintiles of BMI.

Interpretation

Waist-to-hip ratio shows a graded and highly significant association with

myocardial

infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio

instead of BMI increases the estimate of myocardial infarction attributable to

obesity in most ethnic groups.

.... Table 1. Comparative effect of 1 standard deviation increase in a specific

measure of obesity in the overall population and separately in men and women

==================================

Odds Ratio (95% CI)---Odds Ratio (95% CI)

1 SD Adjusted for age, sex, and region Additionally adjusted for WHR or

BMI----1 SD

(women/men) Women Men

Measure (units)

==================================

BMI (kg/m2) 4·15 1·10 (1·07–1·13) 1·02 (0·99–1·04)^* 4·70/3·89 1·04

(0·98–1·09)^*

1·00 (0·97–1·04)^*

Waist circumference (cm) 12·08 1·19 (1·16–1·22) 1·25 (1·21–1·30)^†

12·97/11·58

1·40 (1·30–1·51)^† 1·19 (1·14–1·24)^†

Hip circumference (cm) 10·96 0·96 (0·94–0·99) 0·87 (0·84–0·89)^† 12·18/10·36

0·92

(0·86–0·99)^† 0·85 (0·82–0·89)^†

Waist-to-hip ratio 0·085 1·37 (1·34–1·41) 1·37 (1·33–1·40)^† 0·089/0·078 1·34

(1·27–1·42)^† 1·35 (1·31–1·40)^†

Waist-to-height 0·072 1·19 (1·16–1·22) 1·24 (1·20–1·29)^† 0·082/0·066 1·39

(1·29–1·50)^† 1·18 (1·13–1·23)^†

==================================

BMI=body-mass index. WHR=waist-to-hip ratio.

Odds ratios by sex are adjusted for age, region, and BMI or WHR as appropriate.

^* Adjusted for WHR.

^† Adjusted for BMI and height.

..... Table 2. Increases in odds ratio for myocardial infarction for 1 SD

increase in

body-mass index, waist circumference, or waist-to-hip ratio in different ethnic

groups adjusted for age and sex

==================================

BMI (95% CI)^* Waist (95% CI)^† WHR (95% CI)^‡

==================================

Overall 1·10 1·19 1·37 (1·07–1·13) (1·16–1·22) (1·34–1·41)

European 1·14 1·25 1·44 (1·09–1·20) (1·19–1·31) (1·36–1·51)

Chinese 1·19 1·24 1·08 (1·11–1·27) (1·16–1·33) (1·03–1·14)

South Asian 0·99 1·03 1·52 (0·93–1·05) (0·97–1·10) (1·41–1·64)

Other Asian 1·29 1·58 2·60 (1·17–1·43) (1·41–1·78) (2·25–3·01)

Arab 1·00 1·07 1·43 (0·93–1·07) (0·99–1·16) (1·31–1·57)

Latin American 1·12 1·20 1·43 (1·04–1·21) (1·11–1·29) (1·32–1·56)

Black African 1·29 1·57 1·36 (1·10–1·52) (1·31–1·88) (1·09–1·69)

Mixed-race African^** 1·07 1·16 2·25 (0·94–1·22) (0·99–1·34) (1·79–2·84)

==================================

BMI=body-mass index. WHR=waist-to-hip ratio. SD is not subgroup specific.

^* SD=4·15.

^† SD=12·08.

^‡ SD=0·085.

^** Black and white mixed-race in South Africa. Analysis using SD that are

specific

to each ethnic group leads to similar results for all groups other than Chinese,

in

whom the OR for BMI decreases considerably to 1·04, and for waist circumference

to

1·18, but remains unchanged for WHR.

.... Table 3. Odds ratios and population-attributable risk of myocardial

infarction

for raised waist-to-hip ratio or body-mass index

==================================

High waist-to-hip ratio^*^†^** >0·83 women/>0·9 men BMI >25^†^** (overweight)

BMI

>30^‡^** (obese)

----Prev controls OR^¶ (95% CI) PAR (95%CI)----

==================================

Overall 66·7 1·77 33·7 53·7 1·28 10·8 14·6 1·24 2·8 (1·67 to 1·88) (31·0 to

36·5)

(1·21 to 1·35) (8·6 to 13·6) (1·16 to 1·33) (2·0 to 4·0)

Female 66·8 1·90 35·9 57·3 1·19 9·3 20·2 1·26 5·4 (1·69 to 2·14) (30·5 to

41·7)

(1·07 to 1·32) (5·1 to 16·3) (1·12 to 1·43) (3·4 to 8·5)

Male 66·7 1·73 32·1 52·4 1·31 10·9 12·6 1·23 2·01 (1·62 to 1·85) (29·1 to

35·4)

(1·23 to 1·39) (8·4 to 14·1) (1·13 to 1·34) (1·2 to 3·4)

European 68·4 2·23 44·4 63·3 1·46 16·6 20·7 1·32 5·3 (1·98 to 2·51) (39·4 to

49·6) (1·31 to 1·61) (11·7 to 23·0) (1·17 to 1·48) (3·4 to 8·3)

Chinese 53·8 1·18 8·55 37·9 1·33 11·6 4·4 1·16 0·71 (1·06 to 1·30) (4·6 to

15·4)

(1·20 to 1·47) (8·4 to 15·8) (0·91 to 1·47) (0·16 to 3·15)

South Asian 68·2 1·91 36·8 46·0 1·07 & #8722;0·69 9·7 1·24 1·0 (1·65 to 2·20)

(30·5 to 43·5) (0·94 to 1·21) ( & #8722;6·06 to 4·68) (1·01 to 1·52) (0·16 to

6·3)

Other Asian 57·0 3·63 58·2 36·7 1·54 14·1 5·7 1·84 4·0 (2·91 to 4·52) (51·3

to

64·7) (1·27 to 1·86) (8·7 to 22·1) (1·28 to 2·64) (2·1 to 7·4)

Arabic 78·8 1·47 30·9 72·6 0·99 0·73 26·3 1·02 & #8722;0·80 (1·20 to 1·82)

(20·6

to 43·4) (0·83 to 1·19) ( & #8722;11·48 to 12·93) (0·86 to 1·22) ( & #8722;5·41 to

3·81)

Latin American 79·0 2·06 44·3 64·2 1·24 9·8 18·4 1·26 4·4 (1·64 to 2·59)

(34·1 to

55·1) (1·05 to 1·46) (3·5 to 24·3) (1·04 to 1·52) (1·9 to 9·9)

Black African 66·6 1·94 41·8 60·2 2·33 38·7 22·7 2·23 18·6 (1·19 to 3·17)

(22·5

to 63·9) (1·49 to 3·66) (21·7 to 59·0) (1·45 to 3·45) (9·6 to 32·8)

Mixed-race African 71·0 3·56 63·6 59·3 1·62 18·9 27·8 1·08 & #8722;0·76 (2·27

to

5·58) (49·2 to 76·0) (1·16 to 2·27) (7·1 to 41·5) (0·75 to 1·55) ( & #8722;10·73

to

9·20)

Other 72·8 1·85 49·1 62·2 2·13 34·3 21·1 1·95 11·9 (0·75 to 4·60) (16·7 to

82·3)

(0·98 to 4·61) (9·4 to 72·4) (0·88 to 4·31) (2·4 to 42·9)

==================================

Prev=prevalence. PAR=population-attributable risk. BMI=body-mass index.

WHR=waist-to-hip ratio.

^* Upper two-thirds of the distribution.

^† Overweight.

^‡ Obese.

^** Upper two quintiles for WHR had a PAR of 24·3% versus 7·7% for same

quintiles

for BMI.

^¶ Odds ratio for 2nd tertile versus 1st is 1·36, and for 3rd versus 1st is

2·24. OR

for top two tertiles versus lowest tertile is 1·77.

Black and white mixed-race in South Africa.

.... Since our study is mainly focused on myocardial infarction and uses a

case-control design, we cannot elucidate the relation between the different

measures

of obesity on other outcomes (eg, cancers) or whether there is an increased risk

of

some diseases in those who are very lean. Such an assessment would need very

large

cohort studies or a meta-analysis of all existing studies. INTERHEART shows that

the

waist-to-hip ratio is the strongest anthropometric measure that is associated

with

myocardial infarction risk, and is substantially better than BMI. These results

are

consistent in both sexes, old and young individuals, in different regions, and

in

different ethnic groups. Use of raised waist-to-hip ratio as the index of

obesity

instead of BMI increases the population attributable risk for myocardial

infarction

threefold. Our findings suggest that substantial reassessment is needed of the

importance of obesity for cardiovascular disease in most regions of the world.

.... The INTERHEART study was funded by unrestricted grants from several

pharmaceutical companies (with major contributions from AstraZeneca, Novartis,

Sanofi Aventis, Knoll Pharmaceuticals [now Abbott], Bristol Myers Squibb, and

Sanofi-Synthelabo) ... Italy—Boehringer-Ingelheim, Japan—Sankyo Pharmaceutical

Co,

Banyu Pharmaceutical Co, Astra Japan; Kuwait—Endowment Fund for Health

Development

in Kuwait; Pakistan—ATCO Laboratories; Philippines—Philippine Council for Health

Research & Dev, Pfizer Philippines Foundation, Inc, Astra Pharmaceuticals Inc,

and

the Astra Fund for Clinical Research and Continuing Medical Education, Pharmacia

&

Upjohn Inc; Poland—Foundation PROCLINICA ... South Africa—MRC South Africa,

Warner-Parke- Pharmaceuticals, Aventis ... USA—King Pharma.

Al Pater, PhD; email: old542000@...

__________________________________

FareChase: Search multiple travel sites in one click.

http://farechase.

[Guest guest]

Hi All,

The pdf-available story for:

http://news.xinhuanet.com/english/2005-11/04/content_3731079.htm

is:

Hip, waist size predictor of heart risk

www.chinaview.cn 2005-11-04 14:15:39

BEIJING, Nov. 4 (Xinhuanet)

-- Scientists say they've found a better way of measuring obesity and a

person's

risk of getting a heart attack than the method used by doctors worldwide for

years.

It has long been thought that fat people are more at risk of a heart attack,

but

doctors say today that it is not as simple as that. It all depends on where the

fat

is. A large bottom and thighs could be positively healthy — a “beer belly”, on

the

other hand, spells trouble, no matter how skinny the person may be elsewhere.

Researchers reported in Friday’s issue of The Lancet medical journal that a

hip-to-waist ratio is a better predictor of the risk of heart attack for a

variety

of ethnic groups than body-mass index (BMI), the current standard.

BMI (based on a person's weight and height) takes no notice of where a

person's

fat lies or how muscular that person may be, says Dr. Arya Sharma, co-author of

the

study and a professor of medicine at McMaster University in Hamilton, Ont.

Therefore, a well-muscled athlete and an obese person could have similar BMI

scores.

A study of 27,000 people, including more than 14,000 heart disease patients,

has

found that waist-to-hip ratios can mark out those people more likely to suffer

heart

failure far more effectively than conventional tests.

....

A farewell to body-mass index?

Lancet, 2005 9497, 1589-1591

Charlotte Kragelund and Torbjørn Omland

In today's Lancet, the INTERHEART investigators report the results of a

well-conceived, well-executed, large-scale study on different measures of body

composition and risk of myocardial infarction in multiple populations from 52

countries across the world.1 Amid the dispute over whether or not the metabolic

syndrome, of which obesity is a central feature, exists as a sensible unity in

defining increased cardiovascular risk in populations,2 and 3 and whether or not

the

waist measure, as opposed to body-mass index, is the measure of choice in

assessing

obesity across multiple populations,4 the INTERHEART investigators place what

seems

to be the final nail in the casket for body-mass index as an independent

cardiovascular risk factor.

Last year, the INTERHEART investigators identified nine important risk factors

for

myocardial infarction, including abdominal obesity,5 which accounted for more

than

90% of the worldwide myocardial infarction risk. Today's article further

explores

the complex associations between different measures of obesity and myocardial

infarction risk. The INTERHEART study provides convincing evidence of the

relative

importance of several different measures of obesity in assessing risk of

myocardial

infarction. The investigators focus on four different measures of obesity,

namely

body-mass index, waist-to-hip ratio, waist measure, and hip measure, the last

three

measures serving as surrogate measures for abdominal obesity. The salient

finding of

INTERHEART is that waist-to-hip ratio is the obesity measure most strongly

associated with myocardial infarction. This finding is consistent across

populations

and across well-defined subgroups, and is evident regardless of analytic

approach.

Importantly, these findings were independent of other measures of body

composition

and other known risk factors previously identified in the INTERHEART study

population.5 Finally, the INTERHEART investigators show that the population risk

attributable to waist-to-hip ratio is much larger than the population risk

attributable to body-mass index. This result suggests that previous estimates of

the

impact of obesity as a cardiovascular risk factor have been too low.

The findings from INTERHEART are important in several ways. Previous studies of

the

general population have shown increased risk of cardiovascular disease and

mortality

in obese individuals,6 and 7 with an improved prognosis after weight loss.8

However,

most of these studies have included single well-defined populations, mainly of

European and north American origin, and the evidence for other population groups

is

sparse.9 By contrast, INTERHEART investigated individuals across all continents,

including large groups with different ethnic origins and ages. Increasing

evidence

in patients with established coronary heart disease suggests similar or

decreased

mortality in obese patients compared with patients of normal weight.10 and 11

The

mechanisms underlying this apparently paradoxical relation between obesity and

cardiovascular risk are unclear, but may relate to the definition of obesity

itself.

Traditionally, obesity has been defined by body-mass index, but increasing

evidence

suggests that measurement of abdominal obesity as waist circumference and

waist-to-hip ratio is more important. Other strengths of the current INTERHEART

report include novel information on the prevalence of abdominal obesity in

different

ethnic groups. By contrast with many other studies, body composition was

measured

instead of being self-reported.

Even though INTERHEART is an important contribution to the understanding of the

association between obesity and risk of myocardial infarction, some limitations

should be kept in mind. The cross-sectional case-control design does not allow

inferences to be drawn about causality between obesity and myocardial infarction

risk. The design is susceptible to bias from differential selection of cases and

controls, and so the results must be interpreted with caution. The study does

not

give evidence of the underlying biological causes of the association between

waist-to-hip ratio and risk of myocardial infarction. Waist-to-hip ratio is a

surrogate measure of abdominal obesity, even though previous studies have found

a

high correlation between waist measure and waist-to-hip ratio and amount of

intra-abdominal fat.12 Moreover, the finding that waist-to-hip ratio is a better

risk predictor than body-mass index is not entirely new. For instance, a recent

prospective study on the risk of death in patients with acute myocardial

infarction

identifies abdominal obesity as measured by the waist-to-hip ratio as a better

risk

indicator than body-mass index.11

The main message from the new INTERHEART report is that current practice with

body-mass index as the measure of obesity is obsolete, and results in

considerable

underestimation of the grave consequences of the overweight epidemic. A direct

consequence of these findings is that, for assessment of risk associated with

obesity, the waist-to-hip ratio, and not body-mass index, is the preferred

simple

measure. Future studies must validate the importance of the waist-to-hip ratio

by

assessment of the effect of weight loss and decreasing abdominal obesity on

prognosis.

Obesity and the risk of myocardial infarction in 27 000 participants from 52

countries: a case-control study

Lancet, 2005 9497, , 1640-1649

Salim Yusuf, Hawken, Ôunpuu, Leonelo Bautista, Grazia

Franzosi, Commerford, Chim C Lang, Zvonko Rumboldt, Churchill L Onen,

Liu

Lisheng et al.

.... Findings

BMI showed a modest and graded association with myocardial infarction (OR 1·44,

95%

CI 1·32–1·57 top quintile vs bottom quintile before adjustment), which was

substantially reduced after adjustment for waist-to-hip ratio (1·12, 1·03–1·22),

and

non-significant after adjustment for other risk factors (0·98, 0·88–1·09). For

waist-to-hip ratio, the odds ratios for every successive quintile were

significantly

greater than that of the previous one (2nd quintile: 1·15, 1·05–1·26; 3rd

quintile:

1·39; 1·28–1·52; 4th quintile: 1·90, 1·74–2·07; and 5th quintiles: 2·52,

2·31–2·74

[adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1·77;

1·59–1·97)

and hip (0·73; 0·66–0·80) circumferences were both highly significant after

adjustment for BMI (p<0·0001 top vs bottom quintiles). Waist-to-hip ratio and

waist

and hip circumferences were closely (p<0·0001) associated with risk of

myocardial

infarction even after adjustment for other risk factors (ORs for top quintile vs

lowest quintiles were 1·75, 1·33, and 0·76, respectively). The

population-attributable risks of myocardial infarction for increased

waist-to-hip

ratio in the top two quintiles was 24·3% (95% CI 22·5–26·2) compared with only

7·7%

(6·0–10·0) for the top two quintiles of BMI.

Interpretation

Waist-to-hip ratio shows a graded and highly significant association with

myocardial

infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio

instead of BMI increases the estimate of myocardial infarction attributable to

obesity in most ethnic groups.

.... Table 1. Comparative effect of 1 standard deviation increase in a specific

measure of obesity in the overall population and separately in men and women

==================================

Odds Ratio (95% CI)---Odds Ratio (95% CI)

1 SD Adjusted for age, sex, and region Additionally adjusted for WHR or

BMI----1 SD

(women/men) Women Men

Measure (units)

==================================

BMI (kg/m2) 4·15 1·10 (1·07–1·13) 1·02 (0·99–1·04)^* 4·70/3·89 1·04

(0·98–1·09)^*

1·00 (0·97–1·04)^*

Waist circumference (cm) 12·08 1·19 (1·16–1·22) 1·25 (1·21–1·30)^†

12·97/11·58

1·40 (1·30–1·51)^† 1·19 (1·14–1·24)^†

Hip circumference (cm) 10·96 0·96 (0·94–0·99) 0·87 (0·84–0·89)^† 12·18/10·36

0·92

(0·86–0·99)^† 0·85 (0·82–0·89)^†

Waist-to-hip ratio 0·085 1·37 (1·34–1·41) 1·37 (1·33–1·40)^† 0·089/0·078 1·34

(1·27–1·42)^† 1·35 (1·31–1·40)^†

Waist-to-height 0·072 1·19 (1·16–1·22) 1·24 (1·20–1·29)^† 0·082/0·066 1·39

(1·29–1·50)^† 1·18 (1·13–1·23)^†

==================================

BMI=body-mass index. WHR=waist-to-hip ratio.

Odds ratios by sex are adjusted for age, region, and BMI or WHR as appropriate.

^* Adjusted for WHR.

^† Adjusted for BMI and height.

..... Table 2. Increases in odds ratio for myocardial infarction for 1 SD

increase in

body-mass index, waist circumference, or waist-to-hip ratio in different ethnic

groups adjusted for age and sex

==================================

BMI (95% CI)^* Waist (95% CI)^† WHR (95% CI)^‡

==================================

Overall 1·10 1·19 1·37 (1·07–1·13) (1·16–1·22) (1·34–1·41)

European 1·14 1·25 1·44 (1·09–1·20) (1·19–1·31) (1·36–1·51)

Chinese 1·19 1·24 1·08 (1·11–1·27) (1·16–1·33) (1·03–1·14)

South Asian 0·99 1·03 1·52 (0·93–1·05) (0·97–1·10) (1·41–1·64)

Other Asian 1·29 1·58 2·60 (1·17–1·43) (1·41–1·78) (2·25–3·01)

Arab 1·00 1·07 1·43 (0·93–1·07) (0·99–1·16) (1·31–1·57)

Latin American 1·12 1·20 1·43 (1·04–1·21) (1·11–1·29) (1·32–1·56)

Black African 1·29 1·57 1·36 (1·10–1·52) (1·31–1·88) (1·09–1·69)

Mixed-race African^** 1·07 1·16 2·25 (0·94–1·22) (0·99–1·34) (1·79–2·84)

==================================

BMI=body-mass index. WHR=waist-to-hip ratio. SD is not subgroup specific.

^* SD=4·15.

^† SD=12·08.

^‡ SD=0·085.

^** Black and white mixed-race in South Africa. Analysis using SD that are

specific

to each ethnic group leads to similar results for all groups other than Chinese,

in

whom the OR for BMI decreases considerably to 1·04, and for waist circumference

to

1·18, but remains unchanged for WHR.

.... Table 3. Odds ratios and population-attributable risk of myocardial

infarction

for raised waist-to-hip ratio or body-mass index

==================================

High waist-to-hip ratio^*^†^** >0·83 women/>0·9 men BMI >25^†^** (overweight)

BMI

>30^‡^** (obese)

----Prev controls OR^¶ (95% CI) PAR (95%CI)----

==================================

Overall 66·7 1·77 33·7 53·7 1·28 10·8 14·6 1·24 2·8 (1·67 to 1·88) (31·0 to

36·5)

(1·21 to 1·35) (8·6 to 13·6) (1·16 to 1·33) (2·0 to 4·0)

Female 66·8 1·90 35·9 57·3 1·19 9·3 20·2 1·26 5·4 (1·69 to 2·14) (30·5 to

41·7)

(1·07 to 1·32) (5·1 to 16·3) (1·12 to 1·43) (3·4 to 8·5)

Male 66·7 1·73 32·1 52·4 1·31 10·9 12·6 1·23 2·01 (1·62 to 1·85) (29·1 to

35·4)

(1·23 to 1·39) (8·4 to 14·1) (1·13 to 1·34) (1·2 to 3·4)

European 68·4 2·23 44·4 63·3 1·46 16·6 20·7 1·32 5·3 (1·98 to 2·51) (39·4 to

49·6) (1·31 to 1·61) (11·7 to 23·0) (1·17 to 1·48) (3·4 to 8·3)

Chinese 53·8 1·18 8·55 37·9 1·33 11·6 4·4 1·16 0·71 (1·06 to 1·30) (4·6 to

15·4)

(1·20 to 1·47) (8·4 to 15·8) (0·91 to 1·47) (0·16 to 3·15)

South Asian 68·2 1·91 36·8 46·0 1·07 & #8722;0·69 9·7 1·24 1·0 (1·65 to 2·20)

(30·5 to 43·5) (0·94 to 1·21) ( & #8722;6·06 to 4·68) (1·01 to 1·52) (0·16 to

6·3)

Other Asian 57·0 3·63 58·2 36·7 1·54 14·1 5·7 1·84 4·0 (2·91 to 4·52) (51·3

to

64·7) (1·27 to 1·86) (8·7 to 22·1) (1·28 to 2·64) (2·1 to 7·4)

Arabic 78·8 1·47 30·9 72·6 0·99 0·73 26·3 1·02 & #8722;0·80 (1·20 to 1·82)

(20·6

to 43·4) (0·83 to 1·19) ( & #8722;11·48 to 12·93) (0·86 to 1·22) ( & #8722;5·41 to

3·81)

Latin American 79·0 2·06 44·3 64·2 1·24 9·8 18·4 1·26 4·4 (1·64 to 2·59)

(34·1 to

55·1) (1·05 to 1·46) (3·5 to 24·3) (1·04 to 1·52) (1·9 to 9·9)

Black African 66·6 1·94 41·8 60·2 2·33 38·7 22·7 2·23 18·6 (1·19 to 3·17)

(22·5

to 63·9) (1·49 to 3·66) (21·7 to 59·0) (1·45 to 3·45) (9·6 to 32·8)

Mixed-race African 71·0 3·56 63·6 59·3 1·62 18·9 27·8 1·08 & #8722;0·76 (2·27

to

5·58) (49·2 to 76·0) (1·16 to 2·27) (7·1 to 41·5) (0·75 to 1·55) ( & #8722;10·73

to

9·20)

Other 72·8 1·85 49·1 62·2 2·13 34·3 21·1 1·95 11·9 (0·75 to 4·60) (16·7 to

82·3)

(0·98 to 4·61) (9·4 to 72·4) (0·88 to 4·31) (2·4 to 42·9)

==================================

Prev=prevalence. PAR=population-attributable risk. BMI=body-mass index.

WHR=waist-to-hip ratio.

^* Upper two-thirds of the distribution.

^† Overweight.

^‡ Obese.

^** Upper two quintiles for WHR had a PAR of 24·3% versus 7·7% for same

quintiles

for BMI.

^¶ Odds ratio for 2nd tertile versus 1st is 1·36, and for 3rd versus 1st is

2·24. OR

for top two tertiles versus lowest tertile is 1·77.

Black and white mixed-race in South Africa.

.... Since our study is mainly focused on myocardial infarction and uses a

case-control design, we cannot elucidate the relation between the different

measures

of obesity on other outcomes (eg, cancers) or whether there is an increased risk

of

some diseases in those who are very lean. Such an assessment would need very

large

cohort studies or a meta-analysis of all existing studies. INTERHEART shows that

the

waist-to-hip ratio is the strongest anthropometric measure that is associated

with

myocardial infarction risk, and is substantially better than BMI. These results

are

consistent in both sexes, old and young individuals, in different regions, and

in

different ethnic groups. Use of raised waist-to-hip ratio as the index of

obesity

instead of BMI increases the population attributable risk for myocardial

infarction

threefold. Our findings suggest that substantial reassessment is needed of the

importance of obesity for cardiovascular disease in most regions of the world.

.... The INTERHEART study was funded by unrestricted grants from several

pharmaceutical companies (with major contributions from AstraZeneca, Novartis,

Sanofi Aventis, Knoll Pharmaceuticals [now Abbott], Bristol Myers Squibb, and

Sanofi-Synthelabo) ... Italy—Boehringer-Ingelheim, Japan—Sankyo Pharmaceutical

Co,

Banyu Pharmaceutical Co, Astra Japan; Kuwait—Endowment Fund for Health

Development

in Kuwait; Pakistan—ATCO Laboratories; Philippines—Philippine Council for Health

Research & Dev, Pfizer Philippines Foundation, Inc, Astra Pharmaceuticals Inc,

and

the Astra Fund for Clinical Research and Continuing Medical Education, Pharmacia

&

Upjohn Inc; Poland—Foundation PROCLINICA ... South Africa—MRC South Africa,

Warner-Parke- Pharmaceuticals, Aventis ... USA—King Pharma.

Al Pater, PhD; email: old542000@...

__________________________________

FareChase: Search multiple travel sites in one click.

http://farechase.

[Guest guest]

How to calculate waist-to-hip ratio

Figuring out your risk is simple. Using a tape measure:

Measure your hips. Measure your waist. Then divide the waist number by the hip number. For a healthy woman: the total should be under 0.85

For a healthy man: the total should be below point 0.90

(A 30-inch waist and 36-inch hips would work out to a favorable 0.83, or 83 percent.)

Re: [ ] INTERHEART Paper

Hi All,The pdf-available story for:http://news.xinhuanet.com/english/2005-11/04/content_3731079.htmis:Hip, waist size predictor of heart risk www.chinaview.cn 2005-11-04 14:15:39 BEIJING, Nov. 4 (Xinhuanet)-- Scientists say they've found a better way of measuring obesity and a person'srisk of getting a heart attack than the method used by doctors worldwide for years. It has long been thought that fat people are more at risk of a heart attack, butdoctors say today that it is not as simple as that. It all depends on where the fatis. A large bottom and thighs could be positively healthy — a “beer belly”, on theother hand, spells trouble, no matter how skinny the person may be elsewhere. Researchers reported in Friday’s issue of The Lancet medical journal that ahip-to-waist ratio is a better predictor of the risk of heart attack for a varietyof ethnic groups than body-mass index (BMI), the current standard. BMI (based on a person's weight and height) takes no notice of where a person'sfat lies or how muscular that person may be, says Dr. Arya Sharma, co-author of thestudy and a professor of medicine at McMaster University in Hamilton, Ont. Therefore, a well-muscled athlete and an obese person could have similar BMIscores. A study of 27,000 people, including more than 14,000 heart disease patients, hasfound that waist-to-hip ratios can mark out those people more likely to suffer heartfailure far more effectively than conventional tests. ...A farewell to body-mass index?Lancet, 2005 9497, 1589-1591 Charlotte Kragelund and Torbjørn OmlandIn today's Lancet, the INTERHEART investigators report the results of awell-conceived, well-executed, large-scale study on different measures of bodycomposition and risk of myocardial infarction in multiple populations from 52countries across the world.1 Amid the dispute over whether or not the metabolicsyndrome, of which obesity is a central feature, exists as a sensible unity indefining increased cardiovascular risk in populations,2 and 3 and whether or not thewaist measure, as opposed to body-mass index, is the measure of choice in assessingobesity across multiple populations,4 the INTERHEART investigators place what seemsto be the final nail in the casket for body-mass index as an independentcardiovascular risk factor.Last year, the INTERHEART investigators identified nine important risk factors formyocardial infarction, including abdominal obesity,5 which accounted for more than90% of the worldwide myocardial infarction risk. Today's article further exploresthe complex associations between different measures of obesity and myocardialinfarction risk. The INTERHEART study provides convincing evidence of the relativeimportance of several different measures of obesity in assessing risk of myocardialinfarction. The investigators focus on four different measures of obesity, namelybody-mass index, waist-to-hip ratio, waist measure, and hip measure, the last threemeasures serving as surrogate measures for abdominal obesity. The salient finding ofINTERHEART is that waist-to-hip ratio is the obesity measure most stronglyassociated with myocardial infarction. This finding is consistent across populationsand across well-defined subgroups, and is evident regardless of analytic approach.Importantly, these findings were independent of other measures of body compositionand other known risk factors previously identified in the INTERHEART studypopulation.5 Finally, the INTERHEART investigators show that the population riskattributable to waist-to-hip ratio is much larger than the population riskattributable to body-mass index. This result suggests that previous estimates of theimpact of obesity as a cardiovascular risk factor have been too low.The findings from INTERHEART are important in several ways. Previous studies of thegeneral population have shown increased risk of cardiovascular disease and mortalityin obese individuals,6 and 7 with an improved prognosis after weight loss.8 However,most of these studies have included single well-defined populations, mainly ofEuropean and north American origin, and the evidence for other population groups issparse.9 By contrast, INTERHEART investigated individuals across all continents,including large groups with different ethnic origins and ages. Increasing evidencein patients with established coronary heart disease suggests similar or decreasedmortality in obese patients compared with patients of normal weight.10 and 11 Themechanisms underlying this apparently paradoxical relation between obesity andcardiovascular risk are unclear, but may relate to the definition of obesity itself.Traditionally, obesity has been defined by body-mass index, but increasing evidencesuggests that measurement of abdominal obesity as waist circumference andwaist-to-hip ratio is more important. Other strengths of the current INTERHEARTreport include novel information on the prevalence of abdominal obesity in differentethnic groups. By contrast with many other studies, body composition was measuredinstead of being self-reported.Even though INTERHEART is an important contribution to the understanding of theassociation between obesity and risk of myocardial infarction, some limitationsshould be kept in mind. The cross-sectional case-control design does not allowinferences to be drawn about causality between obesity and myocardial infarctionrisk. The design is susceptible to bias from differential selection of cases andcontrols, and so the results must be interpreted with caution. The study does notgive evidence of the underlying biological causes of the association betweenwaist-to-hip ratio and risk of myocardial infarction. Waist-to-hip ratio is asurrogate measure of abdominal obesity, even though previous studies have found ahigh correlation between waist measure and waist-to-hip ratio and amount ofintra-abdominal fat.12 Moreover, the finding that waist-to-hip ratio is a betterrisk predictor than body-mass index is not entirely new. For instance, a recentprospective study on the risk of death in patients with acute myocardial infarctionidentifies abdominal obesity as measured by the waist-to-hip ratio as a better riskindicator than body-mass index.11The main message from the new INTERHEART report is that current practice withbody-mass index as the measure of obesity is obsolete, and results in considerableunderestimation of the grave consequences of the overweight epidemic. A directconsequence of these findings is that, for assessment of risk associated withobesity, the waist-to-hip ratio, and not body-mass index, is the preferred simplemeasure. Future studies must validate the importance of the waist-to-hip ratio byassessment of the effect of weight loss and decreasing abdominal obesity onprognosis.Obesity and the risk of myocardial infarction in 27 000 participants from 52countries: a case-control studyLancet, 2005 9497, , 1640-1649 Salim Yusuf, Hawken, Ôunpuu, Leonelo Bautista, GraziaFranzosi, Commerford, Chim C Lang, Zvonko Rumboldt, Churchill L Onen, LiuLisheng et al.... FindingsBMI showed a modest and graded association with myocardial infarction (OR 1·44, 95%CI 1·32–1·57 top quintile vs bottom quintile before adjustment), which wassubstantially reduced after adjustment for waist-to-hip ratio (1·12, 1·03–1·22), andnon-significant after adjustment for other risk factors (0·98, 0·88–1·09). Forwaist-to-hip ratio, the odds ratios for every successive quintile were significantlygreater than that of the previous one (2nd quintile: 1·15, 1·05–1·26; 3rd quintile:1·39; 1·28–1·52; 4th quintile: 1·90, 1·74–2·07; and 5th quintiles: 2·52, 2·31–2·74[adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1·77; 1·59–1·97)and hip (0·73; 0·66–0·80) circumferences were both highly significant afteradjustment for BMI (p<0·0001 top vs bottom quintiles). Waist-to-hip ratio and waistand hip circumferences were closely (p<0·0001) associated with risk of myocardialinfarction even after adjustment for other risk factors (ORs for top quintile vslowest quintiles were 1·75, 1·33, and 0·76, respectively). Thepopulation-attributable risks of myocardial infarction for increased waist-to-hipratio in the top two quintiles was 24·3% (95% CI 22·5–26·2) compared with only 7·7%(6·0–10·0) for the top two quintiles of BMI.InterpretationWaist-to-hip ratio shows a graded and highly significant association with myocardialinfarction risk worldwide. Redefinition of obesity based on waist-to-hip ratioinstead of BMI increases the estimate of myocardial infarction attributable toobesity in most ethnic groups. ... Table 1. Comparative effect of 1 standard deviation increase in a specificmeasure of obesity in the overall population and separately in men and women================================== Odds Ratio (95% CI)---Odds Ratio (95% CI) 1 SD Adjusted for age, sex, and region Additionally adjusted for WHR or BMI----1 SD(women/men) Women Men Measure (units) ================================== BMI (kg/m2) 4·15 1·10 (1·07–1·13) 1·02 (0·99–1·04)^* 4·70/3·89 1·04 (0·98–1·09)^*1·00 (0·97–1·04)^* Waist circumference (cm) 12·08 1·19 (1·16–1·22) 1·25 (1·21–1·30)^† 12·97/11·581·40 (1·30–1·51)^† 1·19 (1·14–1·24)^† Hip circumference (cm) 10·96 0·96 (0·94–0·99) 0·87 (0·84–0·89)^† 12·18/10·36 0·92(0·86–0·99)^† 0·85 (0·82–0·89)^† Waist-to-hip ratio 0·085 1·37 (1·34–1·41) 1·37 (1·33–1·40)^† 0·089/0·078 1·34(1·27–1·42)^† 1·35 (1·31–1·40)^† Waist-to-height 0·072 1·19 (1·16–1·22) 1·24 (1·20–1·29)^† 0·082/0·066 1·39(1·29–1·50)^† 1·18 (1·13–1·23)^† ==================================BMI=body-mass index. WHR=waist-to-hip ratio.Odds ratios by sex are adjusted for age, region, and BMI or WHR as appropriate.^* Adjusted for WHR.^† Adjusted for BMI and height..... Table 2. Increases in odds ratio for myocardial infarction for 1 SD increase inbody-mass index, waist circumference, or waist-to-hip ratio in different ethnicgroups adjusted for age and sex================================== BMI (95% CI)^* Waist (95% CI)^† WHR (95% CI)^‡ ==================================Overall 1·10 1·19 1·37 (1·07–1·13) (1·16–1·22) (1·34–1·41) European 1·14 1·25 1·44 (1·09–1·20) (1·19–1·31) (1·36–1·51) Chinese 1·19 1·24 1·08 (1·11–1·27) (1·16–1·33) (1·03–1·14) South Asian 0·99 1·03 1·52 (0·93–1·05) (0·97–1·10) (1·41–1·64) Other Asian 1·29 1·58 2·60 (1·17–1·43) (1·41–1·78) (2·25–3·01) Arab 1·00 1·07 1·43 (0·93–1·07) (0·99–1·16) (1·31–1·57) Latin American 1·12 1·20 1·43 (1·04–1·21) (1·11–1·29) (1·32–1·56) Black African 1·29 1·57 1·36 (1·10–1·52) (1·31–1·88) (1·09–1·69) Mixed-race African^** 1·07 1·16 2·25 (0·94–1·22) (0·99–1·34) (1·79–2·84) ==================================BMI=body-mass index. WHR=waist-to-hip ratio. SD is not subgroup specific.^* SD=4·15.^† SD=12·08.^‡ SD=0·085.^** Black and white mixed-race in South Africa. Analysis using SD that are specificto each ethnic group leads to similar results for all groups other than Chinese, inwhom the OR for BMI decreases considerably to 1·04, and for waist circumference to1·18, but remains unchanged for WHR.... Table 3. Odds ratios and population-attributable risk of myocardial infarctionfor raised waist-to-hip ratio or body-mass index================================== High waist-to-hip ratio^*^†^** >0·83 women/>0·9 men BMI >25^†^** (overweight) BMI>30^‡^** (obese) ----Prev controls OR^¶ (95% CI) PAR (95%CI)----================================== Overall 66·7 1·77 33·7 53·7 1·28 10·8 14·6 1·24 2·8 (1·67 to 1·88) (31·0 to 36·5)(1·21 to 1·35) (8·6 to 13·6) (1·16 to 1·33) (2·0 to 4·0) Female 66·8 1·90 35·9 57·3 1·19 9·3 20·2 1·26 5·4 (1·69 to 2·14) (30·5 to 41·7) (1·07 to 1·32) (5·1 to 16·3) (1·12 to 1·43) (3·4 to 8·5) Male 66·7 1·73 32·1 52·4 1·31 10·9 12·6 1·23 2·01 (1·62 to 1·85) (29·1 to 35·4) (1·23 to 1·39) (8·4 to 14·1) (1·13 to 1·34) (1·2 to 3·4) European 68·4 2·23 44·4 63·3 1·46 16·6 20·7 1·32 5·3 (1·98 to 2·51) (39·4 to49·6) (1·31 to 1·61) (11·7 to 23·0) (1·17 to 1·48) (3·4 to 8·3) Chinese 53·8 1·18 8·55 37·9 1·33 11·6 4·4 1·16 0·71 (1·06 to 1·30) (4·6 to 15·4) (1·20 to 1·47) (8·4 to 15·8) (0·91 to 1·47) (0·16 to 3·15) South Asian 68·2 1·91 36·8 46·0 1·07 & #8722;0·69 9·7 1·24 1·0 (1·65 to 2·20)(30·5 to 43·5) (0·94 to 1·21) ( & #8722;6·06 to 4·68) (1·01 to 1·52) (0·16 to 6·3) Other Asian 57·0 3·63 58·2 36·7 1·54 14·1 5·7 1·84 4·0 (2·91 to 4·52) (51·3 to64·7) (1·27 to 1·86) (8·7 to 22·1) (1·28 to 2·64) (2·1 to 7·4) Arabic 78·8 1·47 30·9 72·6 0·99 0·73 26·3 1·02 & #8722;0·80 (1·20 to 1·82) (20·6to 43·4) (0·83 to 1·19) ( & #8722;11·48 to 12·93) (0·86 to 1·22) ( & #8722;5·41 to3·81) Latin American 79·0 2·06 44·3 64·2 1·24 9·8 18·4 1·26 4·4 (1·64 to 2·59) (34·1 to55·1) (1·05 to 1·46) (3·5 to 24·3) (1·04 to 1·52) (1·9 to 9·9) Black African 66·6 1·94 41·8 60·2 2·33 38·7 22·7 2·23 18·6 (1·19 to 3·17) (22·5to 63·9) (1·49 to 3·66) (21·7 to 59·0) (1·45 to 3·45) (9·6 to 32·8) Mixed-race African 71·0 3·56 63·6 59·3 1·62 18·9 27·8 1·08 & #8722;0·76 (2·27 to5·58) (49·2 to 76·0) (1·16 to 2·27) (7·1 to 41·5) (0·75 to 1·55) ( & #8722;10·73 to9·20) Other 72·8 1·85 49·1 62·2 2·13 34·3 21·1 1·95 11·9 (0·75 to 4·60) (16·7 to 82·3) (0·98 to 4·61) (9·4 to 72·4) (0·88 to 4·31) (2·4 to 42·9) ==================================Prev=prevalence. PAR=population-attributable risk. BMI=body-mass index.WHR=waist-to-hip ratio.^* Upper two-thirds of the distribution.^† Overweight.^‡ Obese.^** Upper two quintiles for WHR had a PAR of 24·3% versus 7·7% for same quintilesfor BMI.^¶ Odds ratio for 2nd tertile versus 1st is 1·36, and for 3rd versus 1st is 2·24. ORfor top two tertiles versus lowest tertile is 1·77.Black and white mixed-race in South Africa.... Since our study is mainly focused on myocardial infarction and uses acase-control design, we cannot elucidate the relation between the different measuresof obesity on other outcomes (eg, cancers) or whether there is an increased risk ofsome diseases in those who are very lean. Such an assessment would need very largecohort studies or a meta-analysis of all existing studies. INTERHEART shows that thewaist-to-hip ratio is the strongest anthropometric measure that is associated withmyocardial infarction risk, and is substantially better than BMI. These results areconsistent in both sexes, old and young individuals, in different regions, and indifferent ethnic groups. Use of raised waist-to-hip ratio as the index of obesityinstead of BMI increases the population attributable risk for myocardial infarctionthreefold. Our findings suggest that substantial reassessment is needed of theimportance of obesity for cardiovascular disease in most regions of the world.... The INTERHEART study was funded by unrestricted grants from severalpharmaceutical companies (with major contributions from AstraZeneca, Novartis,Sanofi Aventis, Knoll Pharmaceuticals [now Abbott], Bristol Myers Squibb, andSanofi-Synthelabo) ... Italy—Boehringer-Ingelheim, Japan—Sankyo Pharmaceutical Co,Banyu Pharmaceutical Co, Astra Japan; Kuwait—Endowment Fund for Health Developmentin Kuwait; Pakistan—ATCO Laboratories; Philippines—Philippine Council for HealthResearch & Dev, Pfizer Philippines Foundation, Inc, Astra Pharmaceuticals Inc, andthe Astra Fund for Clinical Research and Continuing Medical Education, Pharmacia & Upjohn Inc; Poland—Foundation PROCLINICA ... South Africa—MRC South Africa,Warner-Parke- Pharmaceuticals, Aventis ... USA—King Pharma.Al Pater, PhD; email: old542000@... __________________________________ FareChase: Search multiple travel sites in one click.http://farechase.

[Guest guest]

How to calculate waist-to-hip ratio

Figuring out your risk is simple. Using a tape measure:

Measure your hips. Measure your waist. Then divide the waist number by the hip number. For a healthy woman: the total should be under 0.85

For a healthy man: the total should be below point 0.90

(A 30-inch waist and 36-inch hips would work out to a favorable 0.83, or 83 percent.)

Re: [ ] INTERHEART Paper

Hi All,The pdf-available story for:http://news.xinhuanet.com/english/2005-11/04/content_3731079.htmis:Hip, waist size predictor of heart risk www.chinaview.cn 2005-11-04 14:15:39 BEIJING, Nov. 4 (Xinhuanet)-- Scientists say they've found a better way of measuring obesity and a person'srisk of getting a heart attack than the method used by doctors worldwide for years. It has long been thought that fat people are more at risk of a heart attack, butdoctors say today that it is not as simple as that. It all depends on where the fatis. A large bottom and thighs could be positively healthy — a “beer belly”, on theother hand, spells trouble, no matter how skinny the person may be elsewhere. Researchers reported in Friday’s issue of The Lancet medical journal that ahip-to-waist ratio is a better predictor of the risk of heart attack for a varietyof ethnic groups than body-mass index (BMI), the current standard. BMI (based on a person's weight and height) takes no notice of where a person'sfat lies or how muscular that person may be, says Dr. Arya Sharma, co-author of thestudy and a professor of medicine at McMaster University in Hamilton, Ont. Therefore, a well-muscled athlete and an obese person could have similar BMIscores. A study of 27,000 people, including more than 14,000 heart disease patients, hasfound that waist-to-hip ratios can mark out those people more likely to suffer heartfailure far more effectively than conventional tests. ...A farewell to body-mass index?Lancet, 2005 9497, 1589-1591 Charlotte Kragelund and Torbjørn OmlandIn today's Lancet, the INTERHEART investigators report the results of awell-conceived, well-executed, large-scale study on different measures of bodycomposition and risk of myocardial infarction in multiple populations from 52countries across the world.1 Amid the dispute over whether or not the metabolicsyndrome, of which obesity is a central feature, exists as a sensible unity indefining increased cardiovascular risk in populations,2 and 3 and whether or not thewaist measure, as opposed to body-mass index, is the measure of choice in assessingobesity across multiple populations,4 the INTERHEART investigators place what seemsto be the final nail in the casket for body-mass index as an independentcardiovascular risk factor.Last year, the INTERHEART investigators identified nine important risk factors formyocardial infarction, including abdominal obesity,5 which accounted for more than90% of the worldwide myocardial infarction risk. Today's article further exploresthe complex associations between different measures of obesity and myocardialinfarction risk. The INTERHEART study provides convincing evidence of the relativeimportance of several different measures of obesity in assessing risk of myocardialinfarction. The investigators focus on four different measures of obesity, namelybody-mass index, waist-to-hip ratio, waist measure, and hip measure, the last threemeasures serving as surrogate measures for abdominal obesity. The salient finding ofINTERHEART is that waist-to-hip ratio is the obesity measure most stronglyassociated with myocardial infarction. This finding is consistent across populationsand across well-defined subgroups, and is evident regardless of analytic approach.Importantly, these findings were independent of other measures of body compositionand other known risk factors previously identified in the INTERHEART studypopulation.5 Finally, the INTERHEART investigators show that the population riskattributable to waist-to-hip ratio is much larger than the population riskattributable to body-mass index. This result suggests that previous estimates of theimpact of obesity as a cardiovascular risk factor have been too low.The findings from INTERHEART are important in several ways. Previous studies of thegeneral population have shown increased risk of cardiovascular disease and mortalityin obese individuals,6 and 7 with an improved prognosis after weight loss.8 However,most of these studies have included single well-defined populations, mainly ofEuropean and north American origin, and the evidence for other population groups issparse.9 By contrast, INTERHEART investigated individuals across all continents,including large groups with different ethnic origins and ages. Increasing evidencein patients with established coronary heart disease suggests similar or decreasedmortality in obese patients compared with patients of normal weight.10 and 11 Themechanisms underlying this apparently paradoxical relation between obesity andcardiovascular risk are unclear, but may relate to the definition of obesity itself.Traditionally, obesity has been defined by body-mass index, but increasing evidencesuggests that measurement of abdominal obesity as waist circumference andwaist-to-hip ratio is more important. Other strengths of the current INTERHEARTreport include novel information on the prevalence of abdominal obesity in differentethnic groups. By contrast with many other studies, body composition was measuredinstead of being self-reported.Even though INTERHEART is an important contribution to the understanding of theassociation between obesity and risk of myocardial infarction, some limitationsshould be kept in mind. The cross-sectional case-control design does not allowinferences to be drawn about causality between obesity and myocardial infarctionrisk. The design is susceptible to bias from differential selection of cases andcontrols, and so the results must be interpreted with caution. The study does notgive evidence of the underlying biological causes of the association betweenwaist-to-hip ratio and risk of myocardial infarction. Waist-to-hip ratio is asurrogate measure of abdominal obesity, even though previous studies have found ahigh correlation between waist measure and waist-to-hip ratio and amount ofintra-abdominal fat.12 Moreover, the finding that waist-to-hip ratio is a betterrisk predictor than body-mass index is not entirely new. For instance, a recentprospective study on the risk of death in patients with acute myocardial infarctionidentifies abdominal obesity as measured by the waist-to-hip ratio as a better riskindicator than body-mass index.11The main message from the new INTERHEART report is that current practice withbody-mass index as the measure of obesity is obsolete, and results in considerableunderestimation of the grave consequences of the overweight epidemic. A directconsequence of these findings is that, for assessment of risk associated withobesity, the waist-to-hip ratio, and not body-mass index, is the preferred simplemeasure. Future studies must validate the importance of the waist-to-hip ratio byassessment of the effect of weight loss and decreasing abdominal obesity onprognosis.Obesity and the risk of myocardial infarction in 27 000 participants from 52countries: a case-control studyLancet, 2005 9497, , 1640-1649 Salim Yusuf, Hawken, Ôunpuu, Leonelo Bautista, GraziaFranzosi, Commerford, Chim C Lang, Zvonko Rumboldt, Churchill L Onen, LiuLisheng et al.... FindingsBMI showed a modest and graded association with myocardial infarction (OR 1·44, 95%CI 1·32–1·57 top quintile vs bottom quintile before adjustment), which wassubstantially reduced after adjustment for waist-to-hip ratio (1·12, 1·03–1·22), andnon-significant after adjustment for other risk factors (0·98, 0·88–1·09). Forwaist-to-hip ratio, the odds ratios for every successive quintile were significantlygreater than that of the previous one (2nd quintile: 1·15, 1·05–1·26; 3rd quintile:1·39; 1·28–1·52; 4th quintile: 1·90, 1·74–2·07; and 5th quintiles: 2·52, 2·31–2·74[adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1·77; 1·59–1·97)and hip (0·73; 0·66–0·80) circumferences were both highly significant afteradjustment for BMI (p<0·0001 top vs bottom quintiles). Waist-to-hip ratio and waistand hip circumferences were closely (p<0·0001) associated with risk of myocardialinfarction even after adjustment for other risk factors (ORs for top quintile vslowest quintiles were 1·75, 1·33, and 0·76, respectively). Thepopulation-attributable risks of myocardial infarction for increased waist-to-hipratio in the top two quintiles was 24·3% (95% CI 22·5–26·2) compared with only 7·7%(6·0–10·0) for the top two quintiles of BMI.InterpretationWaist-to-hip ratio shows a graded and highly significant association with myocardialinfarction risk worldwide. Redefinition of obesity based on waist-to-hip ratioinstead of BMI increases the estimate of myocardial infarction attributable toobesity in most ethnic groups. ... Table 1. Comparative effect of 1 standard deviation increase in a specificmeasure of obesity in the overall population and separately in men and women================================== Odds Ratio (95% CI)---Odds Ratio (95% CI) 1 SD Adjusted for age, sex, and region Additionally adjusted for WHR or BMI----1 SD(women/men) Women Men Measure (units) ================================== BMI (kg/m2) 4·15 1·10 (1·07–1·13) 1·02 (0·99–1·04)^* 4·70/3·89 1·04 (0·98–1·09)^*1·00 (0·97–1·04)^* Waist circumference (cm) 12·08 1·19 (1·16–1·22) 1·25 (1·21–1·30)^† 12·97/11·581·40 (1·30–1·51)^† 1·19 (1·14–1·24)^† Hip circumference (cm) 10·96 0·96 (0·94–0·99) 0·87 (0·84–0·89)^† 12·18/10·36 0·92(0·86–0·99)^† 0·85 (0·82–0·89)^† Waist-to-hip ratio 0·085 1·37 (1·34–1·41) 1·37 (1·33–1·40)^† 0·089/0·078 1·34(1·27–1·42)^† 1·35 (1·31–1·40)^† Waist-to-height 0·072 1·19 (1·16–1·22) 1·24 (1·20–1·29)^† 0·082/0·066 1·39(1·29–1·50)^† 1·18 (1·13–1·23)^† ==================================BMI=body-mass index. WHR=waist-to-hip ratio.Odds ratios by sex are adjusted for age, region, and BMI or WHR as appropriate.^* Adjusted for WHR.^† Adjusted for BMI and height..... Table 2. Increases in odds ratio for myocardial infarction for 1 SD increase inbody-mass index, waist circumference, or waist-to-hip ratio in different ethnicgroups adjusted for age and sex================================== BMI (95% CI)^* Waist (95% CI)^† WHR (95% CI)^‡ ==================================Overall 1·10 1·19 1·37 (1·07–1·13) (1·16–1·22) (1·34–1·41) European 1·14 1·25 1·44 (1·09–1·20) (1·19–1·31) (1·36–1·51) Chinese 1·19 1·24 1·08 (1·11–1·27) (1·16–1·33) (1·03–1·14) South Asian 0·99 1·03 1·52 (0·93–1·05) (0·97–1·10) (1·41–1·64) Other Asian 1·29 1·58 2·60 (1·17–1·43) (1·41–1·78) (2·25–3·01) Arab 1·00 1·07 1·43 (0·93–1·07) (0·99–1·16) (1·31–1·57) Latin American 1·12 1·20 1·43 (1·04–1·21) (1·11–1·29) (1·32–1·56) Black African 1·29 1·57 1·36 (1·10–1·52) (1·31–1·88) (1·09–1·69) Mixed-race African^** 1·07 1·16 2·25 (0·94–1·22) (0·99–1·34) (1·79–2·84) ==================================BMI=body-mass index. WHR=waist-to-hip ratio. SD is not subgroup specific.^* SD=4·15.^† SD=12·08.^‡ SD=0·085.^** Black and white mixed-race in South Africa. Analysis using SD that are specificto each ethnic group leads to similar results for all groups other than Chinese, inwhom the OR for BMI decreases considerably to 1·04, and for waist circumference to1·18, but remains unchanged for WHR.... Table 3. Odds ratios and population-attributable risk of myocardial infarctionfor raised waist-to-hip ratio or body-mass index================================== High waist-to-hip ratio^*^†^** >0·83 women/>0·9 men BMI >25^†^** (overweight) BMI>30^‡^** (obese) ----Prev controls OR^¶ (95% CI) PAR (95%CI)----================================== Overall 66·7 1·77 33·7 53·7 1·28 10·8 14·6 1·24 2·8 (1·67 to 1·88) (31·0 to 36·5)(1·21 to 1·35) (8·6 to 13·6) (1·16 to 1·33) (2·0 to 4·0) Female 66·8 1·90 35·9 57·3 1·19 9·3 20·2 1·26 5·4 (1·69 to 2·14) (30·5 to 41·7) (1·07 to 1·32) (5·1 to 16·3) (1·12 to 1·43) (3·4 to 8·5) Male 66·7 1·73 32·1 52·4 1·31 10·9 12·6 1·23 2·01 (1·62 to 1·85) (29·1 to 35·4) (1·23 to 1·39) (8·4 to 14·1) (1·13 to 1·34) (1·2 to 3·4) European 68·4 2·23 44·4 63·3 1·46 16·6 20·7 1·32 5·3 (1·98 to 2·51) (39·4 to49·6) (1·31 to 1·61) (11·7 to 23·0) (1·17 to 1·48) (3·4 to 8·3) Chinese 53·8 1·18 8·55 37·9 1·33 11·6 4·4 1·16 0·71 (1·06 to 1·30) (4·6 to 15·4) (1·20 to 1·47) (8·4 to 15·8) (0·91 to 1·47) (0·16 to 3·15) South Asian 68·2 1·91 36·8 46·0 1·07 & #8722;0·69 9·7 1·24 1·0 (1·65 to 2·20)(30·5 to 43·5) (0·94 to 1·21) ( & #8722;6·06 to 4·68) (1·01 to 1·52) (0·16 to 6·3) Other Asian 57·0 3·63 58·2 36·7 1·54 14·1 5·7 1·84 4·0 (2·91 to 4·52) (51·3 to64·7) (1·27 to 1·86) (8·7 to 22·1) (1·28 to 2·64) (2·1 to 7·4) Arabic 78·8 1·47 30·9 72·6 0·99 0·73 26·3 1·02 & #8722;0·80 (1·20 to 1·82) (20·6to 43·4) (0·83 to 1·19) ( & #8722;11·48 to 12·93) (0·86 to 1·22) ( & #8722;5·41 to3·81) Latin American 79·0 2·06 44·3 64·2 1·24 9·8 18·4 1·26 4·4 (1·64 to 2·59) (34·1 to55·1) (1·05 to 1·46) (3·5 to 24·3) (1·04 to 1·52) (1·9 to 9·9) Black African 66·6 1·94 41·8 60·2 2·33 38·7 22·7 2·23 18·6 (1·19 to 3·17) (22·5to 63·9) (1·49 to 3·66) (21·7 to 59·0) (1·45 to 3·45) (9·6 to 32·8) Mixed-race African 71·0 3·56 63·6 59·3 1·62 18·9 27·8 1·08 & #8722;0·76 (2·27 to5·58) (49·2 to 76·0) (1·16 to 2·27) (7·1 to 41·5) (0·75 to 1·55) ( & #8722;10·73 to9·20) Other 72·8 1·85 49·1 62·2 2·13 34·3 21·1 1·95 11·9 (0·75 to 4·60) (16·7 to 82·3) (0·98 to 4·61) (9·4 to 72·4) (0·88 to 4·31) (2·4 to 42·9) ==================================Prev=prevalence. PAR=population-attributable risk. BMI=body-mass index.WHR=waist-to-hip ratio.^* Upper two-thirds of the distribution.^† Overweight.^‡ Obese.^** Upper two quintiles for WHR had a PAR of 24·3% versus 7·7% for same quintilesfor BMI.^¶ Odds ratio for 2nd tertile versus 1st is 1·36, and for 3rd versus 1st is 2·24. ORfor top two tertiles versus lowest tertile is 1·77.Black and white mixed-race in South Africa.... Since our study is mainly focused on myocardial infarction and uses acase-control design, we cannot elucidate the relation between the different measuresof obesity on other outcomes (eg, cancers) or whether there is an increased risk ofsome diseases in those who are very lean. Such an assessment would need very largecohort studies or a meta-analysis of all existing studies. INTERHEART shows that thewaist-to-hip ratio is the strongest anthropometric measure that is associated withmyocardial infarction risk, and is substantially better than BMI. These results areconsistent in both sexes, old and young individuals, in different regions, and indifferent ethnic groups. Use of raised waist-to-hip ratio as the index of obesityinstead of BMI increases the population attributable risk for myocardial infarctionthreefold. Our findings suggest that substantial reassessment is needed of theimportance of obesity for cardiovascular disease in most regions of the world.... The INTERHEART study was funded by unrestricted grants from severalpharmaceutical companies (with major contributions from AstraZeneca, Novartis,Sanofi Aventis, Knoll Pharmaceuticals [now Abbott], Bristol Myers Squibb, andSanofi-Synthelabo) ... Italy—Boehringer-Ingelheim, Japan—Sankyo Pharmaceutical Co,Banyu Pharmaceutical Co, Astra Japan; Kuwait—Endowment Fund for Health Developmentin Kuwait; Pakistan—ATCO Laboratories; Philippines—Philippine Council for HealthResearch & Dev, Pfizer Philippines Foundation, Inc, Astra Pharmaceuticals Inc, andthe Astra Fund for Clinical Research and Continuing Medical Education, Pharmacia & Upjohn Inc; Poland—Foundation PROCLINICA ... South Africa—MRC South Africa,Warner-Parke- Pharmaceuticals, Aventis ... USA—King Pharma.Al Pater, PhD; email: old542000@... __________________________________ FareChase: Search multiple travel sites in one click.http://farechase.

[Guest guest]

Hi All,

There is an expression among carpenters:

" Measure twice, cut once. "

We know what requires cutting.

--- jwwright <jwwright@...> wrote:

> How to calculate waist-to-hip ratio

> Figuring out your risk is simple. Using a tape measure:

>

> Measure your hips.

> Measure your waist.

> Then divide the waist number by the hip number.

> For a healthy woman: the total should be under 0.85

>

> For a healthy man: the total should be below point 0.90

>

> (A 30-inch waist and 36-inch hips would work out to a favorable 0.83, or

83

> percent.)

Al Pater, PhD; email: old542000@...

__________________________________

FareChase: Search multiple travel sites in one click.

http://farechase.

[Guest guest]

Hi All,

There is an expression among carpenters:

" Measure twice, cut once. "

We know what requires cutting.

--- jwwright <jwwright@...> wrote:

> How to calculate waist-to-hip ratio

> Figuring out your risk is simple. Using a tape measure:

>

> Measure your hips.

> Measure your waist.

> Then divide the waist number by the hip number.

> For a healthy woman: the total should be under 0.85

>

> For a healthy man: the total should be below point 0.90

>

> (A 30-inch waist and 36-inch hips would work out to a favorable 0.83, or

83

> percent.)

Al Pater, PhD; email: old542000@...

__________________________________

FareChase: Search multiple travel sites in one click.

http://farechase.