Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study.

Description

In this prospective, population-based study of 24,508 men and women who were followed for an average of 9.1 years, investigators of the European Investigation Into Cancer and Nutrition in Norfolk, United Kingdom, hypothesized that indices of body fat distribution had stronger ties to coronary heart disease (CHD) risk than body mass index (BMI). Waist-to-hip ratio showed the strongest association with CHD risk. Compared to participants in the bottom quintile of waist-to-hip ratio, the hazard ratio for future CHD risk in men in the top quintile was 1.55 (95% CI, 1.28-1.73) and 1.73 (1.44-2.54) in women in the top quintile. Hip circumference was linked to decreased CHD risk independent of BMI and waist circumference. Furthermore, in men and women with an elevated waist circumference, a further increase in hip circumference seemed to decrease CHD risk. Given the well established association between intra-abdominal (visceral) obesity and the atherogenic metabolic risk profile predictive of CHD, this study suggests that a crude marker of intra-abdominal adipose tissue accumulation, such as waist-to-hip ratio, better discriminates CHD risk than BMI alone. Since BMI fails to capture the “cardioprotective” benefits of subcutaneous adipose tissue accumulation, health professionals should take basic anthropometric measurements such as waist and hip circumference in order to better quantify obesity-related CHD risk. This paper is also discussed in an editorial published on our website.