Body mass index, waist circumference and waist-to-hip ratio cut-off points for categorisation of obesity among Omani Arabs

BACKGROUND: There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. OBJECTIVE: To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. DESIGN: A community-based cross-sectional study. SETTING: The survey was conducted in the city of Nizwa in Oman in 2001. SUBJECTS AND METHODS: The study contained a probabilistic random sample of 1421 adults aged > or =20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. RESULTS: Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8 kg m-2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. CONCLUSIONS: To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-off points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.     

Accuracy of self-reported waist and hip measurements in 4492 EPIC-Oxford participants

OBJECTIVE: To assess the accuracy of self-reported waist and hip circumferences and the waist-to-hip ratio (WHR) by comparison with measured waist and hip circumferences and WHR in a sample of middle-aged men and women. DESIGN: Analysis of measured and self-reported waist and hip data from participants in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). PARTICIPANTS: Four thousand four hundred and ninety-two British men and women aged 35-76 years. RESULTS: Spearman's rank correlation coefficients between measured and self-reported waist, hip and WHR were 0.80, 0.74 and 0.44, respectively, for men and 0.83, 0.86 and 0.62 for women. Waist was underestimated, on average, by 3.1 (standard deviation (SD) 5.6) cm in men and 1.9 (SD 5.4) cm in women. The extent of underestimation was greater in participants with larger waists, older participants and women with greater body mass index (BMI). Hip was underestimated by a mean of 1.8 (SD 4.9) cm in men and 1.2 (SD 4.5) cm in women; the extent of underestimation was greater in participants with larger hip circumference and older participants. On average, WHR was underestimated by less than 2% by men and women; the extent of underestimation was greater among those with larger WHR, older people and those with greater BMI. Using self-reported values, the proportion of classification to the correct tertile was over 65% for waist and hip measurements. For WHR this proportion was 50% among men and 60% among women. CONCLUSIONS: Self-reported waist and hip measurements in EPIC-Oxford are sufficiently accurate for identifying relationships in epidemiological studies.     

Comparative evaluation of anthropometric measures to predict cardiovascular risk factors in Tehranian adult women

OBJECTIVE: To compare the ability of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) to predict cardiovascular risk factors in an urban adult population of Tehranian women. DESIGN: Population-based cross-sectional study. SETTING: Tehran, the capital of Iran. SUBJECTS: This study was conducted on 5073 women aged 18-74 years, participants of the Tehran Lipid and Glucose Study. Demographic data were collected. Anthropometric indices were measured according to standard protocols. Cut-off points of BMI, WC, WHR and WHtR were considered as 25 kg m(-2), 80 cm, 0.8 and 0.5, respectively. Blood pressure was measured and hypertension was defined based on the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Biochemical analyses were conducted on fasting blood samples. Diabetes was defined as fasting plasma glucose > or = 126 mg dl(-1) or 2-hour plasma glucose > or = 200 mg dl(-1) and dyslipidaemia based on the third report of the National Cholesterol Education Program Expert Panel. The presence of 'at least one risk factor' from the three major cardiovascular risk factors (hypertension, dyslipidaemia and diabetes) was also evaluated. RESULTS: Mean (+/-standard deviation) age of women was 39.9+/-14.6 years; mean BMI, WC, WHR and WHtR were 27.1+/-1.5 kg m(-2), 86.5+/-13.5 cm and 0.83+/-0.08 and 0.55+/-0.08, respectively. Of the four anthropometric measures, WC had the highest sensitivity and specificity to identify subjects with risk factors in both the 18-39 year and the 40-74 year age categories. WC was seen to have a higher percentage of correct prediction than BMI, WHR and WHtR. CONCLUSION: It is concluded that WC is the best screening measure for cardiovascular risk factors, compared with BMI, WHR and WHtR, in Tehranian adult women.     

Nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, Argentina

OBJECTIVE: To assess the nutritional status of the Andean population of Puna and Quebrada of Humahuaca, Jujuy, using anthropometric measurements. DESIGN AND SUBJECTS: A cross-sectional nutritional survey was carried out in a representative sample (n = 1236) of individuals from these regions. Children aged 2-9 years, adolescents (10-17 years) and adults (>or=18 years; pregnant and lactating women excluded) were considered. Height-for-age, weight-for-height and body mass index (BMI) were calculated in children and adolescents and compared with World Health Organization/National Center for Health Statistics/Centers for Disease Control and Prevention reference standards using Z-scores or percentiles, in order to assess the prevalence of stunting, wasting/thinness and excess weight. In adults, BMI, waist circumference (WC) and waist-to-hip (WHR) ratio were used to identify obesity and central adiposity. RESULTS: Stunting (height-for-age Z-score <-2 standard deviations) and obesity (BMI >or= 95th percentile) were found to be major nutritional problems in children and adolescents. Stunting was prevalent in 10.7% of children and 12.4% of adolescents; 8.2% of children and 3.5% of adolescents were obese. Adults were short (mean: 155.8 cm) and values of overweight (32.3%), obesity (18.3%) and central adiposity (mean WC: 86.5 cm) were high. Older adults and those with higher economic development showed higher prevalence of obesity and central adiposity. CONCLUSIONS: The present population may be at the early stages of nutritional transition as symptoms of undernutrition and overnutrition coexist at the population level. These results suggest that rates of growth retardation may be decreasing owing to improved nutritional conditions; however, this could be accompanied by a sharp increase in the prevalence of other diet-related chronic diseases.     

Anthropometric predictors for the risk of chronic disease in non-diabetic, non-hypertensive young Mexican women

OBJECTIVES: To assess the ability of anthropometric measurements to identify young women at risk of developing diabetes, hypertension and heart disease in the future and to compare cut-off points for common anthropometric measures established with receiver-operating characteristic (ROC) curves with those reported in the literature. DESIGN: Cross-sectional study. SUBJECTS: Eight hundred and two young Mexican women living in semi-urban poverty. MEASUREMENTS/METHODS: The ability of anthropometric measures of fatness and fat distribution (body mass index (BMI), summed skinfold thickness (SST), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI), abdominal volume index (AVI)) to predict risk of future disease (pre-diabetes: fasting blood glucose 100-126 mg dl-1; pre-hypertension: systolic blood pressure 120-139 mmHg and/or diastolic blood pressure 80-89 mmHg; hypertriglyceridaemia: triglycerides > or =150 mg dl-1; or a combination of risk factors) was assessed using ROC curve analysis. RESULTS: Twenty-three of the 802 women who were interviewed had incomplete data and 50 (6.4%) were eliminated from the analysis due to hypertension and/or diabetes. Mean age of the remaining 729 women was 29.6 +/- 5.4 years and mean BMI was 27.7 +/- 4.5 kg m-2. There were no significant differences in the area under the ROC curve for BMI, WC, AVI or SST for any of the four outcomes. However, these indices performed significantly better than WHR and CI (P < 0.05). The BMI cut-off points that maximised sensitivity and specificity for the four outcomes were in the range of 27.7-28.4 kg m-2, and for WC were 89.3-91.2 cm. To detect 90% of the cases of any metabolic alteration, the necessary BMI cut-off was 26.1 kg m-2. Younger women (<25 years) were at greater risk than older women for a given BMI increment (P < 0.05). CONCLUSIONS: We found that BMI and WC cut-off points commonly used for the identification of risk of existing disease were also appropriate in this population for the identification of risk in the future among women without diabetes or hypertension. The early identification of at-risk individuals, prior to the onset of disease, is fundamental particularly in the context of a country with scarce resources that is rapidly undergoing nutrition transition.     

Anthropometry of women of childbearing age in Morocco: body composition and prevalence of overweight and obesity

OBJECTIVE: To determine the prevalence of obesity and body fat distribution of Moroccan women of childbearing age, using a panel of anthropometric measurements. DESIGN AND SETTING: A cross-sectional survey conducted in 1995 in an agricultural community, El Jadida province of Morocco. Weight, height, waist and hip circumferences and triceps, biceps, subscapular and supra-iliac skinfold thicknesses were measured. Body mass index (BMI), waist/hip ratio (WHR), sum of all and sum of trunk skinfold thicknesses were determined. SUBJECTS: In total, 1269 women aged 15-49 years from urban and rural areas were surveyed. RESULTS: The means of all anthropometric measurements including body fat were higher in urban than in rural women and increased with age. Trunk fat contributed 50% of total fat. Globally, 4.7% of women were underweight (BMI<18.5 kg m(-2)), 35.2% were overweight or obese (BMI> or =25 kg m(-2)), 10.1% were obese (BMI> or =30 kg m(-2)) and 16.8% had central obesity (WHR>0.85). The prevalence of overweight and obesity was higher in the urban than in the rural area. Underweight prevalence decreased with age, whereas that of overweight and obesity increased. All anthropometric parameters adjusted for age increased with the increase of BMI and WHR. CONCLUSIONS: Although undernutrition is still prevalent, there is an alarming prevalence of overweight and obesity in Moroccan women of childbearing age. The results indicate a shift in this country from the problem of dietary deficiency to the problem of dietary excess, and alert one to the necessity of establishing an intervention to prevent obesity-related diseases. It is necessary to address which of the anthropometric variables studied here is the best predictor of obesity-related diseases in this population.     

Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

BACKGROUND: BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting. OBJECTIVES: To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1325 Guatemalan adults (44 % stunted: 162 cm men). METHODS: Cardio-metabolic risk factors were systolic/diastolic blood pressure 85 mmHg, glucose 5 mmol/l, TAG 7 mmol/l, ratio of total cholesterol to HDL-cholesterol 0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used. RESULTS: Areas under the ROC curve were in the range of 005978 for WC among men and 006472 among women, respectively. Optimal cut-off points for BMI were 242651 kg/m2 stunted; 242656 kg/m2 among women (262769 kg/m2 non-stunted). Optimal cut-off points for WC were 879134 cm stunted; 889333 cm among women (909486 cm non-stunted).ConclusionOptimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.     

Waist circumference as a determinant of hypertension and diabetes in Brazilian women: a population-based study

OBJECTIVE: To evaluate the role of central adiposity, as evaluated by the measurement of waist circumference (WC), as an independent risk factor for hypertension and type 2 diabetes mellitus in the setting of a developing country. DESIGN: Population-based, cross-sectional study. SETTING: A medium-sized town in southern Brazil. PARTICIPANTS: One thousand and ninety-five non-pregnant women, 20 to 69 years old, recruited by cluster random sampling between 1999 and 2000. Their mean WC was 85.3 cm (standard deviation 13.9 cm) and 23.3% (n=255) were obese (body mass index >30 kg m(-2)). The prevalence of hypertension and diabetes was 25.6% (n=280) and 6.2% (n=68), respectively. RESULTS: The risks of hypertension and diabetes were directly related to WC measurement. Women with WC>80 cm had increased risk of hypertension (odds ratio (OR)=6.2, P<0.001). The association remained significant (OR=1.04 per cm increase in WC, P=0.02) after adjusting for confounders. The effect of WC on diabetes was modified by age. The effect was stronger in women younger than 40 years old (OR=12.7, P=0.016) than in those over 40 years old (OR=2.8, P=0.013). In the multivariate analysis, the odds ratio was 5.7 (P=0.12) in those under 40 years old and 2.8 (P=0.008) in older women. CONCLUSIONS: Waist circumference is an independent determinant for hypertension and diabetes in women in this population. The stronger association between WC and diabetes in younger women suggests that the validity of this indicator to assess abdominal adiposity is age-specific. Further studies should validate the usefulness of WC measurement in different age groups.     

Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England

OBJECTIVES: To look at trends in generalised (body mass index (BMI) >or=30 kg m(-2)) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension-diabetes co-morbidity (HDC) in England. DESIGN: Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). SUBJECTS: Non-institutionalised men and women aged >or=35 years. MEASUREMENTS: Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses. RESULTS: Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC. CONCLUSIONS: If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.     

Physical activity, diet and gene-environment interactions in relation to body mass index and waist circumference: the Swedish young male twins study

OBJECTIVE: The aim of the present study was to examine the relationships between genetic susceptibility to obesity, physical activity (PA), dietary fibre, sugar and fat intakes and 4-year changes in body mass index (BMI) and attained waist circumference (WC) in a cohort of 287 monozygotic and 189 dizygotic young adult male twin pairs. Increased knowledge about interactions between genes and environment may provide insight into why some individuals are more prone to obesity than others. DESIGN: Information about PA, BMI, dietary habits, WC and potential confounders was collected by questionnaire in 1998 and 2002. The cohort data were analysed by mixed linear models. RESULTS: Twins with low PA attained larger WC than twins with high PA (difference 2.5 cm; 95% confidence interval (CI) 1.3, 3.6). The twins with the lowest fibre intake were found to have attained the highest WC and to have increased most in BMI (difference between highest and lowest fibre intakes: 1.6 cm, 95% CI 0.4, 2.9 and 0.45 kg m(-2), 95% CI 0.15, 0.76, respectively). Furthermore, our results suggested the presence of interactions so that twins with genetic susceptibility to obesity were more prone to have larger WC if sedentary than twins without genetic susceptibility. CONCLUSION: PA and a diet rich in fibre may be protective against weight gain among younger adult men. An interaction between PA, genes and attained WC is a novel finding which needs confirmation by other studies.     

Diabetes and hypertension increases in a society with abdominal obesity: results of the Mexican National Health Survey 2000

OBJECTIVES: To determine the prevalences of overweight, obesity, type 2 diabetes mellitus (DM) and hypertension (HT) in the Mexican population and compare them with those of a previous Mexican urban survey and an American survey. DESIGN: A structured, randomised, nationally representative Mexican sample was compared with a 1993 Mexican urban survey and the US Third National Health and Nutrition Examination Survey (NHANES III) of non-Hispanic Whites. SETTING: The Mexican National Health Survey 2000.Subjects: Subjects were 12,856 men and 28,332 women, aged 20-69 years, who had their body weight, height, waist circumference (WC), blood pressure and fasting capillary blood glucose measured. RESULTS: Mexican adult men and women had a high prevalence of overweight (41.3 and 36.3%, respectively) and obesity (19.4 and 29.0%, respectively), similar to those in the USA in 1988-1992 and exceeding those of the 1993 Mexican survey. The prevalence of HT was 33.3% in men and 25.6% in women, with inferred DM rates of 5.6 and 9.7%, respectively. Abdominal obesity affected 46.3% of men (WC>or=94 cm) and 81.4% of women (WC>or=80 cm). There was a high prevalence of abdominal obesity in normal-weight women, with co-morbidities relating better to WC than to body mass index (BMI) in both sexes. Rates of DM and HT exceeded US rates on a comparable BMI or WC basis in adults aged <50 years. CONCLUSION: The high prevalence of obesity and abdominal obesity in Mexicans is associated with markedly increased prevalences of DM and HT to levels comparable with, or even higher than, those in NHANES III of non-Hispanic Whites.     

A comparative study of methods for diagnosis of obesity in an urban mixed-race population in Minas Gerais, Brazil

BACKGROUND: Obesity is defined as an excess of total body fat and may be assessed by different methods. The objective of the present study was to establish the discriminatory power of anthropometric data in determining obesity. METHODS: The subjects comprised 685 individuals, aged 20-79 years, sampled from a population-based survey. The following indicators were used: body mass index (BMI), waist circumference (WC) and total body fat percentage estimated with both Siri's equation (%BF Siri) and foot-to-foot bioelectrical impedance analysis (%BF BIA). Sensitivity and specificity of different cut-off points for each method were determined using %BF BIA as reference. RESULTS: Of 685 participants, 57.6% were aged >/= 40 years, 69.9% were women and 72.6% self-referred themselves as non-white. To classify obesity based on sex and age among women aged 0.05). Classifying according to skin colour did not change cut-off points in any indicator. CONCLUSION: BMI and WC better discriminate obesity among women and men aged >/= 40 years from a mixed-race population.     

Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage

OBJECTIVE: Alcohol consumption may play a role in the development of obesity but the relationship between alcohol and weight is still unclear. The aim of our study was to assess the cross-sectional association of intakes of total alcohol and of specific alcoholic beverages (wine, beer and spirits) with waist-to-hip ratio (WHR) and body mass index (BMI) in a large sample of adults from all over France. DESIGN: Cross-sectional. SETTING: Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases). SUBJECTS: For 1481 women aged 35-60 years and 1210 men aged 45-60 years, intakes of total alcohol and specific alcoholic beverages were assessed by six 24-hour dietary records. BMI and WHR were measured during a clinical examination the year after. RESULTS: A J-shaped relationship was found between total alcohol consumption and WHR in both sexes and between total alcohol consumption and BMI in men only (P<0.05). The same relationships were observed with wine (P<0.05); men and women consuming less than 100 g day(-1) had a lower BMI (men only) and WHR than non-drinkers or those consuming more. Spirits consumption was positively associated with BMI (linear regression coefficient beta=0.21, 95% confidence interval (CI): 0.09-0.34 and beta=0.22, 95% CI: 0.06-0.39 for men and women, respectively) and WHR (beta=0.003, 95% CI: 0.001-0.005 and beta=0.003, 95%CI: 0.0002-0.006) in both sexes in a linear fashion. No relationship between beer consumption and BMI or WHR was found. CONCLUSION: If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.     

Leisure-time and occupational physical activity in relation to cardiovascular risk factors and eating habits in French adults

OBJECTIVE: To investigate the relationships of two main physical activity domains (during leisure and at work) with cardiovascular risk factors and eating habits. DESIGN: Cross-sectional study. SETTING: Preventive medicine centre. SUBJECTS: In 5478 adults (32% women, aged 20-80 years) who consecutively underwent a standardised health examination, leisure-time physical activity (LTPA; i.e. non-sport leisure and sport activities), occupational physical activity (OPA) and eating habits were assessed by self-administered questionnaires. We analysed sex-specific relationships of LTPA and OPA (in quartiles) with (1) various cardiovascular risk factors and (2) eating habits using analysis of variance and logistic regression, respectively. RESULTS: In both genders, with and without adjustment for education in addition to age, LTPA was associated negatively with body mass index, body fat, waist circumference, resting heart rate, diastolic blood pressure and triglycerides, and positively associated with high-density lipoprotein cholesterol (all P < or = 0.005). OPA adjusted for age only was positively associated with most cardiovascular risk factors but these associations were not significant after further adjustment on education (except for waist circumference in women). Age- and education-adjusted LTPA was associated with increased frequency of consumption of fruits (odds ratio (OR) = 2.05, 95% confidence interval (CI) 1.68-2.52 in men; OR = 1.90, 95% CI 1.41-2.05 in women) and vegetables (OR = 1.81, 95% CI 1.48-2.21 in men; OR = 2.22, 95% CI 1.66-2.97 in women). CONCLUSIONS: The data emphasise the favourable associations of LTPA, a modifiable behaviour, with various cardiovascular risk factors and healthy eating habits. The results also suggest that the relationships of OPA with cardiovascular risk factors depend, at least in part, on socio-economic status as reflected by educational level.     

Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort

OBJECTIVES: To examine if obesity status and socio-economic and lifestyle factors are associated with self-reported past food habit change, and also whether the level of obesity depends on the reason for change. DESIGN: Cross-sectional analysis within the Malmo Diet and Cancer (MDC) study using data from the baseline examination and the extensive socio-economic and lifestyle questionnaire including questions of past food habit change. The risk of having changed food habits in the past was examined using logistic regression. Mean differences in obesity status across categories of reasons for past food habit change were examined using analysis of variance. SETTING: Malm?, the third largest city in Sweden. SUBJECTS: A sub-sample (15 282 women and 9867 men) from the MDC cohort recruited from 1992 to 1996. RESULTS: Individuals with body mass index (BMI) >30 kg m(-2) had an increased risk of having reported past food habit change compared with individuals with BMI <25 kg m(-2) (odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.48-1.83 for women; OR = 1.53, 95% CI = 1.32-1.76 for men). The highest level of obesity was observed among individuals who had changed their diet due to reasons related to the metabolic syndrome. Changers were more likely to be highly educated and to live alone, be retired, ex-smokers and non-drinkers at baseline. CONCLUSIONS: Because past food habit change is related to obesity and other lifestyle and socio-economic factors, a complex confounding situation may exist that could seriously influence observed relationships between diet and disease. Studies need to collect information on past food habit change and take this information into account in the analysis and when interpreting study outcomes.     

Dietary diversity score and cardiovascular risk factors in Tehranian adults

AIM: To evaluate the relationship between dietary diversity score (DDS) and cardiovascular risk factors in Tehranian adults. METHODS: In this population-based cross-sectional study, a representative sample of 581 subjects (295 males and 286 females) aged over 18 years, residents of Tehran, participated. Hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol were defined according to the Adult Treatment Panel III guidelines of the National Cholesterol Education Program. Diabetes was defined as fasting plasma glucose concentration > or = 126 mg dl(-1) or 2-h post challenge glucose concentration > or = 200 mg dl(-1). Hypertension was defined on the basis of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Dietary diversity was defined according to the Diet Quality Index revised. RESULTS: Mean (+/- standard deviation) DDS was 6.15 +/- 1.02. The probability of having diabetes (odds ratio (OR) among quartiles: 1.45, 1.26, 1.11 and 1.00, respectively; P for trend = 0.04) and hypertriglyceridaemia (OR = 1.41, 1.23, 1.05 and 1.00, respectively; P for trend=0.04) decreased with increasing quartile of the diversity score for whole grains. The probability of having obesity (OR among quartiles: 1.39, 1.06, 1.03 and 1.00, respectively; P for trend = 0.03), hypercholesterolaemia (OR = 1.46, 1.28, 1.11 and 1.00, respectively; P for trend = 0.03), hypertension (OR = 1.32, 1.17, 1.13 and 1.00, respectively; P for trend = 0.03) and high low-density lipoprotein cholesterol (LDL-C) (OR = 1.25, 1.12, 1.07 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for vegetables. The probability of having hypercholesterolaemia, high LDL-C, hypertension and diabetes decreased with quartile of the DDS. But the probability of being obese increased with quartile of the DDS (P for trend = 0.03). CONCLUSION: DDS was inversely associated with cardiovascular risk factors in this cross-sectional study. Increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle.     

Prevalence of obesity, food choices and socio-economic status: a cross-sectional study in the north-west of Iran

AIM: To document the epidemiological features and influencing factors of obesity in the north-west of Iran, to provide baseline information for setting up a regional population-based centre to control and prevent obesity-related disorders in the area. METHODS: In this cross-sectional study, a total of 300 subjects were selected/studied in Tabriz, one of the major cities in Iran. Data on basic characteristics, anthropometric measurements, dietary assessment and physical activity were collected. Obesity was defined as body mass index > or =30 kg m(-2) for both women and men. RESULTS: Total prevalence of obesity in the area was 22.4% (95% confidence interval (CI): 18.0-27.6). The prevalence of obesity was 24% (95% CI: 18.5-31.4) for women and 18% (95% CI: 12.5-25.6) for men. For both women and men obesity prevalence showed a positive association with age (P<0.001), while there was a negative correlation of obesity with education and income (P<0.001). Fruit consumption decreased the risk of obesity in both women and men (odds ratio (OR)=0.60, 95% CI: 0.49-0.71 vs. OR=0.62, 95% CI: 0.51-0.74, respectively). The same significant pattern was observed for the consumption of green vegetables (OR=0.71, 95% CI: 0.57-0.63 vs. OR=0.86, 95% CI: 0.77-0.98 for women and men, respectively), legumes (OR=0.70, 95% CI: 0.59-0.84 vs. OR=0.78, 95% CI: 0.66-0.91 for women and men, respectively) and dairy products (OR=0.73, 95% CI: 0.61-0.91 vs. OR=0.77, 95% CI: 0.63-0.93 for women and men, respectively). CONCLUSIONS: Our study showed that educational attainment, higher income and consumption of certain food groups (i.e. vegetables, fruits, legumes and dairy products) may decrease the risk of obesity. Our findings also indicate the crucial necessity of establishing a population-based centre for obesity in the area. The essential information is now achieved to propose to local health authorities to act accordingly. However, more population-based investigations on dietary choices are needed to develop effective preventive strategies to control overweight and obesity disorders in different regions.     

Overweight and obesity among Iranian female adolescents in Rasht: more overweight in the lower social group

OBJECTIVE: This study aimed to investigate the frequency of overweight and obesity among Iranian adolescent girls aged 14-17 years and its possible association with maternal education in Rasht city in 2005. DESIGN: A cross-sectional survey on 1054 schoolgirls. SETTING: High schools in Rasht city, Iran. METHODS: A multistage sampling method was used and 1054 randomly selected schoolgirls were studied. Data on age and mother's years of schooling were collected by questionnaire and body weight and height were measured. Overweight and obesity were defined using age- and sex-specific body mass index (BMI) cut-off points proposed by the International Obesity Task Force (IOTF), and compared with 85th and 95th BMI percentile curves of the IOTF reference population, respectively. Data analyses included two groups based on mother's years of schooling: less educated ( < 12 years) and more educated ( > or = 12 years). RESULTS: The overall prevalence of overweight and obesity in this population was 21.9 and 5.3%, respectively. Results of logistic regression analysis showed that the risk of overweight was higher for lower age group (odds ratio = 2.0, 95% confidence interval 0.18-3.09). Overweight was more common in girls with less educated mothers than in girls with more educated mothers (26.0 vs. 19.8%, P = 0.03). CONCLUSION: These data indicate that overweight is highly prevalent among adolescent girls, especially in lower social groups in Rasht, and the rate is exceeding those reported in other parts of the country. Preventive strategies need to be adopted to combat the epidemic of overweight and obesity in this population.     

Mediterranean diet in relation to body mass index and waist-to-hip ratio

OBJECTIVE: The Mediterranean diet is rich in fat and starch, and hence may be related to overweight. We therefore investigated the relationship between adherence to a Mediterranean diet and body mass index (BMI) and waist-to-hip ratio (WHR). DESIGN AND SETTING: Data were obtained from the control group of a network of case-control studies on cancer conducted in major teaching and general hospitals in four Italian areas between 1991 and 2002. An interviewer-administered validated 78-item food-frequency questionnaire was used to obtain information on the subjects' habitual diet. Information on socio-economic factors, lifestyle habits and anthropometric measures was also collected. A Mediterranean diet score (MDS) was derived on the basis of eight characteristics of the Mediterranean diet. SUBJECTS: Subjects were 6619 patients (3090 men, 3529 women) admitted to hospital for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for cancer and long-term modifications of diet. RESULTS: In multiple linear regression models adjusted for age, study centre, education, tobacco smoking, occupational physical activity and total energy intake, the MDS was not related to BMI (beta = 0.05 for men and -0.04 for women) or WHR (beta = 0.000 and 0.001, respectively) in both sexes. CONCLUSIONS: Adherence to the major characteristics of the Mediterranean diet is unrelated to BMI and WHR, confirming previous data from Greece and Spain.     

Dietary and non-dietary determinants of central adiposity among Tehrani women

OBJECTIVE: To determine the correlates of central adiposity. DESIGN: Population-based cross-sectional study. SUBJECTS: A total of 926 women (aged 40-60 years) from all districts of Tehran. METHODS: Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR>or=0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age. RESULTS: Mean WHR was 0.82 +/- 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40-2.53), depressed women (1.36; 1.02-1.93), smokers (1.21; 1.02-1.56) and unemployed women (1.41; 1.13-1.72). Marriage (1.31; 1.10-1.82), menopause (1.22; 1.02-1.61), low vitamin C intake (2.31; 1.25-4.25) and low calcium intake (1.30; 1.07-3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = -0.2, P < 0.05). CONCLUSION: Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.