Latin American Clinical Epidemiology Network Series - Paper 7: Central obesity measurements better identified risk factors for coronary heart disease risk in the Chilean National Health Survey (2009-2010)

Abstract

Objectives: Obesity is an important determinant of cardiovascular risk. However, the optimal measure and cutoffs in Latin America are not defined. We sought to assess the relationship between body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with risk factor prevalence and estimated coronary heart disease (CHD) risk and to assess if recommended cutoffs apply to the Chilean population.

Study design and setting: Data from 2,200 men and 3,216 women from the Chilean Health Survey 2009-2010 were analyzed. Receiver operator characteristic (ROC) curves were used to compare discrimination and estimate optimal cutoffs. Sensitivity, specificity, and net reclassification improvement (NRI) for these cutoffs were compared with values obtained applying international recommendations.

Results: WHtR and WC have a higher ROC area for risk factors and CHD risk. BMI and WC optimal cutoffs did not improve net reclassification when compared with international recommendations. A WHtR of 0.55 in men improves NRI compared with proposed values (P < 0.01). A WHtR of 0.6 in women improves NRI when compared with BMI (P > 0.01) but not when compared with WC.

Conclusion: Central obesity measurements demonstrated the strongest associations with CV risk factors and estimated risk. Optimal cutoffs were similar to those recommended internationally with the exception of WHtR.

Keywords: Body mass index; Cardiovascular risk; Central obesity; Waist circumference; Waist-to-height ratio.