Friday, November 21, 2008

Bulging Waist Carries Risk


A bulging waistline may be a stronger predictor of premature death than a person's overall weight, according to a large-scale European study that bolsters the findings of earlier research.
For the study, published in this week's New England Journal of Medicine, researchers tracked nearly 360,000 men and women in nine European countries for about a decade. Study participants ranged in age from 25 to 70.

At the outset, researchers calculated participants' so-called body-mass index. The BMI has been the standard formula for assessing weight. It uses a person's height and weight to come up with a score. A person with a BMI of between 25 and 29.9 points is considered overweight; those with higher scores are deemed obese.
The researchers also measured the circumference of participants' waists as well as the ratio of their waist and hip measurements. In recent years, various studies have shown that the location of body fat -- particularly if it is in the waist area -- can be an important factor in assessing the risk of various diseases and death. Men with waists measuring over 40 inches are considered at a higher-risk; for women, the figure is 35 inches.

A big waist may predict premature death better than overall weight.
Current treatment guidelines call for physicians to measure patients' waists but usually only when their BMI indicates they are overweight, said Tobias Pischon, the study's lead author and a researcher at the German Institute of Human Nutrition, in Potsdam-Rehbruecke, Germany.
For the study, patients were divided into groups according to their BMI, waist circumference and waist-to-hips ratio. During the course of the research, more than 14,723 of them died from various causes.

Researchers found that even patients who would be considered at normal weight, according to their BMI, faced increased risk of death if they had a large waist.
Normal-weight male participants with waists measuring 102.7 centimeters (about 40 inches) or more were twice as likely to die as those with waists measuring 86 centimeters (34 inches) or less. Women who weighed in the normal BMI range but had waists that were 89 centimeters (35 inches) or more were 79% more likely to die than those with waists measuring 70.1 centimeters (28 inches) or less.
The researchers also calculated that, for a five-centimeter, or about two-inch, increase in waist size for patients with any given BMI score, the risk of death increased by 17% for men and by 13% for women. The researchers found similar trends when they compared waist-to-hips ratios.

Rob M. van Dam, a Harvard Medical School professor not involved with the research, said that while the European study doesn't break new ground, its size and breadth make it a "very important" contribution to the field. "They really put it on the table in a very convincing way," said Mr. van Dam, who has been involved in similar research.

Dr. Pischon, the study's lead author, said in an email that the research didn't focus on why larger waists mean a higher death rate, but added that the fat in the abdomen tends to be so-called visceral fat, which builds up around the organs and secretes certain hormones that contribute to the onset of various diseases.
He said future research should focus on whether treatment for weight problems should focus on preventing increases in waist size rather than holding down weight overall.
NOVEMBER 13, 2008
WSJ ROBERT TOMSHO

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