CORRELATIONS BETWEEN BODY MASS INDEX, WAIST-HIP RATIO AND WAIST CIRCUMFERENCE TO
CARDIOVASCULAR RISK FACTORS IN MIAMI HISPANICS
Connie Ingram*, Claudia Correa*, Maria A. Canossa-Terris*, Mary Comerford, Paul Kurlansky*
INTRODUCTION
*Florida Heart Research Institute, Miami, FL
• Hispanics are the largest and fastest growing minority in the US,
increasing from 12.5% of the US population in 2000 to 15% in
2009.1 Hispanics as a whole have the lowest rate of educational
attainment2 and the rate of poverty among Hispanics in 2008 was
above that of the nation’s as a whole3, though lower than that of
blacks. These factors may translate into a greater risk of disease.
METHODS
RESULTS
• Data from 727 Miami Hispanics (244 men and 483 women) age 18
and over was collected during the course of free public
cardiovascular screenings.
CHARATERISTICS OF THE
SAMPLE
MALES
• Screenings were publicized through radio public service
announcements, radio interviews, brochures and flyers distributed at
Overweight and obesity have been associated with increased risk
public health fairs and, increasingly, by word of mouth.
of cardiovascular disease. Traditionally, body mass index (BMI)
has been the most accepted measure. However, recent studies • No incentives were provided to participants other than a report of
indicate that excess abdominal fat, measured by waist
their cardiovascular risk factor profile, educational brochures and
circumference (WC) or waist-hip ratio (WHR) might be a better
counseling to seek further medical attention when needed.
indicator of cardiovascular risk. Hispanics are known to have
• A self-reported medical history was used to determine presence of
disproportionately high prevalence of metabolic risk factors (BMI,
coronary heart disease and medication use. Demographics were
WC and lipids), so it is important to begin to characterize the
similarly gathered.
association between these metabolic risk factors and the risk of
• Two sitting blood pressure measurements performed with a mercury
cardiovascular disease.
sphygmomanometer were averaged.
Nationally, 64.5% of Hispanics are Mexican, 9.2% Puerto Rican,
• Weight and height were measured and used to calculate body mass
3.5% Cuban, and 22.9% of other origin4.
index (BMI); waist and hip circumference were measured and used to
In 2005-9, 61.4% of Miami-Dade residents were Hispanic. Of
calculate waist-hip ratio.
these, 51.6% were Cuban, 16.3% South America, and 14.8%
• Chi-square analysis was used to determine differences between BMI,
Central American; only 3.4% were Mexican5.
WC, WHR level among risk factors.
Florida Heart Research Institute (FHRI) has been offering free
cardiovascular screenings since 1998; 71.5% of those screened
were Hispanics.
•
•
•
•
STUDY OBJECTIVES
To assess and compare the correlations of WC, WHR, and BMI
with associated cardiovascular risk factors in a sample of Miami
Hispanics.
HISPANIC DISTRIBUTION IN MIAMI DADE COUNTY
3%
16%
South America
Central America
15%
Caribbean
Cuba
52%
 Dyslipidemia:
Total cholesterol ≥ 240mg/dl
LDL ≥130mg/dl
HDL ≤40mg/dl
Triglycerides ≥150mg/dl
Or on lipid lowering medications
Mexico
 Diabetes mellitus:
Fasting glucose levels ≥ 126 mg/dl
Or use of diabetes medications
14%
HISPANIC DISTRIBUTION IN STUDY SAMPLE
10%
1%
4%
 Adiposity Indices
Body Mass Index (BMI):
Normal: <25
Overweight/obesity: ≥ 25
South America
Central America
Caribbean
20%
Cuba
65%
1US
Waist Circumference (WC):
Males: <40 inches
Females: <35 inches
Mexico
Waist-hip ratio (WHR):
Males: <0.95
Females: <0.88
Census Bureau, 2000 Census and 2009 American Community Survey (ACS).
Dept. of Education, National Center for Educational Statistics, Educational Statistics 2007 and US Census Bureau,
(2007) Current Population Survey.
3University of Michigan, National Poverty Center, “Poverty in the United States”, http://www.npc.umich.edu/poverty/
4US Census Bureau, 2005-09 ACS
5 US Census Bureau, 2005-09 American Community Survey (ACS).
2US
N=727
(%)
Male
33.6
Female
66.4
Mean age -male
40.6
Mean age -female
41.7
Single
23.9
Married
54.1
Divorced/Widowed
16.0
Regular exercise
Uninsured
BMI <25
N=40
(%)
Risk Factor
FEMALES
BMI ≥25
N=204
(%)
pvalue
BMI <25
N=137
(%)
BMI ≥25
N=346
(%)
pvalue
Cholesterol ≥240
20.0
18.1
.781
18.2
21.4
.441
LDL ≥130
48.7
52.0
.710
51.5
54.7
.534
HDL ≤ 40
47.5
62.7
.072
14.6
25.7
.008
10.0
19.6
.148
1.5
10.7
.001
12.5
13.2
.900
0.7
4.0
.029
83.2
BP≥140/90 or
on HTN meds
Glucose ≥ 126 or on
diabetic meds
92.3
Triglycerides ≥ 150
27.5
41.2
.105
13.9
28.9
<.001
BMI ≥ 25 was associated in women with elevated triglycerides (≥150; p <.001), hypertension
(BP ≥140/90 or hypertension meds; p=.001) and high glucose (≥126 or diabetes meds; p <.029).
No significant association was seen in men.
CARDIOVASCULAR RISK FACTORS ACCORDING
TO WAIST-HIP-RATIO
CARDIOVASCULAR RISK FACTORS ACCORDING
TO WAIST CIRCUMFERENCE
DEFINITION OF RISK FACTORS
 Hypertension:
Hypertension: SBP ≥140 or DBP≥ 90 and/or
use of antihypertensive medications
CARDIOVASCULAR RISK FACTORS ACCORDING TO BMI
MALES
Risk Factor
WC <40
N=188
(%)
FEMALES
WC ≥40
N=56
(%)
pvalue
WC <35
N=232
(%)
MALES
WC ≥35
pN=251 value
(%)
Risk Factor
FEMALES
WHR <.95 WHR≥.95
pN=186
N=58
value
(%)
(%)
WHR <.88
N=315
(%)
WHR >.88
pN=168
value
(%)
Cholesterol ≥240
19.7
14.3
.361
17.7
3.1
.139
Cholesterol ≥240
18.3
19.0
.906
18.4
23.8
.188
LDL ≥130
52.4
48.2
.582
53.3
54.2
.837
LDL ≥130
53.0
46.6
.393
53.2
54.8
.786
HDL ≤ 40
55.9
75.0
.010
16.8
27.9
.004
HDL ≤ 40
57.5
42.5
.120
17.1
32.7
<.001
BP ≥140/90 or
on HTN meds
15.4
26.8
.052
3.0
12.7
<.001
BP ≥140/90 or
on HTN meds
16.1
24.1
.166
6.7
10.7
.120
Glucose ≥ 126 or
on diabetic meds
10.6
21.4
.036
0.9
6.4
.001
Glucose ≥ 126 or
on diabetic meds
9.1
25.9
<.001
1.0
8.9
<.001
Triglycerides ≥ 150
36.7
38.9
.190
15.1
33.5
<.001
Triglycerides ≥150
39.2
37.9
.858
18.4
36.3
<.001
Waist Circumference, ≥ 35”, in women was found to be significantly correlated to
high triglycerides, hypertension (p < .001), high glucose (p = .001), and low HDL
(≤40; p=.004). Among men, WC ≥40”, was associated with low HDL (p=.010) and
high glucose (p=.036.)
In women WHR ≥.88, was associated with high triglycerides and glucose and low HDL,
for all (p<.001). In men, WHR ≥0.95 was only significantly associated with high glucose
(p<.001).
CONCLUSIONS
• In this unadjusted, pilot data analysis of Miami Hispanics, WC and WHR appeared to be more correlated with cardiovascular risk factors than BMI.
• These results are interesting and suggest that WC and WHR could be important standard anthropometric measures that may help to identify patients at risk
of cardiovascular disease who might otherwise not receive healthy lifestyle because of normal BMI.
• A larger study powered to demonstrate these associations and control for confounders is needed.
This study funded by Florida Heart Research Institute.