Abstract
STUDY OBJECTIVE--The aim was to examine (1) whether health habits are associated with body fat distribution, as measured by the waist/hip girth ratio, and (2) to what extent environmental factors, including anthropometric characteristics, explain the variability in levels of cardiovascular risk factors. DESIGN--The study was a population based cross sectional survey, conducted in the spring of 1987 as a part of an international research project on cardiovascular epidemiology. SETTING--The survey was conducted in three geographical areas of eastern and south western Finland. SUBJECTS--2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%. MEASUREMENTS AND MAIN RESULTS--In men, waist/hip ratio showed stronger associations with exercise (Pearson's r = -0.24), resting heart rate (r = 0.10), alcohol consumption (r = 0.07), smoking (r = 0.05), and education (r = -0.23) than did body mass index. Jointly, exercise, resting heart rate, alcohol consumption, education, and age explained 18% of variance in male waist/hip ratio, but only 9% of variance in male body mass index. In women, environmental factors were more predictive for body mass index than for waist/hip ratio, with age and education being the strongest determinants. Waist/hip ratio and body mass index were approximately equally strong predictors of cardiovascular risk factor levels. The additional predictive power of waist/hip ratio over and above body mass index was tested in a hierarchical, stepwise regression. In this conservative type of analysis the increase in explained variance uniquely attributable to waist/hip ratio was 2-3% for female and 1-2% for male lipoprotein levels, and less than 0.5% for female and 0-2% for male blood pressure values. CONCLUSIONS--The distribution of abdominal obesity in Finland is significantly influenced by health habits and sociodemographic factors in both men and women. This in turn is obviously one reason for the relatively small "independent" effect of body fat distribution on cardiovascular risk factor levels.
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Anderson A. J., Sobocinski K. A., Freedman D. S., Barboriak J. J., Rimm A. A., Gruchow H. W. Body fat distribution, plasma lipids, and lipoproteins. Arteriosclerosis. 1988 Jan-Feb;8(1):88–94. doi: 10.1161/01.atv.8.1.88. [DOI] [PubMed] [Google Scholar]
- Barakat H. A., Burton D. S., Carpenter J. W., Holbert D., Israel R. G. Body fat distribution, plasma lipoproteins and the risk of coronary heart disease of male subjects. Int J Obes. 1988;12(5):473–480. [PubMed] [Google Scholar]
- Baumgartner R. N., Roche A. F., Chumlea W. C., Siervogel R. M., Glueck C. J. Fatness and fat patterns: associations with plasma lipids and blood pressures in adults, 18 to 57 years of age. Am J Epidemiol. 1987 Oct;126(4):614–628. doi: 10.1093/oxfordjournals.aje.a114701. [DOI] [PubMed] [Google Scholar]
- Björntorp P. The associations between obesity, adipose tissue distribution and disease. Acta Med Scand Suppl. 1988;723:121–134. doi: 10.1111/j.0954-6820.1987.tb05935.x. [DOI] [PubMed] [Google Scholar]
- Blair S. N., Kannel W. B., Kohl H. W., Goodyear N., Wilson P. W. Surrogate measures of physical activity and physical fitness. Evidence for sedentary traits of resting tachycardia, obesity, and low vital capacity. Am J Epidemiol. 1989 Jun;129(6):1145–1156. doi: 10.1093/oxfordjournals.aje.a115236. [DOI] [PubMed] [Google Scholar]
- Bouchard C., Pérusse L., Leblanc C., Tremblay A., Thériault G. Inheritance of the amount and distribution of human body fat. Int J Obes. 1988;12(3):205–215. [PubMed] [Google Scholar]
- Ducimetiere P., Richard J., Cambien F. The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study. Int J Obes. 1986;10(3):229–240. [PubMed] [Google Scholar]
- Folsom A. R., Caspersen C. J., Taylor H. L., Jacobs D. R., Jr, Luepker R. V., Gomez-Marin O., Gillum R. F., Blackburn H. Leisure time physical activity and its relationship to coronary risk factors in a population-based sample. The Minnesota Heart Survey. Am J Epidemiol. 1985 Apr;121(4):570–579. doi: 10.1093/oxfordjournals.aje.a114035. [DOI] [PubMed] [Google Scholar]
- Haffner S. M., Stern M. P., Hazuda H. P., Pugh J., Patterson J. K. Do upper-body and centralized adiposity measure different aspects of regional body-fat distribution? Relationship to non-insulin-dependent diabetes mellitus, lipids, and lipoproteins. Diabetes. 1987 Jan;36(1):43–51. doi: 10.2337/diab.36.1.43. [DOI] [PubMed] [Google Scholar]
- Haffner S. M., Stern M. P., Hazuda H. P., Pugh J., Patterson J. K., Malina R. Upper body and centralized adiposity in Mexican Americans and non-Hispanic whites: relationship to body mass index and other behavioral and demographic variables. Int J Obes. 1986;10(6):493–502. [PubMed] [Google Scholar]
- Haffner S. M., Stern M. P., Hazuda H. P., Rosenthal M., Knapp J. A. The role of behavioral variables and fat patterning in explaining ethnic differences in serum lipids and lipoproteins. Am J Epidemiol. 1986 May;123(5):830–839. doi: 10.1093/oxfordjournals.aje.a114312. [DOI] [PubMed] [Google Scholar]
- Hagberg J. M. Effect of training on the decline of VO2max with aging. Fed Proc. 1987 Apr;46(5):1830–1833. [PubMed] [Google Scholar]
- Jacobsen B. K., Thelle D. S. Risk factors for coronary heart disease and level of education. The Tromsø Heart Study. Am J Epidemiol. 1988 May;127(5):923–932. doi: 10.1093/oxfordjournals.aje.a114895. [DOI] [PubMed] [Google Scholar]
- Jeffery R. W., Forster J. L., Folsom A. R., Luepker R. V., Jacobs D. R., Jr, Blackburn H. The relationship between social status and body mass index in the Minnesota Heart Health Program. Int J Obes. 1989;13(1):59–67. [PubMed] [Google Scholar]
- Keil U., Chambless L., Remmers A. Alcohol and blood pressure: results from the Luebeck Blood Pressure Study. Prev Med. 1989 Jan;18(1):1–10. doi: 10.1016/0091-7435(89)90049-2. [DOI] [PubMed] [Google Scholar]
- Kris-Etherton P. M., Krummel D., Russell M. E., Dreon D., Mackey S., Borchers J., Wood P. D. The effect of diet on plasma lipids, lipoproteins, and coronary heart disease. J Am Diet Assoc. 1988 Nov;88(11):1373–1400. [PubMed] [Google Scholar]
- Lapidus L., Bengtsson C., Larsson B., Pennert K., Rybo E., Sjöström L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed) 1984 Nov 10;289(6454):1257–1261. doi: 10.1136/bmj.289.6454.1257. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lapidus L., Helgesson O., Merck C., Björntorp P. Adipose tissue distribution and female carcinomas. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Int J Obes. 1988;12(4):361–368. [PubMed] [Google Scholar]
- Larsson B., Svärdsudd K., Welin L., Wilhelmsen L., Björntorp P., Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br Med J (Clin Res Ed) 1984 May 12;288(6428):1401–1404. doi: 10.1136/bmj.288.6428.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lillioja S., Young A. A., Culter C. L., Ivy J. L., Abbott W. G., Zawadzki J. K., Yki-Järvinen H., Christin L., Secomb T. W., Bogardus C. Skeletal muscle capillary density and fiber type are possible determinants of in vivo insulin resistance in man. J Clin Invest. 1987 Aug;80(2):415–424. doi: 10.1172/JCI113088. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Linn S., Fulwood R., Rifkind B., Carroll M., Muesing R., Williams O. D., Johnson C. High density lipoprotein cholesterol levels among US adults by selected demographic and socioeconomic variables. The Second National Health and Nutrition Examination Survey 1976-1980. Am J Epidemiol. 1989 Feb;129(2):281–294. doi: 10.1093/oxfordjournals.aje.a115133. [DOI] [PubMed] [Google Scholar]
- Marti B., Tuomilehto J., Korhonen H. J., Kartovaara L., Vartiainen E., Pietinen P., Puska P. Smoking and leanness: evidence for change in Finland. BMJ. 1989 May 13;298(6683):1287–1290. doi: 10.1136/bmj.298.6683.1287. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Matthews K. A., Kelsey S. F., Meilahn E. N., Kuller L. H., Wing R. R. Educational attainment and behavioral and biologic risk factors for coronary heart disease in middle-aged women. Am J Epidemiol. 1989 Jun;129(6):1132–1144. doi: 10.1093/oxfordjournals.aje.a115235. [DOI] [PubMed] [Google Scholar]
- Ohlson L. O., Larsson B., Svärdsudd K., Welin L., Eriksson H., Wilhelmsen L., Björntorp P., Tibblin G. The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes. 1985 Oct;34(10):1055–1058. doi: 10.2337/diab.34.10.1055. [DOI] [PubMed] [Google Scholar]
- Ostlund R. E., Jr, Staten M., Kohrt W. M., Schultz J., Malley M. The ratio of waist-to-hip circumference, plasma insulin level, and glucose intolerance as independent predictors of the HDL2 cholesterol level in older adults. N Engl J Med. 1990 Jan 25;322(4):229–234. doi: 10.1056/NEJM199001253220404. [DOI] [PubMed] [Google Scholar]
- Pietinen P., Uusitalo U., Vartiainen E., Tuomilehto J. Dietary survey of the FINMONICA project in 1982. Acta Med Scand Suppl. 1988;728:169–177. doi: 10.1111/j.0954-6820.1988.tb05570.x. [DOI] [PubMed] [Google Scholar]
- Pocock S. J., Shaper A. G., Phillips A. N., Walker M., Whitehead T. P. High density lipoprotein cholesterol is not a major risk factor for ischaemic heart disease in British men. Br Med J (Clin Res Ed) 1986 Feb 22;292(6519):515–519. doi: 10.1136/bmj.292.6519.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Puska P., Salonen J. T., Nissinen A., Tuomilehto J., Vartiainen E., Korhonen H., Tanskanen A., Rönnqvist P., Koskela K., Huttunen J. Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project). Br Med J (Clin Res Ed) 1983 Dec 17;287(6408):1840–1844. doi: 10.1136/bmj.287.6408.1840. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reed D. M., Strong J. P., Resch J., Hayashi T. Serum lipids and lipoproteins as predictors of atherosclerosis. An autopsy study. Arteriosclerosis. 1989 Jul-Aug;9(4):560–564. doi: 10.1161/01.atv.9.4.560. [DOI] [PubMed] [Google Scholar]
- Rimm A. A., Hartz A. J., Fischer M. E. A weight shape index for assessing risk of disease in 44,820 women. J Clin Epidemiol. 1988;41(5):459–465. doi: 10.1016/0895-4356(88)90047-9. [DOI] [PubMed] [Google Scholar]
- Rowe J. W., Kahn R. L. Human aging: usual and successful. Science. 1987 Jul 10;237(4811):143–149. doi: 10.1126/science.3299702. [DOI] [PubMed] [Google Scholar]
- Salomaa V., Korhonen H. J., Tuomilehto J., Vartiainen E., Pietinen P., Kartovaara L., Gref C. G., Nissinen A., Puska P. Serum cholesterol distribution, measurement frequency and cholesterol awareness in three geographical areas of Finland. Eur Heart J. 1990 Apr;11(4):294–301. doi: 10.1093/oxfordjournals.eurheartj.a059701. [DOI] [PubMed] [Google Scholar]
- Salonen J. T., Salonen R., Ihanainen M., Parviainen M., Seppänen R., Kantola M., Seppänen K., Rauramaa R. Blood pressure, dietary fats, and antioxidants. Am J Clin Nutr. 1988 Nov;48(5):1226–1232. doi: 10.1093/ajcn/48.5.1226. [DOI] [PubMed] [Google Scholar]
- Schapira D. V., Kumar N. B., Lyman G. H., Cox C. E. Abdominal obesity and breast cancer risk. Ann Intern Med. 1990 Feb 1;112(3):182–186. doi: 10.7326/0003-4819-112-3-182. [DOI] [PubMed] [Google Scholar]
- Seidell J. C., Björntorp P., Sjöström L., Sannerstedt R., Krotkiewski M., Kvist H. Regional distribution of muscle and fat mass in men--new insight into the risk of abdominal obesity using computed tomography. Int J Obes. 1989;13(3):289–303. [PubMed] [Google Scholar]
- Seidell J. C., Cigolini M., Charzewska J., Ellsinger B. M., Contaldo F. Regional obesity and serum lipids in European women born in 1948. A multicenter study. Acta Med Scand Suppl. 1988;723:189–197. doi: 10.1111/j.0954-6820.1987.tb05943.x. [DOI] [PubMed] [Google Scholar]
- Seidell J. C., Cigolini M., Charzewska J., Ellsinger B. M., Di Biase G., Björntorp P., Hautvast J. G., Contaldo F., Szostak V., Scuro L. A. Indicators of fat distribution, serum lipids, and blood pressure in European women born in 1948--the European Fat Distribution Study. Am J Epidemiol. 1989 Jul;130(1):53–65. doi: 10.1093/oxfordjournals.aje.a115322. [DOI] [PubMed] [Google Scholar]
- Seidell J. C., Cigolini M., Deurenberg P., Oosterlee A., Doornbos G. Fat distribution, androgens, and metabolism in nonobese women. Am J Clin Nutr. 1989 Aug;50(2):269–273. doi: 10.1093/ajcn/50.2.269. [DOI] [PubMed] [Google Scholar]
- Selby J. V., Friedman G. D., Quesenberry C. P., Jr Precursors of essential hypertension. The role of body fat distribution pattern. Am J Epidemiol. 1989 Jan;129(1):43–53. doi: 10.1093/oxfordjournals.aje.a115123. [DOI] [PubMed] [Google Scholar]
- Shimokata H., Muller D. C., Andres R. Studies in the distribution of body fat. III. Effects of cigarette smoking. JAMA. 1989 Feb 24;261(8):1169–1173. [PubMed] [Google Scholar]
- Soler J. T., Folsom A. R., Kushi L. H., Prineas R. J., Seal U. S. Association of body fat distribution with plasma lipids, lipoproteins, apolipoproteins AI and B in postmenopausal women. J Clin Epidemiol. 1988;41(11):1075–1081. doi: 10.1016/0895-4356(88)90077-7. [DOI] [PubMed] [Google Scholar]
- Stern M. P., Haffner S. M. Body fat distribution and hyperinsulinemia as risk factors for diabetes and cardiovascular disease. Arteriosclerosis. 1986 Mar-Apr;6(2):123–130. doi: 10.1161/01.atv.6.2.123. [DOI] [PubMed] [Google Scholar]
- Tuomilehto J., Marti B., Salonen J. T., Virtala E., Lahti T., Puska P. Leisure-time physical activity is inversely related to risk factors for coronary heart disease in middle-aged Finnish men. Eur Heart J. 1987 Oct;8(10):1047–1055. doi: 10.1093/oxfordjournals.eurheartj.a062169. [DOI] [PubMed] [Google Scholar]
- VAGUE J. The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease. Am J Clin Nutr. 1956 Jan-Feb;4(1):20–34. doi: 10.1093/ajcn/4.1.20. [DOI] [PubMed] [Google Scholar]
- Wilson P. W., Garrison R. J., Abbott R. D., Castelli W. P. Factors associated with lipoprotein cholesterol levels. The Framingham study. Arteriosclerosis. 1983 May-Jun;3(3):273–281. doi: 10.1161/01.atv.3.3.273. [DOI] [PubMed] [Google Scholar]
- Yano K., Reed D. M., Curb J. D., Hankin J. H., Albers J. J. Biological and dietary correlates of plasma lipids and lipoproteins among elderly Japanese men in Hawaii. Arteriosclerosis. 1986 Jul-Aug;6(4):422–433. doi: 10.1161/01.atv.6.4.422. [DOI] [PubMed] [Google Scholar]