Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1992 Jun 1;146(11):2009–2019.

Obesity and its relation to cardiovascular disease risk factors in Canadian adults. Canadian Heart Health Surveys Research Group.

B A Reeder 1, A Angel 1, M Ledoux 1, S W Rabkin 1, T K Young 1, L E Sweet 1
PMCID: PMC1490327  PMID: 1596850

Abstract

OBJECTIVE: To describe the distribution of weight and abdominal obesity among Canadian adults and to determine the association of obesity with other risk factors for cardiovascular disease. DESIGN: Population-based cross-sectional surveys. Survey nurses administered a standard questionnaire and recorded two blood pressure measurements during a home visit. At a subsequent visit to a survey clinic two further blood pressure readings were made, anthropometric measurements recorded and a blood specimen taken for plasma lipid determination. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 years was selected from the health insurance registration files of each province. Anthropometry was performed on 17,858 subjects. OUTCOME MEASURES: Body mass index (BMI), ratio of waist to hip circumference (WHR), mean plasma lipid levels, prevalence of high blood pressure (diastolic greater than or equal to 90 mm Hg or patient on treatment) and self-reported diabetes mellitus. MAIN RESULTS: The prevalence of obesity (BMI greater than or equal to 27) increased with age and was greater in men (35%) than in women (27%). Abdominal obesity was likewise higher in men and increased with both age and BMI. The prevalence of high blood pressure was greater in those with higher BMI, especially in those with a high WHR. Although total plasma cholesterol levels increased only modestly with BMI, levels of low density lipoprotein (LDL) cholesterol and triglycerides and the ratio of total cholesterol to high density lipoprotein (HDL) cholesterol increased steadily, while HDL-cholesterol decreased consistently with increasing BMI. High total cholesterol levels (greater than or equal to 5.2 mmol/L) were more prevalent among people with high BMI, especially those with a high WHR. The prevalence of diabetes increased with BMI among those 35 years or older, especially those with abdominal obesity. About half of men and two-thirds of women who were obese were trying to lose weight. CONCLUSION: Obesity remains common among Canadian adults. There is a need for broad-based programs that facilitate healthy eating and activity patterns for all age groups. Health professionals should incorporate measurement of BMI and WHR into their routine examinations of patients to enhance their evaluation of health risk.

Full text

PDF
2017

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andres R., Elahi D., Tobin J. D., Muller D. C., Brant L. Impact of age on weight goals. Ann Intern Med. 1985 Dec;103(6 ):1030–1033. doi: 10.7326/0003-4819-103-6-1030. [DOI] [PubMed] [Google Scholar]
  2. Barrett-Connor E. Epidemiology, obesity, and non-insulin-dependent diabetes mellitus. Epidemiol Rev. 1989;11:172–181. doi: 10.1093/oxfordjournals.epirev.a036035. [DOI] [PubMed] [Google Scholar]
  3. Barrett-Connor E., Khaw K. T. Is hypertension more benign when associated with obesity? Circulation. 1985 Jul;72(1):53–60. doi: 10.1161/01.cir.72.1.53. [DOI] [PubMed] [Google Scholar]
  4. Berns M. A., de Vries J. H., Katan M. B. Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period. Am J Epidemiol. 1989 Dec;130(6):1109–1122. doi: 10.1093/oxfordjournals.aje.a115438. [DOI] [PubMed] [Google Scholar]
  5. Björntorp P. Obesity and the risk of cardiovascular disease. Ann Clin Res. 1985;17(1):3–9. [PubMed] [Google Scholar]
  6. Björntorp P. Regional patterns of fat distribution. Ann Intern Med. 1985 Dec;103(6 ):994–995. doi: 10.7326/0003-4819-103-6-994. [DOI] [PubMed] [Google Scholar]
  7. Bonham G. S., Brock D. B. The relationship of diabetes with race, sex, and obesity. Am J Clin Nutr. 1985 Apr;41(4):776–783. doi: 10.1093/ajcn/41.4.776. [DOI] [PubMed] [Google Scholar]
  8. Bray G. A. Complications of obesity. Ann Intern Med. 1985 Dec;103(6 ):1052–1062. doi: 10.7326/0003-4819-103-6-1052. [DOI] [PubMed] [Google Scholar]
  9. Folsom A. R., Kaye S. A., Prineas R. J., Potter J. D., Gapstur S. M., Wallace R. B. Increased incidence of carcinoma of the breast associated with abdominal adiposity in postmenopausal women. Am J Epidemiol. 1990 May;131(5):794–803. doi: 10.1093/oxfordjournals.aje.a115570. [DOI] [PubMed] [Google Scholar]
  10. Folsom A. R., Prineas R. J., Kaye S. A., Munger R. G. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke. 1990 May;21(5):701–706. doi: 10.1161/01.str.21.5.701. [DOI] [PubMed] [Google Scholar]
  11. Freedman D. S., Jacobsen S. J., Barboriak J. J., Sobocinski K. A., Anderson A. J., Kissebah A. H., Sasse E. A., Gruchow H. W. Body fat distribution and male/female differences in lipids and lipoproteins. Circulation. 1990 May;81(5):1498–1506. doi: 10.1161/01.cir.81.5.1498. [DOI] [PubMed] [Google Scholar]
  12. Harris M. I., Hadden W. C., Knowler W. C., Bennett P. H. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20-74 yr. Diabetes. 1987 Apr;36(4):523–534. doi: 10.2337/diab.36.4.523. [DOI] [PubMed] [Google Scholar]
  13. Hubert H. B., Feinleib M., McNamara P. M., Castelli W. P. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983 May;67(5):968–977. doi: 10.1161/01.cir.67.5.968. [DOI] [PubMed] [Google Scholar]
  14. Jarrett R. J., Shipley M. J., Rose G. Weight and mortality in the Whitehall Study. Br Med J (Clin Res Ed) 1982 Aug 21;285(6341):535–537. doi: 10.1136/bmj.285.6341.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kaye S. A., Folsom A. R., Sprafka J. M., Prineas R. J., Wallace R. B. Increased incidence of diabetes mellitus in relation to abdominal adiposity in older women. J Clin Epidemiol. 1991;44(3):329–334. doi: 10.1016/0895-4356(91)90044-a. [DOI] [PubMed] [Google Scholar]
  16. Kissebah A. H., Vydelingum N., Murray R., Evans D. J., Hartz A. J., Kalkhoff R. K., Adams P. W. Relation of body fat distribution to metabolic complications of obesity. J Clin Endocrinol Metab. 1982 Feb;54(2):254–260. doi: 10.1210/jcem-54-2-254. [DOI] [PubMed] [Google Scholar]
  17. Knowler W. C., Pettitt D. J., Savage P. J., Bennett P. H. Diabetes incidence in Pima indians: contributions of obesity and parental diabetes. Am J Epidemiol. 1981 Feb;113(2):144–156. doi: 10.1093/oxfordjournals.aje.a113079. [DOI] [PubMed] [Google Scholar]
  18. La Vecchia C., Franceschi S., Gallus G., Decarli A., Colombo E., Mangioni C., Tognoni G. Oestrogens and obesity as risk factors for endometrial cancer in Italy. Int J Epidemiol. 1982 Jun;11(2):120–126. doi: 10.1093/ije/11.2.120. [DOI] [PubMed] [Google Scholar]
  19. Laessle R. G., Tuschl R. J., Kotthaus B. C., Pirke K. M. Behavioral and biological correlates of dietary restraint in normal life. Appetite. 1989 Apr;12(2):83–94. doi: 10.1016/0195-6663(89)90098-6. [DOI] [PubMed] [Google Scholar]
  20. 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]
  21. 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]
  22. Le Marchand L., Kolonel L. N., Earle M. E., Mi M. P. Body size at different periods of life and breast cancer risk. Am J Epidemiol. 1988 Jul;128(1):137–152. doi: 10.1093/oxfordjournals.aje.a114936. [DOI] [PubMed] [Google Scholar]
  23. Lew E. A., Garfinkel L. Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979;32(8):563–576. doi: 10.1016/0021-9681(79)90119-x. [DOI] [PubMed] [Google Scholar]
  24. Lubin F., Ruder A. M., Wax Y., Modan B. Overweight and changes in weight throughout adult life in breast cancer etiology. A case-control study. Am J Epidemiol. 1985 Oct;122(4):579–588. doi: 10.1093/oxfordjournals.aje.a114137. [DOI] [PubMed] [Google Scholar]
  25. Micozzi M. S., Albanes D., Jones D. Y., Chumlea W. C. Correlations of body mass indices with weight, stature, and body composition in men and women in NHANES I and II. Am J Clin Nutr. 1986 Dec;44(6):725–731. doi: 10.1093/ajcn/44.6.725. [DOI] [PubMed] [Google Scholar]
  26. Modan M., Karasik A., Halkin H., Fuchs Z., Lusky A., Shitrit A., Modan B. Effect of past and concurrent body mass index on prevalence of glucose intolerance and type 2 (non-insulin-dependent) diabetes and on insulin response. The Israel study of glucose intolerance, obesity and hypertension. Diabetologia. 1986 Feb;29(2):82–89. doi: 10.1007/BF00456115. [DOI] [PubMed] [Google Scholar]
  27. Nomura A., Heilbrun L. K., Stemmermann G. N. Body mass index as a predictor of cancer in men. J Natl Cancer Inst. 1985 Feb;74(2):319–323. [PubMed] [Google Scholar]
  28. 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]
  29. Polivy J., Herman C. P. Dieting and binging. A causal analysis. Am Psychol. 1985 Feb;40(2):193–201. doi: 10.1037//0003-066x.40.2.193. [DOI] [PubMed] [Google Scholar]
  30. Rabkin S. W., Mathewson F. A., Hsu P. H. Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. Am J Cardiol. 1977 Mar;39(3):452–458. doi: 10.1016/s0002-9149(77)80104-5. [DOI] [PubMed] [Google Scholar]
  31. Revicki D. A., Israel R. G. Relationship between body mass indices and measures of body adiposity. Am J Public Health. 1986 Aug;76(8):992–994. doi: 10.2105/ajph.76.8.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Seidell J. C., Cigolini M., Charzewska J., Ellsinger B. M., di Biase G. Fat distribution in European women: a comparison of anthropometric measurements in relation to cardiovascular risk factors. Int J Epidemiol. 1990 Jun;19(2):303–308. doi: 10.1093/ije/19.2.303. [DOI] [PubMed] [Google Scholar]
  33. 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]
  34. Simpson J. M., Brennan P. J., McGilchrist C. A., Blacket R. B. The inheritance of serum cholesterol: adjustment of observed cholesterol levels for age, sex and body weight using inverse-polynomial regression. Int J Epidemiol. 1982 Mar;11(1):76–81. doi: 10.1093/ije/11.1.76. [DOI] [PubMed] [Google Scholar]
  35. 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]
  36. Van Itallie T. B. "Morbid" obesity: a hazardous disorder that resists conservative treatment. Am J Clin Nutr. 1980 Feb;33(2 Suppl):358–363. doi: 10.1093/ajcn/33.2.358. [DOI] [PubMed] [Google Scholar]
  37. Van Itallie T. B. Health implications of overweight and obesity in the United States. Ann Intern Med. 1985 Dec;103(6 ):983–988. doi: 10.7326/0003-4819-103-6-983. [DOI] [PubMed] [Google Scholar]
  38. Vatten L. J., Kvinnsland S. Body mass index and risk of breast cancer. A prospective study of 23,826 Norwegian women. Int J Cancer. 1990 Mar 15;45(3):440–444. doi: 10.1002/ijc.2910450311. [DOI] [PubMed] [Google Scholar]
  39. Waaler H. T. Height, weight and mortality. The Norwegian experience. Acta Med Scand Suppl. 1984;679:1–56. doi: 10.1111/j.0954-6820.1984.tb12901.x. [DOI] [PubMed] [Google Scholar]
  40. Warren C., Cooper P. J. Psychological effects of dieting. Br J Clin Psychol. 1988 Sep;27(Pt 3):269–270. doi: 10.1111/j.2044-8260.1988.tb00787.x. [DOI] [PubMed] [Google Scholar]
  41. White F. M., Pereira L. H., Garner J. B. Associations of body mass index and waist:hip ratio with hypertension. CMAJ. 1986 Aug 15;135(4):313–320. [PMC free article] [PubMed] [Google Scholar]
  42. Young T. K., Sevenhuysen G. Obesity in northern Canadian Indians: patterns, determinants, and consequences. Am J Clin Nutr. 1989 May;49(5):786–793. doi: 10.1093/ajcn/49.5.786. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES