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OKOSUN, IKE S., K. M. DINESH CHANDRA, SIMON CHOI, JACQUELINE CHRISTMAN, G. E. ALAN DEVER, AND T. ELAINE PREWITT. Hypertension and type 2 diabetes comorbidity in adults in the United States: risk of overall and regional adiposity. Obes Res. 2001;9: 1-9. Objective: To evaluate the impact of generalized, abdominal, and truncal fat deposits on the risk of hypertension and/or diabetes and to determine whether ethnic differences in these fat patterns are independently associated with increased risk for the hypertension-diabetes comorbidity (HDC). Research Methods and Procedures: Data (n ϭ 7075) from the Third U.S. National Health and Nutrition Examination Survey were used for this investigation. To assess risks of hypertension and/or diabetes that were due to different fat patterns, odds ratios of men and women with various cutpoints of adiposities were compared with normal subjects in logistic regression models, adjusting for age, smoking, and alcohol intake. To evaluate the contribution of ethnic differences in obesity to the risks of HDC, we compared blacks and Hispanics with whites. Results: Generalized and abdominal obesities were independently associated with increased risk of hypertension, diabetes and HDC in white, black, and Hispanic men and women. The risk of HDC due to generalized, truncal, and abdominal obesities tended to be higher in whites than blacks and Hispanics. In men, the contribution of black and Hispanic ethnicities to the increased risk of HDC due to the various obesity phenotypes was ϳ73% and ϳ61%, respectively. The corresponding values for black and Hispanic women were ϳ115% and ϳ125%, respectively. Conclusions: In addition to advocating behavioral lifestyles to curb the epidemic of obesity among at-risk populations in the United States, there is also the need for primary health care practitioners to craft their advice to the degree and type of obesity in these at-risk groups.

PURPOSE: To determine whether white, black and hispanic young (17 ± 39 y) and middle-aged (40 ± 59 y) adults, and elderly (60 ± 90 y) Americans have the same values of abdominal adiposity (estimated from waist circumference (WC) at the established levels of overweight (body mass index, BMI 25 ± 29.9 kgam 2 ) and obesity (BMI ! 30 kgam 2 ). METHODS: Data (n 16,120) from the US Third National Health and Nutrition Survey were utilized. Age-adjusted linear regression analyses were used to estimate gender-and ethnic-speci®c WC values corresponding to overweight and obesity. Receiver operating characteristic (ROC) curves were also employed to determine the choices of WC values corresponding to the established BMI cut-off points. With ROC, gender-and ethnic-speci®c cut-off points producing the best combination of sensitivity and speci®city were selected as optimal thresholds for WC values corresponding to the established BMI cut-off points. RESULTS: WC values associated with the established BMI were lower in blacks and hispanics compared with whites. In men, the WC values that corresponded to overweight ranged from 89 to 106 cm, from 84 to 95 cm, and from 87 to 97 cm in whites, blacks and hispanics, respectively. The corresponding values for obesity ranged from 99 to 110 cm, from 96 to 107 cm, and from 97 to 108 cm. The WC values that corresponded to overweight in women ranged from 82 to 91 cm, from 81 in to 90 cm, and from 83 to 92 cm in whites, blacks and hispanics, respectively. The analogous values for obesity ranged from 94 to 101 cm, from 93 to 100 cm, and from 94 to 101 cm. CONCLUSIONS: The lack of higher WC values in blacks (particularly women) and hispanics at the same levels of BMI for whites challenges previously held assumptions regarding the role of abdominal adiposity in cardiovascular disease experienced by non-whites. De®ning the anthropometric variables that satisfactorily describe reasons for ethnic differences in cardiovascular disease is one of the challenges for future research.

OBJECTIVE: To determine the types of subcutaneous adiposity represented by different measurements of skinfold thickness that are associated with birth weight in white (n 759), Black (n 916) and Hispanic (n 813) American children aged 5±11 y. We also determined the contribution of birth weight to ethnic differences in subcutaneous and central adiposity. DESIGN AND METHODS: Data for this analysis were from the Third US National Health and Nutrition Examination Survey. The outcome measures were triceps, subscapular, suprailliac and thigh skinfold thicknesses at 5±11 y of age. Central adiposity was de®ned as ratios of subscapular to triceps (STR) and central±peripheral (CPR) (subscapular suprailliac)a(triceps thigh) skinfolds. Partial correlation analyses were used to determine the association between birth weight and measures of subcutaneous fatness, while multiple linear regression analyses were used to determine the independent contribution of birth weight to ethnicity variations in subcutaneous and central adiposity adjusting for sex, age and BMI. RESULTS: Overall, birth weight was negatively associated with subscapular skinfold and central adiposity in White, Black and Hispanic American children (P`0.05). Birth weight was also negatively associated with suprailliac skinfold in both Blacks and Hispanics (P`0.01) and with sum of the four skinfolds in Blacks (P`0.05). Compared with White, Black ethnicity was negatively associated with triceps, suprailliac thigh and sum of skinfold thicknesses controlling for birth weight, sex, age and BMI (P`0.01). Compared with White, Hispanic ethnicity was negatively associated with triceps, thigh and sum of skinfold thicknesses (P`0.01). Both Black and Hispanic ethnicity was positively associated with STR and CPR (P`0.01). CONCLUSIONS: In this population of American children, the association of birth weights with subcutaneous and central fat accumulation may be due to fetal programming. Since the impact of fetal conditions is likely to be modi®ed by life course, de®ning the interaction between factors that are present at birth and subsequent exposures is one of the essential challenges for future research.