A World Health Organization (WHO) Expert Consultation on Waist Circumference (WC) and Waist-Hip Ratio (WHR) was convened in Geneva from 8 to 11 December 2008 to consider approaches to developing international guidelines for indices and action levels in order to characterize health risks associated with these measures of body fat distribution-alternative or complementary to the existing WHO guidelines for assessments of generalized obesity on the basis of body mass index. Six background papers prepared for the Consultation are compiled in this issue. These six papers examine a range of health outcomes and issues, including whether there is a basis for choosing WC over WHR and whether different action levels by gender, age, ethnicity, country or region are warranted. Although guidelines involving WC and WHR are potentially useful and clearly required, the challenges in identifying cutoffs for international guidelines should not be underestimated or oversimplified. The final report and outcomes of the Expert Consultation will be published by WHO. European Journal of Clinical Nutrition IntroductionChronic noncommunicable diseases (NCDs), such as heart disease, hypertension and stroke, diabetes mellitus, as well as various forms of cancer, are significant causes of disability, premature death, impaired quality of life and increasing health-care costs, in low-and middle-income, as well as in high-income countries (WHO, 2000a(WHO, , 2004(WHO, , 2008. Obesityreflecting the accumulation of a potentially harmful level of excess body fat-is a major contributor to the development of NCDs (WHO, 2000b), and has become a global epidemic affecting children and adults alike. Addressing obesity through population-level strategies that promote optimal nutrition, such as appropriate dietary intake and physical activity, is a major focus of the Global Strategy and Action Plan of the World Health Organization (WHO) for the Prevention and Control of Noncommunicable Diseases (NCDs) (WHO, 2000a(WHO, , 2004(WHO, , 2008, complementary to strategies developed to address other aspects of dietary quality, tobacco use and harmful use of alcohol.Surveillance to quantify and track NCDs and their risk factors is a key component of the NCD Action Plan (WHO, 2008), which requires clearly specified diagnostic criteria and classifications. Diagnostic criteria and classifications for obesity potentially relate to both generalized obesity and also to obesity subtypes defined by the distribution of body fat, such as abdominal or central obesity. With respect to generalized obesity in adults, reports of the 1993 WHO Expert Committee (WHO, 1995) kilograms divided by the square of height in metres (kg/m 2 ): overweight (BMI of X25.0) and obesity (BMI of X30), with further gradations of obesity defined by BMI ranges of 30.0-34.9, 35.0-39.9 and X40 based on the severity of the associated risk of comorbidities. These BMI cutoff points were recommended for international use with awareness that the risks are graded along a continuum, and that the risk ...
Current waist circumference (WC) and waist-to-hip ratio (WHR) cutoffs have been identified from studies of predominantly European-derived populations. However, these cutoffs may not be appropriate for other ethnic groups. This paper reviews the literature regarding ethnic differences in body composition and the appropriateness of ethnic-specific WC and WHR cutoffs in various ethnic groups. Studies investigating ethnic-specific cutoffs were identified among Aboriginal, Asian, African (SubSaharan), African-American, Hispanic, Middle Eastern, Pacific Islander and South American populations. Abstracts that recommended WC and/or WHR cutoffs (or rejected the use of cutoffs) were included with their supporting literature. The evidence for ethnic-specific WC and/or WHR cutoffs was then rated as either convincing, probable, possible or insufficient. The majority of studies recommending ethnic-specific cutoffs was for Asian populations. Few studies recommended cutoffs in Aboriginal, African (Sub-Saharan), Pacific Islanders and South American populations. All studies were cross-sectional, and the overwhelming majority of studies used receiver operating characteristic curves. The studies used a number of methods for assessing WC and WHR, and a variety of outcome measures, making cross-study comparison difficult. There is possible evidence that Asians should have a lower WC cutoff than Europeans. The evidence is insufficient for specific cutoffs for African-American, Hispanic and Middle Eastern populations but some studies indicate current cutoffs for Europeans may be appropriate, whereas there is insufficient evidence for the other ethnic groups. Future studies are needed to address the methodological limitations of the current literature.
OBJECTIVEMultifaceted care has been shown to reduce mortality and complications in type 2 diabetes. We hypothesized that structured care would reduce renal complications in type 2 diabetes.RESEARCH DESIGN AND METHODSA total of 205 Chinese type 2 diabetic patients from nine public hospitals who had plasma creatinine levels of 150–350 μmol/l were randomly assigned to receive structured care (n = 104) or usual care (n = 101) for 2 years. The structured care group was managed according to a prespecified protocol with the following treatment goals: blood pressure <130/80 mmHg, A1C <7%, LDL cholesterol <2.6 mmol/l, triglyceride <2 mmol/l, and persistent treatment with renin-angiotensin blockers. The primary end point was death and/or renal end point (creatinine >500 μmol/l or dialysis).RESULTSOf these 205 patients (mean ± SD age 65 ± 7.2 years; disease duration 14 ± 7.9 years), the structured care group achieved better control than the usual care group (diastolic blood pressure 68 ± 12 vs. 71 ± 12 mmHg, respectively, P = 0.02; A1C 7.3 ± 1.3 vs. 8.0 ± 1.6%, P < 0.01). After adjustment for age, sex, and study sites, the structured care (23.1%, n = 24) and usual care (23.8%, n = 24; NS) groups had similar end points, but more patients in the structured care group attained ≥3 treatment goals (61%, n = 63, vs. 28%, n = 28; P < 0.001). Patients who attained ≥3 treatment targets (n = 91) had reduced risk of the primary end point (14 vs. 34; relative risk 0.43 [95% CI 0.21–0.86] compared with that of those who attained ≤2 targets (n = 114).CONCLUSIONSAttainment of multiple treatment targets reduced the renal end point and death in type 2 diabetes. In addition to protocol, audits and feedback are needed to improve outcomes.
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