O B J E C T I V E -Prior studies have supported that waist circ u m f e rence correlates better with visceral adipose tissue and is a better predictor of cardiovascular disease than are BMI and waist-to-hip ratio. In this study, we reexamine the role of waist size on the risk of hypert e n s i o n and type 2 diabetes in African-origin populations from three contrasting enviro n m e n t s . RESEARCH DESIGN AND METHODS-A cross-sectional survey was conducted of 5,042 men and women 25-74 years of age from Nigeria, Jamaica, and the U.S. The re l a t i o nship between waist, blood pre s s u re, and fasting blood glucose was assessed using multiple linear re g ression analyses. Logistic re g ression analyses using sex-specific empirical waist cut-points were used to determine the risks of hypertension and type 2 diabetes. R E S U LT S -Waist circ u m f e rence was positively correlated with blood pre s s u re and fasting blood glucose (P 0 . 0 5 ). I n c reasing waist quartiles were significantly associated with higher risks of hypertension in the three populations, as estimated from age-adjusted odds ratios obtained from sex-specific logistic re g ression models. A highly elevated risk of type 2 diabetes-10-fold for Jamaican men and 23-fold for African-American women-was observed in the comparison of lowest to highest quartiles of waist circ u m f e re n c e C O N C L U S I O N S -Substantial reduction in hypertension and diabetes in men and women is achievable if the waist size is decreased in these populations. Intervention pro g r a m s designed to reduce waist circ u m f e rence through lifestyle modification, including exercise and diet, may have significant public health significance in reducing the incidence of hypert e n s i o n and adult-onset diabetes in these populations.

Objective: The aim of this study was to determine the prevalence of abdominal obesity and its impact on the risks of hypertension in the US adult population. Design and methods: Data from the third US National Health and Nutrition Examination Surveys, 1988-1994, were utilised. Abdominal obesity was defined as waist circumference у102 cm in men and у88 cm in women. Hypertension was defined as mean diastolic blood pressure у90 mm Hg, systolic blood pressure у140 mm Hg or current treatment with prescribed hypertension medication. Prevalences of abdominal obesity were estimated in non-Hispanic White, non-Hispanic Black and Hispanic Americans. Gender-specific logistic regression analysis using empirical waist cut-off points was used to determine the risks of hypertension. The impact of abdominal adiposity on risk of hypertension was estimated from population-attributable risk adjusting for age, current smoking and alcohol intake.

BACKGROUND: Waist circumferences (WC) ! 94 cm for men and ! 80 cm for women (action level I) and ! 102 cm for men and ! 88 cm for women (action level II) have been suggested as limits for health promotion purposes to alert the general public to the need for weight loss. In this analysis we examined the ability of the above cut-off points to correctly identify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados. We also determined population-and gender-speci®c abdominal adiposity cut-off points for epidemiological identi®cation of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as seen from the front or at midpoint between the bottom of the rib cage and 2 cm above the top of the iliac crest. Sensitivity and speci®city of the established WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population-and gender-speci®c cut-off points associated with risk of hypertension were determined over the entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hypertension were poor compared to the speci®c cut-off points estimated for each population. Different values of WC were associated with increased risk of hypertension in these populations. In men, WC cut-off points of 76, 81, 80, 83 and 87 cm provided the highest sensitivity for identifying hypertensives in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identi®cation of risk of hypertension. For the purpose of health promotion, the decision on what cut ± off points to use must be made by considering other additional factors including overall impact on health due to intervention (e.g. weight reduction) and potential burden on health services if a low cut-off point is employed. There is a need to develop abdominal adiposity cut-off points associated with increased risks for cardiovascular diseases in different societies, especially for those populations where the distribution of obesity and associated risk factors tends to be very different from those of the technologically advanced nations.

OKOSUN, IKE S . , TERRENCE E. FORRESTER, CHARLES N. ROTIMI, BABATUNDE 0. OSOTIMEHIN, WALINJOM F. MUNA, AND RICHARD S. COOPER. Abdominal adiposity in six populations of West African descent: prevalence and population attributable fraction of hypertension. Obes Res. 1999;7:453462. Objectives: The objective of this investigation was to examine the prevalence of abdominal adiposity and its association with the prevalence of hypertension among African descent populations in Nigeria, Cameroon, Jamaica, St. Lucia, Barbados, and the United States (US). Research Method: The data for this investigation were obtained from the International Collaborative Study on Hypertension in Blacks. Hypertension was defined as mean diastolic blood pressure 2 9 0 mmHg, systolic blood pressure 2 140 mmHg or current treatment with prescribed antihypertension medication. Abdominal overweight was defined as waist circumference (WC) 2 9 4 and 280 cm for men and women, respectively. Abdominal obesity was defined as WC 2 1 0 2 and 2 8 8 cm for men and women, respectively. We estimated the site-specific prevalence of abdominal overweight and obesity across age and body mass index cut-points. We also calculated the population attributable fraction (AF) of hypertension due to abdominal adiposity. Results:The prevalence of hypertension in these populations was tightly linked to abdominal adiposity. Increases in abdominal overweight accompanied an increasing degree of Westernization, rising from 6.4% and 26.3% in Nigeria, 16.5% and 62.8% in Cameroon, 15.8% and 58.6% in Jamaica, 14.3% and 62.1% in St. Lucia, 21.4% and 70.3% in Barbados to 38.9%, and 76.4% in the US for men and women, respectively. The corresponding values for abdominal obesity were 1.6% and 12.3% in Nigeria, 5.1% and 38.9% in Cameroon, 5.5% and 34.0% in Jamaica, 2.7% and 40.7% in St. Lucia, 7.8% and 44.7% in Barbados to 21.7% and 54.1% in the US for men and women, respectively. Body mass index-adjusted estimates of AF suggest that in most of these populations, especially in females, avoidance of abdominal overweight or obesity would help to curb the development of hypertension. Discussion: An important public health challenge is to clarify how lifestyle factors influence risks of abdominal adiposity and ultimately the increased risk of cardiovascular diseases.

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