Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Ravensbergen, Henrike Rianne J C; Lear, Scott A.; Claydon, Victoria E.

doi:10.1089/neu.2013.3042

Cited by 78 publications

(76 citation statements)

References 52 publications

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“…15 We recently showed that WC was the best measure of obesityrelated CVD risk after SCI. 16 In this study, BMI was strongly correlated with adiposity, but not with CVD risk. However, the impact of different scaling factors for height correction in individuals with SCI is unknown, and may improve the relationships between these measures, as has been shown in the able-bodied.…”

Section: Introductionmentioning

confidence: 45%

“…16 The study received ethical approval from the Research Ethics Committee at Simon Fraser University and the Vancouver Coastal Health Research Institute. Measurements were taken on individuals with chronic SCI (41 year), who gave written informed consent, had no known pre-existing (prior to injury) CVD and were not taking any cardiovascular-related medications.…”

Section: Materials and Methods Participantsmentioning

confidence: 99%

“…Height in meters was determined using an electronic ruler (Matlab 2012b, Math Works, MA, USA) on the DEXA images, as previously described. 16 In cases where participants could not fully straighten their legs because of contractures or spasticity, self-reported height was used (n = 4). WC was measured in centimeters, using a stretch-resistant tensiometer measuring tape, at the narrowest part of the waist after a normal expiration, while lying supine on the DEXA scanner bed.…”

Section: Motor and Sensory Assessmentmentioning

confidence: 99%

“…Total body fat mass in kilograms and total body fat percentage, computed as (total body fat mass/total mass) × 100, were determined using the whole-body DEXA scan. Abdominal fat mass in kilograms was determined using standardized landmarks 16 to distinguish the trunk region, and abdominal fat percentage was computed as (abdominal fat mass/total mass in the defined region) × 100.…”

Section: Motor and Sensory Assessmentmentioning

confidence: 99%

“…Entering a value of 120 mm Hg is neutral to the score, and therefore excludes any effect of SAP on the generated risk score. 16 As a sensitivity analysis, we re-ran the same analyses using the original Framingham scores, which included the measured SAP.…”

Section: Framingham 30-year Risk For Cvd Scorementioning

confidence: 99%

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Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury

et al. 2014

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Study design: Observational cross-sectional study. Objectives: Body mass index (BMI), measured as a ratio of weight (Wt) to the square of height (Wt/Ht 2 ), waist circumference (WC) and waist-to-height ratio (WHtR) are common surrogate measures of adiposity. It is not known whether alternate scaling powers for height might improve the relationships between these measures and indices of obesity or cardiovascular disease (CVD) risk in individuals with spinal cord injury (SCI). We aimed to estimate the values of 'x' that render Wt/Ht x and WC/Ht x maximally correlated with dual energy x-ray absorptiometry (DEXA) total and abdominal body fat and Framingham Cardiovascular Risk Scores. Setting: Canadian public research institution. Methods: We studied 27 subjects with traumatic SCI. Height, Wt and body fat measurements were determined from DEXA whole-body scans. WC measurements were also obtained, and individual Framingham Risk Scores were calculated. For values of 'x' ranging from 0.0 to 4.0, in increments of 0.1, correlations between Wt/Ht x and WC/Ht x with total and abdominal body fat (kg and percentages) and Framingham Risk Scores were computed. Results: We found that BMI was a poor predictor of CVD risk, regardless of the scaling factor. Moreover, BMI was strongly correlated with measures of obesity, and modification of the scaling factor from the standard (Wt/Ht 2 ) is not recommended. WC was strongly correlated with both CVD risk and obesity, and standard measures (WC and WHtR) are of equal predictive power. Conclusion: On the basis of our findings from this sample, alterations in scaling powers may not be necessary in individuals with SCI; however, these findings should be validated in a larger cohort. INTRODUCTIONWith advances in the acute care and management of spinal cord injury (SCI), affected individuals have a longer life expectancy, and as a consequence, secondary complications such as cardiovascular disease (CVD) are becoming a priority for researchers, clinicians and those living with SCI. 1 CVD is now the leading cause of morbidity and mortality in this population. 2 In addition, SCI individuals experience an increased risk, earlier onset and faster rate of progression of CVD than in the general population. 3,4 For example, individuals with SCI exhibit a more than twofold increased risk of stroke, heart disease and type 2 diabetes compared with able-bodied individuals. [5][6][7] Obesity is a well-known risk factor for CVD, and is particularly important to examine following SCI as adverse changes in body composition, metabolic rate and autonomic function are known consequences of injury. 8,9 These adaptations, in combination with reduced activity levels as a result of physical disability, may lead to a higher prevalence of obesity and greater CVD risk in this population. 10 Thus, accurate and practical measures of obesity, coupled with better

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Section: Introductionmentioning

confidence: 45%

Section: Materials and Methods Participantsmentioning

confidence: 99%

Section: Motor and Sensory Assessmentmentioning

confidence: 99%

Section: Motor and Sensory Assessmentmentioning

confidence: 99%

Section: Framingham 30-year Risk For Cvd Scorementioning

confidence: 99%

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Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury

et al. 2014

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A Practice‐Focused Overview of Methods to Assess Obesity Before Arthroplasty

Sahafi

Bramwell

Harris

et al. 2015

Musculoskeletal Care

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Obesity is associated with poorer outcomes after hip and knee arthroplasty. Body mass index is the most commonly used measure of obesity, but it does not reliably assess body composition. This paper reviewed the literature to provide a practice focused overview of existing approaches to measure obesity and discussed their suitability in informing decisions for hip and knee arthroplasty. We found that measures of obesity that are practical in clinical settings and high utility when making decisions on arthroplasty could be clustered into three groups: reliable but costly; inexpensive and assessing body composition; and inexpensive without body composition assessment. Measures of obesity of value to surgeons' decision making could be drawn from a combination of the first or second group measures with the third group.

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Visceral adiposity in persons with chronic spinal cord injury determined by dual energy X‐Ray absorptiometry

Cirnigliaro

LaFountaine

Dengel

et al. 2015

Obesity

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Objective: To determine visceral adipose tissue (VAT) volume (VAT vol ) by dual energy X-ray absorptiometry (DXA) in spinal cord injured (SCI) and able-bodied (AB) participants and to explore the relationships between VAT vol and routine anthropometric measures. Methods: Sixty-three subjects with SCI and 126 healthy male AB controls were stratified as low risk [LR: waist circumference (WC) < 102 cm] and moderate to high risk (MHR: WC 102 cm) for identification of risk for cardiometabolic disease: AB-LR, SCI-LR, AB-MHR, and SCI-MHR. Anthropometrics and standard body composition measurements by DXA with analysis to derive VAT vol were performed. Results:Comparison of the four subgroups demonstrated the highest subcutaneous adipose tissue volume (SAT vol ) in the AB-MHR group (P < 0.01), and the highest VAT vol in the SCI-MHR group (P < 0.01). Furthermore, when compared to the AB group, participants with SCI had a 27% increase in VAT vol for every centimeter increase in WC and a 20% increase in VAT vol for every unit increase in BMI. Conclusions: Because cutoff values for the routine surrogate measures of adiposity underestimate visceral adiposity in persons with SCI, the risk of adverse metabolic consequences would also be underestimated, which necessitates adjustment of the these cutoff values or, preferably, to perform its direct measurement.

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Waist Circumference Is the Best Index for Obesity-Related Cardiovascular Disease Risk in Individuals with Spinal Cord Injury

Cited by 78 publications

References 52 publications

Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury

Optimal scaling of weight and waist circumference to height for adiposity and cardiovascular disease risk in individuals with spinal cord injury

A Practice‐Focused Overview of Methods to Assess Obesity Before Arthroplasty

Visceral adiposity in persons with chronic spinal cord injury determined by dual energy X‐Ray absorptiometry

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