Waist circumference measurement: knowledge, attitudes and barriers in patients and practitioners in a multi-ethnic population

Dunkley, Alison J.; Stone, Margaret; Patel, Naina; Davies, Melanie J.; Khunti, Kamlesh

doi:10.1093/fampra/cmp048

Cited by 42 publications

(65 citation statements)

References 18 publications

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“…In contrast, despite evidence that waistline is a strong predictor of cardiovascular related morbidity and mortality and has been recommended since 1998 [46], only one in ten patients had a measure done [47,48]. Low levels of uptake have also been documented in other countries [49,50]. One study reported that family physicians cited lack of time, extra workload, opportunity costs, and concerns about the acceptability of this manoeuvre as barriers to uptake [50].…”

Section: Discussionmentioning

confidence: 99%

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Liddy

Singh

Hogg

et al. 2012

BMC Cardiovasc Disord

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BackgroundPrimary care plays a key role in the prevention and management of cardiovascular disease (CVD). We examined primary care practice adherence to recommended care guidelines associated with the prevention and management of CVD for high risk patients.MethodsWe conducted a secondary analysis of cross-sectional baseline data collected from 84 primary care practices participating in a large quality improvement initiative in Eastern Ontario from 2008 to 2010. We collected medical chart data from 4,931 patients who either had, or were at high risk of developing CVD to study adherence rates to recommended guidelines for CVD care and to examine the proportion of patients at target for clinical markers such as blood pressure, lipid levels and hemoglobin A1c.ResultsAdherence to preventive care recommendations was poor. Less than 10% of high risk patients received a waistline measurement, half of the smokers received cessation advice, and 7.7% were referred to a smoking cessation program. Gaps in care exist for diabetes and kidney disease as 54.9% of patients with diabetes received recommended hemoglobin-A1c screenings, and only 55.8% received an albumin excretion test. Adherence rates to recommended guidelines for coronary artery disease, hypertension, and dyslipidemia were high (>75%); however <50% of patients were at target for blood pressure or LDL-cholesterol levels (37.1% and 49.7% respectively), and only 59.3% of patients with diabetes were at target for hemoglobin-A1c.ConclusionsThere remain significant opportunities for primary care providers to engage high risk patients in prevention activities such as weight management and smoking cessation. Despite high adherence rates for hypertension, dyslipidemia, and coronary artery disease, a significant proportion of patients failed to meet treatment targets, highlighting the complexity of caring for people with multiple chronic conditions.Trial RegistrationNCT00574808

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Section: Discussionmentioning

confidence: 99%

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Liddy

Singh

Hogg

et al. 2012

BMC Cardiovasc Disord

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“…BMI is a simple and widely used clinical measure; however, BMI may not be a reliable indicator of health risk across all racial and ethnic groups (6,8,9). This may be due, at least in part, to errors inherent in the use of self-report measures of BMI (6).…”

Section: Introductionmentioning

confidence: 99%

“…This may be due, at least in part, to errors inherent in the use of self-report measures of BMI (6). Considerable attention has been given to waist circumference as a complementary (10) and, in some cases, superior (8) assessment to BMI.…”

Section: Introductionmentioning

confidence: 99%

Independent Association of Waist Circumference With Hypertension and Diabetes in African American Women, South Carolina, 2007–2009

Warren

Wilcox²,

Dowda³

et al. 2012

Prev. Chronic. Dis.

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IntroductionObesity is associated with hypertension and diabetes, which are independent risk factors for cardiovascular disease (CVD); 53% of African American women are obese. Of the approximately 44% of African American women who are hypertensive, more than 87% are overweight or obese. Additionally, more than twice as many African American women (13.1%) as white women (6.1%) have been diagnosed with type 2 diabetes. Obesity is usually measured using body mass index (BMI). However, abdominal adiposity may be more predictive of CVD risk than BMI. This study investigates the independent association of waist circumference with hypertension and diabetes in African American women.MethodsAs part of the Faith, Activity, and Nutrition (FAN) program, we recruited 843 African American women (mean age 53.8 y [SD, 14.1 y]) from African Methodist Episcopal churches. If a participant reported she had hypertension or had measured systolic blood pressure at or higher than 140 mm Hg or measured diastolic blood pressure at or higher than 90 mm Hg, she was classified as having hypertension. To assess increased health risks associated with waist circumference, we used the World Health Organization’s standards to categorize waist circumference as normal risk (waist circumference <80 cm), increased risk (waist circumference 80–88 cm), or substantially increased risk (waist circumference >88 cm). We used logistic regression models to test predictors of hypertension and diabetes.ResultsOf 843 study participants, 205 had diabetes and 545 were hypertensive. Women with a waist circumference of 88 cm or more were at increased risk for hypertension (odds ratio [OR] = 7.17, P < .002) and diabetes (OR = 6.99, P < .001). Associations remained after controlling for all variables (hypertension OR = 5.53, P < .001; diabetes, OR = 5.38, P < .001).ConclusionAfter controlling for all variables, waist circumference was independently associated with a 5-fold risk in hypertension and diabetes in African American women.

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“…5, 6 Waist circumference (WC) and waist-to-hip ratio (WHR), measures of central adiposity, are stronger predictors of cardiovascular risk compared to BMI, yet are infrequently quantified in the clinical setting. 7 Central adiposity is linked to adverse metabolic profiles and greater systemic inflammation, both potent risk factors for the development of cardiovascular disease. 8 Previous analyses have shown an independent association between measures of central obesity and left ventricular (LV) dysfunction, particularly diastolic dysfunction.…”

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confidence: 99%

Association of Central Adiposity With Adverse Cardiac Mechanics

Selvaraj

Martinez

Aguilar

et al. 2016

Circ: Cardiovascular Imaging

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Background Central obesity, defined by increased waist circumference (WC) or waist-hip ratio (WHR), is associated with increased cardiovascular (CV) events, including heart failure. However, the pathophysiological link between central obesity and adverse CV outcomes remains poorly understood. We hypothesized that central obesity and larger WHR are independently associated with worse cardiac mechanics (reduced left ventricular [LV] strain and systolic [s’] and early diastolic [e’] tissue velocities). Methods and Results We performed speckle-tracking analysis of echocardiograms from participants in the HyperGEN study, a population- and family-based epidemiologic study (N=2181). Multiple indices of systolic and diastolic cardiac mechanics were measured. We evaluated the association between central obesity and cardiac mechanics using multivariable-adjusted linear mixed effects models to account for relatedness among participants. The mean age of the cohort was 51±14 years, 58% were female, and 47% were African-American. Mean body-mass index (BMI) was 30.8±7.1 kg/m2, WC 102±17 cm, WHR 0.91±0.08, and 80% had central obesity based on WC and WHR criteria. After adjusting for multiple potential confounders, including age, sex, race, physical activity, BMI, heart rate, smoking status, systolic blood pressure, fasting glucose, total cholesterol, anti-hypertensive medication use, glomerular filtration rate, LV mass index, wall motion abnormalities, and ejection fraction, central obesity and WHR remained associated with worse global longitudinal strain, early diastolic strain rate, s’ velocity, and e’ velocity (P < 0.05 for all comparisons). There were no significant statistical interactions between WHR and obesity status. Conclusions In this cross-sectional study of participants with multiple comorbidities, central obesity was found to be associated with adverse cardiac mechanics.

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Waist circumference measurement: knowledge, attitudes and barriers in patients and practitioners in a multi-ethnic population

Abstract: This study adds to our understanding of views on WCM in a multi-ethnic setting, highlighting factors for consideration if WCM is to be facilitated in routine practice.

Cited by 42 publications

References 18 publications

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Quality of cardiovascular disease care in Ontario, Canada: missed opportunities for prevention - a cross sectional study

Independent Association of Waist Circumference With Hypertension and Diabetes in African American Women, South Carolina, 2007–2009

Association of Central Adiposity With Adverse Cardiac Mechanics

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