Relation of generalized and central obesity to cardiovascular risk factors and prevalent coronary heart disease in a sample of American Indians: the Strong Heart Study

• Published in: International Journal of Obesity Vol. 24; no. 7; pp. 849 - 860
• Main Authors: Gray, R.S, Fabsitz, R.R, Cowan, L.D, Lee, E.T, Welty, T.K, Jablonski, K.A, Howard, B.V
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01-07-2000; Nature Publishing Group
• Subjects: Age Factors; Aged; albumins; American Indians; Arizona - epidemiology; Biological and medical sciences; Blood pressure; Body Composition - physiology; Body Constitution - physiology; body fat distribution; Body Mass Index; Cardiovascular disease; Cardiovascular diseases; clinical examination; Cohort Studies; Confidence Intervals; coronary disease; Coronary Disease - epidemiology; Coronary Disease - etiology; Coronary Disease - genetics; diabetes; Diabetes Complications; Diabetes Mellitus - genetics; electrocardiography; Female; fibrinogen; gender; glucose; glycohemoglobin; Health risks; Humans; Indians, North American - genetics; Insulin; Insulin resistance; lipoproteins; Male; Medical sciences; men; Metabolic diseases; Middle Aged; Native North Americans; Obesity; Obesity - complications; Obesity - epidemiology; Obesity - genetics; Prevalence; Risk Factors; Sex Factors; waist; waist circumference; women; North Dakota; Oklahoma; Arizona; South Dakota; United States > US; Body mass index; Obesity; Prevalence; Nutrition disorder; Risk factor; Cardiovascular disease; Indian; Coronary heart disease; Nutritional status; Visceral obesity
• ISSN: 0307-0565; 1476-5497
• DOI: 10.1038/sj.ijo.0801243

OBJECTIVE: To examine the hypothesis linking measures of obesity including body mass index (BMI), waist circumference (waist) and percentage body fat to coronary heart disease (CHD) prevalence and its risk factors in American Indians. DESIGN: The Strong Heart Study assesses the prevalence of CHD and its risk factors in American Indians in Arizona, Oklahoma and South/North Dakota. Participants underwent a physical examination and an electrocardiogram; anthropometric and blood pressure measurements were taken, as were measurements of glucose, lipoproteins, fibrinogen, insulin, hemoglobin A1c and urinary albumin. PARTICIPANTS: Data were available for 4549 men and women between 45 and 74 y of age. MEASUREMENTS: Obesity, measured using body mass index, waist circumference and percentage body fat, was correlated with prevalent CHD and its risk factors. RESULTS: More than 75% of participants were overweight (BMI > 25 kg/m2). Measures of obesity were greater in women than in men, in younger than in older participants, and in participants with diabetes than in nondiabetic participants. CHD risk factors were associated with measures of obesity but, except for insulin concentration, changes in metabolic variables with increasing obesity were small. Associations were not stronger with waist than with BMI. The prevalence of CHD in those whose BMI and/or waist measurements lay in the lowest and highest quintiles, by gender and diabetic status, was similar. CONCLUSIONS: Although CHD risk factors are associated with obesity in American Indians, distribution of obesity (ie waist) is no more closely related to risk factors than is generalized obesity (ie BMI), and changes in CHD risk factors with obesity were small. Thus, the relations among obesity, body fat distribution and CHD risk may differ in this population.