PRNENnM CARDIDLDGY Waist Circumference and Abdominal Sagittal Diameter: Best Simple Anthropometric Indexes of Abdominal Visceral Adipose Tissue Accumulation and Related Cardiovascular Risk in Men and Women Marie-Christine Pouliot, MSc, Jean-Pierre Desprk, PhD, Simone Lemieux, MSc, Sital Moorjani, PhD, ClaudeBouchard, PhD, AngeloTremblay, PhD, Andr6 Nadeau, MD, PhD, and PaulJ. Lupien, MD, PhD The amount of abdominal visceral adipose tissue measured by computed tomography is a critical comlate of the potentially “atherogenic” mets bolic disturbances associated with abdominal obe- sity. In this study conducted in samples of 81 men and 70 women, data are presented on the anthm pometric con-elates of abdominal visceral adipose tissue accumulation and related cardiovascular disease risk factors (triglyceride and hiienslty lipoprotein cholesterol levels, fasting and postglu- case insulin and glucose levels). Results indicate that the waist circumferem~ and the abdominal sagdtal diameter are better correlates of abdomi- nal visceral adipose tissue accumulation than the commonly used waist-tohip ratio (WHR). In women, the waist circumference and the abdomi- nal sagittal diameter also appeared more closely related to the metabolic variables than the WHR. When the samples were divided into quintiles of waist circumference, WHR or abdominal sagittal diameter, it was noted that increasing values of waist chwmference and abdominal sa@ttal diam eter were more consistently associated with iu creases in fasting and postglucose insulin levels than increasing values of WHR, especially in women. 7hese findi- suggest that the waist cir cumference or the abdominal sagittal diameter, rather than the WHR, shouki be used as indexes of abdominal visceral adipose tissue deposition and in the Bss88smenf of cardiovascular risk. lt is suggested from these data that waist circumfeP ence values above approximately 100 cm, or al, dominsl sagittal diameter values ~25 cm are most From the Lipid Research Center, Physical Activity Sciences Laborato- ry, and Diabetes Research Unit, Lava1 University, Ste-Foy, Quebec, Canada. This study was supported by the Quebec Heart Foundation, the Medical Research Council of Canada, and the “Fonds de la recherche en Sante du QuCbec (FRSQ).” Dr. Despres is an FRSQ scholar, and Dr. Pouliot is the recipient of an FRSQ fellowship. Manuscript received December 15, 1992; revised manuscript received August 20, 1993, and accepted August 30. Address for reprints: Jean-Pierre Despres, PhD, Lipid Research Center, Lava1 University Medical Research Centre, CHUL, 2705 Boulevard Laurier, Ste-Foy, Quebec, G 1 V 4G2, Canada. likely to be associated with potentially “atheu+ genie” metabolic disturbances. (Am J Cardiol1994;73:46D-468) R ecent prospective studies have demonstrated that a predominant accumulation of adipose tissue in the abdominal region confers an increased risk of cardiovascular disease and premature death.’ There is ample data in published reports suggesting that this increased cardiovascular risk is accounted for, at least partly, by the metabolic alterations associated with ab- dominal obesity. Indeed, disturbances in lipoprotein metabolism and plasma insulin-glucose homeostasis, which are risk factors for atherosclerosis, have been re- ported in subjects with an excessive deposition of adi- pose tissue at the abdominal leve1.24 From a clinical point of view, estimation of regional adipose tissue dis- tribution must therefore be considered as important in the evaluation of the patient’s cardiovascular risk pro- file. Currently, the waist-to-hip circumferences ratio (WHR) is by far the most widely used index of region- al adipose tissue distribution. Nevertheless, the best tech- nology actually available for measurement of regional adipose tissue distribution is computed tomography,7 a method that has allowed one to demonstrate that the amount of abdominal visceral adipose tissue, i.e., the amount of adipose tissue located within the abdominal cavity, is the most critical correlate of the metabolic dis- turbances associated with abdominal obesity.s*4 How- ever, computed tomography is expensive and requires ir- radiation of the subjects, therefore limiting its use for clinical and epidemiologic purposes. Since the WHR has been shown to be associated, although moderately, with the amount of abdominal visceral adipose tissue,7J5-*7 this index has been widely used to investigate the rela- tions between regional adipose tissue distribution and the metabolic profile. However, some studies have re- ported that the waist circumference alone is more close- ly correlated with the amount of abdominal visceral adi- pose tissue than the WHR. lea9 On the other hand, it has been recently proposed that the abdominal sagittal di- ameter may also be a good anthropometric correlate of abdominal visceral adipose tissue accumulation.7 How- 460 THE AMERICANJOURNAL OF CARDIOLOGY VOLUME 73 MARCH I,1994