Endocrine Abstracts

There is a clear relationship between degree of obesity and abdominal obesity with the development of cardiovascular disease.

Objective: To assess body mass index (BMI) and waist circumference (WC) as predictors of cardiovascular risk (CVR) in type 2 diabetes mellitus (T2DM) patients.

Material and Methods: Cross-sectional study in 452 consecutive out-patients with T2DM who visited our clinic in Madrid, Spain for a routine follow-up. All patients weight and height were measured to the nearest 0.1 kg and 0.1 cm respectively. BMI was calculated as weight divided by square height (kg/m²). The WC was recorded as the smallest girth between the rib cage and the iliac crest.Ten-year cardiovascular risk was calculated using the risk tables (Framingham). According to the ADA recommendations for adults with T2DM and WHO we applied a BMI <25 kg/m² and a WC <102 cm in ♂ and <88 cm in ♀ as targets for good control. Comparisons of mean levels were performed with the Student’s t-test, and comparison of proportions with the chi-square test. Multiple regression analyses adjusted for age and sex were performed with CVR as dependent variable, and BMI and WC as independent variables, using the ‘stepwise’ method to assess the contribution of each variable to the CVR. A level of P<0.05 was considered significant (SPSS, v. 13.0).

Results: The mean age was 65.2±11.2 years, 200 ♂ (44%). The mean BMI was 30.9±6.1 kg/m², being higher in ♀ than ♂ (32.3±6.77 vs 29.2±4.7 kg/m², P=0.0000). Fifty-one percent of patients were obese (BMI≥30), and only 60 patients (13%) achieved a BMI <25 kg/m². The percentage of patients who had a BMI≥30 kg/m² was greater in ♀ than ♂ (64 vs 35%, P=0.0002), and the patients who achieved a BMI <25 kg/m² was higher in ♂ than ♀ (17 vs 11%, P=0.05). The WC average was 102.2±12.8 cm, without significant differences between ♂ and ♀. The percentage of ♀ who had a WC>88 cm was much higher than those with a WC≤88 cm (83 vs 17%, P=0.01.The mean CVR was 14.5±7.7%, being higher in ♀ than ♂ (16.4±9.2% vs 13.0±6.2%, P=0.0000). Multiple regression analysis showed that only the WC contributed to the variance of CVR (20%, P=0.0001).

Conclusions: The results demonstrate the high prevalence of obesity and abdominal obesity, and its poor control in the diabetic population studied, especially in ♀, and support the need to recommend strict adherence to the diet of these patients to achieve recommended targets to reduce the CVR. The measurement of WC is a better predictor of CVR and easier to obtain than BMI.