The Relationship Between Waist Circumference and Biomarkers for Diabetes and CVD in Healthy Non-Obese Women. The Pensacola Study

Kristina Jackson Behan, PhD, MT(ASCP); Justice Mbizo, DrPH


Lab Med. 2007;38(7):422-427. 

In This Article

Abstract and Introduction


Background:Waist circumference (WC) measurement has been shown to perform as well as or better than body mass index (BMI) in identifying women at risk for diabetes and cardiovascular disease (CVD). The goal of this study was to determine the relationship between WC and the classic biomarkers of risk in healthy women.
Methods: Nondiabetic, non-obese, middle-aged women were categorized by WC quartiles. The correlation of WC to fasting plasma glucose (FPG), A1c, lipid profile, C-reactive protein (CRP) and white blood cell count (WBC) was examined.
Results: Waist circumference correlated with triglycerides, CRP, cholesterol/HDL, non-HDL, LDL, and glucose, and inversely with HDL (r = 0.465, 0.414, 0.321, 0.299, 0.267, 0.279, -0.266, respectively; P = 0.000 for all), but not A1c or WBC. There was a trend of increasing glucose, LDL, and CRP with increasing WC. Quartile 4 showed the highest glucose, CRP, LDL, triglycerides, cholesterol/HDL ratio, and non-HDL.
Conclusion: Increasing WC correlates with several biomarkers of risk for diabetes and CVD in healthy women.


Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) are intimately linked,[1,2,3,4] with obesity and inflammation[5,6,7,8] being common threads. The prevalence of obesity in American women was 61.8% in 2004[9]; the prevalence increases with age and is influenced by ethnicity. Timely intervention is effective in delaying and diminishing the effects of T2DM and CVD, and the American Heart Association and American Diabetes Association use public education strategies, such as online quizzes and brochures, to help individuals assess their risk.[10,11] Body mass index (BMI) has been the conventional assessment of obesity and is determined by measuring height and weight, but it is a confusing measurement for the general public as it requires conversion of height and weight to meters and kilograms. Furthermore, the designation of a BMI of 25 as overweight and of 30 as obese[12] does not account for individual differences in gender, muscle mass, or distribution of fat, and may not be applicable across all races.[13] The National Institutes of Health has determined that abdominal fat is an independent predictor for morbidity, and that waist circumference (WC) is a clinically-acceptable measure of abdominal fat. A WC greater than 35 inches (88 cm) is considered high risk for women.[14] Increased WC has recently been shown to perform as well as or better than BMI in identifying women at risk for diabetes[15] and CVD.[13,16,17] Waist measurement is simple to perform at home and does not add any cost to a physical examination done by a professional. Studies have been conducted that examined either the effect of WC on the risk factors for diabetes, the incidence of diabetes, risk factors of CVD, or the incidence of CVD, and usually focused on obese individuals or diabetic individuals, or both. The true laboratory values of the biomarkers are often blurred, as many times participants are taking lipid-lowering medication.

The goal of this study was to determine the relationship between increasing WC and the conventional laboratory biomarkers for T2DM and CVD in healthy subjects without the confounders of medication use, obesity, diabetes, gender, and age, and to identify a WC cutoff that could be used to identify women who might be at risk. The biomarkers measured were fasting plasma glucose (FPG), A1c, high sensitivity C-reactive protein (CRP), white blood cell count (WBC), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides.


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