Having a large waist circumference, which indicates the level of fat in the abdomen, has previously been associated with an increased risk of heart disease in adults and young people. A recently published study (1) wanted to investigate how a Mediterranean diet might influence accumulation of fat around the middle (waist circumference).
The study(1) took place in Spain and involved over 2500 young people aged 10-24 years old. Dietary data was collected to see how strongly individuals adhered to a Mediterranean diet. Waist circumference was measured as was physical activity. A higher score on the adherence to Mediterranean diet was significantly associated with higher leisure time physical activity levels and higher maternal education. A high score was also associated with a lower waist circumference and lower waist-to-height ratio. The authors of the study conclude that “These results suggest that following Mediterranean dietary principles may be important in reducing the risk of high waist circumference in young people”.
A traditional Mediterranean style of eating includes plentiful amounts of vegetables, fruits, nuts/seeds, olive oil, legumes (beans and peas), wholegrains, fish (including oily fish such as salmon, trout, sardines and mackerel) and low-fat dairy products. This kind of eating pattern is ‘nutrient dense’ – the food is packed with lots of vitamins, minerals, fibre and flavonoids (members of the polyphenol family, plant chemicals), much of the food is not high in calories (not energy dense) but is high in nutrition, a great way of eating for health and weight control reasons.
BMI (Body Mass Index) is a measure often used for healthy weight, it is worked out as weight divided by height squared. To check your own BMI you may find it useful to visit the Food Standards Agency website where an online BMI calculator can be found. Generally a BMI of 19-25 is viewed as a healthy weight. However, measuring waist circumference might actually be a better measure for health. A recently published, large, study (2) suggests that how obesity and overweight is measured may be very important. Results indicate that in any body mass index BMI (the classic way of measuring obesity) group – normal, overweight and obese – avoiding abdominal obesity, as measured by waist circumference, can reduce risk the risk of premature death from all causes.
At the moment the National Institute for Health and Clinical Excellence (NICE) recommends(3) that waist circumference be used in addition to BMI in overweight (BMI 25 to <30) and obese (BMI 30) adults to assess health risks. There are no specific weight loss goals for abdominally obese patients, with a waist circumference of 88cm in women and 102cm in men, who are in the normal BMI category (18.5 to <25).
This (2) 9 year study examined the association between waist circumference and death among 48500 men and 56343 women aged 50 years or older. Very high waist circumference ( 120cm compared with <90cm in men and 110cm compared with <75cm among women) was associated with an approximately 2-fold higher risk of all cause mortality, including death from cancer, cardiovascular and respiratory causes, even after adjustment for BMI and other risk factors. Increased waist circumference was associated with an increased risk of mortality in normal, overweight, and obese BMI categories.
Based on its expert report(4) the World Cancer Research Fund recommends that, for cancer prevention, individuals “be as lean as possible without becoming underweight”. The report also emphasises the role that excess abdominal ‘visceral’ fat, as indicated by waist circumference, may have in increasing cancer risk. Having a large waist circumference is also associated with inflammation, insulin resistance, type 2 diabetes, abnormal cholesterol levels and heart disease. A person does not have to be obese or overweight, as categorised by BMI, to have high levels of visceral fat. The study(2) indicates that a simple waist measurement might be a better predictor of health risk than BMI alone.
Further evidence is needed to solidify the link between waist circumference and mortality, however the authors propose their results may affect the development of future guidelines for obesity.
NICE guidelines for waist circumference (3):
For women:
Ideal: less than 80cm (32”).
High: 80cm to 88cm (32” to 35”).
Very high: more than 88cm (35”).
For men:
Ideal: less than 94cm (37”).
High: 94cm to 102cm (37” to 40”).
Very high: more than 102cm (40”).
For useful information on weight loss/weight maintenance you might want to download the WCRF booklet “Staying Lean For Cancer Prevention”
(1) Schröder H et al. 2010. Mediterranean diet and waist circumference in a representative national sample of young Spaniards. International journal of pediatric obesity. Posted online on September 23, 2010. (doi:10.3109/17477161003777417)
(2)Jacobs EJ et al. 2010. Waist Circumference and All-Cause Mortality in a Large US Cohort. Arch Intern Med. 170(15):1293-1301
(3) National Institute for Health and Clinical Excellence. http://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf. Issue date: December 2006. Obesity guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE clinical guideline 43
(4)WCRF/AICR. 2007. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR, 2007.
Schröder H et al. 2010. Mediterranean diet and waist circumference in a representative national sample of young Spaniards. International journal of pediatric obesity. Posted online on September 23, 2010. (doi:10.3109/17477161003777417)
Written by Ani Kowal
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