Turk Kardiyol Dern Ars. 2005; 33(4): 195-203

Clustering of risk factors for abdominal obesity in Turkish adults and its demographic distribution

Altan Onat¹, Hüseyin Uyarel², Ahmet Karabulut², Sinan Albayrak³, Yüksel Doğan⁴, Günay Can⁵, Gülay Hergenç⁶, Vedat Sansoy7^{7
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OBJECTIVES
We investigated the distribution of abdominal obesity among Turkish adults, according to age groups and geographic regions, and the prevalence and type of its clustering with traditional risk factors including high total and low HDL cholesterol levels, smoking, hypertension, and diabetes.
STUDY DESIGN
The study included a cohort of 3267 individuals (1607 men, 1660 women; mean age 52±12 years) whose waist circumferences were measured at least one time in the past three surveys of the Turkish Adult Risk Factor Study from 2000 to 2004. Cardiovascular disease was diagnosed on the basis of the presence of angina history, the Minnesota coding of resting electrocardiograms, and a history of stroke. Criteria of the NCEP ATP III guidelines proposed for metabolic syndrome were adopted for defining abdominal obesity and hypertension.
RESULTS
Out of every four adults aged 50 years or above, one man and three women had abdominal obesity. The prevalence of abdominal obesity did not exhibit marked changes among geographic regions. Coexistence of 3-5 risk factors in subjects with abdominal obesity showed a significantly higher proportion than other clusters of risk factors (p<0.001). All of the six risk factors studied exhibited significant and independent associations with abdominal obesity in women, whereas in men, only smoking, low HDL-C levels, and hypertension were independent factors. In contradistinction to men, there was an over three-fold adjusted likelihood of diabetes to accompany abdominal obesity in women, with hypercholesterolemia significantly clustering with both. While abdominal obesity conferred an increased likelihood of coronary heart disease through mediation of five risk factors in women, it was found as a residual independent component in men.
CONCLUSION
According to the NCEP ATP III criteria, abdominal obesity is three times more prevalent among Turkish women than in men. The female-specific combination of abdominal obesity, diabetes, and hypercholesterolemia may partly contribute to the comparatively high risk for cardiovascular disease in Turkish women. This study needs a re-evaluation of the role of abdominal obesity in Turkish men with a threshold of ?96 cm, which was previously proposed by the authors.

Keywords: Abdomen; coronary disease; diabetes mellitus; female; hypercholesterolemia; hypertension; lipoproteins, HDL cholesterol; obesity; risk factors

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