Academic journal article Journal of Health Population and Nutrition

Body Mass Index, Waist-Circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Academic journal article Journal of Health Population and Nutrition

Body Mass Index, Waist-Circumference and Cardiovascular Disease Risk Factors in Iranian Adults: Isfahan Healthy Heart Program

Article excerpt


Chronic non-communicable diseases (CNCDs), such as cardiovascular diseases (CVDs), cancers, and diabetes mellitus (DM), are the major causes of death worldwide (1). Moreover, CVDs are the leading cause of death in Iran (2) while the prevalence of coronary artery disease (CAD) was 19.4% in Isfahan, a central city of Iran (3).

Body mass index (BMI) has been identified as a potential of CVD risk factor for a long time (4-7). Central adiposity in adults make them more susceptible to major metabolic problems, such as ischaemic heart diseases, myocardial infarction, hypertension (HTN), dyslipidaemia (DLP), and dibetes mellitus (DM), and it cannot be indicated by BMI (8-10). It was assessed by measuring waist-circumference (WC) which is a better predictor than BMI for obesity outcomes (11,12). According to the National Institute of Health guidelines, it is supposed that BMI and WC have independent effects on obesity-related diseases (13). It is clear that combination of WC and BMI predicts health risks better than does BMI alone (9,10); however, the reverse is uncertain.

According to Adult Treatment Panel III (ATP III) criteria, about 33.8% of Iranian adults (more than 10.6 million) were centrally obese. It was about 4 times in females compared to males (14).

Considering the importance of CNCDs and the main effect of obesity on these diseases, this study was performed to assess the association between BMI, WC, and major cardiometabolic risk factors and to corroborate whether either or both BMI and WC are independently associated with these risk factors in a sample of Iranian adults who participated in the baseline survey of Isfahan Healthy Heart Program (IHHP). IHHP was a long-term community-based interventional programme for health promotion through reduction of CVD risk factors, and hence, reduction of morbidity and mortality-due to CVDs. The study was conducted in 3 central counties of Iran (15).



This is an analytical study done with data of the baseline survey of IHHP (15,16). IHHP was undertaken in 3 counties of Isfahan, Najafabad, and Arak in the central part of Iran. According to the 2000 National Census, the population was 1,895,856, 275,084, and 668,531 in Isfahan, Najafabad, and Arak respectively (15,16). Multistage random-sampling technique was employed based on sex, age, and settlement distributions in each community to select 12,600 adults aged >19 years. Approximately 5-10% of households within these clusters were randomly selected. One individual aged >19 years per household was randomly selected. The selection criteria were: Iranian and mentally-competent individuals and also non-pregnant women (15,16).

Single eligible subject within the household was selected randomly from one of the six age-groups: 19-<25, 25-<35, 35-<45, 45-<55, 55-64, or 65 years and more (15).

Data collection

Eligible individuals had a 30-minute home interview by trained health professionals. The questionnaire included questions on socioeconomic and demographic characteristics, health knowledge, cardiovascular risk-related attitudes and behaviours regarding dietary practice, smoking, and physical activity (15). Medical and drug history of participants were obtained for DLP, DM, and HTN by well-trained physicians.

Trained nurses obtained blood samples from the participants by venipuncture from the left antecubital vein after 12-14 hours of fasting. They kept all blood samples frozen at -20[degrees]C to be assayed within 72 hours at the central laboratory of Isfahan Cardiovascular Research Center (ICRC) which meets the criteria of the National Reference Laboratory (a WHO-collaborating centre). Serum total cholesterol (TC) and triglyceride (TG) were determined by enzymatic method, using special kits (Immunodiagnostic, Germany) in an Elan 2000 auto-analyzer (Eppendorf, Germany). …

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