IS THE WAIST/HEIGHT RATIO A BETTER PARAMETER THAN BMI IN DETERMINING THE CARDIOMETABOLIC RISK PROFILE OF OBESE PEOPLE?

MALAFAIA, Andressa Bressan; NASSIF, Paulo Afonso Nunes; LUCAS, Ricardo Wallace das Chagas; GARCIA, Rodrigo Ferreira; RIBEIRO, José Guilherme Agner; PROENÇA, Laura Brandão DE; MATTOS, Maria Eduarda; ARIEDE, Bruno Luiz

doi:10.1590/0102-672020210003e1610

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 34 (03) • 2021 • https://doi.org/10.1590/0102-672020210003e1610 copy

IS THE WAIST/HEIGHT RATIO A BETTER PARAMETER THAN BMI IN DETERMINING THE CARDIOMETABOLIC RISK PROFILE OF OBESE PEOPLE?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

The increased prevalence of obesity has led to a significant increase in the occurrence of metabolic syndrome, a recognized risk factor for increased morbidity and mortality from cardiovascular diseases. Hyperglycemia or type 2 diabetes mellitus, dyslipidemia and arterial hypertension are its main components. Since 2015, international guidelines have recognized the benefits of bariatric surgery in each isolated factor of this syndrome.

Aim:

To evaluate the impact of Roux-en-Y gastric bypass in this syndrome comparing pre- and postoperative periods with laboratory analysis and to compare waist/height ratio and BMI in relation to the determination of the cardiometabolic risk profile.

Methods:

A retrospective study was carried out, selecting 80 patients undergoing Roux-en-Y gastric bypass. Total cholesterol, HDL, LDL, triglycerides, fasting glucose, glycated hemoglobin, insulin, body mass index (BMI), vitamin D, vitamin B12, waist circumference and waist/height ratio in three periods were analyzed: the preoperative period from 1 to 6 months, postoperative from 1 to 6 months and postoperative from 1 to 2 years.

Results:

There was an improvement in all parameters of the clinical analyses. The preoperative BMI had a mean value of 39.8, in the preoperative period from 1 to 6 months, the values dropped to 33.2 and in the postoperative period of 1 year, the mean was 26. The perimeter mean values of 118.5 preoperatively, 105.2 postoperatively from 1 to 6 months and 90.3 postoperatively from 1 to 2 years. Waist/height ratio was 0.73, 0.65 and 0.56 in pre, post 1 to 6 months and 1 to 2 years respectively.

Conclusion:

Roux-en-Y gastric bypass improves metabolic syndrome and waist-to-height ratio is superior to BMI in the assessment of the cardiometabolic risk profile.

HEADINGS:
Obesity; Metabolic Syndrome; Diabetes Mellitus, type 2; Anastomosis, Roux-en-Y

Variable	Classif	Result*
Age (years)		41.5±10.4 (20.5 - 66)
Gender	Female	69 (86.3%)
Gender	Male	11 (13.8%)
DM2 (pre)	No	61 (76.3%)
DM2 (pre)	Yes	19 (23.8%)
Dyslipidemia (pre)	No	38 (47.5%)
Dyslipidemia (pre)	Yes	42(52.5%)
SAH (pre)	No	46 (57.5%)
SAH (pre)	Yes	34 (42.5%)

Variable	Classif	Pre	Post 1 to 6 m	Post 1 to 2 y	p*
Variable	Classif	Pre	Post 1 to 6 m	Post 1 to 2 y	Pre x post 1 to 6 m	Pre x post 1 to 2 y	Post 1 to 6 m x post 1 to 2 y
DM2	No	61 (76.3%)	78 (97.5%)	78 (97.5%)
DM2	Yes	19 (23.8%)	2 (2.5%)	2 (2.5%)	<0.001	<0.001	1
SAH	No	46 (57.5%)	73 (91.3%)	75 (93.8%)
SAH	Yes	34 (42.5%)	7 (8.8%)	5 (6.3%)	<0.001	<0.001	1
Dyslipidemia	No	38 (47.5%)	78 (97.5%)	78 (97.5%)
Dyslipidemia	Yes	42 (52.5%)	2 (2.5%)	2 (2.5%)	<0.001	<0.001	1

Variable	Evaluation	Mean ± standard deviation	Median (min-max)	p*
Variable	Evaluation	Mean ± standard deviation	Median (min-max)	Pre x post 1-6 m x pós 1-2 y	Pre x post 1-6 m	Pre x Post 1-2 y	Post 1-6 m x post 1-2 y
AW (cm)	Pre	118.5 ± 9.4	119 (98 - 140)
	Post 1-6 m	105.2 ± 9.9	106 (81 - 126)
	Post 1-2 y	90.3 ± 7.7	90 (74 - 110)	<0.001	<0.001	<0.001	<0.001
WHtR	Pre	0.73 ± 0.06	0.72 (0.61 - 0.87)
	Post 1-6 m	0.65 ± 0.07	0.65 (0.50 - 0.80)
	Post 1-2 y	0.56 ± 0.05	0.55 (0.45 - 0.69)	<0.001	<0.001	<0.001	<0.001
Vitamin B12	Pre	509.8 ± 276.1	454.5 (209 - 2000)
	Post 1-6 m	693.5 ± 417.1	591.5 (198 - 2000)
	Post 1-2 y	639.6 ± 388.5	511 (192 - 2000)	0.002	0.001	0.052	0.733
Vitamin D	Pre	26.8 ± 7.2	26.7 (10.3 - 47.5)
	Post 1-6 m	31.8 ± 9.3	30.1 (6.9 - 64.3)
	Post 1-2 y	33.3 ± 10.8	32 (11.3 - 78.4)	<0.001	0.001	<0.001	0.843
Total colesterol	Pre	174.6 ± 34.2	177.5 (66 - 246)
	Post 1-6 m	149.6 ± 31.8	153 (77 - 217)
	Post 1-2 y	150.2 ± 28.2	147.5 (94 - 227)	<0.001	<0.001	<0.001	1
HDL	Pre	49.7 ± 12.1	47.5 (21 - 79)
	Post 1-6 m	45.6 ± 12.0	43.5 (25 - 89)
	Post 1-2 y	57.5 ± 13.1	56 (28 - 89)	<0.001	0.002	<0.001	<0.001
LDL	Pre	96.6 ± 27.5	100.5 (43 - 169)
	Post 1-6 m	85.5 ± 27.4	82 (41 - 176)
	Post 1-2 y	76.3 ± 25.9	74.5 (30 - 166)	<0.001	<0.001	<0.001	0.004
Triglycerides	Pre	152.6 ± 68.3	133 (50 - 423)
	Post 1-6 m	96.1 ± 34.8	89.5 (41 - 195)
	Post 1-2 y	82.1 ± 28.7	79.5 (36 - 179)	<0.001	<0.001	<0.001	0.017
Glycated hemog	Pre	6.1 ± 1.6	5.8 (4.8 - 14.4)
	Post 1-6 m	5.7 ± 1.4	5.3 (4.3 - 13.3)
	Post 1-2 y	5.6 ± 1.4	5.3 (4.5 - 13.6)	<0.001	<0.001	<0.001	0.367
Insuline	Pre	22.2 ± 12.4	20 (5 - 71.2)
	Post 1-6 m	8.1 ± 4.4	7 (2 - 24.4)
	Post 1-2 y	6.2 ± 2.9	5.5 (1 - 16)	<0.001	<0.001	<0.001	0.265
Glucose	Pre	102 ± 25.6	97 (67 - 238)
	Post 1-6 m	90 ± 16.6	87 (65 - 180)
	Post 1-2 y	88.3 ± 18.3	84 (71 - 185)	<0.001	<0.001	<0.001	0.504
BMI (kg/m²)	Pre	39.8 ± 3.8	39.5 (31 - 52.5)
	Post 1-6 m	33.2 ± 4.3	33.4 (23.3 - 45.2)
	Post 1-2 y	26.0 ± 3.2	25.8 (19.6 - 38)	<0.001	<0.001	<0.001	<0.001

Evaluation	Correlation coefficient of Pearson between relationship WHtR and BMI	p
Pre	0.54	<0.001
Post 1 to 6 m	0.37	0.001
Post 1 to 2 y÷	0.42	<0.001
Reduction (pre - post 1 to 6 m)	0.12	0.294
Reduction (pre - post 1 to 2 y)	0.42	<0.001
Reduction (after 1 to 6 m - after 1 to 2 y)	0.32	0.004

Evaluation	Group	n	BMI (kg/m²)		p*
Evaluation	Group	n	Mean ± standard deviation	Median (min-max)
Pre	1	8	38.2 ± 2.7	37.4 (35.3 - 43.5)
Pre	2	72	40 .0± 3.8	39.7 (31 - 52.5)	0.205
Post 1 to 6 m	1	8	30.9 ± 3.8	31.8 (24.6 - 36.3)
Post 1 to 6 m	2	72	33.5 ± 4.4	33.7 (23.3 - 45.2)	0.116
Post 1 to 2 y	1	8	23.0 ± 1.7	22.9 (21 - 25.8)
Post 1 to 2 y	2	72	26.4 ± 3.2	26.1 (19.6 - 38)	0.004
Reduction (pre - 1 to 6 m)	1	8	7.26 ± 3.83	7.45 (1.3 - 12.6)
Reduction (pre - 1 to 6 m)	2	72	6.50 ± 3.67	6.0 (-1.5 - 16.3)	0.578
Reduction (pre - 1 to 2 y)	1	8	15.2 ± 1.69	15.2 (11.9 - 17.7)
Reduction (pre - 1 to 2 y)	2	72	13.6 ± 3.56	13.4 (5.7 - 25.3)	0.043
Reduction (after 1 to 6 m - after 1 to 2 y)	1	8	7.91 ± 3.64	7.4 (2.4 - 14.2)
Reduction (after 1 to 6 m - after 1 to 2 y)	2	72	7.11 ± 3.65	7.25 (-1 - 16.8)	0.557

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[1] Correspondence: Paulo Afonso Nunes Nassif E-mail: paulonassif@terra.com.br