presents mean BMI, weight, and waist circumference by race, sex, and age groups. While age and sex differences were observed, the most striking differences were seen across racial/ethnic groups. Chinese American men and women had a lower mean BMI and waist circumference in all age and sex categories (approximately 13% and 10% lower than the next lowest group). White women had a lower BMI and waist circumference than African American or Hispanic women. The prevalence of being obese and overweight by age category are presented in the . A prevalence of 75% or more of being overweight was observed in African American participants, Hispanic participants, and white men, with a more than 60% prevalence observed in white women. In contrast, only one-third of Chinese American participants were classified as overweight. Overall, more than 50% of African American women, 40% of Hispanic women, 30% of African American and Hispanic men, and nearly 30% of white men and women were classified as obese. In contrast, only 5% of Chinese American participants were classified as obese. The pattern of being obese and overweight was similar in middle-aged and older adults.
Body Mass Index (BMI), Weight, and Waist Circumference in the Multi-Ethnic Study of Atherosclerosis Participants by Age, Sex, and Racial/Ethnic Group
Obesity (defined as a body mass index [calculated as weight in kilograms divided by height in meters squared] of 25.0–29.9) and overweight (defined as a body mass index of >30.0) prevalence by age and race and ethnic group.
A higher BMI was associated with more adverse levels of blood pressure, lipoproteins, and fasting glucose despite a higher prevalence of pharmacologic treatment (). Systolic blood pressure levels were significantly higher in the obese than in the normal BMI group in all racial/ethnic and sex groups (6–20 mm Hg higher, age adjusted), HDL cholesterol levels were significantly lower in all racial/ethnic and sex groups (4–14 mg/dL lower, age adjusted [to convert cholesterol to millimoles per liter, multiply by 0.0259]), fasting glucose levels were significantly higher in white, African American, and Hispanic (8–17 mg/dL higher, age adjusted), while triglyceride levels (18–55 mg/dL higher, age adjusted [to convert triglycerides to millimoles per liter, multiply by 0.0113]) and LDL particle size (109–173 nmol/L higher, age adjusted) were significantly greater in all racial/ethic and sex groups. No consistent differences across body size groups were observed for LDL cholesterol. Compared with the normal body size groups, the overweight (age-adjusted RR, 1.2- to 1.8-fold higher) and obese (age-adjusted RR, 1.5- to 2.3-fold higher) groups had much higher levels of antihypertensive medication use. The use of oral hypoglycemic medication or insulin was also greater in the overweight and obese groups (age-adjusted RR, 2.1- to 9.6-fold higher and 1.2- to 2.8-fold higher, respectively). Less consistent associations between lipid-lowering medication use and body size were observed. For 6459 MESA participants (95%) who were younger than 80 years, the 10-year Framingham coronary heart disease risks were also compared across body size group (). Greater body size was associated with a significantly higher Framingham coronary heart disease risk in all racial/ethnic and sex groups (except African American and Hispanic women).
Blood Pressure (BP), Glucose, and Lipid Levels and Treatment Across Body Size Group in the Multi-Ethnic Study of Atherosclerosis
The prevalence and the age-adjusted prevalence ratios of hypertension and diabetes are presented across body size groups in . Overweight status and obesity were strongly associated with a higher prevalence of hypertension. Compared with the normal body size group, the prevalence ratios of hypertension ranged from 1.05 to 1.37 in the overweight group and 1.29 to 2.31 in the obese group. The prevalence of glucose intolerance (impaired glucose tolerance or diabetes) was higher in the overweight and obese groups in all racial/ethnic and sex groups (except Chinese American women). The glucose intolerance prevalence ratios ranged from a 1.4- to 3.1-fold increase in the obese group compared with the normal body size group and were significantly greater in all groups except Chinese American women.
Hypertension and Glucose Intolerance Across Body Size Group in the Multi-Ethnic Study of Atherosclerosis
presents levels of subclinical CVD markers across body size groups adjusted for race, sex, age, and risk factors. Increased body size was significantly (P<.001) associated with a 1.2-fold greater prevalence of CAC in the obese group compared with the normal body size group. The association with CAC persisted after traditional CVD risk factor adjustment, with no race-ethnicity interaction observed. Using a CAC score cut-point of 100, the association was even stronger. Increased body size was significantly associated with a maximum IMT (>80th percentile). After adjustment for race, sex, and age, there was a 32% greater risk of ICA IMT and a 45% greater risk of CCA IMT exceeding the 80th percentile in the obese group compared with the normal body size group. After further adjustment for traditional CVD risk factors, the association with CCA IMT persisted, but the association with ICA IMT became marginally significant (P=.07). No race-ethnicity interaction was observed. A more than 2-fold greater risk of LV mass exceeding the 80th percentile was observed in the obese group compared with the normal body size group, and this association persisted after traditional CVD risk factor adjustment. For LV mass, we found an interaction between race-ethnicity and body size groups, with a significant association between body size and LV mass observed in all racial/ethnic groups, although with an even stronger association observed in Chinese American participants.
Subclinical Cardiovascular Disease (CVD) by Body Size Group, Adjusted for Age and Risk Factors in the Multi-Ethnic Study of Atherosclerosis