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Pennington Center
6400 Perkins Road
Baton Rouge, LA 70808
E-mail: brayga{at}pbrc.edu
Dear Sir:
The letter by Bigaard et al discusses their article (1) that examined body mass index and waist circumference in relation to mortality in a Danish population and that appeared in print as I was writing my editorial to accompany the article by Janssen et al (2). I am happy to see the concurrence between my view and that of Bigaard et al. The figures that Bigaard et al add to their letter are helpful in pointing out the interaction between body mass index and waist circumference and the greater value of one over the other at different ends of the body mass index distribution.
The articles by Janssen et al (2) and Bigaard et al (1) focused on mortality, most of which was cardiovascular in nature. For cardiovascular mortality, the relation to body mass index is less pronounced than that for mortality from diabetes and gall bladder disease. Analysis of a large data set with information about mortality, cardiovascular disease, and diabetes would be most instructive. Until there is new information, however, I still maintain that the appropriate clinical steps for evaluating the risk associated with body weight are measurement of body mass index and waist circumference coupled with other laboratory measurements related to the metabolic syndrome (3).
The one point that I would like to stress from my editorial is that the current recommendations for waist circumference cutoffs do not adequately reflect the ranges that could help clinicians make judgments when evaluating their patients. Adoption of new cutoffs would be a step forward.
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