Skip to main content
Download PDF

Association between anthropometric measures and cardiovascular disease (CVD) risk factors in Hainan centenarians: investigation based on the Centenarian’s health study

BMC Cardiovascular Disorders volume 18, Article number: 73 (2018) Cite this article

Abstract

Background

Centenarians refer to a special group who have outlived most of their fellows. Body shape and abdominal obesity have been identified as cardiovascular disease (CVD) risk factors. Our study aimed to evaluate the relationship between body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) and CVD risk factors among male and female centenarians in Hainan province.

Methods

Five hundred thirty-seven centenarians aged between 100 and 115 (Mage = 107 years old) years participated in this study. Each participant received a standardized questionnaire and physical examination. We measured anthropometric variables (BMI, WC, WHR, WHtR, SBP and DBP) and serum lipid (TC, TG, HDL-C and LDL-C).

Results

76.9% (n = 413) of the study subjects were female. TC, TG, LDL-C and HDL-C were significantly higher in female group than that of male group. BMI, WC and WHtR were well-correlated with the CVD risk factors. The anthropometric measures were negatively related with HDL-C levels and positively related with the other CVD risk factors.

Conclusions

Hainan centenarians were short in stature and underweight. Moreover, female centenarians were often pear-shaped, while male centenarians were often apple-shaped. Further, BMI, WC and WHtR were well-correlated with the serum lipid, and TC, TG, LDL-C and HDL-C were significantly higher in females than males. Also, BMI, WC and WHtR were closely related to the incidence of dyslipidemia in females, including high TG, high LDL-C and low HDL-C.

Peer Review reports

Background

Centenarians represent a special group that deserves more attention. They have outlived most of their fellows. Data, anthropometric measures and biochemical indicators, from centenarians can be collected and used to study. So, our study aimed to elucidate the relationship between anthropometric measurements and cardiovascular disease (CVD) risk factors in Hainan centenarians.

Methods

Study population

Five hundred thirty-seven centenarians (413 female and 124 male) were enrolled in the study between June 2014 and October 2016 in Hainan. All participants provided written informed consent. The study protocol was approved by the ethical committee of the Hainan branch of PLA General Hospital (Sanya, China).

Anthropometric measurements

Anthropometric indices, Height (H), Weight (W), waist circumference (WC) and hip circumference (HC), were measured with participants dressed in light clothing and barefoot. We measured the height and weight of the elderly with a scale (seca, Germany). Each parameter was measured twice. We computed the BMI, WHR and WHtR using the following standard formula: BMI=W/H2, WHR = WC/HC, WHtR = WC/H.

Serum analysis

Blood samples were analysed by the Hainan Branch of PLA General Hospital (Sanya, China). TC, TG, LDL-C and HDL-C were measured by electrochemiluminescence (Roche automatic biochemical analyser, cobas 6000, USA).

Blood pressure measurement

Two blood pressure recordings were measured by electronic sphygmomanometers (Omron HEM-7200, Japan). If the difference between the first and second measurement was more than 5 mmHg, the repeated measurements were performed.

Definition of CVD risk factors

Hypertension was defined as having one or more of the following: (1) a systolic BP ≥140 mmHg, (2) a diastolic BP ≥ 90 mmHg, (3) physician-diagnosed hypertension. Dyslipidemia was defined according to the Chinese guidelines on the prevention and treatment of dyslipidemia in adults (2007): TC ≥ 240 mg/dl as high; LDL-C ≥ 160 mg/dl as high; HDL-C < 40 mg/dl as low; and TG ≥ 200 mg/dl as high.

Statistical analysis

We used EpiData 3.0 software to double-enter the data, and SPSS 19.0 software (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Continuous variables were tested for normality using the Kolmogorov-Smirnov test, and chisquare test for categorical variables. Comparisons between males and females were performed using two independent samples t-test or the Mann-Whitney U test for continuous variables. The associations between anthropometric measures and CVD risk factors were firstly examined using Spearman’s correlation coefficients. Receiver Operating Characteristic (ROC) analyses were then used to calculate the area under the ROC curves (AUC). Multiple logistic regressions were used in female centenarians at last. p < 0.05 indicated statistical significance.

Results

Characteristics of study subjects

We collected 537 centenarians’ personal information (Table 1). There were a statistically significant difference in illiteracy, widowed, alcohol and tea drinking between male and female centenarians. Anthropometric measurements and CVD risk factors are shown in Table 2. Differences on BMI and WHtR were significant. With regards to serum lipids, TC, TG, LDL-C and HDL-C were significantly higher in female group than that of male group. Moreover, the difference was statistically significant in SBP between men and women. Correspondingly, the prevalence of hypertension and high TG were significantly higher in females than males.

Table 1 General Information of Study Subjects
Full size table
Table 2 Characteristics of Anthropometric Measurements and CVD Risk Factors
Full size table

Correlations between anthropometric measures and CVD risk factor variables

The gender-stratified Spearman’s coefficients for the correlations between the various anthropometric measures and CVD risk factors are shown in Table 3. BMI, WC and WHtR were well-correlated with the various CVD risk factors. The anthropometric measures were negatively related with HDL-C levels and positively related with the other CVD risk factors. However, the relationship is not fairly distributed between women and men.

Table 3 Spearman Correlation Coefficient between Anthropometric Indices and Cardiovascular Disease Risk Factors
Full size table

Association of various anthropometric measures and CVD risk factors using ROC curve analyses

The area under the ROC curves (AUCs) for the association between CVD risk factors and anthropometric measures are shown in Table 4. BMI and WC were associated with the highest AUCs for two of the five CVD risk factors (high TG and low HDL-C), and WHtR was associated with the highest AUC for high TG. However, the differences in the AUCs for the various anthropometric measures were often small, demonstrating overlapping 95% confidence intervals (CIs).

Table 4 Adjusted Area Under Receiver Operating Characteristic (ROC) Curve for the Various Anthropometric Indices and Cardiovascular Disease Risk Factors
Full size table

Association of various anthropometric indices and CVD risk factors in female centenarians

Multiple logistic regressions were used to evaluate the association between anthropometric indices and CVD risk factors in female centenarians, as shown in Table 5. The incidence of high TG, low HDL-C and high LDL-C were closely related to BMI, 10.59 times, 2.30 times and 2.16 times, respectively. Besides, high TG is also associated with WC (4.24 times unadjusted and 3.66 times adjusted). Furthermore, low HDL is associated with WHtR (2.87 times unadjusted and 3.11 times adjusted). However, it should be noted that there were a very few centenarians with high TG with WHR ≤0.8. So, the data in this column showed infinity.

Table 5 Multiple Logistic Regression between Anthropometric Indices and CVD Risk Factors
Full size table

Discussion

Cardiovascular diseases (CVD) have become serious causes of death among old people. Dyslipidemia is one of the most important independent risk factors for CVD [1, 2]. Increasing the awareness and management of patients with dyslipidemia has a positive impact on CVD prevention.

This study was conducted in Hainan to comprehensive investigate the physical condition of the centenarians as well as the associated CVD risk factors. Our results indicated that the difference was statistically significant in TC, TG, LDL-C and HDL-C between males and females. It was also revealed that BMI, WC and WHtR were negatively related with HDL-C levels and positively related with the other CVD risk factors. Furthermore, our results suggested that the presence of dyslipidemia was significantly associated with body size.

Study has shown that the longevity of people has its own characteristics, such as short stature, light weight and more. Consistent with prior studies, our results showed that Hainan centenarians were short in stature (female 143.21±±7.94 cm, male 155.29 ± 7.60 cm), underweight (female 36.24 ± 7.92 kg, male 45.79 ± 7.10 kg), and BMI (17.99 ± 3.50) was far lower than the cut-off values for Asian populations.

Generally, abdominal fat was positively correlated with cardiovascular risk factors. Much research has been proved that the people in the Asian-pacific regions are easy to gain the abdominal obesity. In the study, we observed that female centenarians were often pear-shaped (WHR ≥ 0.8 for women), while males were often apple-shaped (WHR < 0.9 for men). Our results were in line with previous studies [3, 4]. It has been proposed that circulating gonadal steroids determine these sex-specific differences in adipose tissue distribution, which can be observed even after menopause [5]. Moreover, women’s adipose tissue is more favourable to accumulate in the peripheral and gluteofemoral depots to prevent the development of atherosclerosis [6,7,8]. In a word, the fat distribution pattern of women contributes to more healthier metabolic status, and may even take part in the determination of the overall life expectancy.

On the other hand, studies reported that age was one of major risk factors of dyslipidemia, which may be related to hereditary characteristics and degenerative processes as well as adipose tissue distribution and progressive development of insulin resistance [9, 10]. In our study, BMI, WC and WHtR were well-correlated with the serum lipid, and TC, TG, LDL-C and HDL-C were significantly higher in females than males. This may be associated with changes in postmenopausal hormone levels [11]. oestrogen levels are lower, glucose and lipid metabolism may differ significantly [12, 13] . In addition, we observed that BMI and WC were exhibited the relationship with high TG and low HDL-C. This was consistent with some previous studies [9, 11, 14]. Interestingly, the results using multiple logistic regressions indicated that BMI, WC and WHtR were closely related to the incidence of dyslipidemia in femals centenarians, including high TG, high LDL-C and low HDL-C. This suggests that body measurement indices are important non-invasive indicators in evaluating health, which is used to assess lipid metabolism abnormalities. Unfortunately, due to the insufficient number of male centenarians, we failed to complete the multiple logistic regression analysis. We still need to continue our investigation and preserve these precious data to further guide our research.

Conclusion

Hainan centenarians were short in stature and underweight. Moreover, female centenarians were often pear-shaped, while male centenarians were often apple-shaped. Further, BMI, WC and WHtR were well-correlated with the serum lipid, and TC, TG, LDL-C and HDL-C were significantly higher in females than males. Also, BMI, WC and WHtR were closely related to the incidence of dyslipidemia in females, including high TG, high LDL-C and low HDL-C.

Abbreviations

BMI:

Body mass index

CVD:

Cardiovascular disease

DBP:

Diastolic blood pressure

HC:

Hip circumference

HDL-C:

High-density lipoprotein cholesterol

LDL-C:

Low-density lipoprotein cholesterol

SBP:

Systolic blood pressure

TC:

Total cholesterol

TG:

Triglyceride

WC:

Waist circumference

WHR:

Waist-hip ratio

WHtR:

Waist-to-height ratio

References

  1. Li JH, Wang LM, Mi SQ, Zhang M, Li YC, Jiang Y, Xu Y, Dai M, Wang LH. Awareness rate, treatment rate and control rate of dyslipidemia in Chinese adults, 2010. Zhonghua Yu Fang Yi Xue Za Zhi. 2012;46(8):687–91.

    PubMed  Google Scholar 

  2. Luo JY, YT Ma ZXY, Yang YN, Xie X, Ma X, Liu F, Li XM, Chen BD. Prevalence, awareness, treatment and control of dyslipidemia among adults in northwestern China: the cardiovascular risk survey. Lipids Health Dis. 2014;13:4. https://doi.org/10.1186/1476-511x-13-4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zhao X, Zhu X, Zhang H, Zhao W, Li J, Shu Y, Li S, Yang M, Cai L, Zhou J, Li Y. Prevalence of diabetes and predictions of its risks using anthropometric measures in southwest rural areas of China. BMC Public Health. 2012;12:821. https://doi.org/10.1186/1471-2458-12-821.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Karastergiou K, Smith SR, Greenberg AS, Fried SK. Sex differences in human adipose tissues - the biology of pear shape. Biol Sex Differ. 2012;3(1):13. https://doi.org/10.1186/2042-6410-3-13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Fuente-Martin E, Argente-Arizon P, Ros P, Argente J, Chowen JA. Sex differences in adipose tissue: it is not only a question of quantity and distribution. Adipocyte. 2013;2(3):128–34. https://doi.org/10.4161/adip.24075.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Tanko LB, Bagger YZ, Alexandersen P, Larsen PJ, Christiansen C. Central and peripheral fat mass have contrasting effect on the progression of aortic calcification in postmenopausal women. Eur Heart J. 2003;24(16):1531–7.

    Article  PubMed  Google Scholar 

  7. Lissner L, Bjorkelund C, Heitmann BL, Seidell JC, Bengtsson C. Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes Res. 2001;9(10):644–6. https://doi.org/10.1038/oby.2001.85.

    Article  CAS  PubMed  Google Scholar 

  8. Tanko LB, Bagger YZ, Alexandersen P, Larsen PJ, Christiansen C. Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women. Circulation. 2003;107(12):1626–31. https://doi.org/10.1161/01.cir.0000057974.74060.68.

    Article  PubMed  Google Scholar 

  9. Bayram F, Kocer D, Gundogan K, Kaya A, Demir O, Coskun R, Sabuncu T, Karaman A, Cesur M, Rizzo M, Toth PP, Gedik V. Prevalence of dyslipidemia and associated risk factors in Turkish adults. J Clin Lipidol. 2014;8(2):206–16. https://doi.org/10.1016/j.jacl.2013.12.011.

    Article  PubMed  Google Scholar 

  10. Ni WQ, Liu XL, Zhuo ZP, Yuan XL, Song JP, Chi HS, Xu J. Serum lipids and associated factors of dyslipidemia in the adult population in Shenzhen. Lipids Health Dis. 2015;14:71. https://doi.org/10.1186/s12944-015-0073-7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sharma U, Kishore J, Garg A, Anand T, Chakraborty M, Lali P. Dyslipidemia and associated risk factors in a resettlement colony of Delhi. J Clin Lipidol. 2013;7(6):653–60. https://doi.org/10.1016/j.jacl.2013.06.003.

    Article  PubMed  Google Scholar 

  12. Hong SC, Yoo SW, Cho GJ, Kim T, Hur JY, Park YK, Lee KW, Kim SH. Correlation between estrogens and serum adipocytokines in premenopausal and postmenopausal women. Menopause. 2007;14(5):835–40. https://doi.org/10.1097/GME.0b013e31802cddca.

    Article  PubMed  Google Scholar 

  13. Mattsson C, Olsson T. Estrogens and glucocorticoid hormones in adipose tissue metabolism. Curr Med Chem. 2007;14(27):2918–24.

    Article  CAS  PubMed  Google Scholar 

  14. Shen Z, Munker S, C Wang LX, Ye H, H Chen GX, Zhang H, Chen L, Yu C, Li Y. Association between alcohol intake, overweight, and serum lipid levels and the risk analysis associated with the development of dyslipidemia. J Clin Lipidol. 2014;8(3):273–8. https://doi.org/10.1016/j.jacl.2014.02.003.

    Article  PubMed  Google Scholar 

Download references

Funding

The study was funded by Key Research and Development Project of Hainan (NO. ZDYF2016135, ZDYF2017095) and Natural Science Foudation of Hainan (NO. 817360).

Availability of data and materials

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

Author information

Author notes

    Authors and Affiliations

    1. Hainan Branch of PLA General Hospital, Sanya, 572000, China

      Qiao Zhu, Yao Yao, Chao-Xue Ning, Xiao-Ping Chen, Fu-Xin Luan & Ya-Li Zhao

    2. Department of Military Education and Training, Naval Aeronautical and Astronautical University, Yantai, 264001, China

      Xiao-Bing Wang

    Authors
    1. Qiao Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Xiao-Bing Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yao Yao
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Chao-Xue Ning
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Xiao-Ping Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Fu-Xin Luan
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Ya-Li Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    Contributions

    ZQ and WXB performed the statistical analysis and drafted the manuscript. YY participated in the design of the study and performed the investigation. NCX performed the statistical analysis and made substantial contributions to acquisition and analysis of data. CXP performed data entry and sample management. LFX and ZYL conceived the study, participated in its design and coordination, and helped draft the manuscript. All authors read and approved the final manuscript.

    Corresponding authors

    Correspondence to Fu-Xin Luan or Ya-Li Zhao.

    Ethics declarations

    Ethics approval and consent to participate

    The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Hainan Branch of PLA General Hospital, Sanya, China. Written informed consent was obtained from individual participants.

    Competing interests

    The authors declare that they have no competing interests.

    Publisher’s Note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    Rights and permissions

    Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhu, Q., Wang, XB., Yao, Y. et al. Association between anthropometric measures and cardiovascular disease (CVD) risk factors in Hainan centenarians: investigation based on the Centenarian’s health study. BMC Cardiovasc Disord 18, 73 (2018). https://doi.org/10.1186/s12872-018-0810-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • DOI: https://doi.org/10.1186/s12872-018-0810-8

    Keywords

    BMC Cardiovascular Disorders

    ISSN: 1471-2261

    Contact us