We are delighted that our article has prompted such positive feedback and that the critical interest in the topic is so high. In the following we comment in detail on Dr Schneider's remarks.
In order to assess the risk of health relevant endpoints, the simultaneous consideration of body mass and fat distribution is essential. We were able to underline this by means of our results with regard to the risk of type 2 diabetes, by showing that the strength of the association of waist circumference with the risk of type 2 diabetes depends on the BMI. This is particularly relevant for people of normal weight or even underweight, who constitute a thus far neglected risk group if they have an increased waist circumference.
Measuring waist circumference only does not take into consideration body height. As Dr. Schneider describes, the waist to height ratio would be a simple measure in this context. However, our investigations have shown that when BMI and height are taken into consideration, the risk increases in tandem with increasing waist circumference (1,2). This fact presents problems in determining set maximum threshold values for assessing the risk, for waist circumference as well as the waist to height ratio. We are aware, however, that for the purposes of medical practice, using simple maximum threshold values to identify persons at increased risk is extremely helpful. This points to the necessity of a critical revision of current guidelines. Calculating separate maximum values for the waist dependent parameter within different BMI categories seems sensible in this setting. Our article did not intend to answer the question of what these maximum threshold values may be or which measure is most appropriate for gauging abdominal fat. These questions will have to be investigated in future studies.
Dipl.-Ernähr. Silke Feller
Prof. Dr. oec. troph. Heiner Boeing
PD Dr. med. Tobias Pischon, MPH
Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke
14558 Nuthetal, Germany
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Pischon, T, et al.: General and abdominal adiposity and risk of death in Europe. N Engl J Med, 2008; 359(20): 2105–20. MEDLINE|
|2.||Feller S, Boeing H, Pischon T: Body mass index, waist circumference, and the risk of type 2 diabetes mellitus—Implications for routine clinical practice. Dtsch Arztebl Int 2010; 107(26): 470–6. VOLLTEXT|