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Apples vs. Pears: Waist and Hip Measurement as a Predictor of Heart Disease

It seems to be a reasonable expectation that many women gain weight as they grow older; however, increasing evidence indicates that this tendency is not benign. Considerable research has determined that excess weight increases the risk of developing or dying from several diseases, including coronary heart disease. Interestingly, the location of fat distribution is now considered to be significant. Increased girth, particularly around the waist, the so-called "apple" distribution is much more strongly associated with coronary heart disease than extra weight around the hips, the so-called "pear" distribution. In a study published in the Journal of the American Medical Association in December 1998, it was reported that excess weight in the abdominal area, as opposed to excess weight in general, increased the risk of coronary heart disease.

Waist and hip measurements provided by women aged 40-65 years who were participants in the Nurses' Health Study reported that those whose waist size approached or exceeded their hip size (waist to hip ratios, 0.9 or greater) had three times the risk of a nonfatal heart attack or dying from coronary heart disease than women whose waists were smaller than their hips. Moreover, waist size itself estimated increased risk of coronary heart disease. Subjects with waist sizes of 38 inches or more were three times as likely to develop coronary heart disease as women with smaller waists. Additionally, in women who were not overweight and in whom coronary heart disease was less frequent, but who had waists of 30 inches or more had twice the rate of coronary heart disease as the pear-shaped women. The mechanism accounting for these observations remains to be clarified. However, it is another reminder that maintaining a trim waist is not a cosmetic issue, but a matter of good health not only to prevent high blood pressure, diabetes, and elevated lipids, but also to prevent heart disease, the major killer of American women.


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