IJCS | Volume 33, Nº4, July and August 2020

345 analysis, which are uncommon in cross-sectional studies. 16 A 5-year longitudinal cohort study including Australian adults reported an increase in mean WC of 0.46 cm/year. 17 In our study, we observed that, in addition to the increase in mean WC with increasing age, mean WC values were above the normal values in all groups (for both IDF and NCEP-ATPIII criteria), corroborating the high prevalence of increased WC in our study. In the association analysis, we showed a significant correlation between WC and all risk factors evaluated. The same was also observed with increased WC. Several studies have reported a relationship between WC and risk factors for cardiovascular disease. A classic study, conducted with 70 women aged 23-50 years, reported that WC correlates moderately with plasma triglycerides andHDL-cholesterol levels andweaklywith fasting glucose levels (blood pressure was not evaluated in the study). 4 Significant correlations between WC and cardiovascular risk factors (HDL-cholesterol, total cholesterol, SBC, and DBP) have also been reported in subjects aged 20-59 years. 3 Some authors have reported correlations of WC with indicators of MS. Shen et al., 18 evaluated 1,010 healthy men and women and found weak but significant correlations betweenWC and each MS component (SBP, DBP, and serum levels of glucose, TG, HDL-cholesterol, and insulin). Another population-based study published in 2002 by Zhu et al., 19 including 9,019 American men and women found that WC correlated weakly but significantly with SBP, DBP, and levels of serum LDL- cholesterol, HDL-cholesterol, and plasma glucose. A substantial limitation of all the studies mentioned above was the lack of WC categorization, as done in our study. Only a few authors have assessed individuals grouped into normal and increased WC categories. For example, Elbassuoni 20 reported an association of increased WC with cardiovascular risk factors (SBP, DBP, fasting glucose, triglycerides, andHDL-cholesterol) among 68 pre-menopausal women with a mean age of 32 years. Also, using previous data from a large cohort representative of the US population (US Department of Health and Human Services, National Center) and gender-specific WC cut-off points according to the NIH guidelines, Janssen et al., 21 showed that the health risks associated with increased WC (> 102 cm for men and > 88 cm for women) in men were limited to overweight individuals, but in women, the risks affected those with normal weight, overweight, and class 1 obesity. This finding emphasizes the importance of incorporatingWC measurements into clinical practice. Considering that in the present study the cut-off values for WC in both IDF and NCEP-ATPIII criteria showed correlations with SBP, DBP, and HLD-cholesterol levels, WC values ≥ 80 cm (which would also include those above 88 cm), could potentially be included as a regular measurement in clinical practice. On regression analysis, we found that increased WC could explain the variability of high SBP (> 60%), high DBP (> 35%) and low HDL-cholesterol levels ( ≥ 17%) among young adult women. To the best of our knowledge, this is the first study to report such finding. In 2010, Stevens et al., 16 pointed out that the inclusion of separate cut-off values by gender was appropriate and that the same is not adequate for age, since the inclusion of age-specificWC cut-off values in adults would require an examination of disease risk and use of different cut- off values for different age groups, compromising the simplicity of this useful health risk indicator. Limitations of the present study include the small sample size, which does not allow inference of a causal relationship. Future studies with greater sample size should be conducted to confirm our findings. The results from our study, if confirmed in a larger cohort, emphasize the importance of categorizing WC values by age groups and indicate that two simple measurements – blood pressure and WC – should be performed in young adult women in preventive health programs. Conclusions This study showed an association of WC ≥ 80 cmwith SBP, DBP, and HDL-cholesterol levels in adult women and is in line with population-based studies aimed at simplifying the identification of health risk factors in daily practice. Additionally, the detection of SBP ≥ 130 mmHg andWC ≥ 80 cm in a young adult women patient should trigger further investigation of health risks factors, particularly cardiometabolic ones. Acknowledgments We would like to express our thanks to all womenwho kindly volunteered to donate blood. We also would like to thank the Postgraduation Program in Health Sciences at UFG, for partially financing the study. Silva et al Waist circumference and increased blood pressure Int J Cardiovasc Sci. 2020; 33(4):340-347 Original Article