Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3701_Библиотеки_им_академика_М_И_Перельмана

It is worthy to note that the universally categorised risk cut-offs for metrics such as overweight/obesity [2], WHR ≥0.90 in men and≥0.85 in women (<1 in both) [14], WC >94 (102) in men and>80 (88) in women [13, 14, 56], and WHtR >0.5 and<1 in both sexes, may provide confounding and association biases for causal risk. This occurs when the mathematical relationships are unbalanced between the simple measurements of healthy and unhealthy cases, and a spurious risk assignment being slanted in direction to the group of cases in the confounding metrics. At the same time, in the overlapping areas of the confounding metrics, subjects with similar baseline values must present different risk assignments when conditional on both imbalances between simple measurements and the real predictive variables [37]. Thus, regardless of WC, HC and height should be controlled in data analyses to preclude a differ­ent–equal risk assignment between subjects who have equal–different high risk BC and risk. Accordingly, a higher strength of association for WHR or WC with respect to WHtR does not mean higher risk, but association biases where both the high risk BC and relative volume were not well compared. In other words, WHR-associated risk above WC and WC-associated risk beyond that of WHtR were always a bias error, which is evidence that posed issues for the cardiovascular sciences for a long time due to the research process itself. Thus, when ignoring biases in research, false inferences could be drawn to predict MI/CVD risk in both sexes. On the contrary, only WHtR­associated risk above WC and WHR will hold true. Thereby, by identifying and remov­ing biases in research, WHtR will always provide equality and balance between healthy populations and MI/CVD cases to be used as an entity of risk, while also having the importance of being cheap, accessible and easy to measure. Therefore, an appropriate ethnically-based and sex-specific WHtR risk cut-off would be the easiest and most definitive anthropometric tool to meet the best epidemiological criteria for the judge­ment of causal associations and to identify individuals at risk of MI/CVD. Broadly, it would occur while the degree of adiposity/overweight/obesity still has the importance of accumulating a homogenously distributed body fat volume. A continuous process of accumulating body fat over time provides changes in body shape and a higher degree of adiposity, even with fat flaps that would involve a higher risk and volume excess non-homogeneously distributed and, therefore, non-fully measurable from WC and height. In any case, a high degree of fatness will always keep a high correlation with WHtR, %BF and components of risk of the somatotype [10, 24, 27, 31, 45, 48].