***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND OBJECTIVES Overweight and obesity are important determinants of health leading to adverse metabolic changes , including increase in blood pressure . Being overweight is associated with two- to six-fold increase in the risk of developing hypertension . Studies in urban Indian population showed strong relationship between different anthropometric indicators and blood pressure levels . Surprisingly , little is known about these relationships in rural population of India . The present study was carried out to examine the relationship between different anthropometric indicators and blood pressure levels in rural population of Wardha district in central India . METHODS This cross-sectional study was carried out in the areas of two Rural Health Training Centres ( RHTC ) of Department of Community Medicine , Mahatma G and hi Institute of Medical Sciences , Sewagram ; namely Bhidi and Anji through house-to-house visits . Two stage sampling method ( 30 cluster followed by systematic r and om ) was used to reach the respondents ' households . Partial correlation coefficients were used for continuous variables . Linear regression analysis was used to assess the influence of different anthropometric indicators on the systolic and diastolic blood pressure . ROC analysis was done to identify optimal cut-off values while likelihood ratios were calculated to identify the odds of having hypertension in comparison to those with lower values of anthropometric indicators . RESULTS The mean systolic blood pressures were 120.2 and 118.4 mmHg while the mean diastolic blood pressures were 77.7 and 76.3 mmHg in men and women respectively . There was a significant positive correlation of obesity indicators with both systolic and diastolic blood pressure . For SBP , the correlation coefficient was 0.23 with BMI , 0.23 with waist circumference , 0.11 with WHR and 0.22 with WHtR. For DBP , it was 0.13 with BMI , 0.12 with WC , 0.04 with WHR and 0.11 with WHtR. Step-wise linear regression suggested that BMI and WC were important predictors of hypertension . The suggested cut-off values for BMI were 21.7 for men and 21.2 for women ; for waist circumference , the cut-offs were 72.5 for men and 65.5 for women . INTERPRETATION AND CONCLUSION BMI and WC had strong correlation with systolic and diastolic blood pressure . The suggested lower cut-off values of the anthropometric indicators will cover maximum of the population with higher odds of having hypertension and may help in reducing the mean population blood pressure levels To identify anthropometrical indices of body fat distribution for predicting the risk of hypertension and diabetes , a population -based prospect i ve study was design ed . Subjects in two communities ( n=2,422 and 3,195 ) , who were free of hypertension and diabetes , respectively , were followed-up . The area and gender-specific risk of hypertension and diabetes were compared among tertiles of body mass index ( BMI ) and body fat distribution , including waist circumference ( WC ) , waist-to-hip ratio ( WHR ) , waist-to-height ratio ( WHtR ) , and subscapular skinfold-thickness ( SSF ) . During the 10-year follow-up for hypertension and diabetes , the incident cases of hypertension were 72 for Yao men , 125 for Kyowa men , 160 for Yao women and 193 for Kyowa women and those of diabetes were 27 , 64 , 37 and 77 , respectively . One SD differences in BMI and WC were associated with 1.2 to1.6-fold higher risk of hypertension , and that of SSF was associated with 1.4 to 1.6-fold higher risk of diabetes for both men and women in Yao and for women , but not men , in Kyowa . One SD differences of BMI , WC and WHtR were also associated with 1.4 to 2.0-fold higher risk of diabetes for Yao and Kyowa women . In conclusion , the significant predictors for hypertension were BMI and WC and those for diabetes were BMI and SSF in both genders in both communities , except for men in Kyowa . WC and WHtR were also predictors for diabetes in women but not in men OBJECTIVE To investigate which anthropometric measurements of obesity best predict  type 2 diabetes in a population of Pima Indians and whether additional information on diabetes risk could be obtained by combining measures of general obesity with measures of body fat distribution . RESEARCH DESIGN AND METHODS We conducted a prospect i ve study of 624 men and 990 nonpregnant women > 18 years of age without diabetes . Subjects were followed a mean of 5.25 years for the development of type 2 diabetes ( using 1997 American Diabetes Association criteria ) . RESULTS A total of 322 new cases of type 2 diabetes ( 107 men and 215 women ) were diagnosed during follow-up . Baseline obesity measurements were highly correlated and predicted diabetes in proportional hazards models adjusted for age . BMI had the highest hazard ratio in men and women , with age-adjusted hazard ratios per SD of 1.73 ( 95 % CI 1.44 - 2.07 ) and 1.67 ( 1.45 - 1.91 ) , respectively . According to receiver-operating characteristic analysis , BMI and waist-to-height ratio were the best predictors of diabetes in men , while in women BMI , waist-to-height ratio , waist circumference , and waist-to-thigh ratio were the best predictors . The predictive abilities of models containing BMI were not significantly improved by including other measures of general obesity or measures of the body fat distribution . CONCLUSIONS Throughout its range , BMI was an excellent predictor of  type 2 diabetes risk in Pima Indians and was not significantly improved by combining it with other measures of general adiposity or body fat distribution Levels of coronary heart disease ( CHD ) risk factors such as systolic and diastolic blood pressure , fasting blood glucose , hemoglobin A1c , triglyceride , cholesterol , HDL-cholesterol , prevalence of hypertension , abnormal glucose tolerance , hypertriglyceridemia , hypercholesterolemia , low HDL-cholesterol level , and fatty liver in normal body mass index ( BMI ) subjects with high or low waist/height ratios were investigated in middle aged men ( 45 - 54 years , BMI : 22 - 23.2 kg/m2 ) undergoing a routine health examination . The subjects were divided into two groups according to whether their waist/height ratios were > or = 0.5 ( n = 131 ) or < 0.5 ( n = 121 ) . There was no significant difference in age or BMI between the two groups , however , fasting blood glucose , hemoglobin A1c , triglyceride , cholesterol levels , the prevalence of abnormal glucose tolerance , hypercholesterolemia , fatty liver ( 30.5 % vs. 15.7 % , p < 0.01 ) , and morbidity index for CHD risk factors ( sum of the five risk factors scored as one point each if present ) ( 1.46 vs. 1.04 , p < 0.01 ) were significantly higher in the high waist/height group . In conclusion , even normal BMI subjects should pay attention to their waist/height ratio because of higher CHD risk factor levels , prevalences , morbidity index for CHD risk factors , and higher prevalence of fatty liver Background and Purpose — Although both general and abdominal adiposity are well-established risk factors for coronary heart disease , their associations with stroke are less well characterized , particularly in generally lean Asian population s. Methods — We evaluated associations of  body mass index ( BMI ) , waist-hip ratio ( WHR ) , waist circumference ( WC ) , and waist-height ratio ( WHtR ) with stroke risk in the Shanghai Women ’s Health Study , a population -based prospect i ve cohort study of 74 942 Chinese women aged 40 to 70 years with anthropometric measurement taken at recruitment in 1996 to 2000 . For this analysis , we included 67 083 women with no prior history of stroke , coronary heart disease , rheumatic heart disease , cardiac surgery , or cancer at recruitment . Incident stroke was ascertained by biennial home visits and linkage with vital statistics registries . Results — Cut points for the highest quintiles of BMI , WHR , WC , and WHtR among this cohort were 26.6 ( kg/m2 ) , 0.85 ( cm/cm ) , 84.1 ( cm ) , and 0.54 ( cm/cm ) , respectively . During a mean follow-up of 7.3 years , 2403 incident stroke cases were identified . All selected anthropometric measurements were positively and significantly associated with risk of total , ischemic , and hemorrhagic stroke in a dose-response manner ( all probability values for trend < 0.01 ) . The multivariable-adjusted hazard ratios ( 95 % confidence intervals ) for total stroke comparing the highest versus lowest quintiles of these measurements were 1.71 ( 1.49 to 1.97 ) , 1.59 ( 1.37 to 1.85 ) , 1.77 ( 1.53 to 2.05 ) , and 1.91 ( 1.61 to 2.27 ) for BMI , WHR , WC , and WHtR , respectively . Conclusion — Increasing levels of general or abdominal adiposity consistently predict increased risk of stroke  in predominantly nonobese Chinese women CONTEXT Individual contributions of obesity and physical fitness ( physical activity and functional capacity ) to risk of coronary heart disease in women remain unclear . OBJECTIVE To investigate the relationships of measures of obesity ( body mass index [ BMI ] , waist circumference , waist-hip ratio , and waist-height ratio ) and physical fitness ( self-reported Duke Activity Status Index [ DASI ] and Postmenopausal Estrogen-Progestin Intervention question naire [ PEPI-Q ] scores ) with coronary artery disease ( CAD ) risk factors , angiographic CAD , and adverse cardiovascular ( CV ) events in women evaluated for suspected myocardial ischemia . DESIGN , SETTING , AND PARTICIPANTS The National Heart , Lung , and Blood Institute-sponsored Women 's Ischemia Syndrome Evaluation ( WISE ) is a multicenter prospect i ve cohort study . From 1996 - 2000 , 936 women were enrolled at 4 US academic medical centers at the time of clinical ly indicated coronary angiography and then assessed ( mean follow-up , 3.9 [ SD , 1.8 ] years ) for adverse outcomes . MAIN OUTCOME MEASURES Prevalence of obstructive CAD ( any angiographic stenosis > or=50 % ) and incidence of adverse CV events ( all-cause death or hospitalization for nonfatal myocardial infa rct ion , stroke , congestive heart failure , unstable angina , or other vascular events ) during follow-up . RESULTS Of 906 women ( mean age , 58 [ SD , 12 ] years ) with complete data , 19 % were of nonwhite race , 76 % were overweight ( BMI > or=25 ) , 70 % had low functional capacity ( DASI scores < 25 , equivalent to < or=7 metabolic equivalents [ METs ] ) , and 39 % had obstructive CAD . During follow-up , 337 ( 38 % ) women had a first adverse event , 118 ( 13 % ) had a major adverse event , and 68 ( 8 % ) died . Overweight women were more likely than normal weight women to have CAD risk factors , but neither BMI nor abdominal obesity measures were significantly associated with obstructive CAD or adverse CV events after adjusting for other risk factors ( P = .05 to.88 ) . Conversely , women with lower DASI scores were significantly more likely to have CAD risk factors and obstructive CAD ( 44 % vs 26 % , P<.001 ) at baseline , and each 1-MET increase in DASI score was independently associated with an 8 % ( hazard ratio , 0.92 ; 95 % confidence interval , 0.85 - 0.99 ; P = .02 ) decrease in risk of major adverse CV events during follow-up . CONCLUSIONS Among women undergoing coronary angiography for suspected ischemia , higher self-reported physical fitness scores were independently associated with fewer CAD risk factors , less angiographic CAD , and lower risk for adverse CV events . Measures of obesity were not independently associated with these outcomes Background : New-onset diabetes was associated with a 90 % increase in risk of all-cause mortality and a 120 % increase in risk of cardiovascular mortality compared with study participants without diabetes . The aim of this study was to study prospect ively the predictors of incident diabetes mellitus in Basrah , Iraq , with special emphasis on predictive performance of the four anthropometric variables of obesity , namely body mass index ( BMI ) , waist circumference ( WC ) , waist-to-hip ratio ( WHpR ) or waist-to-height ratio ( WHtR ) . Material and Methods : A total of 13,730 subjects ( 7,101 males and 6,629 females ) diabetes-free at baseline were followed for a mean of 5 years ( January 2001 to end of December 2006 ) . Results : There were 935 ( 6.80 % ) cases of incident diabetes ( 513 males and 422 females ) . All anthropometric indices ( BMI , W 
    Output:
    
The AUROC analyses indicate  that WHtR  may be a more useful global clinical screening tool than WC , with a weighted mean boundary value of 0·5 , supporting the simple public health message ' keep your waist circumference to less than half your height '