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New studies on the relationship between waist size and the risk for developing heart disease, diabetes and other illnesses suggest that some belt-tightening may be in order.

The circumference of the waist appears to be a better predictor of disease than calculating body fat using weight-to-height or waist-to-hip ratios, researchers have found.

Everyone pretty much agrees that having a body mass index (weight-to-height ratio) of 25 or less is desirable _ that's the cutoff for being overweight; 30 and higher is considered obese.

BMI for a 6-foot tall man exceeds 25 if he weighs more than 190 pounds; for a 5-foot-4 woman, if she exceeds 150 pounds.

Guidance has been less sure for waist size, even though it's a simple tape measurement to establish. Most experts have been advising that waist size greater than 40 inches for men and 38 in women is reason for concern. But the new research pares this down.

In general, health experts have found that more fat stored around the abdomen _ an apple shape _ is more dangerous than carrying fat around the hips and thighs, the pear shape.

Back-to-back studies in the February and March issues of the American Journal of Clinical Nutrition document the waistline as a window to health status.

The first, done by researchers from the Medical College of Wisconsin and the New York Obesity Research Center at Columbia University, looked at waist circumference of more than 10,000 people who took part in a government survey of health data between 1988 and 1994.

They found better correlation between waist size and cholesterol, blood pressure and blood glucose levels than BMI in both men and women, including blacks, Hispanics and whites, largely independent of age.

Using those results, the researchers conclude that in all three racial-ethnic groups, the overweight BMI of 25 corresponds to a waist size greater than 35 inches in men and 33 inches in women; the obese BMI of 30 matches a waist of 39.8 inches for men, 37 inches for women.

The most recent study, led by Youfa Wang, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, looked only at men's waist sizes relative to diabetes risk, but also found that risk started to creep up when the belt size went higher than 35 inches, and that 80 percent of type 2 diabetes cases occurred in men with waists larger than 37 inches.

"Both BMI and waist circumference are useful tools to assess health risk," said Wang. "But abdominal fat measured by waist circumference can indicate a strong risk for diabetes whether or not a man is considered overweight or obese according to his BMI.

"Many of the men who developed type 2 diabetes had measurements lower than the current (40 inch) cutoff."

The study was based on data collected from 27,270 men tracked over 13 years through the Harvard Health Professionals Follow-Up Study.

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Men who had a waist size of 40 inches or more were 12 times more likely to develop the type of diabetes in which the pancreas either doesn't make enough insulin or doesn't respond properly to insulin than men with waist sizes of 34 or less.

With a waist size of 34 to 36, the diabetes risk doubled; at 36 to 38 inches, the risk tripled; and at 38 to 40 inches, the risk for the disease was five times greater.

So, in addition to measuring BMI, the researchers recommend that doctors measure waist size as an indicator of central obesity to estimate diabetes risk for patients and make decisions with them about changes in diet and lifestyle.

On the Net: www.ajcn.org

Adding Soy Protein to the Diet

For consumers interested in increasing soy protein consumption to help reduce their risk of heart disease, health experts say they need not completely eliminate animal-based products such as meat, poultry, and dairy foods to reap soy's benefits.

While soy protein's direct effects on cholesterol levels are well documented, replacing some animal protein with soy protein is a valuable way to lower fat intake.

"If individuals begin to substitute soy products, for example, soy burgers, for foods high in saturated fat, such as hamburgers, there would be the added advantage of replacing saturated fat and cholesterol [in] the diet," says Alice Lichtenstein, D.Sc., professor of nutrition at Tufts University. Whole soy foods also are a good source of fiber, B vitamins, calcium, and omega-3 essential fatty acids, all important food components.

The American Heart Association recommends that soy products be used in a diet that includes fruits, vegetables, whole grains, low-fat dairy products, poultry, fish, and lean meats. The AHA also emphasizes that a diet to effectively lower cholesterol should consist of no more than 30 percent of total daily calories from fat and no more than 10 percent of calories from saturated fat.

Nowadays, a huge variety of soy foods is on shelves not only in health food stores, but increasingly in mainstream grocery stores. As the number of soy-based products grows, it becomes increasingly easy for consumers to add enough soy to their daily diets to meet the 25-gram amount that FDA says is beneficial to heart health.

According to soybean industry figures, the numbers add up quickly when you look at the protein contained in typical soy foods. For example:

• Four ounces of firm tofu contains 13 grams of soy protein.
• One soy "sausage" link provides 6 grams of protein.
• One soy "burger" includes 10 to 12 grams of protein.
• An 8-ounce glass of plain soymilk contains 10 grams of protein.
• One soy protein bar delivers 14 grams of protein.
• One-half cup of tempeh provides 19.5 grams of protein.
• And a quarter cup of roasted soy nuts contains 19 grams of soy protein.

Though some consumers may try soy products here and there, it takes a sustained effort to eat enough to reach the beneficial daily intake. This is especially true for those who have elevated cholesterol levels. "Dietary interventions that can lower cholesterol are important tools for physicians," says Antonio Gotto, M.D., professor of medicine at Cornell University, "particularly since diet is usually prescribed before medication and is continued after drug therapy is begun."

He emphasizes that in order to succeed, such diets must have enough variety that patients don't get bored and lapse back into old eating habits. He says his experience with patients suggests that it's important to learn how to "sneak" soy into the diet painlessly.

"People think it's challenging to get a high concentration of soy into your diet," says chef and cookbook author Dana Jacobi. "But it's actually easy to consume 25 grams [of soy protein], once you realize what a wide range of soy products is available."

For those new to soy, she recommends what she calls "good-tasting" soy foods such as smoothies, muffins made with soy flour, protein bars, and soy nuts.

The American Dietetic Association recommends introducing soy slowly by adding small amounts to the daily diet or mixing into existing foods. Then, once the taste and texture have become familiar, add more.

Because some soy products have a mild or even neutral flavor, it's possible to add soy to dishes and barely know it's there. Soy flour can be used to thicken sauces and gravies. Soymilk can be added to baked goods and desserts.

And tofu takes on the flavor of whatever it is cooked in, making it suitable for stews and stir-fries. "Cook it with strong flavors such as garlic, crushed red pepper, or ginger," says Amy Lanou, a New York-based nutritionist.

"One of my favorites is tofu sautéed with a spicy barbecue sauce." She also suggests commercial forms of baked tofu, which she says has a "cheese-like texture and a mild, but delicious, flavor." For soy "newbies," she also recommends trying a high-quality restaurant that really knows how to prepare soy dishes--just to see how professionals handle soy.

Soy chefs and nutritionists suggest the following further possibilities for adding soy to the diet for easy loss weight:

• Include soy-based beverages, muffins, sausages, yogurt, or cream cheese at breakfast.
• Use soy deli meats, soy nut butter (similar to peanut butter), or soy cheese to make sandwiches.
• Top pizzas with soy cheese, pepperoni, sausages, or "crumbles" (similar to ground beef).
• Grill soy hot dogs, burgers, marinated tempeh, and baked tofu.
• Cube and stir fry tofu or tempeh and add to a salad.
• Pour soymilk on cereal and use it in cooking or to make "smoothies."
• Order soy-based dishes such as spicy bean curd and miso soup at Asian restaurants.
• Eat roasted soy nuts or a soy protein bar for a snack.

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