0%, 0.0%, and 11.6%, respectively) than that in the present study. This may be because the Dutch cohort was less severely impaired compared with the current sample (only 2 adults were nonambulatory) and the relatively younger age range of participants. The prevalence of obesity, defined by BMI, in the present study (7.3%) was relatively low in comparison to a sample of Dutch adults Entinostat with CP (18.5%)7 and to the general Irish adult population without CP (25%).28

The use of BMI as an indicator of cardiovascular disease risk in adults with CP has been debated, however, given that it is unable to distinguish between body fat and muscle mass. Adults with CP experience significant muscle atrophy,11 which may result in misclassification of overweight as normal weight if BMI cutoff points for the general population are used to classify overweight/obesity in adults with CP. Previous studies investigating the association between BMI and cardiometabolic risk factors in adults with CP have reported conflicting results. Bleomycin One study reported that BMI was associated with diastolic blood pressure and that there was a trend toward an association with 10-year risk of fatal cardiovascular disease.7 A second study reported that BMI was not associated with TC, HDL-C, LDL-C, TC/HDL-C ratio, or triglycerides.15

This is in agreement with the results of the present study. The present study is the first, however, to investigate and demonstrate an association between BMI and insulin resistance in adults with CP. Although the results of this study suggest that all anthropometric measures are associated with ≥1 cardiometabolic risk factors in adults with CP, ROC curve

analysis indicated that WC was the best predictor of a number of cardiometabolic risk factors. This is in agreement with studies of the general population.12 and 13 WC was also associated with triglyceride levels and systolic blood pressure independent of BMI. Unlike BMI, WC provides an indication of visceral adipose tissue. The secretion of Phosphoprotein phosphatase proinflammatory cytokines and adipokines from visceral adipose tissue contributes to insulin resistance, hypertension, and dyslipidemia and may provide the link between central obesity and cardiovascular disease.29 Imaging techniques such as magnetic resonance imaging, abdominal computed tomography, and dual-energy X-ray absorptiometry provide accurate measurements of visceral adipose tissue but are expensive and often unfeasible to use in the clinical setting. The consistent association between WC and cardiometabolic risk factors in this study suggests that WC provides a proxy measure of visceral adipose tissue among adults with CP and can be used to identify those at risk of developing cardiovascular disease and type 2 diabetes mellitus. Defining obesity according to WC, rather than BMI, may therefore be a more appropriate method of classifying obesity in adults with CP.