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Economic efficiency in the NHS

volume and with degree of insulin sensitivity in vivo.4 5 We propose that an increase in androgenic activity may result in enlargement ofabdominal fat cells and thus a high waist to hips girth ratio, leading to the development of insulin resistance both in adipose tissue and in other metabolically active tissues-such as skeletal muscle6-which in turn results in the development of metabolic aberrations and hence in an increased susceptibility to coronary heart disease. As previously suggested, measurement of waist to hips girth ratio is a simple practical means of assessing body fat distribution, comparing well with more complex indices such as those based on skinfold thicknesses or the brachiofemoral adipomuscular ratio (paper by D J Evans and others presented at the proceedings of the North American Association for the Study of Obesity in Ploughkeepsie, New York, 1982), and may provide a useful marker of predisposition to metabolic aberrations and cardiovascular disease.