Abstract
BackgroundThe applicability of the internationally advocated cut-off points of waist circumference (WC) derived from Caucasians to diagnose metabolic syndrome (MS) in HIV-infected Africans is unknown. This study aimed to determine the optimal WC cutoffs for MS diagnosis in HIV-infected people receiving care at public healthcare facilities in the Western Cape Province in South Africa.MethodsData from 748 randomly selected participants (591 women), with a median age of 38 years, were analysed. The Youden’s index and the top-left-point approaches were used to determine the optimal cutoffs of WC for predicting ≥2 non-adipose MS components.ResultsThe two approaches generated the same WC cut-off point in women, 92 cm (sensitivity 64%, specificity 64%) but different cut-off points in men: 87 cm (sensitivity 48%, specificity 85%) based on the Younden’s index and 83 cm (sensitivity 59%, specificity 74%) by the top-left-point method. The advocated thresholds of 94 cm in men had low sensitivity (30%) but high specificity (92%) whereas 80 cm in women showed low specificity (32%) but high sensitivity (85%) for diagnosing MS in this sample. Most African-specific cut-off points performed well, with 90 cm providing acceptable performance in both men (sensitivity 43%, specificity 88%) and women (sensitivity 66%, specificity 59%).ConclusionsThis study underlines the sub-optimal performance of internationally recommended WC thresholds for MS diagnosis in HIV-infected Africans, and supports the need to revisit the guidelines on WC criterion in African population across the board. A single threshold of 90 cm for both genders would be a practical suggestion.
Highlights
Metabolic syndrome (MS) represents the constellation of cardio-metabolic risk factors that includes abnormal fat distribution, dyslipidaemia, hyperglycaemia, and hypertension
Popular diagnostic criteria include those of the World Health Organization (WHO) in 1998, the European Group for the Study of Insulin Resistance (EGIR) in 1999, the Adult Treatment Panel III (ATPIII) (2001, 2004, 2005), the International Diabetes Federation (IDF) in 2005, and most recently in 2009 the harmonized Joint Interim Statement (JIS) [1]
Body mass index (BMI) and waist-to-hip ratio (WHR) were indicators of body fat used in the WHO criteria, [2] while waist circumference (WC) has been recommended as a surrogate for abnormal fat distribution in more recent MS criteria [1]
Summary
Metabolic syndrome (MS) represents the constellation of cardio-metabolic risk factors that includes abnormal fat distribution, dyslipidaemia, hyperglycaemia, and hypertension Since it was first described by Reaven in 1988, several international organisations, and expert groups have proposed diagnostic criteria for the MS based on variable combinations of cardio-metabolic risk factors and at times, at variable thresholds [1]. Emerging evidence from few cross-sectional studies across Africa are not in support of uncritical application of Europid WC thresholds in African populations [5,6,7,8,9]
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