Optimal Waist Circumference Cutoff Research Articles

Optimal Waist Circumference for Prediction of Metabolic Syndrome in Young Korean Women With Polycystic Ovary Syndrome

The International Diabetes Federation consensus proposed an ethnically specific criteria of waist circumference (WC) for central obesity, but, the nationwide definition is still debated in Korea. For the detection of the optimal WC cutoff value, the nonadipose components of the metabolic syndrome (MS) were defined by modification of revised 2003 Rotterdam consensus as having two or more risk factors such as hypertension, hyperglycemia, and dyslipidemia without consideration of abdominal obesity. By using receiver-operating characteristic (ROC) curve analysis, cutoff points of WC and visceral fat area (VFA) for prediction of MS were 80 cm and 53.1 cm(2). WC cutoff points corresponding to VFA >53.1 and 100 cm(2) were 73.3 and 77.8 cm. The sensitivity and specificity of currently used value of WC 88 cm were 41.9 and 91.5%, suggesting that it could be too high in Korean population. Central obesity defined as WC >80 cm was significantly associated with nonadipose components of MS after adjustment for age, BMI, cholesterol, triglycerides, fasting insulin, and free testosterone levels. Central obesity with WC of >80 cm predicted the presence of nonadipose MS (odds ratio 16.6; 95% confidence interval (CI) 6.5-42.6). It was also significant (odds ratio 14.7; 95% CI 3.4-64.3) when we applied the WC value of 70 cm instead of 80 cm. In conclusion, WC of 80 and 70 cm could be appropriate cutoff points to identify the MS and visceral adiposity in Korean women with polycystic ovary syndrome (PCOS), respectively. Therefore, PCOS women with a WC over 70 cm should be closely monitored for the development of MS.

Optimal Waist Circumference Cutoff Values for Metabolic Syndrome Diagnostic Criteria in a Korean Rural Population

The Korean Society for the Study of Obesity (KSSO) has defined the waist circumference cutoff value of central obesity as 90 cm for men and 85 cm for women. The purpose of this investigation was to determine the corresponding waist circumference values. A total of 3,508 persons in the Korean Rural Genomic Cohort Study were enrolled in this survey. Receiver operating characteristic (ROC) curve analysis was used to find appropriate waist circumference cutoff values in relation to insulin resistance determined by homeostasis model assessment for insulin resistance (HOMA-IR), body mass index (BMI), and components of metabolic syndrome. The optimal waist circumference cutoff values were 87 cm for men and 83 cm for women by ROC analysis to HOMA-IR and 86 cm for men and 83 cm for women by ROC analysis to value with more than two components of metaobolic syndrome. By using a BMI ≥25 kg/m2, 86 cm for men and 82 cm for women were optimal waist circumference cutoff values. In this study, we suggest that the most reasonable waist circumference cutoff values are 86-87 cm for men and 82-83 cm for women.

Optimal Waist Circumference Cutoff Value Reflecting Insulin Resistance as a Diagnostic Criterion of Metabolic Syndrome in a Nondiabetic Korean Population Aged 40 Years and Over: The Chungju Metabolic Disease Cohort (CMC) Study

PurposeWe aimed at determining the cutoff value of waist circumference with respect to its ability to reflect insulin resistance in a Korean population.Materials and MethodsA total of 8,817 subjects aged 40 years and over were analyzed. Insulin resistant individuals were defined as those who had the highest quartile value of the homeostasis model assessment of insulin resistance (HOMA-IR) in a non-diabetic population. Receiver operating characteristic (ROC) curve analysis and multiple logistic regression analysis were applied.ResultsThe cutoff value of waist circumference reflecting insulin resistance from the ROC analysis was 84.4 cm for men and 80.6 cm for women. Sensitivity and specificity were 70.0% and 54.2% in men and 71.1% and 59.3% in women, respectively. After being controlled for other covariates, the odds ratio for the risk of insulin resistance using < 70 cm of waist circumference as a reference increased significantly in the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women. In addition, statistically significant associations were consistently observed over the category of 85.0-89.9 cm for men and 80.0-84.9 cm for women.ConclusionThe optimal cutoff value for waist circumference reflecting insulin resistance is considered to be 85 cm for men and 80 cm for women, suggesting that the Asian criterion of abdominal obesity (90 cm for men and 80 cm for women) as a component of metabolic syndrome (MetS) might not be applicable for middle-aged to older men in Korea.

Authorship Policy of the Journal of Korean Medical Science

The Journal of Korean Medical Science (JKMS) follows the recommendations for authorship by the International Committee of Medical Journal Editors (ICMJE, 2008, www.icmje.org) and the Good Publication Practice Guidelines by the Korean Association of Medical Journal Editors (KAMJE, 2008, www.kamje.or.kr). The Uniform Requirements by the ICMJE recommends authorship as follows. credit should be based on 1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2) drafting the article or revising it critically for important intellectual content; and 3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3. Beyond the ICMJE recommendations, the KAMJE guidelines suggest that all authors should make a substantial intellectual contribution to the publication, the guidelines warn against authorship abuse, and list common types of abuse. Authorship is an important aspect of research publication, and all involved authors should agree whole contents of the document including authorship. Contributors should be differentiated from authors as recommended by the ICMJE. JKMS does not allow multiple corresponding authors for one article even when it is reporting on a multicenter study. Only one author should correspond with the editorial office and readers for one article. JKMS accepts notice of equal contribution for the first author when the study was clearly performed by co-first authors. However, the present issue of JKMS (Vol. 25 No. 5: 734-7) publishes one article which has two corresponding authors. The article, which is titled Optimal Waist Circumference Cutoff Values for Metabolic Syndrome Diagnostic Criteria in a Korean Rural Population, is published exceptionally because the authorship policy of JKMS has not been open declared yet. The authorship policy is declared open through this editorial and also at the homepage of JKMS, http://jkms.org. JKMS does not correct authorship after publication unless any mistake has been made by the editorial or publishing staff. Authorship may be changed before publication but after submission when an authorship correction is requested by all authors involved.

The optimal cutoff values and their performance of waist circumference and waist-to-hip ratio for diagnosing type II diabetes

Studies on the theme of optimal cutoff values of waist circumference (WC) and waist-to-hip ratio (WHR) for assessing risk of type II diabetes were reviewed. Twenty-eight studies of individuals aged 18-74 years are eligible for inclusion. Four of these studies are prospective and the rest are all cross-sectional. Tongans had the highest WC (103 cm for both men and women) cutoff value (but not for WHR), followed by studies in the USA and U.K. The WC cutoff values were higher for all races in the USA and the UK studies compared with their counterparts in their original countries. The optimal WC (WHR) cutoff values were 97-99 cm (0.95) for White men and 85 cm (0.83-0.85) for White women living outside the USA and the UK, whereas they were 85 cm (0.90) for Asian men and 75-80 cm (0.79-0.85) for Asian women; the values for other ethnic groups were between those for White and Asians. Men had higher values than women in White, Chinese, Japanese, Indians and Bangladeshis, but not in Thai, Iranians, Iraqi, Tunisians, Mexicans, Africans and Tongans. At these optimal cutoff points the sensitivities were around 60-70%, which was higher or equal to the specificity. There is no universal cutoff value that can be applied worldwide, and a country-specific value should be considered taking into account the purposes and resources.

Identification of waist circumference cutoffs for abdominal obesity in the Chinese population: a 7.8-year follow-up study in the Shanghai urban area

To identify the appropriate visceral adipose tissue (VAT) cutoff values for the diagnosis of abdominal obesity in predicting diabetes and the corresponding waist circumference in the Chinese population. At baseline, 381 volunteers aged 35-75 years were enrolled without diabetes from the Shanghai urban area. Anthropometry and VAT area determined by magnetic resonance imaging were measured. During the average 7.8 years of follow-up, glucose tolerance was monitored. Receiver operating characteristic (ROC) curve analysis was used to define the optimal cutoff points for abdominal obesity. At the end of the study, 290 participants were followed up, in which 63 participants developed diabetes. Using ROC curve analyses in participants with normal glucose regulation, the appropriate VAT cutoff was 90 cm(2) for both genders to predict diabetes development. In logistic regression models, the relative risks (95% confidence intervals) of VAT value over 90 cm(2) were 3.35 (1.10-10.18, P=0.033) in men and 4.57 (1.73-12.07, P=0.002) in women after adjusted for age, impaired glucose regulation, hypertension and dyslipidemia. The optimal waist circumference cutoffs were 88 cm for men and 82 cm for women to indicate VAT value over 90 cm(2) in ROC analyses. VAT cutoff of 90 cm(2) is useful for defining visceral obesity in Chinese individuals. The appropriate waist circumference cutoffs for abdominal obesity are 88 cm for men and 82 cm for women in the Chinese population.

Waist circumference and insulin resistance: a cross-sectional study of Japanese men

BackgroundVisceral obesity is positively related to insulin resistance. The nature of the relationship between waist circumference and insulin resistance has not been known in Japanese populations. This study examined the relationship between waist circumference and insulin resistance and evaluated the optimal cutoff point for waist circumference in relation to insulin resistance in middle-aged Japanese men.MethodsStudy subjects included 4800 Japanese men aged 39 to 60 years. Insulin resistance was evaluated by the homeostasis model assessment of insulin resistance (HOMA-IR). The relationship of waist circumference with HOMA-IR was assessed by use of adjusted means of HOMA-IR and odds ratios of elevated HOMA-IR defined as the highest quintile (≥2.00). Receiver operating characteristics (ROC) curve analysis using Youden index and the area under curve (AUC) was employed to determine optimal cutoffs of waist circumference in relation to HOMA-IR.ResultsAdjusted geometric means of HOMA-IR and prevalence odds of elevated HOMA-IR were progressively higher with increasing levels of waist circumference. In the ROC curve analysis, the highest value of Youden index was obtained for a cutoff point of 85 cm in waist circumference across different values of HOMA-IR. Multiple logistic regression analysis also indicated that the AUC was consistently the largest for a waist circumference of 85 cm.ConclusionWaist circumference is linearly related to insulin resistance, and 85 cm in waist circumference is an optimal cutoff in predicting insulin resistance in middle-aged Japanese men.

Waist Circumference and Cardiovascular Risk Factors in Japanese Men and Women

This research aims to examine the relationship of waist circumference with cardiovascular risk factors and to determine optimal cutoffs for waist circumference in the context of cardiovascular risk factors in a Japanese population. Study subjects were 8,275 Japanese men and women aged 5074 years in Fukuoka City who participated in the baseline survey of a cohort study on lifestyle-related diseases. We defined high blood pressure, elevated non-HDL cholesterol, low HDL cholesterol, and elevated hemoglobin A1c. Odds ratios were obtained using multiple logistic regression analysis of cardiovascular risk factors in relation to waist circumference. Receiver operating characteristic curve analysis was performed to determine optimal cutoffs for waist circumference in relation to the multiplicity of cardiovascular risk factors. Waist circumference was strongly and positively associated with the prevalence odds ratios of each cardiovascular risk factor and multiplicity of these risk factors in both men and women. The optimal value of waist circumference predicting cardiovascular risk factors was 85 cm for both men and women. conclusion: The findings add evidence that waist circumference is an important correlate of cardiovascular factors and lend further support to the Japanese criterion for central obesity for men, but not for women.

Waist circumference, body mass index and glycated hemoglobin in Japanese men and women

Aims To investigate the relationship of waist circumference and body mass index (BMI) with glycated hemoglobin (HbA 1c) concentrations and to define optimal cutoffs for these indices with respect to elevated HbA 1c (>5.8%). Methods Study subjects were 7731 Japanese men and women aged 50–74 years in Fukuoka City who participated in the baseline survey of a cohort study on lifestyle-related diseases. Linear regression analysis and logistic regression analysis were used with and without adjustment for age, smoking, alcohol use and physical activity. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoffs for the obesity indices. Results Waist circumference and BMI were linearly related to HbA 1c concentrations in men and women with almost the same magnitude in strength. With adjustment for the covariates, mean percent changes of HbA 1c per one standard deviation (S.D.) of waist circumference and BMI were 1.6% and 1.8% respectively in men, and 1.3% and 1.4% respectively in women. Adjusted odds ratios of elevated HbA 1c per one S.D. of waist circumference and BMI also showed statistically significant increases. Optimal cutoffs for waist circumference were 89 cm for men and 85 cm for women. The area under the ROC curve was much greater in women than in men. Conclusions In a population of middle-aged or elderly Japanese men and women, both waist circumference and BMI were strongly, positively associated with HbA 1c concentrations. The determined optimal cutoff points for waist circumference did not support the current Japanese criterion for abdominal adiposity.

Waist Circumference Cutoff Points in School‐aged Chinese Han and Uygur Children

To examine the distribution of age- and gender-specific waist circumference (WC) and to identify optimal cutoffs for predicting cardiovascular (CV) risk factors in Chinese Han and Uygur children. In total 4,224 Han and Uygur children aged 7-18 were randomly selected from schools in Urumqi city, China. WC, height, and weight were accurately measured in all subjects. Blood pressure, fasting lipids, glucose, and insulin were determined in 258 overweight/obese children and 370 age-, gender-, and ethnicity-matched normal-weight controls selected from the same study sample. LMS (lambda-mu-sigma) method was used to construct WC centile curves. Optimal WC cutoffs were determined by comparing the performance of five sets of WC cutoffs in predicting CV risk factors. Han boys and girls had higher WC at all percentiles and ages except for girls over the age of 16. Uygur girls also showed a greater increase in WC corresponding with age (2.1 cm/year vs. 1.6 cm/year for the median) than Han girls. Compared with the other four sets of cutoffs, the 85th WC percentile showed the best combination of sensitivity (81.0%) and specificity (71.4%). The two sets of WC cutoffs constructed by allowing centile curves passing through the adult cutoffs for central adiposity using the fitted LMS curves provided poor sensitivities in predicting the presence of cluster of CV risk factors. The growth pattern of WC varies with gender and ethnicity. The 85th percentile of WC is an appropriate cutoff for Chinese Han and Uygur children in the prediction of CV risks.

Optimal waist circumference cutoffs for abdominal obesity in Chinese

Objective To determine the appropriate cutoffs for visceral fat area (VFA) measured by magnetic resonance imaging linking to risk of the metabolic syndrome (MetS) and the corresponding waist circumference in Chinese. Methods and results Totally 1140 individuals (men 525, women 615) aged from 35 to 75 years were included. The components of the MetS were defined by International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) definition, respectively. Receive operating characteristic curve analyses were used to determine the appropriate cutoffs of VFA and corresponding waist circumference in the prediction of the MetS. The optimal VFA cutoff was near 80 cm 2 in identifying the MetS with two or more components but not including overweight/obesity by either of the two definitions in all subjects. There was no difference in men by ages while women aged <50 years tended to have lower VFA cutoff than those aged ≥50 years by the two definitions. The appropriate waist circumference cutoffs were 90 cm in men and 85 cm in women for the MetS. Conclusion The optimal cutoff of waist circumference for abdominal obesity is 90 cm for men and 85 cm for women in Chinese.

Optimal Cutoff Point of Waist Circumference and Use of Home Blood Pressure as a Definition of Metabolic Syndrome: The Ohasama Study

Self-measured blood pressure (BP) at home (HBP) has a stronger predictive power for cardiovascular mortality and morbidity than casual-screening BP (CBP). No studies have evaluated the clinical significance of self-measured HBP for diagnosing metabolic syndrome (MS). Eight scientific associations recently defined MS for the Japanese population. However, this definition remains controversial, especially with respect to the cutoff value of waist circumference (WC) being higher in women than in men. The: participants of this population-based survey were the 395 residents (> or =35 years of age) of Ohasama, a rural Japanese community. They measured HBP and underwent the oral glucose tolerance test between the years 2000 and 2006. We calculated the optimal cutoff values of WC required to diagnose MS, and examined the association of HBP with metabolic risk-factor clustering using multivariate analyses. Receiver operation characteristic analysis indicated that the optimal WC cutoff values for identifying clusters of metabolic risk factors were 87 and 80 cm in men and women, respectively. Elevated HBP was significantly associated with the clustering of metabolic risk factors but CBP was not. The appropriate WC cutoff value in the current MS criteria for Japanese women would be 80 cm. We suggest that HBP would be useful when considering a diagnosis of MS. The association between MS determined using HBP and the prognosis of cardiovascular diseases (CVDs) requires further investigation.

Anthropometric indexes in the prediction of type 2 diabetes mellitus, hypertension and dyslipidaemia in a Mexican population.

To determine values of simple anthropometric measurements which are associated with the presence of type 2 diabetes mellitus, hypertension and dyslipidaemia and to assess anthropometric cut-off values for predicting the likelihood of these chronic conditions in a Mexican population. The data were obtained from PRIT (Prevalence of Cardiovascular Risk Factors in General Hospital Workers) surveys from 1994 to 2000 adjusted to the structure of the overall Mexican population. A total of 2426 men and 5939 women aged 38.99+/-7.11 and 39.11+/-14.25 y, respectively. The optimal sensitivity and specificity of using various cut-off values of BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumference) and WTH (waist-to-height ratio) to predict type 2 diabetes mellitus (DM), hypertension (HT), or dyslipidaemia were examined by receiver operating characteristic curve (ROC) analysis. The likelihood ratios for having diabetes, hypertension and dyslipidaemia in subjects with various cut-off values of BMI, WHR, WC and WTH were calculated. Multiple step-wise logistic regression analysis was used to examine the independent relationship between the anthropometric indexes, age and smoking, and the odds ratio of having chronic conditions. The BMI cut-off to predict DM, HT, or dyslipidaemia varied from 25.2 to 26.6 kg/m2 in both men and women. The optimal WC cut-offs were 90 cm in men and 85 cm in women. The WHR cut-off was about 0.90 in men and 0.85 in women, and the optimal WTH cut-off was 52.5 in men and varied from 53 to 53.5 in women. The cut-off levels for WC, WHR and WTH corresponded to the inflexion points in the likelihood ratio graphs. In the case of BMI likelihood ratio graphs, we found a significant increase in the risk for chronic conditions from 22 to 23 BMI levels in both genders. Logistic regression analyses disclosed that only BMI and age were included in all the models as well as the influence of smoking in DM and dyslipidaemia in men. Although these results may not be readily applied to the rest of the Mexican population or to other Hispanic populations, they point to the necessity of similar studies with large randomized samples to find the cut-off levels for chronic conditions in different populations.