Set Of Cut Points Research Articles

Accelerometer Cutpoint Non-Equivalence in Preschool Children

There are no universally accepted accelerometer cutpoints to quantify moderate-to-vigorous physical activity (MVPA). Estimates of MVPA from one set of cutpoints cannot be directly compared to MVPA estimates using different cutpoints, even when the same outcome units are reported (MVPA min·d-1). PURPOSE: To illustrate the utility of an equating system that translates MVPA estimates from one set of cutpoints into another set of cutpoints. Such an equating system would have a major impact on systematic reviews and would allow for reported data to be maximally utilized to inform public health policy. METHODS: The data from a large preschool project (N = 419, 3-5yr-olds, CHAMPS) was used to conduct the analyses. Conversions were made among the four most common ActiGraph cutpoints used to derive MVPA in preschool children: Pate (PT), Sirard (SR), Puyau (PY) and Freedson Equation (FR). PT cutpoints served as the criterion MVPA estimate, on which SR, PY, and FR estimates were equated, based on methodological quality of PT's initial calibration study - indirect calorimetry, free-living activities, preschool-age sample. A 10-fold cross-validation procedure was used to develop prediction equations using MVPA from PT as the dependent variable, with MVPA estimated from SR, PY, and FR serving as the predictor variable. Absolute percent error (APE) were calculated and Bland Altman (BA) plots constructed to evaluate agreement across the conversions. RESULTS: The mean levels of MVPA for the total sample ranged from 39.5 (SR) to 269.0 (FR) min·d-1. Across the prediction models, the mean proportion of variance explained (R2) was 0.78 (range 0.71-0.87). The median APE was 15.8% (range 12%-20.2%). The BA plot mean difference across conversions was: PY to PT 0.26 minutes (limits of agreement [LOA] -29.0 to 29.5); FR to PT -0.47 minutes, LOA -38.2 to 37.3; and SR to PT 0.22 minutes (LOA -32.3 to 32.7). CONCLUSION: The prediction equations developed in this study provide a way to make direct comparisons between studies employing different cutpoints in preschool aged children. Using the prediction equations developed here gives public health researchers and policy makers a more concise picture of physical activity levels of preschool aged children. *Supported by a grant from the National Institutes of Health (NIH), R01 HD043125.

Equating accelerometer estimates of moderate-to-vigorous physical activity: In search of the Rosetta Stone

No universally accepted ActiGraph accelerometer cutpoints for quantifying moderate-to-vigorous physical activity (MVPA) exist. Estimates of MVPA from one set of cutpoints cannot be directly compared to MVPA estimates using different cutpoints, even when the same outcome units are reported (MVPA min d –1). The purpose of this study was to illustrate the utility of an equating system that translates reported MVPA estimates from one set of cutpoints into another, to better inform public health policy. Secondary data analysis. ActiGraph data from a large preschool project ( N = 419, 3–6-yr-olds, CHAMPS) was used to conduct the analyses. Conversions were made among five different published MVPA cutpoints for children: Pate (PT), Sirard (SR), Puyau (PY), Van Cauwengerghe (VC), and Freedson Equation (FR). A 10-fold cross-validation procedure was used to develop prediction equations using MVPA estimated from each of the five sets of cutpoints as the dependent variable, with estimated MVPA from one of the other four sets of cutpoints (e.g., PT MVPA predicted from FR MVPA). The mean levels of MVPA for the total sample ranged from 22.5 (PY) to 269.0 (FR) min d −1. Across the prediction models (5 total), the median proportion of variance explained ( R 2) was 0.76 (range 0.48–0.97). The median absolute percent error was 17.2% (range 6.3–38.4%). The prediction equations developed here allow for direct comparisons between studies employing different ActiGraph cutpoints in preschool-age children. These prediction equations give public health researchers and policy makers a more concise picture of physical activity levels of preschool-aged children.

HDD: a hypercube division-based algorithm for discretisation

Discretisation, as one of the basic data preparation techniques, has played an important role in data mining. This article introduces a new hypercube division-based (HDD) algorithm for supervised discretisation. The algorithm considers the distribution of both class and continuous attributes and the underlying correlation structure in the data set. It tries to find a minimal set of cut points, which divides the continuous attribute space into a finite number of hypercubes, and the objects within each hypercube belong to the same decision class. Finally, tests are performed on seven mix-mode data sets, and the C5.0 algorithm is used to generate classification rules from the discretised data. Compared with the other three well-known discretisation algorithms, the HDD algorithm can generate a better discretisation scheme, which improves the accuracy of classification and reduces the number of classification rules.

Validity of accelerometry in ambulatory children and adolescents with cerebral palsy

To evaluate the validity of the ActiGraph accelerometer for the measurement of physical activity intensity in children and adolescents with cerebral palsy (CP) using oxygen uptake (VO(2)) as the criterion measure. Thirty children and adolescents with CP (mean age 12.6 ± 2.0 years) wore an ActiGraph 7164 and a Cosmed K4b(2) portable indirect calorimeter during four activities; quiet sitting, comfortable paced walking, brisk paced walking and fast paced walking. VO(2) was converted to METs and activity energy expenditure and classified as sedentary, light or moderate-to-vigorous intensity according to the conventions for children. Mean ActiGraph counts min(-1) were classified as sedentary, light or moderate-to-vigorous (MVPA) intensity using four different sets of cut-points. VO(2) and counts min(-1) increased significantly with increases in walking speed (P < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that, of the four sets of cut-points evaluated, the Evenson et al. (J Sports Sci 26(14):1557-1565, 2008) cut-points had the highest classification accuracy for sedentary (92%) and MVPA (91%), as well as the second highest classification accuracy for light intensity physical activity (67%). A ROC curve analysis of data from our participants yielded a CP-specific cut-point for MVPA that was lower than the Evenson cut-point (2,012 vs. 2,296 counts min(-1)), however, the difference in classification accuracy was not statistically significant 94% (95% CI = 88.2-97.7%) vs. 91% (95% CI = 83.5-96.5%). In conclusion, among children and adolescents with CP, the ActiGraph is able to differentiate between different intensities of walking. The use of the Evenson cut-points will permit the estimation of time spent in MVPA and allows comparisons to be made between activity measured in typically developing adolescents and adolescents with CP.

Advanced Psychometric Methods for Developing and Evaluating Cut-Point-Based Indicators

In this study, we offer some advice on the use of empirical techniques to create categorical indicators from responses to multiple survey questions that ostensibly compose scales. We discuss the use of advanced psychometric methods, including confirmatory factor analysis for ordered categorical measures (CFA-OCM) and item response theory (IRT), to expand 12 previously published criteria for cut-point development and evaluation offered by Moore et al. (Indicators of Child Well-Being: The Promise for Positive Youth Development. Annals of the American Academy of Political and Social Science. Special Issue: Positive Development: Realizing the Potential of Youth. 591:125–145, 2004). We present an application of this advice by developing categorical cut-points for the social skills and behavior problems subscales of the U.S. National Survey of Children’s Health (NSCH) Social Competence Scale. We used data from the 2007 NSCH, a large cross-sectional, random-digit-dial telephone survey of a representative sample of the noninstitutionalized population of U.S. children 0–17 years of age. Parents of children aged 6 to 17 years (n = 63,364) responded to 4 questions about their children’s behavior problems and 4 questions about their children’s positive social skills. IRT analyses indicated that IRT model-based scores of +1.8 and −0.7 provided suitable high and low cut-points, respectively, for the behavior problems subscale. These cut-points had marginal reliabilities of 0.70 and 0.67 respectively, and corresponded to raw subscale scores of 13 and 8 IRT analyses indicated that an IRT model-based score of −1.8 provided a suitable cut-point for identifying children with low levels of positive social skills. This cut-point had a marginal reliability of 0.63 and corresponded to a raw subscale score of 13. For both subscales and cut-point sets, frequency distributions demonstrated that the cut-points identified sufficient proportions of children generally as well as within demographic subgroups. Our findings indicate that analysts can use raw subscale scores and cut-points of 13 and 8 to identify children with high, moderate, and low levels of behavior problems. Our results demonstrate that, for the positive social skills subscale, the subscale’s psychometric properties only support a single cut-point of 13 that identifies children with low levels of positive social skills. Our study highlights the iterative, empirically-based process that cut-point development should follow and shows the value of modern test theory-based psychometric methods to inform this process.

Waist circumference thresholds for the prediction of cardiometabolic risk: is measurement site important?

Waist circumference (WC) is frequently measured in clinical and research settings. Although measurement protocols may differ considerably, a single set of sex-specific cut-points are typically used to denote elevated risk. The purpose of this study was to determine whether the appropriate WC thresholds for identifying cardiometabolic risk vary according to anatomical measurement site. WC was measured at four common sites in 520 community-dwelling adults (20-66 years): superior border of the iliac crest, midpoint between the iliac crest and the lowest rib, umbilicus and minimal waist. Resting blood pressures and fasting levels of total cholesterol, high-density lipoprotein-cholesterol, triglycerides and glucose were measured. The sensitivity and specificity of current WC thresholds (M: >102 cm/40 inch; W: >88 cm/35 inch) for detecting abnormal risk factor levels were calculated for each WC measurement site, and receiver operating characteristic (ROC) curves were used to select optimal thresholds for identifying individuals with risk factor clustering (>or=2 risk factors). The area under the ROC curve for WC measured at each anatomical site was similar for each risk factor and for the presence of risk factor clustering. However, WC >88/102 cm at the umbilicus showed the greatest sensitivity for all outcomes, whereas measurements at the minimal waist had the best specificity in this sample. The sensitivity of WC >88/102 cm for detecting >or=2 risk factors ranged from 75 to 89% in women and from 48 to 59% in men, and specificity ranged from 52 to 79% in women and from 77 to 88% in men, across measurement sites. At present, recommended WC thresholds may not have the same clinical utility at all anatomical locations of WC measurement.

Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points

This article compares prevalence estimates of excess weight among Canadian children and youth according to three sets of body mass index (BMI) reference cut-points. The cut-points are based on growth curves generated by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control (CDC). A secondary objective is to compare estimates by method of data collection. Prevalence estimates of overweight and obesity were produced for 2- to 17-year-olds using the three sets of BMI cut-points. Estimates are based on data from 8 661 respondents from the 2004 Canadian Community Health Survey and 1 840 respondents from the 1978/79 Canada Health Survey. In both surveys, the height and weight of children were measured. The 2004 prevalence estimate for the combined overweight/obese category is higher (35%) when based on the WHO cut-points compared with the IOTF (26%) or CDC (28%) cut-points. Estimates of the prevalence of obesity are similar based on WHO and CDC cut-points (13%), but lower when based on IOTF cut-points (8%). Absolute differences in excess weight estimates between 1978/79 and 2004 are similar based on the three sets of cut-points, but the relative increase is greater when based on the IOTF cut-points. Estimates vary substantially by method of data collection. When interpreting prevalence estimates of overweight and obesity for children and youth, it is important to consider the definitions used and the method of data collection.

EVIDENCE FOR THE VALIDITY OF THE AMERICAN MEDICAL ASSOCIATION'S CAREGIVER SELF‐ASSESSMENT QUESTIONNAIRE AS A SCREENING MEASURE FOR DEPRESSION

EVIDENCE FOR THE VALIDITY OF THE AMERICAN MEDICAL ASSOCIATION'S CAREGIVER SELF‐ASSESSMENT QUESTIONNAIRE AS A SCREENING MEASURE FOR DEPRESSION

A Single Set of Numerical Cutpoints to Define Moderate and Severe Symptoms for the Edmonton Symptom Assessment System

Symptom intensity in cancer and palliative care patients is frequently assessed using a 0–10 ranking score. Results are then often grouped into verbal categories (mild, moderate, or severe) to guide therapy. Numerical cutpoints separating these categories are often variable, with previous work suggesting different cutpoints across different symptoms, which is unwieldy for clinical use. The Edmonton Symptom Assessment Symptom (ESAS) assesses nine common symptoms using this 0–10 scale. The primary aim of this study was to examine the relationship between the numerical and verbal scores using the ESAS and to identify a single cutpoint to separate severe from nonsevere symptomatology. A second goal was to similarly identify a cutpoint to separate moderate or severe from none or mild symptom intensity. Consenting patients ( n = 400) completed both a standard ESAS and an identical form that replaced 0–10 with none, mild, moderate, and severe. Receiver operating characteristic curves were generated to identify the best fit between sensitivity and specificity. For the “severe” ranking, six symptoms had a best fit of 7, with sensitivity for the remaining three symptoms still greater than 80%. For the combined grouping of moderate or severe, results were less uniform. A cutpoint of either 4 or 5 would be supported by our data, with a greater sensitivity using 4 and improved specificity using 5 as the cutpoint. Across all ESAS symptoms, then, 7 or higher represents a severe symptom by patient definition, whereas a cutpoint of either 4 or 5 could reasonably define combined moderate and severe symptoms.

Harmonizing the Metabolic Syndrome

A cluster of risk factors for cardiovascular disease and type 2 diabetes mellitus, which occur together more often than by chance alone, have become known as the metabolic syndrome. The risk factors include raised blood pressure, dyslipidemia (raised triglycerides and lowered high-density lipoprotein cholesterol), raised fasting glucose, and central obesity. Various diagnostic criteria have been proposed by different organizations over the past decade. Most recently, these have come from the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. The main difference concerns the measure for central obesity, with this being an obligatory component in the International Diabetes Federation definition, lower than in the American Heart Association/National Heart, Lung, and Blood Institute criteria, and ethnic specific. The present article represents the outcome of a meeting between several major organizations in an attempt to unify criteria. It was agreed that there should not be an obligatory component, but that waist measurement would continue to be a useful preliminary screening tool. Three abnormal findings out of 5 would qualify a person for the metabolic syndrome. A single set of cut points would be used for all components except waist circumference, for which further work is required. In the interim, national or regional cut points for waist circumference can be used.

What Should be the Optimal Cut Points for Mild, Moderate, and Severe Pain?

Grouping patients' rating of pain intensity from 0 to 10 into categories of mild, moderate, and severe pain is useful for informing treatment decisions, interpreting study outcomes, as well as aiding policy or clinical practice guidelines development. In 1995, Serlin and colleagues developed a technique to establish the cut points for mild, moderate, and severe pain by grading pain intensity with functional interference. Since then, a number of studies attempted to confirm these findings in similar or different populations but had different results. Such inconsistencies in the literature prompt for more research to establish the definition of mild, moderate and severe pain. Thus, the purpose of the current study was to identify optimal cut points (CP) of the three pain severity categories for worst, average, and current pain. The study population (n = 199) was patients with symptomatic bone metastases referred to a palliative radiotherapy clinic. Using the Brief Pain Inventory (BPI), patients reported their worst, average, and current pain intensity, as well as the degree of functional interference due to pain. All possible combinations for the CPs, between 2 and 8, were created and related to the set of 7 interference items from the BPI using the multivariate analysis of variance (MANOVA). The criteria used to determine the optimal set of cut points for mild, moderate and severe pain was a MANOVA among pain severity categories that yielded the largest F ratio for the between-category effect on the 7 interference items as indicated by Pillai's trace, Wilk's lambda, and Hotelling's trace F statistics. Results confirmed a non-linear relationship between cancer pain severity and functional interference. The optimal CP for worst and average pain was CP4, 6 (mild = 1-4, moderate = 5-6, and severe = 7-10), confirming Serlin and colleagues's findings. These findings are pivotal in further understanding the meaning of pain intensity levels and the assessment of pain in patients with metastatic cancer. However, further research in alternative methods of defining the optimal CP and clinically important change should be considered.

From continua to ℝ–trees

We show how to associate an R-tree to the set of cut points of a continuum. If X is a continuum without cut points we show how to associate an R-tree to the set of cut pairs of X.

On [formula omitted]-homogeneous continua

A continuum is 1 2 -homogeneous provided there are exactly two orbits for the action of the group of homeomorphisms of the continuum onto itself. In this paper we study some relations between 1 2 -homogeneous continua and their set of cut points. We also prove that if X is a hereditarily decomposable continuum whose proper, nondegenerate subcontinua are arc-like, then X is 1 2 -homogeneous if and only if X is an arc. Suitable examples and counterexamples are given.

Leukocyte and bacterial counts do not correlate with severity of symptoms in men with chronic prostatitis: the National Institutes of Health Chronic Prostatitis Cohort Study.

We examine whether leukocytes and bacteria correlate with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome. All 488 men screened into the National Institutes of Health Chronic Prostatitis Cohort Study before close of recruitment on August 22, 2001 were selected for analysis. The National Institutes of Health Chronic Prostatitis Symptom Index, including subscores, were used to measure symptoms. Urethral inflammation was defined as white blood cell (WBC) counts of 1 or more (1+) in the first voided urine. Participants were classified as category IIIa based on WBC counts of 5 or more, or 10 or more (5+, 10+) in the expressed prostatic secretion, or 1+ or 5+ either in the post-expressed prostatic secretion urine (voided urine 3) or semen. Uropathogens were classified as localizing if the designated bacterial species were absent in voided urine 1 and voided urine 2 but present in expressed prostatic secretion, voided urine 3 or semen, or present in expressed prostatic secretion, voided urine 3 or semen at 2 log concentrations higher than at voided urine 1 or 2. Associations between symptoms, and inflammation and infection were investigated using generalized Mantel-Haenszel methods. Of all participants 50% had urethral leukocytes and of 397 with expressed prostatic secretion samples 194 (49%) and 122 (31%) had 5+ or 10+ WBCs in expressed prostatic secretion, respectively. The prevalence of category IIIa ranged from 90% to 54%, depending on the composite set of cut points. None of the index measures were statistically different (p >0.10) for selected leukocytosis subgroups. Based on prostate and semen cultures, 37 of 488 men (8%) had at least 1 localizing uropathogen. None of the index measures were statistically different (p >0.10) for selected bacterial culture subgroups. Although men with chronic prostatitis routinely receive anti-inflammatory and antimicrobial therapy, we found that leukocytes and bacterial counts as we defined them do not correlate with severity of symptoms. These findings suggest that factors other than leukocytes and bacteria also contribute to symptoms associated with chronic pelvic pain syndrome.

Hausdorff dimension and dendritic limit sets

Let Γ be a singly degenerate closed surface group acting properly discontinuously on hyperbolic 3-space, H3, such that H3/Γ has positive injectivity radius. It is known that the limit set is a dendrite of Hausdorff dimension 2. We show that the cut-point set of the limit set has Hausdorff dimension strictly less than 2.

Correlation between generalized and focal retinal arteriolar narrowing in an older population.

This study aimed to assess the associations between generalized and focal retinal arteriolar narrowing in the Blue Mountains Eye Study population (n = 3654 persons aged 49+ years). Summarized estimates of the average retinal arteriolar diameter, the central retinal arteriolar equivalent (CRAE) and arteriole-to-venule ratio were obtained from right eye photographs of each participant using a computer-assisted method. Focal retinal arteriolar narrowing was graded from retinal photographs of both eyes using a 'light-box' method. The proportion of subjects with focal arteriolar narrowing increased as CRAE decreased from the widest (2.2%) to the narrowest (7.8%) quintile (P for trend = 0.001). A receiver operating characteristic curve was constructed using CRAE to detect focal arteriolar narrowing. With the diagnostic cut point set at the 4th decile of CRAE, the sensitivity and specificity in detecting focal arteriolar narrowing were 64% and 61%,respectively. These data suggest a moderate correlation between generalized (CRAE) and focal arteriolar narrowing. However, no significant association was found between arteriole-to-venule ratio and focal arteriolar narrowing.

Leukocyte and Bacterial Counts Do Not Correlate With Severity of Symptoms in Men With Chronic Prostatitis: The National Institutes of Health Chronic Prostatitis Cohort Study

We examine whether leukocytes and bacteria correlate with symptom severity in men with chronic prostatitis/chronic pelvic pain syndrome. All 488 men screened into the National Institutes of Health Chronic Prostatitis Cohort Study before close of recruitment on August 22, 2001 were selected for analysis. The National Institutes of Health Chronic Prostatitis Symptom Index, including subscores, were used to measure symptoms. Urethral inflammation was defined as white blood cell (WBC) counts of 1 or more (1+) in the first voided urine. Participants were classified as category IIIa based on WBC counts of 5 or more, or 10 or more (5+, 10+) in the expressed prostatic secretion, or 1+ or 5+ either in the post-expressed prostatic secretion urine (voided urine 3) or semen. Uropathogens were classified as localizing if the designated bacterial species were absent in voided urine 1 and voided urine 2 but present in expressed prostatic secretion, voided urine 3 or semen, or present in expressed prostatic secretion, voided urine 3 or semen at 2 log concentrations higher than at voided urine 1 or 2. Associations between symptoms, and inflammation and infection were investigated using generalized Mantel-Haenszel methods. Of all participants 50% had urethral leukocytes and of 397 with expressed prostatic secretion samples 194 (49%) and 122 (31%) had 5+ or 10+ WBCs in expressed prostatic secretion, respectively. The prevalence of category IIIa ranged from 90% to 54%, depending on the composite set of cut points. None of the index measures were statistically different (p >0.10) for selected leukocytosis subgroups. Based on prostate and semen cultures, 37 of 488 men (8%) had at least 1 localizing uropathogen. None of the index measures were statistically different (p >0.10) for selected bacterial culture subgroups. Although men with chronic prostatitis routinely receive anti-inflammatory and antimicrobial therapy, we found that leukocytes and bacterial counts as we defined them do not correlate with severity of symptoms. These findings suggest that factors other than leukocytes and bacteria also contribute to symptoms associated with chronic pelvic pain syndrome.

Peripheral splittings of groups

We define the notion of a “peripheral splitting” of a group. This is essentially a representation of the group as the fundamental group of a bipartite graph of groups, where all the vertex groups of one colour are held fixed—the “peripheral subgroups”. We develop the theory of such splittings and prove an accessibility result. The theory mainly applies to relatively hyperbolic groups with connected boundary, where the peripheral subgroups are precisely the maximal parabolic subgroups. We show that if such a group admits a non-trivial peripheral splitting, then its boundary has a global cut point. Moreover, the non-peripheral vertex groups of such a splitting are themselves relatively hyperbolic. These results, together with results from elsewhere, show that under modest constraints on the peripheral subgroups, the boundary of a relatively hyperbolic group is locally connected if it is connected. In retrospect, one further deduces that the set of global cut points in such a boundary has a simplicial treelike structure.

The Dimension of the Planar Brownian Frontier is 4/3

In a series of recent preprints, we have proven that with probability one the Hausdorff dimension on the outer boundary of planar Brownian motion is 4/3, confirming a conjecture by Mandelbrot. It is also shown that the Hausdorff dimension of the set of cut points is a.s. 3/4. The present paper is an expository outline of the arguments involved in the proof of these and related results.

Predictive values of waist circumference for dyslipidemia, type 2 diabetes and hypertension in overweight White, Black, and Hispanic American adults

Waist circumferences (WC) ⩾102 cm for men and ⩾88 cm for women have been proposed by an expert panel as cut-points for identifying increased risk for the development of obesity comorbidities for most adults. The aim of this investigation was to examine the predictive values of these WC cut-points for hypercholesterolemia, low concentration of high (HDL-C), and high concentration of low (LDL-C) density lipoprotein cholesterol, hypertriglyceridemia, type 2 diabetes, and hypertension in overweight American adults. Data from NHANES III were utilized for the analysis. Predictive abilities were determined by calculating sensitivity, specificity, positive (PV+) and negative (PV−) predictive values in overweight subjects with BMI 25–29.9 kg/m 2. Sensitivity of WC cut-point was stronger for high LDL-C compared to other risk factors with the highest values recorded in the 40–59 and 60–69 year age groups in men and women, respectively. PV+ of WC cut-points for dyslipidemia, type 2 diabetes, and hypertension were low in men compared to women. PV+ tended to increase with age, from 19–39, 40–59 to 60–90 year age groups in Whites, Blacks, and Hispanic men. In men, the highest PV+ were recorded for hypertriglyceridemia in the 60–90 years old groups, with values of 71.6%, 52.5%, and 43.3% in Whites, Blacks, and Hispanics, respectively. The CVD risk factor associated with the highest PV+ in women was diabetes with values of 97.2% in Whites and 88.9% in Blacks, and hypertriglyceridemia with a value of 93.8% in the 17–39 year age group in Hispanics. Among Black men 40–59 years of age, only 32% of a population of overweight hypertensives were detected by the WC cut-points, and among Black women, 40–59 years of age, only 54% were detected. Given the low sensitivity of these cut-points for detecting hypertension, one of the major co-morbidities of obesity, these cut-points failed to provide adequate evidence for the use of WC in determining or evaluating patients as to co-morbid states. We recommend further studies to determine a set of specific cut-points associated with increased risk of CVD in different population groups.