Waist Circumference Cut-off Points Research Articles

Visceral Fat, Waist Circumference, and BMI: Impact of Race/ethnicity

BMI and waist circumference are used to define risk from excess body fat. Limited data in women suggest that there may be racial/ethnic differences in visceral adipose tissue (VAT) at a given BMI or waist circumference. This study tested the hypothesis that racial/ethnic differences exist in both men and women in the relationship of anthropometric measures of body composition and computed tomography (CT)-determined VAT or subcutaneous adipose tissue (SAT). Subjects included 66 African American, 72 Hispanic, and 47 white men and women, aged > or =45. Waist circumference and BMI were measured using standard methods. Total abdominal and L4L5 VAT and SAT were measured using CT. Among both men and women, groups did not differ in waist circumference or BMI. White men had greater L4L5 VAT than African-American men, and both white and Hispanic men had greater total VAT than African-American men. Among women, Hispanics and whites had greater L4L5 VAT than African Americans, and Hispanics had greater total VAT than African Americans. The slope of the linear relationship between BMI or waist circumference and VAT was lower in African Americans than in Hispanics and/or whites. Middle-aged and older African-American men and women had lower VAT despite similar BMI and waist circumference measurements. Altered relationships between anthropometric measures and VAT may have implications for defining metabolic risk in different populations. Different waist circumference or BMI cutoff points may be necessary to adequately reflect risk in different racial/ethnic groups.

Anthropometric predictors for the risk of chronic disease in non-diabetic, non-hypertensive young Mexican women

To assess the ability of anthropometric measurements to identify young women at risk of developing diabetes, hypertension and heart disease in the future and to compare cut-off points for common anthropometric measures established with receiver-operating characteristic (ROC) curves with those reported in the literature. Cross-sectional study. Eight hundred and two young Mexican women living in semi-urban poverty. MEASUREMENTS/METHODS: The ability of anthropometric measures of fatness and fat distribution (body mass index (BMI), summed skinfold thickness (SST), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI), abdominal volume index (AVI)) to predict risk of future disease (pre-diabetes: fasting blood glucose 100-126 mg dl-1; pre-hypertension: systolic blood pressure 120-139 mmHg and/or diastolic blood pressure 80-89 mmHg; hypertriglyceridaemia: triglycerides > or =150 mg dl-1; or a combination of risk factors) was assessed using ROC curve analysis. Twenty-three of the 802 women who were interviewed had incomplete data and 50 (6.4%) were eliminated from the analysis due to hypertension and/or diabetes. Mean age of the remaining 729 women was 29.6 +/- 5.4 years and mean BMI was 27.7 +/- 4.5 kg m-2. There were no significant differences in the area under the ROC curve for BMI, WC, AVI or SST for any of the four outcomes. However, these indices performed significantly better than WHR and CI (P < 0.05). The BMI cut-off points that maximised sensitivity and specificity for the four outcomes were in the range of 27.7-28.4 kg m-2, and for WC were 89.3-91.2 cm. To detect 90% of the cases of any metabolic alteration, the necessary BMI cut-off was 26.1 kg m-2. Younger women (<25 years) were at greater risk than older women for a given BMI increment (P < 0.05). We found that BMI and WC cut-off points commonly used for the identification of risk of existing disease were also appropriate in this population for the identification of risk in the future among women without diabetes or hypertension. The early identification of at-risk individuals, prior to the onset of disease, is fundamental particularly in the context of a country with scarce resources that is rapidly undergoing nutrition transition.

日本の「メタボリック・シンドローム」診断基準の統計的問題

The article by The Examination Committee of Criteria for ‘Obesity Disease’ in Japan and Japan Society for the Study of Obesity (2002) established cut-off points of waist circumference at 85 cm for males and 90 cm for females as criteria of obesity disease. Their article has also become a basis for criteria of metabolic syndrome in Japan; however, their article has various problems on statistical aspects. How the criteria on waist circumference should vary was investigated through reexamination based on descriptions in their article. First, their article obtained criteria on visceral fat area (VFA) from data in which males and females were pooled, while our reexamination suggested that we should use separate criteria on VFA between males and females. Second, their article inappropriately used regression lines to estimate waist circumference corresponding to VFA cut-off points. Our reexamination with errors-in-variables models suggested alternative cut-off points of waist circumference at 87 cm for males and 85 cm for females. Our simulation confirmed that the criteria by their article might lead to inappropriate diagnosis which is strict for males and easy for females.

Epidemiology of metabolic syndrome in Asia.

Metabolic syndrome (MS) is a rising disease entity characterized by a clustering of metabolic conditions. Although prevalence of obesity as defined by the World Health Organization (WHO) is relatively low in Asia compared to western countries, metabolic syndrome is growing into a significant public health problem. Comparative studies indicate that metabolic responses to obesity may be greater in South and East Asians than their western counterparts at given Body Mass Indexes (BMIs). Higher percentage body fat in Asians at given BMIs and over-responsiveness to obesity may in part explain the phenomenon for which the underlying causes are not clear. Furthermore, aborigines may be at an even greater MS risk. The metabolic syndrome definition itself as well as whether it should be defined are controversial. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) gives equal weight to each component disorder, while the International Diabetes Federation (IDF) takes central obesity as a pre-requisite. Both criteria adopt ethnic-specific cut-off points for waist circumference. Asian data favour the new NCEP-ATP III definition, as individuals that were selected through the NCEP criteria but disregarded by the IDF criteria had similar Framingham cardiovascular disease risk scores to those picked by both definitions. Prospective data show that the metabolic syndrome not only increases the risk of coronary artery disease but also cerebrovascular disease in Asians. Macronutrient composition and the quality of the diet are associated with the risk of metabolic syndrome. More research is needed to relate diet and metabolic syndrome in Asians.

Revised Optimal Cut-Off Point of Waist Circumference for the Diagnosis of Metabolic Syndrome in Japanese Women and the Influence of Height

We reevaluated waist circumference as a diagnostic criterion of metabolic syndrome (MetS) in Japanese. We enrolled 5,571 subjects (3,148 men and 2,423 women) who had health check-ups in our center. The criterion was reevaluated using the positive predictive value of a receiver-operating characteristics (ROC) curve at 10 different hypothesized lengths of waist circumference with or without a cluster of risk factors. We also drew ROC curves based on the atherosclerotic findings of clinical examinations. Based on the ROC curves, the optimal waist circumference cut-off was 85 cm in men and 80 cm in women. Using this 80 cm cut-off point in women, misdiagnosis rates of MetS were lowered (-19.1--56.6%) compared to the cut-off point currently in use. Integrating the influence of height, namely by using a waist-to-height(2) ratio, misdiagnosis rates in shorter populations were decreased in both men and women. These data suggested an optimal waist circumference cut-off to improve the diagnostic probability of MetS in Japanese women of 80 cm, as well as the utility of an easily detected anthropometric index such as a waist-to-height (cm x 100/cm) or waist-to-height(2) (cm x 10,000/cm(2)) ratio, determined as 51 in men and 52 in women, or 30 in men and 33 in women, respectively.

Cut-off values for waist circumference in rural Iraqi adults for the diagnosis of metabolic syndrome

The determination of cutoff points for healthy waist circumference (WC) is of paramount importance for prevention, optimum management, and prognostication of obesity, the metabolic syndrome (MetS), type 2 diabetes mellitus, and coronary heart disease. The aim of this project was to establish the cutoff level for WC in rural Basrah in Iraq, one of the eastern Mediterranean and Middle East (Arab) populations. This was a community-based, cross-sectional survey for establishing the normal value for WC among a rural district population in Basrah (Abu-Al-khasib), Iraq. A stratified sampling procedure was used for sample selection. The cutoff level yielding maximum sensitivity and specificity for predicting the presence of multiple risk factors was 97 cm in men and 99 cm in women. Sensitivity and specificity using these cutoff values were 70% and 50%, respectively, in men and 70% and 45%, respectively, in women. We propose the optimal cutoff point for WC for the diagnosis of MetS in the Iraqi adult rural population as 99 cm in women and 97 cm in men.

Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome

In the new world-wide criteria for metabolic syndrome (MetS) by the International Diabetes Federation (IDF) in 2006, the Japanese is the only ethnicity in which the recommended waist circumference (WC) cutoff value is higher in women (≧90 cm) than in men (≧85 cm), and its validity appears to be controversial. We investigated the optimal cutoff points for the diagnosis of central obesity in Japanese men and women, using the receiver operating characteristic (ROC) curve analysis for both of WC and visceral fat area (VFA) in 1870 middle-aged Japanese. VFA was superior to WC and Body mass index (BMI) for discriminating the subjects with two or more nonadipose components of MetS. The optimal cutoff points of VFA and WC were 132.6 cm 2 and 89.8 cm for men and 91.5 cm 2 and 82.3 cm for women. The stratifications of MetS components more than 1.0 in average occurred more steeply by the accumulation of VFA in women than in men. In conclusion, setting the cutoff points of WC and VFA lower values in women than in men for the definition of central obesity is needed to identify the subjects with MetS in Japanese, as in other Asian populations.

Waist Circumference and BMI Cut‐off Based on 10‐year Cardiovascular Risk: Evidence for “Central Pre‐Obesity”

The objective was to assess the waist circumference (WC) cut-off point that best identifies a level of 10-year cardiovascular disease (CVD) risk with optimal balance of sensitivity and specificity in Chinese subjects according to their predicted 10-year CVD risk. A community-based cross-sectional observational study involving 14,919 Hong Kong Chinese subjects. The 10-year CVD risk based on various prediction models was calculated. The projected WC cut-off points were then determined. There were 4837 (32.4%) men and 10,082 (67.6%) women (mean age +/- standard deviation, 47.3 +/- 13.5 years; age range, 18 to 93 years; median age, 45.0 years). The mean optimal WC or BMI predicting a 15% to 30% 10-year CVD risk were 83 to 88 cm and 25 kg/m(2) for men, and 76 cm and 23 kg/m(2) for women, respectively. With WC >or=90 cm in men and >or=80 cm in women, the likelihood ratio at various WC cut-off points to develop a >or=20% 10-year CVD risk is 1.5 to 2.0 in men and 3.0 in women. The likelihood ratio was 1.5 in men with WC at 84 cm and in women at 70 cm. Our results agree with the present guidelines on the definition of general and central obesity in Asia-Pacific regions. We propose the creation of an intermediate state of high WC, the "central pre-obesity" for Chinese men with WC >or=84 to 90 cm (>or=33 to 36 inches) and women with WC >or=74 to 80 cm (>or=29 to 32 inches). People with central pre-obesity, similar to those with overweight (BMI >or=23 to 25 kg/m(2)), already have an increased risk of co-morbidities.

Impact of Fatty Liver Disease on Health Care Utilization and Costs in a General Population: A 5-Year Observation

Fatty liver disease is a common condition in the Western world. Fatty liver may progress to steatohepatitis and cirrhosis. It is not yet known whether fatty liver disease results in higher health care utilization and costs. We used data from the Study of Health in Pomerania (SHIP), Germany, to assess the relation of fatty liver disease to self-reported health care utilization and costs at baseline and 5 years. The SHIP is a general population cohort study of 4310 adults aged 20 to 79 years at baseline in Pomerania. Fatty liver disease was defined as the presence of a hyperechogenic pattern of the liver and elevated serum alanine aminotransferase (ALT) levels. In multivariable analyses, average annual overall health care costs at baseline and follow-up measurement were significantly higher for individuals with sonographic fatty liver and increased serum ALT levels. For example, controlling for comorbid conditions, subjects with sonographic fatty liver disease and increased serum ALT levels had 26% higher overall health care costs at 5-year follow-up. Analyses also suggest that diabetes and cardiovascular disease might mediate the relation of fatty liver disease and health care utilization and costs. Policies seeking to minimize costs associated with fatty liver disease might want to consider addressing behavioral risk factors of fatty liver disease.

Metabolic syndrome and visceral fat thickness in obese adolescents

Background Metabolic syndrome (MS) is one of the long-termconsequences of obesity which can be found in adolescents. MS iscaused by excessive visceral fat accumulation. The visceral fatthickness (VFT) itself can be measured by using waist circumference(WC) measurement and abdominal ultrasonography. Until now,there are no WC and VFT cut-off points to predict MS in childrenand adolescents. This study used MS criteria based on NationalCholesterol Education Program – Adult Treatment Panel III(NCEP-ATP III) which specifically modified.Objective The objectives of this study are (a) to determine the MSocurrence based on modified NCEP-ATP III in obese adolescents;(b) to measure the VFT by using abdominal ultrasonography in obeseadolescent with MS and obese adolescent without MS.Methods We conducted a cross-sectional study from March toMay 2006. Fifty obese adolescents were recruited from severaljunior and senior high schools in Jakarta.Results Of those 50 obese adolescents, there were 34 subjects withWC&gt;P 80 and 16 subjects with WC &lt;P 80 . Of those 34 subjectswith WC&gt;P 80 , 17 subjects had MS and the others had no MS. Allthe 16 subjects with WC &lt;P 80 did not have MS. The VFT in 17subjects with WC&gt;P 80 who had MS was 5.19 cm (SD 2.07 cm).The VFT in 17 subjects with WC&gt;P 80 who had no MS was 3.94cm (SD 1.62 cm). The VFT in all 16 subjects with WC &lt;P 80 whodid not have MS was 3.54 cm (SD 0.92 cm). All obese adolescentswith MS had WC&gt;P 80 and they also had visceral fat which wasthicker than obese adolescents without MS.Conclusions All obese adolescents with MS have WC&gt;P 80 andthicker visceral fat than obese adolescents without MS; the VFTof obese adolescents without MS, who had WC&gt;P 80 was 3.94cm (SD 1.62 cm), and the VFT of obese adolescents without MS,who had WC &lt;P 80 was 3.54 cm (SD 0.92 cm).

Re-evaluation of waist circumference in metabolic syndrome: a comparison between Japanese men and women.

We re-evaluated the criteria for waist circumference to predict the accumulation of the components of metabolic syndrome. We used data for 3,185 Japanese, aged 20-79 years. Metabolic syndrome has recently been redefined by a new criterion in Japan, in which waist circumference cutoff points, i.e. 85 cm for men and 90 cm for women, are employed. Among the 3,185 Japanese considered in the present study, 335 men (26.8%) and 69 women (3.6%) were diagnosed as having metabolic syndrome. A cutoff point as a predictor for 2 or more components of metabolic syndrome was evaluated by sensitivity/specificity and a receiver operating characteristic (ROC) curve. The optimal point was estimated as being approximately 85 cm of waist circumference in men and 75 cm in women. We therefore recommend a cutoff value, 75 cm of waist circumference, for the criterion of metabolic syndrome in women.

The prevalence of metabolic syndrome in Japanese renal transplant recipients

The prevalence of metabolic syndrome (MS) after renal transplantation has yet to be elucidated. In the present study, we investigated the prevalence of MS in Japanese renal transplant recipients. A cross-sectional study was conducted to determine the prevalence of MS in 101 renal transplant recipients at Osaka City University Hospital. The prevalence of MS was determined using the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) criteria (modified and original) and the International Diabetes Federation (IDF) criteria. Using the modified (Japanese) NCEP criteria, a total of 24 out of 101 patients (23.8%) had MS including 21 out of 64 male patients (32.8%) and three out of 37 female patients (8.1%). Using the modified (Asian) NCEP criteria, MS was diagnosed in 23 patients (22.8%); 19 male (29.7%) and four female (10.8%). Using the original NCEP criteria, MS was diagnosed in 15 patients (14.9%); 12 male (18.8%) and three female (8.1%). Using the IDF criteria, MS was diagnosed in 16 patients (15.8%); 15 male (23.4%) and one female (2.7%). The prevalence of MS differed according to the NCEP criteria used, which had different cut-off points for waist circumference (14.9-23.8%). By the IDF criteria, which cites central obesity as an essential component, the prevalence of MS was slightly lower. Furthermore, in our study, MS was more prevalent in male renal transplant recipients.

Índice de massa corporal e circunferência da cintura como marcadores de hipertensão arterial em adolescentes

To evaluate the sensitivity and specificity of anthropometric measurements of body fat in a sample of Brazilian adolescents for the prediction of hypertension. The arterial blood pressure was measured on two visits in a sample of 456 students aged 12 to 17 years, from public and private schools of the Fonseca neighborhood, in Niterói, between 2003 and 2004. A subject was defined as hypertensive if he/she had systolic and diastolic pressures above the 95th percentile for sex, age and height. A questionnaire was applied and Body Mass Index (BMI) and waist circumference (WC) measurements were made. A statistically significant correlation was observed between hypertension and the cutoff points considered unfavorable, both for BMI and WC. The greatest association was with the cutoff point proposed for the Brazilian population. As to the BMI sensitivity used for American Black or White populations or for the Brazilian population, we found 52.4% to 57.1% and 52.4%, respectively. And BMI specificity was 69.3%, 70.0% and 80.88%, respectively. The sensitivity found in our sample, relative to the cutoff points for WC proposed for all American ethnic groups, was also low (45.0%) and specificity was a little higher (77.6% and 74.5%, respectively). Existing American WC measurements showed low sensitivity and specificity for hypertension in our population. As to BMI, the available cutoff points also showed a low level of sensitivity. There is a need to establish body fat cutoff points that can provide a better prediction of cardiovascular risk.

Should Central Obesity Be an Optional or Essential Component of the Metabolic Syndrome?

The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD). From the population-based cohort study (baseline 1992-1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.6 years by linkage with three national registries. Cox's proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of a first IHD event. The prevalence of metabolic syndrome was 17.7% by IDF criteria and 26.2% by AHA/NHLBI criteria using Asian waist circumference cutoff points for central obesity. Asian Indians had higher rates than Chinese and Malays. There were 135 first IHD events. Compared with individuals without metabolic syndrome, those with central obesity/metabolic syndrome and no central obesity/metabolic syndrome were at significantly increased risk of IHD, with adjusted HRs of 2.8 (95% CI 1.8-4.2) and 2.5 (1.5-4.0), respectively. Having metabolic syndrome either with or without central obesity confers IHD risk. However, having central obesity as an "optional" rather than "essential" criterion identifies more individuals at risk of IHD in this Asian cohort.

Toward establishing normal waist circumference in Eastern Mediterranean and Middle East (Arab) populations. Cutoff values for waist circumference in Iraqi adults

Background: Determination of cutoff points for waist circumference (WC) is of paramount importance for prevention,optimum management, and prognosis of obesity, the metabolic syndrome (MetS), type 2 diabetes mellitus, and coronaryheart disease. The aim of this project was to establish cut-off levels for waist circumference in Eastern Mediterranean andMiddle East (Arab) populations in Basrah, Iraq. Methods: This was a community-based cross-sectional survey forestablishing normal value of WC from one district in Basrah (Abu-Al-khasib). A multiple stratified sampling procedure wasused for sample selection. Results: The cutoff level yielding the maximal sensitivity plus specificity for predicting thepresence of multiple risk factors was 97cm in men and 99 cm in women. Sensitivity and specificity using these cut-off valueswere 70% and 50% respectively in men and 70% and 45% respectively in women. Conclusion: We propose an optimalcutoff point of WC for the diagnosis of MetS in the Iraqi population: 99 cm in women and 97 men. (Int J Diabetes Metab15:14-16, 2007)

Waist circumference cut‐off points for identification of abdominal obesity among the tunisian adult population

Waist circumference (WC) is a convenient measure of abdominal adipose tissue. It itself is a cardiovascular disease (CVD) and diabetes-risk factor and is strongly linked to other CVD risk factors. There are, however, ethnic differences in the relationship of WC to the other risk factors. The aim of this study was to determine the optimal cut-off points of WC and body mass index (BMI) at which cardiovascular risk factors can be identified with maximum sensitivity and specificity in a representative sample of the Tunisian adult population and to investigate any correlation between WC and BMI. We used a sample of the Tunisian National Nutrition Survey, a cross-sectional population-based survey, conducted in 1996 on a large nationally representative sample, which included 3435 adults (1244 men and 2191 women) of 20 years or older. WC, BMI, blood pressure and fasting blood measurements (plasma glucose, total cholesterol, triglycerides) were recorded. Receiver operating characteristic (ROC) curve analysis was used to identify optimal cut-off values of WC and BMI to identify with maximum sensitivity and specificity the detection of high blood pressure, hyperglycaemia, high blood cholesterol and hypertriglyceridaemia. ROC curve analysis suggested WC cut-off points of 85 cm in men and 85 cm in women for the optimum detection of high blood pressure, diabetes and dyslipidaemia. The optimum BMI cut-off points for predicting cardiovascular risk factors were 24 kg/m(2) in men and 27 kg/m(2) in women. The cut-off points recommended for the Caucasian population differ from those appropriate for the Tunisian population. The data show a continuous increase in odds ratios of each cardiovascular risk factor, with increasing level of WC and BMI. WC exceeding 85 cm in men and 79 cm in women correctly identified subjects with a BMI of >/=25 kg/m(2), sensitivity of >90% and specificity of >83%. Based on the ROC analysis, we suggest a WC of 85 cm for both men and women as appropriate cut-off points to identify central obesity for the purposes of CVD and diabetes-risk detection among Tunisians. WCs of 85 cm in men and 79 cm in women were the most sensitive and specific to identify most subjects with a BMI >/=25 kg/m(2).

Critério de obesidade central em população brasileira: impacto sobre a síndrome metabólica

To identify and propose the optimal waist circumference cut-off points (WCp) for the diagnosis of central obesity (CO) in a Brazilian population, so as to compare these cut-off points with those recommended by the ATPIII (WC-ATPIII), and to estimate the difference in prevalence rates of metabolic syndrome (MS) using the two criteria. Cross-sectional study conducted in a population subgroup of 1439 adults in the city of Salvador, Brazil. ROC curves of waist circumference (WC) were plotted to identify diabetes mellitus (DM) and obesity. ROC curve sensitivity and specificity values >60% and the closest to each other were used to define WCp. The prevalence of MS was estimated using WCp and WC-ATPIII. Eight hundred and twenty nine women comprised 57.7% of the sample. The WCp selected were 84 cm for women and 88 cm for men. These cut-off points detected DM with a 68.7% and 70% sensitivity, and a 66.2% and 68.3% specificity, respectively. For obesity, sensitivity and specificity were 79.8% and 77.6% in women and 64.3% and 71.6% in men, respectively. Using WC-ATPIII, 88 cm (for women) and 102 cm (for men), the sensitivity was 53.3% and 26.5%, respectively, to diagnose DM. For obesity, sensitivity was 66.5% (for women) and 28.6% (for men). The prevalence of MS using WCp was 23.7%, 95%CI (21.6-25.9), whereas using WC-ATPIII it was 19.0%, 95%CI (17.1-20.9), 1.2 times higher using WCp. WC-ATPIII were inappropriate and underestimated the prevalence of MS in the population studied, particularly among men. We suggest that the WC cut-off points > 84 cm for women and > 88 cm for men should be tested in other Brazilian populations.

The utility of different definitions of metabolic syndrome in Andean population

The definition and diagnostic criteria of Metabolic Syndrome (MS) has lead in the last weeks to intensive controversy[1,2]. The inclusion of the waist circumference (WC) as an obligatory criteria, proposed by the International Diabetes Federation (IDF), and the application of different cut-off points of WC by ethnics or countries are key elements of discussion because they could label millions of people with a presumed disease that may be does not exist [3,4]. This controversy is especially important to undeveloped countries where exist an epidemic of cardiovascular diseases (CVD) and resources for prevention are limited.

A Proposal for the Cutoff Point of Waist Circumference for the Diagnosis of Metabolic Syndrome in the Japanese Population

In a community-based cohort of 692 Japanese individuals, Hara et al. (1) investigated the relationship between cutoff values used for the waist circumference to define central obesity and rates of detection of subjects displaying multiple risk factors of metabolic syndrome. Using the receiver-operator characteristic (ROC) curve, they proposed an optimal cutoff point of waist circumference for the diagnosis of metabolic syndrome …

An evaluation of the International Diabetes Federation definition of metabolic syndrome in Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus

The objective of the study was to determine the most accurate metabolic syndrome (MS) definition among the definitions proposed by the International Diabetes Federation (IDF), the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III [ATPIII]), and the World Health Organization (WHO) and to evaluate the cutoff point of waist circumference using the IDF definition for optimally defining MS in the Chinese population. One thousand thirty-nine Chinese patients older than 30 years and diagnosed with type 2 diabetes mellitus were investigated by randomized cluster sampling in the Shanghai downtown, and 1008 patients were analyzed in this study. Body mass measurements, resting blood pressure, fasting blood measures, and carotid atherosclerotic measurements including common carotid artery intima-media thickness (IMT) and carotid plaque were investigated. The IDF definition was compared with the other 2 definitions, and the carotid atherosclerosis was evaluated among the patients according to these definitions. (1) The MS prevalence was 50.0%, 55.7%, and 70.0% under the IDF, ATPIII, and WHO definitions, respectively. (2) The percentage of all the participants categorized as either having or not having the MS was 69.9% (under the IDF and ATPIII definitions) and 70.2% (under the IDF and WHO definitions). (3) Common carotid artery IMT of patients with MS determined by the IDF definition was thicker than those determined by the WHO and ATPIII definitions, and the percentage of carotid plaque of patients with MS determined by the IDF definition was greater than those determined by the WHO and ATPIII definitions. (4) When the cutoff point of waist circumference in men determined by the IDF definition was modified from 90 to 85 cm, common carotid artery IMT of the emerging male patients with MS was thicker than that of the male patients with MS determined by the original IDF definition. In conclusion, the prevalence of MS was 50.0%, 55.7%, and 70.0% under the IDF, ATPIII, and WHO definitions, respectively. The preferable IDF definition served as a better predictor of cardiovascular disease risk in the Chinese patients diagnosed with type 2 diabetes mellitus compared with the ATPIII and WHO definitions. The modified cutoff point of waist circumference in men under the IDF definition specific for the Chinese population (from 90 to 85 cm) might be more suitable for predicting atherosclerosis.