Waist Circumference Cutoff Research Articles

Prevalence of metabolic syndrome in elderly Japanese-Brazilians

SummaryBackgroundPrevalence of individuals with a high cardiovascular risk is elevated in elderly populations. Although metabolic syndrome (MS) increases cardiovascular risk, information is scarce on the prevalence of MS in the elderly. In this study we assessed MS prevalence in a population of elderly Japanese-Brazilians using different MS definitions according to waist circumference cutoff values.Material/MethodsWe studied 339 elderly subjects, 44.8% males, aged between 60 to 88 years (70.1±6.8). MS was defined according to criteria proposed by the Joint Interim Statement in 2009. As waist circumference cutoff point values remain controversial for Asian and Japanese populations, we employed 3 different cutoffs that are commonly used in Japanese epidemiological studies: 1) ≥90 cm for men and ≥80 cm for women; 2) ≥85 cm for men and ≥90 cm for women; 3) ≥85 cm for men and ≥80 cm for women.ResultsMS prevalence ranged from 59.9% to 65.8% according to the different definitions. We observed 90% concordance and no statistical difference (p>0.05) in MS prevalence between the 3 definitions. MS diagnosis according to all 3 cutoff values was found in 55.8% of our population, while in only 34.2% was MS discarded by all cutoffs. The prevalence of altered MS components was as follows: arterial blood pressure 82%, fasting glycemia 65.8%, triglyceride 43.4%, and HDL-C levels 36.9%.ConclusionsElderly Japanese-Brazilians present high metabolic syndrome prevalence independent of waist circumference cutoff values. Concordance between the 3 definitions is high, suggesting that all 3 cutoff values yield similar metabolic syndrome prevalence values in this population.

Waist circumference cutoff and metabolic syndrome

Sir, The report on the waist circumference cutoff and metabolic syndrome revealed many interestingaspects.[1] Pratyush et al. concluded that “WC of 90 cm in males and 85 cm in females should be a mandatory criterion of MetS in our subset of population.[1]” Several concerns on this work should be discussed. First, clarification on quality control of laboratory investigations and analysis is needed. Lipid profile and blood glucose measurement can be easily disturbed by interference such as hemolysis during blood collection. The limitation of using calculated LDL as parameter is already mentioned by Pratyush et al. in the report.[1] Also, the reliability of the waist circumference measurement technique should be discussed. Whether the circumference was directly and correctly measured or not should be discussed. The indirect measurement or self-report of the subjects can be unreliable.[2] Despite measurement by medical personnel, several factors can affect the results including “patient movement or position changes, poor positioning of the measuring tape or differences in tension applied to the tape by the clinician.[3]” In a recent report by Bernritter et al.,[3] the “Height of Iliac Crest (HIC) method” is a recommended technique. Second, the use of closed relatives of the patients as subjects might not be a good representative of healthy population. These things should be considered before acceptance of the concluded cutoff for implementation in practice.

Screening high-risk population for hypertension and type 2 diabetes among Thais.

waist circumference (WC) and body mass index (BMI) are simple screening tools for hypertension (HT) and type 2 diabetes (DM). Cutoffs of WC for BMI for Asians have been discussed. This study aimed to assess the accuracy of screening tools and associations of WC, BMI with HT and DM. Data from the national screening programme for metabolic syndrome conducted in 2010 in 21 provinces in the central region of Thailand were analysed. A total of 10 748 participants aged >35 years were included in the analysis with cutoffs of WC set at 90 cm for men, 80 cm for women, and BMI at 23 kg/m2 for both sexes. WC produced low sensitivity and high specificity among male participants, and moderate sensitivity and specificity among female participants, while BMI produced moderate sensitivity and specificity in both sexes. Significant associations were found among those who had high WC only, high BMI only, and both high WC and BMI with HT and DM in both sexes. (males for HT, OR=1.63, 95%CI: 1.15-2.33, OR=1.22, 95%CI: 1.03-1.44 and OR=2.03, 95%CI: 1.07-2.42; males for DM, OR=1.39, 95%CI: 1.05-1.83), OR=1.77, 95%CI: 1.07-2.94 and OR= 2.05, 95%CI: 1.57-2.69, females for HT, OR=1.69: 95%CI 1.38-2.07, OR=1.32; 95%CI: 1.09-1.60 and OR=2.54, 95%CI: 2.11-2.91; females for DM, OR=1.45, 95%CI: 1.08-1.94, OR=1.45, 95%CI: 1.09-1.91 and OR=1.70, 95%CI: 1.39-2.09). When the cutoff WC was lowered among male participants to 85 cm, sensitivity increased, and significant strengths of associations with HT and DM were nearly the same. For Thailand, WC and BMI with appropriate cutoffs can be effective screening tools to recruit high-risk populations into health promotion programmes. However, WC and BMI should be implemented with other screening tools for other risk factors because of their moderate accuracy.

Should waist circumference be replaced by index of central obesity (ICO) in definition of metabolic syndrome?

Waist circumference has been widely used as the parameter of central obesity in defining metabolic syndrome. Global consensus definition of metabolic syndrome has suggested various race- and gender-specific cutoffs of waist circumference for quantifying central obesity. We have earlier proposed that using index of central obesity (ICO), the need for race- and gender-specific cutoffs may be obviated. We propose that waist circumference be supplanted with index of central obesity in all definitions of metabolic syndrome. Using index of central obesity a common cutoff of 0.5 applicable across races and genders might be obtained. Moreover, it will enhance the sensitivity of definition by diagnosing subjects who are shorter than general population. Among 258 male and 242 female diabetic patients, subjects with metabolic syndrome (defined as per gender-specific waist circumference cutoffs), were found to have a common lower range of index of central obesity suggesting that a common cutoff of waist circumference may be obtained. In another study from National Health and Nutrition Examination Survey database, replacing index of central obesity with waist circumference was found to enhance the specificity and sensitivity of definition of metabolic syndrome.

Statistical Reassessment of the Association between Waist Circumference and Clustering Metabolic Abnormalities in Japanese Population

The use of ethnic-specific cutoff values of waist circumference (WC) has been recently recommended, but they were originally developed on different statistical grounds. We investigated whether different statistical procedures and clinical settings generate different WC cutoff values in one ethnic population. We recruited 3810 Japanese subjects and performed the following three statistical analyses: 1) search for WC cutoff points associated with the risk of clustering metabolic abnormalities, 2) calculation of WC associated with certain body mass index (BMI) levels, 3) evaluation with receiver operating characteristic (ROC) curves for the risk. We also simulated population models to evaluate whether WC cutoff values depend on the clinical settings of the study population. First, in risk analysis, males and females had the same risk when females had 10 cm larger WC than males, although the risk increased almost linearly, without any clear threshold. Second, WC corresponding to BMI of 25 kg/m(2) was 87 cm in males and 85 cm in females, with a slight sex difference. Third, ROC curves showed that the male optimal cutoff value was 85 cm, larger than the female one (79 cm). However, simulated population models with various WC distributions gave different ROC curves and different WC cutoff values. Furthermore, WC cutoff values varied by age in any of the three statistical procedures. Different statistical grounds could generate different WC cutoff values. If one plans to establish a unified trans-ethnic diagnostic tool of metabolic syndrome, ethnic-specific WC cutoff values should be primarily provided based on a unified statistical ground.

Cut off values for abdominal obesity as a criterion of metabolic syndrome in an ethnic Kyrgyz population (Central Asian region)

BackgroundPeople of different racial and ethnic backgrounds have a distinct pattern of central fat deposition, thus making it necessary to devise a race based approach for the diagnosis and evaluation of abdominal obesity (AO). This is the first study to determine the optimal waist circumference (WC) cutoff values for definition of AO in an ethnic Kyrgyz population.Methods323 persons of Kyrgyz ethnicity (183 women and 140 men), with a mean age of 51.8 ± 9.5 years old were included in the study. Measurement of blood pressure (BP), anthropometric data (including body mass index calculation and WC measurement), fasting blood sugar, serum lipid parameters and insulin were performed in all examined individuals. Insulin resistance (IR) was considered as HOMA index (insulin × fasting glucose/22.5) ≥ 2.77. Sensitivity and specificity for the presence of IR or two other criteria of MS (according to the international classification, 2009) were calculated by using receiver operating characteristic (ROC) curves for men and women separately.ResultsThe optimal sensitivity and specificity obtained from the ROC curves for IR were 88 cm in women (sensitivity of 0.85, 95%CI (0.72-0.93), specificity of 0.58, 95%CI (0.49-0.66)) and 94 cm for men (sensitivity of 0.8, 95% CI (0.65-0.91), specificity of 0.61, 95% CI (0.51-0.71)). The data from the ROC curve for any two other MS criteria confirmed the results and the WC 88 cm in women (sensitivity of 0.82, 95% CI (0.72-0.9), specificity of 0.72, 95% CI (0.62-0.8)) and 94 cm in men (sensitivity of 0.74, 95% CI (0.62-0.84), specificity of 0.73, 95% CI (0.61-0.83)) were corresponded to the optimal sensitivity and specificity.ConclusionWC ≥ 88 cm and ≥ 94 cm should be used as a criterion for the diagnosis of AO for Kyrgyz women and men respectively based on these results.

Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the Korean genome and epidemiology study.

BackgroundIn this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices.MethodsThe cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001–2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices.ResultsThe numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m2 in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively.ConclusionsBoth overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.

Proposed cutoff level of waist circumference in Japanese men: evaluation by homeostasis model assessment of insulin resistance levels.

The aim of this study is to propose the cutoff level of waist circumference (WC) on the basis of homeostasis model assessment of insulin resistance (HOMA-IR) levels in order to diagnose metabolic syndrome (MetS). We examined a total of 798 non-diabetic men (40-65 years of age) by using a receiver operating characteristic (ROC) curve to determine the cutoff level that yielded the maximum sensitivity plus specificity. According to the criteria proposed by the International Diabetes Federation (IDF), and the Japanese Society of Internal Medicine (JSIM), subjects with ≥ 2 metabolic components other than abdominal obesity, were considered to have MetS. The overall prevalence rates of IDF- and JSIM-MetS were 17.4% (n=139) and 15.5% (n=124), respectively. The median levels of WC and HOMA-IR were 83.1 [interquartile range (IQR): 78.5-88.4] cm and 0.84 (IQR: 0.61-1.19), respectively. HOMA-IR was highly correlated with each metabolic parameter (each p<0.05), and in addition, multiple linear regression analysis of HOMA-IR (adjusted R2=0.459) showed that WC level was the strongest independent predictors of HOMA-IR level (F=141.1, p<0.05). According to ROC curve analysis, the cutoff level of HOMA-IR for predicting IDF- and JSIM-MetS was 0.92 for both (sensitivity: 79.9% and 78.2%, specificity: 64.9% and 63.6%). Based on the HOMA-IR level, the proposed WC cutoff level was 82.7 cm (sensitivity: 75.4%, specificity: 63.8%). This study suggests that WC level should be more strictly managed than current criteria, for preventing the development of MetS in non-diabetic middle-aged Japanese men.

Relationship between Alcohol Consumption and Metabolic Syndrome according to Facial Flushing in Korean Males.

BackgroundThe aim of the present study is to evaluate the risk of metabolic syndrome (MS) according to alcohol consumption for those subjects showing facial flushing, as well as the absence of facial flushing.MethodsOne thousand two hundred and one males were recruited in the health promotion center of a university hospital. Evaluation of alcohol consumption and facial flushing was assessed via questionnaires and interviews. The criteria for MS were defined according to the National Cholesterol Education Program Adult Treatment Panel III criteria with a modified waist circumference cutoff value (men ≥ 90 cm) for Korean subjects. Subjects were divided into three groups according to the amount of alcohol they consume: nondrinkers, moderate drinkers (≤14 standard drinks per week), and heavy drinkers (>14 standard drinks per week). They were also separated into two groups according to facial flushing: non-flushers (no occurrence) and flushers (steady occurrence). Factors related to MS were assessed by logistic regression analysis.ResultsIn non-flushing moderate drinkers, the risk of MS did not significantly increase compared to non-drinkers. However in flushing moderate drinkers, there was significant increase (odds ratio [OR], 1.81; confidence interval [CI], 1.08 to 3.06) compared to non-drinkers. In non-flushing and flushing heavy drinkers, significant increase (OR, 2.23; CI, 1.23 to 4.04; OR, 2.90; CI, 1.25 to 6.73, respectively) was evident compared to non-drinkers.ConclusionNon-flushing moderate drinkers did not show an increased risk of metabolic syndrome compared to the non-drinkers, but flushing moderate drinkers showed an increased risk of metabolic syndrome compared to non-drinkers.

Determining the Waist Circumference Cut off which Best Predicts the Metabolic Syndrome components in urban Africans: The SABPA study

Various studies have shown that the relationship between waist circumference (WC) and abdominal obesity is age, gender as well as ethnicity-dependent. WC criteria for Sub Saharan Africans have not been defined by the International Diabetes Federation (IDF). The aim was to determine which WC cut off best predicted Metabolic Syndrome (MetS) in a group of urban African teachers (80 males and 93 females). We determined sphygmomanometer blood pressure, WC, glucose, high density lipoprotein cholesterol (HdL) and triglyceride (TRIG) values. The males' MetS profile was less favourable as their glucose, TRIG and blood pressure levels were higher than the proposed cut off for MetS. The females could be classified as obese, based on their mean BMI (32.78±6.36) and WC (93.48±15.68). Receiver operating characteristic (ROC) WC cut offs of 90, 91, 94 and 96 cm for the respective MetS components in males (blood pressure, HdL, glucose and TRIG) were suggested. In the females, cut offs of 92, 98, 94 and 94 cm for TRIG, blood pressure, HdL and glucose respectively, were put forward. Odds ratios revealed that increased blood pressure best predicted ROC WC in both males (OR 9.59; 95% CI 3.14-29.32) and females (OR 3.11; 95% CI 1.30-7.42) irrespective of age. We suggest that the optimal cut off point for the males be set at 90 cm, as opposed to the current 94 cm; whilst the female cut off be set at 98 cm as opposed to the existing cut off of 80 cm. Larger sample groups are recommended to justify our data.

J-033 THE ASSOCIATION BETWEEN SERUM URIC ACID LEVEL AND METABOLIC SYNDROME

Background Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the associations of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. Methods We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38–87) who participated in baseline examinations of the Korean Genome and Epidemiology Study- Kangwha study. Blood samples were collected after at least 8-hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8–5.6, 5.6–6.5, and ≥6.5 mg/dL for males: and <3.8, 3.8–4.3, 4.3–5.1, and ≥5.1 mg/dL for females. Metabolic syndrome was defined by the criteria proposed by the National Cholesterol Education Program Adult Treatment Panel-III with adjusted cutoffs for waist circumference (>90 cm for males, >80 cm for females). Association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. Results Odds ratio for having metabolic syndrome for the highest versus lowest quartiles of serum uric acid level was 2.67 (95% CI, 1.78–4.00) in males and 3.32 (95% CI, 2.46–4.48) in females. The association remained significant after adjustment for age, sex, smoking, alcohol intake, body mass index, total cholesterol, HDL-cholesterol, HbA1c, albumin, γ-glutamyltransferase, blood urea nitrogen, and C-reactive protein; the corresponding odds ratio was 2.08 (95% CI, 1.21–3.57) in males and 1.68 (95% CI, 1.14–2.49) in females. Conclusion Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.

Optimal Cut-Off Values of Anthropometric Markers to Predict Hypertension in North Indian Population

The aim of the study was to determine the cut-offs of anthropometric markers for detecting hypertension in an endogamous North Indian population. A cross-sectional study was carried out to collect data from 578 adult Aggarwal Baniya subjects (271 men and 307 women, mean age: 43.4±5.3 and 38.7±4.9 respectively) using multistage, stratified sampling method. Individual body weight, height, waist circumference (WC), hip circumference, blood pressure were assessed. Receiver operating characteristic (ROC) analysis was used to find out the optimal cut-off values of various anthropometric markers to predict hypertension. The likelihood ratios for having hypertension in subjects with various cut-off values were calculated. Logistic regression analysis was used to examine the independent relationship between the anthropometric markers and odds of having hypertension. The BMI cut-off to predict hypertension was 22.8kg/m(2) in men and 28.8kg/m(2) in women. The optimal WC cut-offs varied from 91-92cm in both men and women. The WHR cut-off was about 0.90 in men and 0.78 in women respectively, and the optimal WHtR cut-off was 0.56 in men and 0.43 in women. The cut-off levels for BMI, WC and WHtR corresponded to the inflexion points in the likelihood ratio graphs. The area under curve (AUC) and odds ratios showed that the risk of having hypertension was highest with respect to increased BMI and that BMI is the best predictor of having hypertension. The cut-off points for detecting cardiovascular risk factors among our population are lower than the criteria by the World Health Organization. Although these results may not be readily applied to the rest of the Indian populations due to the multiethnic composition, they point to the necessity of similar studies with large randomized samples to find the cut-off levels for chronic conditions in different populations.

Cut off values of waist circumference &amp; associated cardiovascular risk in egyptians

BackgroundRecent guidelines stressed the need to adopt different values of waist circumference (WC) measurements to define abdominal obesity in different ethnic groups. The aim of this study is to identify WC cutoff points in normotensive and hypertensive subjects which are diagnostic of abdominal obesity in a Middle Eastern population and the prevalence of abdominal obesity in a nationwide sample.MethodsData were collected during phase-2 of the Egyptians National Hypertension Project survey. Blood pressure, anthropometric measurements and laboratory studies were performed according to a standardized protocol by trained personnel. To derive the cutoff points for WC, we applied the factor analysis on CV risk factors: diabetes mellitus, decrease in HDL-C and increase in LDL-C, triglycerides and left ventricular mass index by echocardiography.ResultsThe sample included 2313 individuals above the age of 25 years. WC values (mean ± SD) were 88 ± 14 cm and 95 ± 14 cm for normotensive (NT) and hypertensive (HT) men respectively, and 89.6 ± 14.7 cm and 95.7 ± 15.9 cm for NT and HT women respectively. Applying factor analysis, the weighted average cutoff points were 93.5 cm for both NT and HT men and 91.5 and 92.5 cm for NT and HT women respectively. Based on these thresholds, the prevalence of abdominal obesity was 48% in men and 51.5% in women.ConclusionThis is the first report of specific abdominal obesity cutoff points in a Middle Eastern country. The cutoff points were different from the Europid standards. There is a high prevalence rate of abdominal obesity among Egyptians which is associated with increased prevalence of cardiometabolic risk factors.

Optimal Cutoff Values for High-Risk Waist Circumference in Older Adults Based on Related Health Outcomes

The authors aimed to explore optimal cutoffs for high-risk waist circumference (WC) in older adults to assess the health risks of obesity. Prospective data from 4,996 measurements in 2,232 participants aged ≥70 years were collected during 5 triennial measurement cycles (1992/1993-2005/2006) of a population-based cohort study, the Longitudinal Aging Study Amsterdam (Amsterdam, the Netherlands). Cross-sectional associations of WC with pain, mobility limitations, incontinence, knee osteoarthritis, cardiovascular disease, and diabetes were studied. Generalized estimating equations models were fitted with restricted cubic spline functions in order to carefully study the shapes of the associations. Model fits for applying different cutoffs to categorize WC in the association with all outcomes were tested using the quasi-likelihood under the Independence Criterion (QIC). On the basis of the spline regression curves, potential WC cutoffs of approximately 109 cm in men and 98 cm in women were proposed. Based on the model fit, cutoffs between 100 cm and 106 cm were equally applicable in men but should not be higher. In women, the QIC confirmed an optimal cutoff of 99 cm.

Determination of the cutoff point for waist circumference that establishes the presence of abdominal obesity in Latin American men and women

AimsThe recent definitions of the metabolic syndrome (MS) recognize the need for ethnic and region-specific waist circumference (WC) cut-offs that identify people with abdominal obesity. We tested WC as a diagnostic tool to identify people with visceral adiposity in Hispanics from the Latin America region. MethodsWe used the area of visceral adipose tissue (VAT) ≥100cm2 at the level between the 4th and 5th lumbar vertebrae in abdominal CT scans as a marker of visceral adiposity and established the optimal WC threshold for men and women by means of receiver operating characteristic (ROC) curves. Results179 men and 278 women from Mexico, El Salvador, Venezuela, Colombia and Paraguay were included. The ROC curves were highly discriminative of excess VAT for men and women (area under the curve 0.9 and 0.8 respectively) and the WC threshold was identified at 94cm for men and between 90 and 92cm for women. ConclusionIn men the WC cutoff was equal to that proposed for europids and suggested for US adults who may have strong genetic contribution to insulin resistance such as Hispanics. In women the threshold was significantly higher than previously proposed for South and Central Americans.

Appropriate Waist Circumference Cutoff Values for the Diagnosis of Metabolic Syndrome in Mexican American Adults

BackgroundMetabolic syndrome (MS) increases the risk of cardiovascular disease and diabetes. The International Diabetes Federation (IDF) recently proposed new criteria for the diagnosis of the MS, which requires the presence of central obesity as measured by ethnic specific waist circumference (WC) cutoff values. Currently, no specific WC thresholds for central obesity are available in Hispanics.ObjectiveTo determine appropriate gender specific WC thresholds for diagnosis of central obesity in Mexican American adults and to estimate the prevalence of MS using the IDF definition with and without our modified WC in this population.DesignData from 3265 Mexican American adults aged 20–80 years who participated in the National Health and Nutrition Examination Survey 1999–2006 were used.ResultsROC curve analysis suggested that yielding at least 80% sensitivity, the WC value of 90 cm in both genders was more appropriate in predicting the presence of two or more MS risk factors in this population. Based on our cutoff, there was 34% reduction in the prevalence of central obesity in women (82.5% to 54.2%). The age adjusted prevalence of MS decreased from 58.4 to 48.2%. The MS was more common among Mexican American men than women (55.8% in men versus 37.8% in women, P =0.0003).ConclusionOur findings provide practical guidance in the assessment and screening of central obesity and MS in Mexican Americans.

Periodontitis and Obesity: A Study of the Fourth Korean National Health and Nutrition Examination Survey

The present study aims to determine whether there is an association between periodontitis and obesity among Korean adults who participated in the Fourth Korean National Health and Nutrition Examination Survey (KNHANES). In 2007, 4,246 subjects, >19 years of age, who participated in the KNHANES (a cross-sectional survey conducted by the Korea Centers for Disease Control and Prevention) were selected for analysis. Participants underwent a periodontal examination and anthropometric measurements, and were asked to complete a questionnaire about their socioeconomic status and overall health status. Body mass index (BMI) and waist circumference (WC) were used as measures of overall body fat and upper body fat. Standard BMI and WC cutoff points were used, as established by the World Health Organization and the Korean Society for the Study of Obesity. Periodontal status was assessed by Community Periodontal Index and periodontitis was defined as ≥ "code 3." Multivariate logistic regression analyses were carried out, adjusting for the following variables: sex; age; household income; bedtime toothbrushing habits; use of dental floss; use of an interproximal toothbrush; presence of active tooth decay; the number of decayed, missing, or filled permanent teeth; diabetes mellitus; and present smoking status. In multivariate logistic regression analysis, there was no association between BMI and periodontitis. Obese people with BMI ≥25 had an adjusted odds ratio of 0.991 (0.806 to 1.220) for having periodontitis. But we found a significant association between abdominal obesity and periodontitis. After adjusting for all covariates, the adjusted odds ratio for periodontitis was 1.358 (confidence interval 1.003 to 1.839) for obese subjects. A high WC seems to be associated with periodontitis, whereas BMI does not. This finding shows that abdominal obesity is significantly correlated with periodontitis.

Problems in the Japanese criteria for metabolic syndrome.

Dear Editor, Ogawa et al. studied the cut-off point of waist circumference (WC) for the clustering of two or more metabolic risk factors among the three non-WC components of Japanese metabolic syndrome (JMetS) and proposed to amend JMetS regarding the cut-off point of WC for women1. However, the most dangerous drawback of JMetS criteria is that it makes abdominal obesity a necessary component. Other problems of JMetS criteria are the cut-off point of impaired fasting glucose, the unnecessary combination of two components (hypertriglyceridemia and hypo-high-density lipoprotein cholesterolemia into one component) and the cut-off point of high-density lipoprotein cholesterol for women. In 2009, a worldwide consensus statement2 for the criteria of metabolic syndrome (MetS) was jointly issued by the International Diabetes Federation (IDF) Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute (NHLBI); American Heart Association (AHA); World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. In this statement, the revised National Cholesterol Education Program (NCEP) criteria (AHA/NHLBI criteria) where abdominal obesity is not a necessary component was adopted as the worldwide definition of MetS. The 2005 IDF criteria of MetS where abdominal obesity is a necessary component were withdrawn by the IDF itself. However, the cut-off points of WC could not be determined for any ethnic groups2. In 2007, the Association for Weight Management and Obesity Prevention, the Obesity Society, the American Society for Nutrition, and the American Diabetes Association issued a consensus statement regarding WC, where they stated that there is not yet a compelling body of evidence showing that WC provides clinically meaningful information that is independent of well-known cardiometabolic risk factors3. Although the cut-off points of WC were controversial, those of body mass index (BMI) were widely accepted as 25 kg/m2 for overweight and 30 kg/m2 for obesity. We compared BMI, WC and percentage of body fat as markers for the clustering of metabolic risk factors in 2444 Japanese men and 1442 Japanese women, and found no significant difference among these three obesity parameters as a marker of metabolic risk clustering4. Therefore, both a BMI cut-off point of 25 kg/m2 and a WC cutoff point of 85 cm for men and 80 cm for women might be appropriate for a cut-off point of an obesity component of MetS. However, the most important point is that obesity is not a necessary component of MetS. It was pointed out by NIPPON DATA90 that the definition of MetS where obesity is a necessary component is dangerous, because normal-weight individuals have a high mortality risk and are more prevalent than obese or overweight subjects in Japan. A Japan Public Health Center-based (JPHC) study also concluded that the MetS definition requiring obesity or overweight as a necessary component might not necessarily identify normal-weight individuals who have a high mortality risk and are more prevalent than subjects with JMetS, and suggested that MetS based on the AHA/NHLBI criteria predicts cardiovascular disease better than MetS based on the 2005 IDF criteria where abdominal obesity is a necessary component.

The Prevalence of Metabolic Syndrome and Determination of the Optimal Waist Circumference Cutoff Points in a Rural South African Community

OBJECTIVETo determine the prevalence of metabolic syndrome and to define optimal ethnic-specific waist-circumference cutoff points in a rural South African black community.RESEARCH DESIGN AND METHODSThis was a cross-sectional survey conducted by random-cluster sampling of adults aged >15 years. Participants had demographic, anthropometric, and biochemical measurements taken, including a 75-g oral glucose tolerance test. Metabolic syndrome was defined using the 2009 Joint Interim Statement (JIS) definition.RESULTSOf 947 subjects (758 women) studied, the age-adjusted prevalence of metabolic syndrome was 22.1%, with a higher prevalence in women (25.0%) than in men (10.5%). Peak prevalence was in the oldest age-group (≥65 years) in women (44.2%) and in the 45- to 54-year age-group in men (25.0%). The optimal waist circumference cutoff point to predict the presence of at least two other components of the metabolic syndrome was 86 cm for men and 92 cm for women. The crude prevalence of metabolic syndrome was higher with the JIS definition (26.5%) than with the International Diabetes Federation (IDF) (23.3%) or the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII) (18.5%) criteria; there was very good agreement with the IDF definition (κ = 0.90 [95% CI 0.87–0.94]) and good concordance with ATPIII criteria (0.77 [0.72–0.82]).CONCLUSIONSThere is a high prevalence of metabolic syndrome, especially in women, suggesting that this community, unlike other rural communities in Africa, already has entered the epidemic of metabolic syndrome. Waist circumference cutoff points differ from those currently recommended for Africans.

Use of waist circumference and its optimal value to identify obesity in relation to hypertension: a cross-sectional study among adult male slum dwellers of Eastern India

Background: Waist circumference (WC) is a useful surrogate marker of abdominal adiposity and a risk factor of cardiovascular disease and hypertension. Asians have higher abdominal fat at a lower level of body mass index (BMI). Previous studies showed that WC was the best measure and correlate of abdominal fat and general adiposity, respectively, among the Bengalee people of Eastern India including the present sample.This study aimed to evaluate the clinical usefulness of waist circumference and its appropriate cut-off in identifying obesity and hypertension.Methods: Adult male slum dwellers aged between 18 and 60 years were included in the study. Height, weight, skinfolds, waist circumference, systolic- (SBP) and diastolic blood pressures (DBP) were measured.Body mass index (BMI) and percent body fat (PBF) were also calculated. Obesity was defined as &gt;25% of body fat. Mean (+ SD) and range statistics were used to describe the variables. WC values were divided into four categories, viz. &lt;72cm, 72-79.9cm, 80-84.9cm and ≥ 85.0cm. ANCOVA was performed to observe the differences in mean SBP and, DBP between the WC categories, with age, smoking and alcohol consumption status as covariates. Pearson correlation and multiple linear regressions were employed to examine the relationship of WC with SBP and DBP. Adjusted odds ratios for hypertension by WC categories were obtained through logistic regression analysis. Receiver operating characteristic (ROC) curve analysis revealed the optimal value of WC to identify obesity. Results and conclusions: PBF increased significantly (F = 208.74, p&lt;0.001) from the lowest WC category (10.6%) to the highest one (26.9%). Mean SBP and DBP also increased significantly from the lowest to the highest WC categories. Waist circumference had significant positive effect on both SBP (T=2.559, p&lt;0.01) and DBP (T=3.256, p&lt;0.05) irrespective of age and PBF. WC value &gt;80.9cm could be accepted as the best cut-off point for WC to identify obesity. Participants with a WC of 80-84.9 cm were around three times more likely to have HT(p&lt;0.005), however the likelihood increased to over 5 for those with a WC of &gt; 85.0 cm when compared to lower WC categories. The odds ratio significantly increased for WCs at or above 80cm.Therefore the measurement of WC could be used to identify general obesity and be used as a screening toolfor HT risk factors in Bengalee urban slum dwelling men. The WC cut off to define obesity and identifyinghypertension was around 81cm