Aim:We reevaluated waist circumference as a diagnostic criterion of metabolic syndrome (MetS) in Japanese. Methods: 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. Results: 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. Conclusion: 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 100/cm) or waist-to-height 2 (cm 10,000/cm 2 ) ratio, determined as 51 in men and 52 in women, or 30 in men and 33 in women, respectively. J Atheroscler Thromb, 2008; 15:94-99.Key words; Metabolic syndrome (MetS), Waist circumference, ROC curve, Height and 90 cm in women, accompanied by at least two of the following three risk factors: dyslipidemia, raised blood pressure, and raised fasting glucose. Although the cut-off point for waist circumference was defined by unique evidence corresponding to visceral fat area obtained by computed tomography (CT) scanning in Japanese subjects 9) , the optimal waist circumference cut-off has now become controversial. Because overt visceral fat obesity in Japanese is relatively low especially in women, waist circumference might lead to misdiagnosis, even when other risk factors are clustered. In fact, data obtained from 692 subjects in a community-based cohort study 10) and 329 subjects in a population-based study 11) in Japan indicate that a shorter waist circumference cut-off than those currently used would be optimal.

Background: The association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes. We investigated the usefulness of GA by comparing it with hemoglobin A1c (HbA1c) in this patient population. Research design and methods: This was a multi-center, prospective cohort study of 841 Japanese chronic hemodialysis patients with diabetes. There were 235 women and 606 men included, with a mean age of 64 years. The primary and secondary endpoints were the incidence of all-cause and cause-specific mortality, respectively. The hazard ratios of GA and HbA1c for the endpoints were estimated using the values at baseline and during the study period. Results: During the mean follow-up period of 3.1 years, there were 184 deceased cases, in which 30 and 154 resulted from atherosclerotic cardiovascular disease (ASCVD) and non-ASCVD, respectively. The hazard ratio for a 1% increase in GA was 1.033 (95% confidence interval 1.006-1.060, p = 0.017) for all-cause mortality with a statistical significance when GA was treated as a time dependent variable, but not when the baseline levels or the mean levels during the followup period were used in the analysis (p = 0.815 and 0.517, respectively). GA was a significant predictor for ASCVD-related mortality in the above 3 models, but was not for non-ASCVD mortality. Higher levels of HbA1c were only associated with ASCVD-related mortality when HbA1c was treated as a time-dependent variable.

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