Anthropometric cut-points for discriminating diabetes and the metabolic syndrome among Arabs and Asians: the Kuwait Diabetes Epidemiology Program

Abstract

This study aimed to determine anthropometric cut-points for screening diabetes and metabolic syndrome (MetS) in Arab and South Asian ethnic groups in Kuwait; and to compare the prevalence of MetS based on the ethnic-specific waist circumference (WC) cut-point and the International Diabetes Federation (IDF), and American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) WC criteria. The national population-based survey dataset of diabetes and obesity in Kuwait adults aged 18-60 years were analysed. Age-adjusted logistic regression and receiver operating characteristic (ROC) analyses were conducted to evaluate for 3589 individuals the utility of WC, waist-to-height ratio (WHtR) and body mass index (BMI) to discriminate both diabetes and ≥3 CVD risk factors. Areas under the ROC curve were similar for WC, WHtR and BMI. In Arab men, WC, WHtR and BMI cut-offs for diabetes were 106 cm, 0.55, and 28 kg/m2; and for ≥3 CVD risk factors, 97cm, 0.55, and 28 kg/m2, respectively. In Arab women, cut-offs for diabetes were 107 cm, 0.65, and 33 kg/m2; and for ≥3 CVD risk factors, 93 cm, 0.60 and 30 kg/m2 respectively. WC cut-offs were higher for South Asian women than men. IDF-based WC cut-offs corresponded to a higher prevalence of MetS across gender and ethnic groups, compared to Kuwait-specific cut-offs. Any of the assessed anthropometric indices can be used in screening of diabetes and ≥3 CVD risk factors in Kuwaiti Arab and Asian populations. ROC values were similar. The WC threshold for screening MetS in Kuwaiti Arabs and South Asians are higher for women.

Assessing metabolic syndrome prediction quality using seven anthropometric indices among Jordanian adults: a cross-sectional study

“…Also, a study among Arab and South Asian Residents in Kuwait presented men with more incidence of metabolic abnormalities including hypertension, elevated FPG, and TG in both Arabs and South Asian groups. Abnormal low levels of HDL-C, was seen in Arab men more than Arab women, but it was higher among Asian women than men 46 . In the East of Asia, specifically China, more women had an abnormal WC, HDL-C, TC, and LDL-C compared to men, whereas hypertension, elevated TG and FPG levels occurred in men more than in women 47 .…”

Metabolically Healthy and Unhealthy Obese Phenotypes among Arabs and South Asians: Prevalence and Relationship with Cardiometabolic Indicators

“…In both BMI- and WC-defined obesity, our study found that the MuHO phenotype has the highest mean or median hs-CRP, ALT, and HOMA-IR values compared to other phenotypes. However, the relationship between these markers and MHO are of particular interest given the high prevalence of diabetes, obesity, and associated increased CVD risk in the Kuwait population [ 17 , 20 , 25 , 26 ], and the understanding that obesity is not invariably associated with adverse metabolic conditions [ 27 ].…”

“…A total of 1712 participants remained for analysis after the exclusion of records without hs-CRP measures. South Asian expatriates residing in Kuwait were predominantly from India, Pakistan, Sri Lanka, and Bangladesh; Arab groups were mainly from Kuwait, Egypt, Lebanon, Syria, Jordan, Iran, Palestine, and Yemen, as previously described [ 20 ]. Given that this is a secondary analysis of the data from the Kuwait Diabetes Epidemiology program, our prevalence estimates of MHO from this subsample (1712 participants) will be generalisable at 8% margin of error, and 90% confidence level, assuming a 24% baseline prevalence of MHO [ 21 ], and 40% non-response rate.…”

“…Anthropometric measurements were carried out on participants in light clothing and barefoot. The procedure and measuring instrument used to evaluate obesity and hypertension in this study have been published in our previous study [ 17 , 20 ]. The body mass index (BMI) was used to classify participants into underweight (<18.5 kg/m 2 ), normal weight (18.5–24.9 kg/m 2 ), overweight (25.0–29.9 kg/m 2 ), and obese (≥30 kg/m 2 ).…”

“…The method used for the measurement of biochemical parameters in this survey has been published previously [ 17 , 20 ]. For brevity, study participants fasted for at least 10 h prior to the collection of fasting blood samples.…”