Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups

Abstract

Current waist circumference (WC) and waist-to-hip ratio (WHR) cutoffs have been identified from studies of predominantly European-derived populations. However, these cutoffs may not be appropriate for other ethnic groups. This paper reviews the literature regarding ethnic differences in body composition and the appropriateness of ethnic-specific WC and WHR cutoffs in various ethnic groups. Studies investigating ethnic-specific cutoffs were identified among Aboriginal, Asian, African (SubSaharan), African-American, Hispanic, Middle Eastern, Pacific Islander and South American populations. Abstracts that recommended WC and/or WHR cutoffs (or rejected the use of cutoffs) were included with their supporting literature. The evidence for ethnic-specific WC and/or WHR cutoffs was then rated as either convincing, probable, possible or insufficient. The majority of studies recommending ethnic-specific cutoffs was for Asian populations. Few studies recommended cutoffs in Aboriginal, African (Sub-Saharan), Pacific Islanders and South American populations. All studies were cross-sectional, and the overwhelming majority of studies used receiver operating characteristic curves. The studies used a number of methods for assessing WC and WHR, and a variety of outcome measures, making cross-study comparison difficult. There is possible evidence that Asians should have a lower WC cutoff than Europeans. The evidence is insufficient for specific cutoffs for African-American, Hispanic and Middle Eastern populations but some studies indicate current cutoffs for Europeans may be appropriate, whereas there is insufficient evidence for the other ethnic groups. Future studies are needed to address the methodological limitations of the current literature.

Body fat distribution and noncommunicable diseases in populations: overview of the 2008 WHO Expert Consultation on Waist Circumference and Waist–Hip Ratio

“…As already noted, the same questions were asked about BMI cutoff points in Asian populations (WHO, 2004), resulting in qualified support for the use of different cutoff points. The conclusion by Lear et al (2009) regarding WC and WHR is congruent with the BMI finding in that, lower cutoffs may be appropriate for Asians compared with Europeans. Data were inconclusive or insufficient to come to conclusions that special cutoff points would be required for any of the other ethnic groups addressed in the reviews.…”

“…The issue of whether cutoff points should vary for different ethnic groups has not been settled, and is addressed most extensively in the review by Lear et al (2009), which draws on studies in Aboriginal, Asian, Sub-Saharan African, African American, Hispanic, Pacific and South-American populations. These authors point out that differences in body composition or conformation may influence the validity of inter-ethnic comparisons and, furthermore, that ethnic or 'racial' classifications are difficult to standardize and interpret.…”

Optimal cut-off values and population means of waist circumference in different populations

“…Since most studies are cross-sectional, more cohort studies in this area have been encouraged (2,70) . However, if the approach of maximising sensitivity and specificity is applied to cohort data, the strong relationship between estimated cut-off values and population means remains, as indicated by the high correlation coefficient among cohort studies in the present review.…”

“…The identification of waist circumference cut-off points is critical for both clinical care and public health research. Recently, an increasing number of research papers have been published to define optimal waist circumference cutoff values in different populations (2,3) . Most of those papers solely rely on the receiver-operating characteristic (ROC) curve method to maximise sensitivity and specificity to define 'optimal' cut-off values.…”

“…Therefore, waist circumference is often used as a surrogate marker of abdominal fat mass, because waist circumference correlates with abdominal fat mass and is associated with cardiometabolic disease risk (1) . Although there is a continuous association between waist circumference and the risk of cardiometabolic disease, a cut-off point is often determined for defining abdominal (or central) obesity for population screening (2,3) . The identification of waist circumference cut-off points is critical for both clinical care and public health research.…”