Development of Health‐Related Waist Circumference Thresholds Within BMI Categories

Abstract

Research Methods and Procedures:The sample included adults classified as normal weight (BMI ϭ 18.5 to 24.9), overweight (BMI ϭ 25 to 29.9), obese I (BMI ϭ 30 to 34.9), and obese IIϩ (BMI Ն 35) from the Third U.S. National Health and Nutrition Examination Survey (NHANES III; n ϭ 11,968) and the Canadian Heart Health Surveys (CHHS; n ϭ 6286). Receiver operating characteristic curves were used to determine the optimal WC thresholds that predicted high risk of coronary events (top quintile of Framingham scores) within BMI categories using the NHANES III. The BMI-specific WC thresholds were crossvalidated using the CHHS. Results: The optimal WC thresholds increased across BMI categories from 87 to 124 cm in men and from 79 to 115 cm in women. The validation study indicated improved sensitivity and specificity with the BMI-specific WC thresholds compared with the single thresholds. Discussion: Compared with the recommended WC thresholds, the BMI-specific values improved the identification of health risk. In normal weight, overweight, obese I, and obese IIϩ patients, WC cut-offs of 90, 100, 110, and 125 cm in men and 80, 90, 105, and 115 cm in women, respectively, can be used to identify those at increased risk.

Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity

“…27 Waist circumference cutoff point were defined to be 80.5 and 71.5 cm for Taiwanese 28 and X85 and X80 cm for Chinese men and women, respectively. 29 Lower waist circumference cutoff points as compared to the presently accepted values have been shown for other Asian populations as well: Japanese 30 and Malays. 31 Asian Indians have relatively higher truncal and abdominal fat mass as compared to Caucasians and black population despite similar or less average value of waist circumference.…”

Addition of Cardiorespiratory Fitness Within an Obesity Risk Classification Model Identifies Men at Increased Risk of All-Cause Mortality

“…Waist circumference was measured at the level of the umbilicus. Participants were classified as abdominally obese according to body mass index-specific thresholds derived by Ardern et al [7]. Thresholds for males are: normal body mass index (18.5-24.9), waist circumference threshold of ≥90 cm; overweight body mass index (25.0-29.9), waist circumference threshold of ≥100 cm; and obese body mass index (30.0-34.9) waist circumference threshold of ≥110 cm.…”

“…Thresholds for males are: normal body mass index (18.5-24.9), waist circumference threshold of ≥90 cm; overweight body mass index (25.0-29.9), waist circumference threshold of ≥100 cm; and obese body mass index (30.0-34.9) waist circumference threshold of ≥110 cm. For the analysis involving waist circumference alone, a waist circumference threshold of 96 cm was used [7].…”

“…Use of the 102 cm threshold classifies very few individuals with normal and overweight body mass index, and almost all individuals who are obese with high waist circumference based on this cut-point [6]. In response, Ardern and colleagues proposed the use of waist circumference values specific to each body mass index category to identify coronary heart disease mortality risk that were developed and cross-validated using large representative samples [7].…”

Application of obesity treatment algorithms to Canadian adults

“…An ROC analysis of the CHHS (Dobbelsteyn et al, 2001) demonstrated that thresholds of 80 cm (F)/90 cm (M) provided the best balance between sensitivity and specificity in predicting the presence of Z2 CVD risk factors. Recently, it was shown that specific WC thresholds within BMI categories could improve the identification of individuals at high risk of future coronary events over a single WC cutoff (Ardern et al, 2004). Adjusting the currently recommended WC cutoffs may help identify at-risk individuals with an elevated WC and Z2 CVD risk factors who may otherwise escape the attention of clinicians using the NIH algorithm.…”