Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Brazilian adults: baseline analyses of the Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

BackgroundWaist circumference (WC) has been incorporated in the definition of the metabolic syndrome (MetS) but the exact WC cut-off points across populations are not clear. The Joint Interim Statement (JIS) suggested possible cut-offs to different populations and ethnic groups. However, the adequacy of these cut-offs to Brazilian adults has been scarcely investigated. The objective of the study is to evaluate possible WC thresholds to be used in the definition of MetS using data from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of civil servants (35–74 years old) of six Brazilian cities.MethodsWe analyzed baseline data from 14,893 participants (6772 men and 8121 women). A MetS was defined according to the JIS criteria, but excluding WC and thus requiring 2 of the 4 remaining elements. We used restricted cubic spline regression to graph the relationship between WC and MetS. We identified optimal cut-off points which maximized joint sensitivity and specificity (Youden’s index) from Receiver Operator Characteristic Curves. We also estimated the C-statistics using logistic regression.ResultsWe found no apparent threshold for WC in restricted cubic spline plots. Optimal cut-off for men was 92 cm (2 cm lower than that recommended by JIS for Caucasian/Europids or Sub-Saharan African men), but 2 cm higher than that recommended for ethnic Central and South American. For women, optimal cut-off was 86, 6 cm higher than that recommended for Caucasian/Europids and ethnic Central and South American. Optimal cut-offs did not very across age groups and most common race/color categories (except for Asian men, 87 cm).ConclusionsSex-specific cut-offs for WC recommended by JIS differ from optimal cut-offs we found for adult men and women of Brazil´s most common ethnic groups.

Anthropometric and metabolic profile of a Brazilian Amerindian group: The Xikrin (Mebengôkre)

“…Chronic noncommunicable diseases (NCDs) only began to be observed in Brazilian indigenous populations in the late 1970s. The emergence of NCDs among indigenous people is closely related to such factors as changes in subsistence, diet, and physical activity, which are associated with sociocultural and economic changes resulting from interaction with mainstream society that has led to the "Westernization" of customs (review in Basta et al, 2012). These changes are comparable to those affecting Native Americans in the second half of the 20th century, during which important sociocultural changes led to a dramatic increase in chronic diseases (Young, 1997).…”

“…Available data from Brazilian indigenous health show that the epidemiological profile of most populations is characterized by the coexistence of old health problems, such as malnutrition, and deficiency diseases, such as anemia among children and women of reproductive age, and new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemias), along with the so-called social pathologies-violence and negative effects of alcohol and drug abuse, mainly among adults (review in Basta, Orellana, & Arantes, 2012). Based on this evidence, this study was carried out with the objective of describing the prevalence of predisposing factors for cardiovascular diseases, based on the metabolic and anthropometric profile, among the Xikrin Amerindian group located in the state of Pará, Brazilian Amazon, in order to plan health education actions and early treatment to contain or minimize the impact of these diseases on this indigenous population.…”

Neutrophil-Lymphocyte Ratio in Patients with Acute Heart Failure Predicts In-Hospital and Long-Term Mortality

“…To find the cut-off value of the NLR, the multivariate restricted cubic splines methods was used. This method provide a useful tool for the analysis of the effect of a continuous predictor on an outcome when the relationship between an outcome (dependent) variable and the explanatory (indepednet) variables is not linear because this method allows for great flexibility in the form of the relationship between predictor and outcome [18,19]. All p values are two-sided, and a value of less than 0.05 was considered statistically significant.…”

Optimal cut-off points for waist circumference in the definition of metabolic syndrome in Chile

“…This recommendation has also been considered by the Latin American Association of Diabetes. In Brazil, after analysing 6772 men and 8121 women, Cardinal et al (21) found cut-off points of 92•0 and 86•6 cm for men and women, respectively (21) . In Colombia, Mora-García identified a threshold of 85•0 cm in women (22) .…”

“…MetS is usually defined as the presence of at least three out of five components (7)(8)(9) . However, as WC was the outcome in the current study, instead of using three out of five in the definition of MetS, at least two out of four were used to indicate its presence following previous approaches in Latin American studies (21,22) .…”