Waist Circumference as a Screening Tool for Cardiovascular Risk Factors: Evaluation of Receiver Operating Characteristics (ROC)

Han, Thang S.; Leer, E.M. van; Seidell, Jacob C.; Lean, Michael E. J.

doi:10.1002/j.1550-8528.1996.tb00267.x

Cited by 87 publications

(75 citation statements)

References 19 publications

(5 reference statements)

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“…55 y old at some sites are in line with the notion that high overall adiposity is not more associated with CVD in older than younger subjects. 1,44 In these populations and in West African men in particular, WC values were generally lower than those that have been described for Western populations. 10,21,45,46 The reason for this may due to the mean BMI values in these subjects, which were also somewhat low and may also have contributed to the predictive differences for hypertension.…”

Section: Discussioncontrasting

confidence: 53%

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Predictive value of abdominal obesity cut-off points for hypertension in Blacks from West African and Caribbean island nations

Okosun

et al. 2000

Int J Obes

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BACKGROUND: Waist circumferences (WC) ! 94 cm for men and ! 80 cm for women (action level I) and ! 102 cm for men and ! 88 cm for women (action level II) have been suggested as limits for health promotion purposes to alert the general public to the need for weight loss. In this analysis we examined the ability of the above cut-off points to correctly identify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados. We also determined population-and gender-speci®c abdominal adiposity cut-off points for epidemiological identi®cation of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as seen from the front or at midpoint between the bottom of the rib cage and 2 cm above the top of the iliac crest. Sensitivity and speci®city of the established WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population-and gender-speci®c cut-off points associated with risk of hypertension were determined over the entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hypertension were poor compared to the speci®c cut-off points estimated for each population. Different values of WC were associated with increased risk of hypertension in these populations. In men, WC cut-off points of 76, 81, 80, 83 and 87 cm provided the highest sensitivity for identifying hypertensives in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identi®cation of risk of hypertension. For the purpose of health promotion, the decision on what cut ± off points to use must be made by considering other additional factors including overall impact on health due to intervention (e.g. weight reduction) and potential burden on health services if a low cut-off point is employed. There is a need to develop abdominal adiposity cut-off points associated with increased risks for cardiovascular diseases in different societies, especially for those populations where the distribution of obesity and associated risk factors tends to be very different from those of the technologically advanced nations.

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Section: Discussioncontrasting

confidence: 53%

“…The point of intersection between lines of speci®city and sensitivity identi®ed the highest numbers of subjects with and without hypertension. 1 We also calculated positive and negative predictive values of WC cut-off points for hypertension.…”

Section: Methodsmentioning

confidence: 99%

Predictive value of abdominal obesity cut-off points for hypertension in Blacks from West African and Caribbean island nations

Okosun

et al. 2000

Int J Obes

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“…For example, waist circumference acts as a good proxy for total abdominal fat, 9,10 and can be used satisfactorily as an indication of clinical risk. 11,12 Both lean mass (LM) and fat mass (FM) are positively correlated with height, hence to be most informative, comparisons between individuals require its confounding effect to be removed. In this paper, we use the term relative LM (or FM) to describe these body components after adjustment for height.…”

Section: Introductionmentioning

confidence: 99%

A simplified approach to analysing bio-electrical impedance data in epidemiological surveys

et al. 2006

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Background: Bio-electrical impedance analysis (BIA) is widely used to estimate body composition. It is simple, quick and cheap, but less accurate than other methods. It has potential epidemiological value, but has conventionally required validation before application. Aims: To develop a simple method of expressing weight, height and impedance data that avoids the need for populationspecific validation equations in order to facilitate epidemiological application. Methods: Body composition was measured using the four-component model in young adults (43 males, 90 females). Impedance (R) was measured hand-foot and foot-foot. Lean mass and fat mass were adjusted for height to give lean mass index (LMI) and fat mass index (FMI). Based on theoretical principles, we generated the index 1/R, which provides an index of body water adjusted for height. Sex-specific regression models were used to investigate the relationships between (a) 1/R and LMI, and (b) body mass index (BMI) adjusted for 1/R and FMI. The success of this approach was evaluated in relation to the conventional BIA approach, using correlation analysis. Results: 1/R was a highly significant predictor of LMI. BMI adjusted for 1/R was a significant predictor of FMI. Our approach performed as well as the conventional approach for LMI, but not for FMI. Discussion: Direct use of BIA data, rather than their combination with population-specific equations for the prediction of total body water, proved successful at ranking individuals of both sexes in terms of LMI and FMI. The index 1/R may prove particularly valuable in epidemiological studies where ranking of LMI is required.

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“…16 It is now well known that both body composition (lean and fat mass) and body fat distribution (the body shape) play a major role in causing morbidity and mortality. [17][18][19][20][21][22][23][24][25] In particular, lower levels of muscle mass and subcutaneous fat are associated with an increased risk of cancer mortality; 26 excess intra-abdominal fat, as measured by large waist circumference (WC), is associated with an increased risk of developing a number of chronic diseases (including type 2 diabetes and cardiovascular disease), 27,28 whereas larger hip circumference (HC) independently predicts good health and is associated with a better metabolic profile. [29][30][31] In order to obtain a more complete picture of the relationship between behavioural factors and body adiposity, we examined the association of socioeconomic and lifestyle factors with anthropometric estimates of overall fatness and regional (intra-abdominal and subcutaneous) fat accumulation adjusting for potential confounders.…”

Section: Introductionmentioning

confidence: 99%

Lifestyle correlates of anthropometric estimates of body adiposity in an Italian middle-aged and elderly population: a covariance analysis

Leite

Nicolosi

2006

Int J Obes

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Objective: To study the relationship between behavioural factors, body adiposity and muscle mass. Subjects and methods: A total of 1415 Italian individuals (705 men and 710 women) aged 40-74 years from a populationbased survey carried out in the town of Bollate (Milan). Analysis of covariance was used to refine and improve the precision of the comparisons. Results: Men: Smoking and sedentary behaviour were related to larger waist circumference (WC) and smaller hip circumference (HC). Increased WC was also associated with high-fat diet and moderate-to-heavy drinking (compared to light drinkers). Those more educated (completed high school) were leaner and ex-smokers had higher body mass index (BMI) than non-smokers. Women: BMI was inversely related with education, the more educated having also lower muscle mass. The light drinkers were leaner and moderate-to-heavy drinkers had less muscle mass than abstainers. Moderate-to-heavy drinkers had larger WC than light drinkers. A strong negative trend was found in the relationship between dietary fibre and WC. Overall adiposity (BMI) and, more weakly, HC and peripheral subcutaneous fat increased with more TV watching, whereas BMI lowered, together with WC and muscle mass (as measured by the mid-arm circumference), with more walking/cycling. Conclusions: Modifiable habits such as smoking (men) and moderate-to-heavy alcohol drinking are associated with a pattern that is particularly deleterious to health: increased intra-abdominal fat and less muscle mass. Prevention strategies should be simultaneously aimed at promoting physical activities and reducing sedentary behaviours. A low-fat, fibre-rich diet seems to be closely related to a healthy distribution of body fat.

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Waist Circumference as a Screening Tool for Cardiovascular Risk Factors: Evaluation of Receiver Operating Characteristics (ROC)

Cited by 87 publications

References 19 publications

Predictive value of abdominal obesity cut-off points for hypertension in Blacks from West African and Caribbean island nations

Predictive value of abdominal obesity cut-off points for hypertension in Blacks from West African and Caribbean island nations

A simplified approach to analysing bio-electrical impedance data in epidemiological surveys

Lifestyle correlates of anthropometric estimates of body adiposity in an Italian middle-aged and elderly population: a covariance analysis

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