Optimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population

The association of central and extremity circumference with all-cause mortality and cardiovascular mortality: a cohort study

Background

Central obesity increases the risk of several diseases, including diabetes, cardiovascular disease (CVD), and cancer. However, the association between extremity obesity and mortality has not been extensively evaluated. The objective of this study was to investigate the quantitative effects of waist circumference (WC), arm circumference (AC), calf circumference (CC), and thigh circumference (TC) on all-cause mortality and CVD mortality.

Methods

The study used data from the National Health and Nutrition Examination Survey (NHANES) sample survey from 1999 to 2006. A total of 19,735 participants were included in the study. We divided the participants into four groups (Q1-Q4) and used Q1 as a reference to compare the risk of all-cause mortality and CVD mortality in Q2-Q4. COX proportional hazard regression model was used to analyze the relationship between WC, AC, CC and TC on all-cause and CVD mortality. In addition, we conducted a stratified analysis of gender.

Results

After a mean follow-up of 11.8 years, we observed a total of 3,446 deaths, of which 591 were due to cardiovascular disease. The results showed that for both men and women, compared to the first group, the risk of all-cause mortality was significantly higher in the other three groups of WC and significantly lower in the other three groups of AC, CC, and TC. Similar results were observed after adjusting for confounding factors such as demographics.

Conclusions

Our results show that all-cause and CVD mortality are positively associated with measures of central obesity and negatively associated with measures of extremity obesity, and that AC, CC, and TC can be used as potential tools to measure prognosis in the general population.

Association of metabolic syndrome with risk of cardiovascular disease mortality and all-cause mortality among Malaysian adults: a retrospective cohort study

OBJECTIVES

This study is aimed at determining the association between metabolic syndrome and risk of cardiovascular disease (CVD) mortality and all-cause mortality among Malaysian adults.

DESIGN

Retrospective cohort study.

SETTING

The Malaysian Non-Communicable Disease Surveillance (MyNCDS-1) 2005/2006.

PARTICIPANTS

A total of 2525 adults (1013 men and 1512 women), aged 24-64 years, who participated in the MyNCDS-1 2005/2006.

METHODS

Participants' anthropometric indices, blood pressure, fasting lipid profile and fasting blood glucose levels were evaluated to determine the prevalence of metabolic syndrome by the Harmonized criteria. Participants' mortality status were followed up for 13 years from 2006 to 2018. Mortality data were obtained via record linkage with the Malaysian National Registration Department. The Cox proportional hazards regression model was applied to determine association between metabolic syndrome (MetS) and risk of CVD mortality and all-cause mortality with adjustment for selected sociodemographic and lifestyle behavioural factors.

RESULTS

The overall point prevalence of MetS was 30.6% (95% CI: 28.0 to 33.3). Total follow-up time was 31 668 person-years with 213 deaths (111 (11.3%) in MetS subjects and 102 (6.1%) in non-MetS subjects) from all-causes, and 50 deaths (33 (2.9%) in MetS group and 17 (1.2%) in non-MetS group) from CVD. Metabolic syndrome was associated with a significantly increased hazard of CVD mortality (adjusted HR: 2.18 (95% CI: 1.03 to 4.61), p=0.041) and all-cause mortality (adjusted HR: 1.47 (95% CI: 1.00 to 2.14), p=0.048). These associations remained significant after excluding mortalities in the first 2 years.

CONCLUSIONS

Our study shows that individuals with MetS have a higher hazard of death from all-causes and CVD compared with those without MetS. It is thus imperative to prescribe individuals with MetS, a lifestyle intervention along with pharmacological intervention to improve the individual components of MetS and reduce this risk.

Comparisons of conventional and novel anthropometric obesity indices to predict metabolic syndrome among vegetarians in Malaysia

Our study aimed to compare the ability of anthropometric obesity indices to predict MetS and to determine the sex-specific optimal cut-off values for MetS among Malaysian vegetarians. Body weight, height, waist circumference (WC), blood pressure (BP), fasting venous blood sample were collected from 273 vegetarians in Selangor and Kuala Lumpur, Malaysia. The abilities of body mass index (BMI), body fat percentage (BF%), waist to height ratio (WHtR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), and body roundness index (BRI) to identify MetS were tested using receiver operating characteristic (ROC) curve analyses. MetS was defined according to the Joint Interim Statement 2009. The ROC curve analyses show that BMI, BF%, WHtR, LAP and VAI were able to discriminate MetS in both sexes. LAP was a better predictor to predict MetS, followed by WHtR for male and female vegetarians. The suggested WHtR’s optimal cut-offs and LAP’s optimal cut-offs for MetS for male and female vegetarians were 0.541, 0.532, 41.435 and 21.743, respectively. In conclusion, LAP was a better predictor to predict MetS than other anthropometric obesity indices. However, WHtR could be an alternative obesity index in large epidemiology survey due to its convenient and cost-effective characteristics.

Sex-bias in the diagnosis of malnutrition in the elderly: a pilot study

This research aimed to show that using different cutoff points for women and men in nutritional assessment through the Mini Nutritional Assessment (MNA) and different anthropometric variables, improves the diagnostic accuracy of malnutrition among people over 65 years. A cross-sectional study was carried out in a sample of 240 patients of 65 to 104 years in Córdoba (Spain) between 2013 and 2015. Excluded were those with disabling diseases that prevented informed consent. We assessed Nutritional status using the MNA and the Chang Method (Gold Standard). Global cut points per sex were determined for each independent variable using Receiver Operating Characteristic curves, choosing the best of each according to the highest Youden´s index (J). None of the variables studied showed high precision in the diagnosis of malnutrition in the elderly. Different cutoff points were found for all variables by sex, as well as variations in their validity indexes. The number of lymphocytes was more accurate in women (J = 0.58), being the muscular circumference of the arm the best in men (J = 0.8). Regarding MNA, the Long Form version showed higher sensitivity (S) in women (S = 76%) and short versions in men (S = 71% and 59%) at different cutoff points. The introduction of the sex variable seems determinant to achieve a more accurate diagnostic of malnutrition, avoiding biases derivate from a global study without considering its effect in the development of diseases.

Discriminatory Capacity of Anthropometric Indices for Cardiovascular Disease in Adults: A Systematic Review and Meta-Analysis

INTRODUCTION

Obesity is one of the main risk factors for cardiovascular disease (CVD) and cardiometabolic disease (CMD). Many studies have developed cutoff points of anthropometric indices for predicting these diseases. The aim of this systematic review was to differentiate the screening potential of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) for adult CVD risk.

METHODS

We used relevant key words to search electronic databases to identify studies published up to 2019 that used receiver operating characteristic (ROC) curves for assessing the cut-off points of anthropometric indices. We used a random-effects model to pool study results and assessed between-study heterogeneity by using the I² statistic and Cochran's Q test.

RESULTS

This meta-analysis included 38 cross-sectional and 2 cohort studies with 105 to 137,256 participants aged 18 or older. The pooled area under the ROC curve (AUC) value for BMI was 0.66 (95% CI, 0.63-0.69) in both men and women. The pooled AUC values for WC were 0.69 (95% CI, 0.67-0.70) in men and 0.69 (95% CI, 0.64-0.74) in women, and the pooled AUC values for WHR were 0.69 (95% CI, 0.66-0.73) in men and 0.71 (95% CI, 0.68-0.73) in women.

CONCLUSION

Our findings indicated a slight difference between AUC values of these anthropometric indices. However, indices of abdominal obesity, especially WHR, can better predict CVD occurrence.

Predicting metabolic syndrome by anthropometric measures among adults 35-65 years in the west of Iran; a cross sectional study from an Iranian RaNCD cohort data

AIMS

Anthropometric indices have been proposed for the early detection of metabolic syndrome (MetS) and its risk factors. The present study aimed to determine optimal cutoff points for the Body Mass Index (BMI), Waist Circumference (WC), and Waist Hip Ratio (WHR) in the prediction of MetS.

METHODS

This cross-sectional study was performed on 9746 adults 35-65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort. The receiver operating characteristic (ROC) curve analysis was used to compare the predictive validity and determine optimal cutoff values.

RESULTS

The optimal cutoff points for BMI, WC and WHR were 27.3 kg/m² (AUC: 78.6; 95%CI 77.1, 80.1), 97 cm (AUC: 63.8; 95%CI 60.4, 67.2) and 0.95 (AUC: 75.5; 95% CI 73.9, 77.1), respectively in men for the prediction of MetS. But in women the optimal cutoff points for BMI, WC and WHR were 28.6 kg/m² (AUC: 65.7; 95%CI 62.1, 69.4), 98.1 cm (AUC: 65.6; 95%CI 62.4,68.8) and 0.95 (AUC:62.39; 95%CI 60.9,63.9). The risk of MetS in men and women with a BMI higher than the optimal cutoff point was respectively 2.23 and 2.30 times higher than that in those with a WC lower than the cutoff point.

CONCLUSIONS

BMI is a better predictor of MetS than WC and WHR in adults 35-65 years. We recommend that the optimal cut off point be set for men 27.3 kg/m² and for women 28.6 kg/m².

Lowered obesity indicator cutoff points more effectively predict 5-year incidence of hypertension in premenopausal women

OBJECTIVE

To compare proposed new cutoff points for four obesity indicators-waist-to-height ratio (WHtR), waist circumference (WC), waist-to-hip ratio (WHR) and body mass index (BMI)-with their current cutoff points to determine which are better standards predicting 5-year incidence of hypertension (HT) and diabetes mellitus (DM) among premenopausal women.

DESIGN

Data were obtained from the 2002 and 2007 Survey on the Prevalence of HT, Hyperglycemia and Hyperlipidemia in Taiwan conducted by the Ministry of Health and Welfare, Taiwan. Premenopausal women were grouped based on the proposed cutoff points versus reference cutoff points for obesity indicators.

PARTICIPANT

A total of 1466 premenopausal women aged between 20 and 57 years old were recruited.

MAIN OUTCOME MEASURE

Five-year incidence of HT and DM.

RESULTS

Our new obesity indicator cutoff points-WHtR 0.49, WC 74.7 cm, WHR 0.79 and BMI 22.3 kg/m2-were better predictors for 5-year HT incidence in premenopausal women compared with those of current standards, but were not significantly different for DM. Among the four obesity indicators, WHtR and WC were optimal for their 5-year predictive ability for HT and DM in premenopausal women.

CONCLUSIONS

To avoid too many cutoff points for practitioners to adopt and memorize, the proposed new cutoff points were recommended preferentially to prevent the incidence of HT and DM in premenopausal women.

Poor glycaemic control and its metabolic and demographic risk factors in a Malaysian community-based study

OBJECTIVES

The lack of population-based evidence on the risk factors for poor glycaemic control in diabetics, particularly in resource-poor settings, is a challenge for the prevention of long-term complications. This study aimed to identify the metabolic and demographic risk factors for poor glycaemic control among diabetics in a rural community in Malaysia.

METHODS

A total of 1844 (780 males and 1064 females) known diabetics aged ≥ 35 years were identified from the South East Asia Community Observatory (SEACO) health and demographic surveillance site database.

RESULTS

41.3% of the sample had poor glycaemic control. Poor glycaemic control was associated with age and ethnicity, with older participants (65+) better controlled than younger adults (45-54), and Malaysian Indians most poorly controlled, followed by Malay and then Chinese participants. Metabolic risk factors were also highly associated with poor glycaemic control.

CONCLUSIONS

There is a critical need for evidence for a better understanding of the mechanisms of the associations between risk factors and glycaemic control.

Neck circumference as a screening measure of overweight/obesity among Indian adults

Neck circumference (NC) is an anthropometric measurement of differentiating body fat distributions and a marker of upper subcutaneous adiposity. The present study highlights the association and importance of NC as a suitable proxy screening measure of overweight/obesity as compared to the conventional anthropometric variables used among Indian adults. The present community based cross-sectional study was undertaken among 1169 Karbi adults (males: 625; females: 544) residing in Karbi Anglong district of Assam, Northeast India, who were selected through a multistage stratified random sampling method. Height, weight, waist circumference (WC), hip circumference (HC) and NC were recorded using standard procedures. The body mass index (BMI) was calculated and prevalence of overweight/obesity was assessed using standard cut-offs. The prevalence of obesity using BMI (≥25.00 kg m-2) was 15.52% and 15.26% among males and females, respectively (p≥0.05).The prevalence of obesity using NC was observed to be significantly higher among males (48.80%) than females (19.12%) (p<0.01). The binary logistic regression analysis showed that NC predicted obesity over the conventional anthropometric variables with reasonable accuracy (p<0.01). The ROC-AUC analysis showed a relatively greater significant association between BMI, WC and HC and NC for obesity (p<0.01). Thus, NC appears to be a potentially simple, easyto- use screening measure for predicting obesity among adults. Further studies are required to validate its use for screening of obesity among other ethnic populations in India.

The performance of obesity screening tools among young Thai adults

Obesity is a worldwide medical condition that leads to physical and psychological impairment. Specific ethnicity, gender and age group are related to different performances of anthropometric indices to predict obesity. The objectives of this study were to estimate the performance of the anthropometric indices for detecting obesity based on percentage of body fat (PBF), to study the correlation among those indices, and to determine the optimal cut-off point of the indices among young Thai adults. This is a cross-sectional study of healthy urban subjects in Khon Kaen, Thailand who were aged 20-39 years. Baseline characteristics and anthropometric measures were collected. PBF was determined using bioelectrical impedance analysis. Demographic data and anthropometric variables were analyzed using descriptive statistics. Receiver-operating characteristic (ROC) curves were used to compare the performance of anthropometric measures as predictors of obesity. One-hundred men and 100 women were recruited for this study. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio (WSR) were significantly correlated to PBF. BMI demonstrated the best performance according to the area under the ROC curves in both sexes at cut-off points of 22.5 in women or 25 kg/m(2) in men. WC and WSR showed better performance than WHR to detect obesity. In conclusion, anthropometric indices in young Thai adults were correlated well with PBF to predict obesity as shown in prior reports. Different cut-off points of these indices to define obesity in young Thai adults are recommended. The global cut-off points of WSR in women regardless of ethnicity are supported.