The cut-off values of anthropometric indices for identifying subjects at risk for metabolic syndrome in Iranian elderly men

Diagnostic Accuracy of Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Identifying Metabolic Syndrome and Its Components in Older Adults: A Systematic Review and Meta-Analysis

Background

Although numerous studies have indicated the utility of waist-to-height ratio (WHtR) in early screening for individuals with adverse cardiometabolic health, there is controversy on using WHtR as a one-size-fits-all approach, including in older adults.

Objectives

Our study aims to identify the pooled diagnostic accuracy of WHtR in screening for metabolic syndrome (MetS) and its components among older adults.

Methods

A systematic review of observational studies was performed using 4 databases. A diagnostic meta-analysis with a random effects model was conducted, and the pooled area under the summary receiver operating characteristic curve, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (dOR) of each outcome compared with WHtR, body mass index (BMI), and waist circumference (WC) were calculated, with sex-stratified analysis.

Results

A total of 17 studies with 74,520 participants were included. As reflected by the dOR, WHtR (7.65; 95% CI: 6.00, 9.75) performed better than BMI (5.17; 95% CI: 4.75, 5.62) and WC (5.77; 95% CI: 4.60, 7.25) in screening for MetS among older adults and was potentially better among males. For hyperglycemia, hypertension, and dyslipidemia, the performances of WHtR, BMI, and WC were comparable.

Conclusion

More studies focusing on older adults are still needed to determine the cutoff values of WHtR to screen for MetS.The search strategy was registered in PROSPERO as CRD42022350379.

Abdominal volume index, waist-to-height ratio, and waist circumference are optimal predictors of cardiometabolic abnormalities in a sample of Lebanese adults: A cross-sectional study

The prevalence of cardiometabolic abnormalities is high globally. This is concerning since these abnormalities increase the risk of morbidity and mortality. Using noninvasive, low-cost, and ethnic-specific anthropometric indices is crucial for widespread screening and early detection of cardiometabolic abnormalities. In this cross-sectional study, we enrolled 221 Lebanese participants (62.9% females; mean age: 43.36 ± 16.05 years; mean body mass index (BMI): 28.43 ± 6.10 Kg/m2). The main outcome measure was cardiometabolic abnormality (CMA), defined as the presence of at least two or more non-anthropometric components of the Metabolic Syndrome. Several anthropometric indices: Total body fat percent, Conicity index, Abdominal volume index (AVI), Weight-adjusted-waist index, Waist circumference (WC), Neck circumference, Hip circumference, Waist-to-hip ratio, Waist-to-height ratio (WtHR), Neck-to-height ratio, and BMI were assessed in their prediction of CMA, using logistic regression modelling and c-statistic [95% confidence intervals (CIs)], and calibration plots, as well sensitivity, specificity, and negative and positive predictive values measures. The Benjamini-Hochberg correction procedure was used to correct for multiple testing. The prevalence of CMA was 52.0% (47.5% in females and 59.8% in males). Significant associations were found between all the anthropometric indices and CMA, except for neck-to-height ratio. AVI and WC were most predictive for CMA in the total sample. WtHR and WC were most predictive in females with suggested cut-off values of 0.58 and 91.25 cm, whereas AVI and WC were most predictive in males with suggested cut-off values of 19.61 and 101.50 cm. The neck-to-height measurement had the lowest predictive ability for CMA. Adding anthropometric indices to sociodemographic variables did not significantly improve model discrimination. AVI, WHtR, and WC best predicted CMA in a sample of Lebanese adults. These less invasive, low-cost, easy-to-measure indices can be used to screen widely for CMA to better manage and prevent disease and subsequent morbidity and mortality.

Blood Pressure and Cardio-Metabolic Risk Profile in Young Saudi Males in a University Setting

Background and Objectives: The prevalence of cardiovascular diseases (CVDs) poses significant clinical and public health challenges across the world. This study aimed to study the metabolic risk factors and the association with blood pressure alteration. Materials and Methods: This was a cross-sectional study conducted between 2017 and 2018 among 284 male university students in Eastern province, Saudi Arabia. The obesity and cardiovascular measurements were taken using standardized instruments, including blood pressure (BP), mean arterial pressure, body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and basal metabolic rate (BMR). Statistical Analysis: Blood pressure was classified according to the United States of America, Sixth Joint National committee (JNC-VI) guidelines. The mean and standard error were calculated for each hypertension group variable. Logistic regression was applied to predict associations. Results: The prevalence of hypertension in the present study was 61.6%., and that of overweight and obesity was 16.5% and 34.9%, respectively. The cut-off values of BMI and WC were 22.23 and 75.24, respectively. Conclusions: The results demonstrated that BMI, WC, WHR, and WHtR significantly predict hypertension and that WC has a greater discrimination capacity than other measures. The findings also emphasize the importance of cardiovascular risk screening for young adults to detect any alterations in blood pressure and thus identify the population that is vulnerable to CVDs at an early stage. The findings highlight the need for health and university policymakers to adopt measures to monitor and control hypertension and obesity at the university level.

Visceral Adiposity Index and Lipid Accumulation Product as diagnostic markers of Metabolic Syndrome in South Indians with Polycystic Ovary Syndrome

BACKGROUND

Cardiovascular disease (CVD) is one of the debilitating consequences of polycystic ovary syndrome (PCOS). Early diagnosis of metabolic syndrome (MetS) with a simple but accurate method can reduce the risk of progression to CVD in PCOS.

AIMS

This study aimed to determine the accuracy of various anthropometric indices and lipid accumulation product (LAP), in assessing the risk of MetS in PCOS.

SETTINGS AND DESIGN

This is a cross-sectional study including 150 PCOS women and 100 control subjects.

MATERIALS AND METHODS

Anthropometric parameters were measured and calculated. Lipid profile, fasting plasma glucose (FPG), and insulin were estimated. MetS was detected according to the International Diabetes Federation criteria.

STATISTICAL ANALYSIS

Logistic regression and receiver operating characteristic curve analysis were applied to determine the potential association of anthropometric indices such as body mass index, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, conicity index (CI), visceral adiposity index (VAI), abdominal volume index (AVI), body adiposity index (BAI), and a body shape index (ABSI) and LAP with MetS.

RESULTS

In our study of PCOS women of the south Indian population, the prevalence of MetS was 59.3%, which was higher than other populations and the cutoff values of VAI and LAP were 6.05 and 53, respectively. VAI showed the strongest association with MetS, followed by diastolic blood pressure BP, FPG, and LAP.

CONCLUSIONS

We recommend VAI and LAP as new indices for MetS diagnosis. As these indices exhibit population specificity, it is imperative that independent cutoffs are determined for every demographic population.

Potential Role of New Anthropometric Parameters in Childhood Obesity with or Without Metabolic Syndrome

BACKGROUND

Obese children and adolescents are more prone to have metabolic syndrome (MS).MS is a cluster of cardiovascular risk factors associated with insulin resistance. Body round index [BRI], visceral adiposity index [VAI] and a body shape index [ABSI] are among the new obesity anthropometric parameters.

AIM

To evaluate the new markers for obesity in children and their possible association with other laboratory and clinical variables of MS.

METHODS

Eighty nine obese children and 40 controls aged 10-18 years were recruited. Full history taking, thorough clinical examination, anthropometric and biochemical features were performed in the studied groups. Subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were estimated by ultrasonography.

RESULTS

Obese children, exhibited significantly higher values in all anthropometric measurements (P < 0.001). Diastolic and systolic blood pressure were significantly higher (P < 0.001) in the obese group. ABSI, BRI and VAI have been found to be significantly higher in obese subjects (P < 0.001), with no significant gender difference. BMI, WHtR, WC/HR, SBP, DBP, subcutaneous fat thickness and visceral fat thickness, Liver Span, ABSI, BRI, VAI and HOMA_IR were significantly higher among children with MS than those without MS. Positive significant correlations of VAI with BMI, WC/Ht, WC/Hip, SBP, DBP, SFT, VFT, Liver size and HOMA-IR (r = 0.384, 0.239, 0.268, 0.329, 0.516, 0.320, 0.254, 0.251, and 0.278 respectively) are shown. The area under the ROC curve (AUC) of BMI, VAI, ABSI, BRI for predicting MS was 0.802 (0.701-0.902), 0.737 (0.33-0.841), 0.737 (0.620-0.855), 0.816 (0.698-0.934).

CONCLUSION

We suggest using the VAI and WHtR indexes, as they are better predictor of MS.

Performance of Anthropometric Indicators in the Prediction of Metabolic Syndrome in the Elderly

Introduction: Studies have demonstrated the relevance of anthropometric indicators in the prediction of metabolic syndrome (MetS). However, researches involving older people are still scarce. Therefore, the objective was to describe the frequency of MetS and to determine the performance of anthropometric indicators as predictors of MetS in the total sample, in men and women. Methods: Cross-sectional study involving 479 elderly individuals attended in primary health care. The revised National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) guidelines were used for the MetS diagnosis. The anthropometric indicators evaluated were neck circumference, sagittal abdominal diameter (SAD), SAD/height, sagittal index, and conicity index (C-Index). The predictive performance of the MetS anthropometric indicators was determined using a receiver operating characteristic (ROC) curve. A cutoff point >0.700 was used to evaluate diagnostic performance. Results: The frequency of MetS was 60.5%. The anthropometric indicators demonstrating adequate performance were in total sample: SAD/height (auROC = 0.810), SAD (auROC = 0.777), and C-Index (auROC = 0.706); in women: SAD (auROC = 0.820), SAD/height (auROC = 0.810), neck circumference (auROC = 0.782), and C-Index (auROC = 0.727); in men: SAD/height (auROC = 0.768), SAD (auROC = 0.760), and C-Index (auROC = 0.724). Conclusions: A high frequency of MetS was observed. Of the five anthropometric indicators investigated, three presented good performance in the total sample (SAD, SAD/height, and C-Index), four in women (SAD, SAD/height, neck circumference, and C-Index), and three in men (SAD, SAD/height, and C-Index). The anthropometric indicators, SAD, SAD/height, and C-Index, proved to perform adequately in all the three segments investigated.

Anthropometric parameter that best predict metabolic syndrome in South west Nigeria

AIM

This study compared the ability of anthropometric parameters to predict Metabolic Syndrome (MetS).

METHODS

Eleven anthropometric parameters: waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), a body shape index (ABSI), body roundness index (BRI), visceral adiposity index (VAI), abdominal volume index (AVI), Conicity Index (CI), body adiposity index (BAI), lipid accumulation product (LAP) and waist circumference-triglyceride index (WTI) were measured and calculated in apparently healthy subjects with and without MetS. A receiver operating characteristic (ROC) curve was applied to assess their ability to predict MetS.

RESULTS

Of the 535 subjects recruited 23% had MetS. WC had the largest area under the curve (AUC) in both men (0.814 95% CI 0.721-0.907) and women (0.819 95%CI 0.771-0.867). This did not differ from the AUC of BMI, WHtR, BRI, CI, BAI, LAP in men and BMI, WHtR, BAI, LAP, VAI and WTI in women (P > 0.05). The cutoff point for WC was 89.5 cm and 91.8 cm in men and women respectively. The AUC of WC was the largest in the 40-49 and 60 years and above age groups while the AUC of LAP was the largest for age groups 30-39 and 50-59 years.

CONCLUSION

Of the 11 anthropometric parameters assessed, the WC was the best at predicting MetS in both men and women. There is need to ascertain the cutoff point and establish landmark for measuring WC especially for the sub Saharan region.

Comparison of anthropometric indices (body mass index, waist circumference, waist to hip ratio and waist to height ratio) in predicting risk of type II diabetes in the population of Yazd, Iran

BACKGROUND AND OBJECTIVES

The purpose of this study was to determine the best anthropometric index and calculate the cut-off point for each anthropometric index in predicting the risk of type II diabetes in the population of Yazd city in Iran.

MATERIALS AND METHODS

The present analytical cross-sectional study was performed using the data from Yazd Health Study (YaHS) with a sample size of 9293. All required data including anthropometric indices BMI, WC, WHR, and WHtR were extracted from the YAHS questionnaire. The ROC curve was employed to compare the predictive power of each anthropometric index in the risk of developing the type II diabetes.

RESULTS

WHtR in both genders had better predictive power for the risk of type II diabetes (AUC = 0.692 for males and AUC = 0.708 for females), and BMI showed a weaker predictive power (AUC = 0.603 for males and AUC = 0.632 for females), WC and WHR also revealed similar predictive power in the risk of type II diabetes. The cut-off point of BMI for predicting the risk of diabetes was almost identical in both genders (26.2 in males and 25.9 in females), the cut-off point of WC (91 cm), and WHtR (0.56) in males was lower than in the females (96 cm for WC and 0.605 for WHtR). The cut-off point of WHR in males (0.939) was higher than in females (0.892).

CONCLUSION

The WHtR showed the best predictor of diabetes risk compared to other indices, and the BMI was the weakest predictor of the risk for diabetes.

Accuracy of BMI and waist circumference cut-off points to predict obesity in older adults

The main objectives were to analyse the validity and accuracy of Body Mass Index (BMI) and Waist Circumference (WC) to evaluate obesity by excess of body fat in older adults and to identify more adequate cut-off points for this age group. The recommended cut-off points for BMI (25, 27 or 30 kg/m2) and WC (≥ 102 cm for men and ≥ 88 cm for women or ≥ 90cm for men and ≥ 80 cm for women) were compared to the total body densitometry. BF was defined by a value higher than the 90th percentile. Out of the 132 participants, 61% were women and aged between 60 and 91 years. The recommended cut-off points of BMI ≥ 25kg/m2 and BMI ≥ 27 kg/m2 showed similar performances. BMI ≥ 30 kg/m2 showed high specificity but low sensitivity to identify BF in men and better performance in women. Conventional WC cut-off points showed low sensitivity and specificity. Based on our analyses, new cut-off points for BMI (25 kg/m2 for men and 26.6 kg/m2 for women) and WC (98.8 cm for men and 77.8cm for women) were proposed. The new cut-off points showed sensitivity and specificity values > 74% and accuracy > 76%. The areas under the curve (ROC) were > 0.86. The new BMI and WC cut-off points proposed in the present study for the diagnosis of obesity in older adults showed the best levels of sensitivity and specificity for this age group.

Accuracy of waist circumference for predicting other components of metabolic syndrome: evidence from the Bambuí cohort study of the elderly

Abstract Objectives: To examine the accuracy of waist circumference to predict two or more metabolic syndrome (MS) components among the elderly and to compare it with the recommendations of the Joint Interim Statement (JIS) for adults. Method: The study was conducted among participants of the baseline of the Bambuí (Minas Gerais) Cohort Study. The best waist circumference cut-off point for the outcome was determined by the Younden Index. The accuracy of such cut-off points was assessed by the area under the ROC curve (AUROC) and the sensitivity, specificity and positive and negative predictive values. Results: The prevalence of MS was 63.8% among women and 43.4% among men. Of these, the waist circumference cut-off that best predicted two or more components of MS (≥88 cm) was similar to that recommended by JIS (≥90 cm) (AUROC=0.673 and 0.672, respectively). Among women, the corresponding value was higher (≥92 cm) than recommended by the JIS (≥80 cm) (AUROC=0.605 and 0.560, respectively). Conclusion: The overall accuracy of waist circumference (AUROC) for the outcome was low for both genders, indicating that this measure is not an effective predictor of other components of MS in the study population.

A relação pescoço-coxa (RPCx) pode servir como índice antropométrico para diagnosticar a síndrome metabólica?

Resumo Objetivo: Investigar a Relação Pescoço-Coxa (RPCx) como índice antropométrico para diagnosticar a Síndrome Metabólica em estudantes universitários brasileiros. Métodos: Estudo transversal com 691 adultos (> 18 anos) de ambos os sexos. Foram investigados os seguintes parâmetros antropométricos: circumferência abdominal, circumferência de pescoço, circumferência de coxa, índice de massa corporal e RPCx. Além disso, foram coletados dados laboratoriais, tais como: triglicérides, glicemia e colesterol HDL. Resultados: Foram encontrados valores de circumferência abdominal (83,59 ± 10,68 cm), de pescoço (37,29 ± 2,36 cm), coxa (52,37 ± 5,71 cm) e relação de pescoço-coxa (0,72 ± 0,07 cm) superiores entre os homens (p <0,001). Ao analisar os componentes da síndrome, a RPCx mostrou uma correlação linear positiva estatisticamente significante com todos. Conclusão: Nesta pesquisa foi demonstrado que a RPCx não serve como critério diagnóstico da SM, mas indica alterações nos componentes constituintes da síndrome.

Indicators of Adiposity Predictors of Metabolic Syndrome in the Elderly

BACKGROUND

Adiposity indicators can be used as predictors of cardiovascular risk in the elderly. However, there are only a very few studies that deal with the accuracy of adiposity indicators as predictors of metabolic syndrome (MS) in the elderly. We evaluated the performance of adiposity indicators of MS prediction in the elderly.

METHODS

A cross-sectional study with 203 elderly people of both genders.

VARIABLES

MS defined by harmonized criteria, waist circumference (WC), waist-to-height ratio (WHtR), conicity index (CI), lipid accumulation product (LAP), and visceral adiposity index (VAI). Area under the receiver operating characteristic curve (AUC), sensitivity (sens) and specificity (spec).

RESULTS

The WC, WHtR, and LAP indicators showed the highest AUC, with values greater than 0.84. For the general population, WHtR and LAP had the highest Youden index values, identifying a point of approximately 0.55 (sens: 85.6%; spec: 80.4%) for WHtR and 32.3 (sens: 81.1%; spec: 75.0%) for LAP. When analyzed by gender, it was observed that the WC and WHtR had the highest Youden index values for prediction of MS in both genders. The CI and VAI showed the lowest discriminatory power for MS.

CONCLUSION

Both the adiposity indicators, WC and WHtR, as well as LAP, had high accuracy in MS discrimination. Therefore, they are effective in MS assessment in the elderly and during follow-up for individual and collective clinical practice.

Prevalence and determinants of metabolic syndrome in Qatar: results from a National Health Survey

OBJECTIVES

To determine optimum measurements for abdominal obesity and to assess the prevalence and determinants of metabolic syndrome in Qatar.

DESIGN

National health survey.

SETTING

Qatar National STEPwise Survey conducted by the Supreme Council of Health during 2012.

PARTICIPANTS

2496 Qatari citizens aged 18-64 representative of the general population.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measure of obesity (body mass index, waist circumference or waist-to-height ratio) that best identified the presence of at least 2 other factors of metabolic syndrome; cut-off values of waist circumference; frequency of metabolic syndrome.

RESULTS

Waist circumference ≥102 for men and ≥94 cm for women was the best predictor of the presence of other determinants of metabolic syndrome (raised blood pressure, fasting blood glucose, triglycerides and reduced high-density lipoprotein cholesterol). Using these values, we identified 28% of Qataris with metabolic syndrome, which is considerably lower than the estimate of 37% calculated using the International Diabetes Federation (IDF) criteria. Restricting the analysis to participants without known elevated blood pressure, elevated blood sugar or diabetes 16.5% would be classified as having metabolic syndrome. In a multivariable logistic regression analysis, the prevalence of metabolic syndrome increased steadily with age (OR=3.40 (95% CI 2.02 to 5.74), OR=5.66 (3.65 to 8.78), OR=10.2 (5.98 to 17.6) and OR=18.2 (7.01 to 47.5) for those in the age group '30-39', '40-49', '50-59', '60-64' vs '18-29'; p<0.0001), decreased with increasing educational attainment (OR=0.61 (0.39 to 0.96) for those who attained 'secondary school or more' compared with 'less than primary school'; p=0.03) and exercise (OR=0.60 (0.42 to 0.86) for those exercising ≥3000 vs <600 MET-min/week; p=0.006) but was not associated with smoking or diet.

CONCLUSIONS

Waist circumference was the best measure of obesity to combine with other variables to construct a country-specific definition of metabolic syndrome in Qatar. Approximately 28% of adult Qatari citizens satisfy the criteria for metabolic syndrome, which increased significantly with age. Education and physical activity were inversely associated with this syndrome.

Relationship between metabolic syndrome and angiographic severity of coronary artery disease

BACKGROUND

There are a few literature data on the correlation between metabolic syndrome (MetS) and coronary disease among Iranian population. This study aimed to find relationship between MetS and severity of coronary artery disease (CAD) in presence of diabetes.

METHODS

Total of 192 patients were consecutively enrolled in the study who were admitted to coronary care unit because of acute coronary syndrome (ACS) and then underwent coronary angiography. MetS was defined by Iranian criteria. A coronary atherosclerosis score was used to quantify the extent of atherosclerotic involvement. The relationship between MetS and angiographic CAD severity or clinical presentation was compared between them after adjusting for diabetes.

RESULTS

Individuals with MetS (n = 125) had a higher prevalence of ST-elevation myocardial infarction (71% vs 30%, P < 0.001), multi-vessel disease (50% vs. 34%, P = 0.003), decreased ejection fraction (P = 0.001) and more severe angiographic stenosis based on both modified Gensini (P = 0.081) and syntax (P = 0.008) scores, compared to those without MetS. Syntax score showed statistically significant difference between two groups before (P = 0.021) and after adjustment for diabetes (P = 0.005).

CONCLUSION

MetS was related to the severity of CAD both clinically and by angiographic scores but diabetes was a challenging factor and may independently increase the severity of CAD.

The Accuracy of Body Mass Index and Gallagher's Classification in Detecting Obesity among Iranians

BACKGROUND

The study was conducted to examine the comparability of the BMI and Gallagher's classification in diagnosing obesity based on the cutoff points of the gold standards and to estimate suitable cutoff points for detecting obesity among Iranians.

METHODS

The cross-sectional study was comparative in nature. The sample consisted of 20,163 adults. The bioelectrical impedance analysis (BIA) was used to measure the variables of interest. Sensitivity, specificity, positive predictive power (PPV), and negative predictive power (NPV) were used to evaluate the comparability of the two classification methods in detecting obesity.

RESULTS

The BMI wrongly classified 29% of the obese persons as overweight. In both classifications, as age increased, the accuracy of detecting obesity decreased. The Gallagher's classification is better than MBI in detecting obesity in men with the exception of those older than 59 years. In females, the BMI was better in determining sensitivity. In both classifications, either female or male, an increase in age was associated with a decrease in sensitivity and NPV with the exception of the BMI for the 18 year olds. Gallagher can correctly classify males and females who are less than 40 and 19 years old, respectively.

CONCLUSION

Gallagher's classification is recommended for non-obese in both sexes and in obese males younger than 40 years old. The BMI is recommended for obese females. The suitable cutoff points for the BMI to detect obesity are 27.70 kg/m(2) for females and males, 27.70 kg/m(2) for females, and 27.30 kg/m(2) for males.