A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population

Sex differences in waist circumference obesity and eating speed: a cross-sectional study of Japanese people with normal body mass index

Background

Fast eating has been positively associated with visceral fat accumulation in normal-weight individuals according to body mass index (BMI). However, previous studies have not examined energy and nutrients, or adjusted for food intake. We examined the relationship between eating speed and visceral fat accumulation, using waist circumference as an index, in middle-aged participants who were considered to be of standard weight according to BMI, with nutrient intake added as an adjustment factor.

Methods

We included 6,548 Japanese participants (3,875 men and 2,673 women) aged 40-74 years with BMI 18.5-25.0 kg/m2 who were enrolled in the Yamagata Cohort Study. Participants were divided into "fast," "normal," and "slow" eaters according to self-reported eating speed. Nutrient and food intake were evaluated using a food frequency questionnaire, and the difference in intake by eating speed and sex was compared. Logistic regression analysis was used to examine the relationship between waist circumference obesity (men ≥85 cm, women ≥90 cm, according to Japanese criteria) and eating speed, adjusted for nutrient intake and other lifestyle habits.

Results

In men, slow eaters had greater intakes of dietary protein, fat, polyunsaturated fatty acids (PUFA), omega-3 PUFA, total dietary fiber, soluble dietary fiber, insoluble dietary fiber, soybean products, fish, green and yellow vegetables, other vegetables, mushrooms, and seaweed in comparison with normal-speed eaters. In men, waist circumference obesity was significantly lower among slow eaters than in the group with normal eating speed. In women, waist circumference obesity was not significantly associated with eating speed and was not also associated with nutrient/food consumption except omega-6 PUFA.

Conclusion

Eating slowly was associated with healthy dietary habits. Our results could help prevent waist circumference obesity in men with a BMI between 18.5 and 25.0 kg/m2. However, similar findings were not observed in women, suggesting a sex difference.

Proposing new body mass index and waist circumference cut-offs based on cardiometabolic risks for a Central Asia population: A feasibility study

BACKGROUND

Lower BMI cutoffs as compared to standard cut-offs have been recommended to reduce the risk of obesity-related co-morbidities in some ethnic populations (e.g. south Asian and Chinese populations). Recent attempts have also been made to establish ethnicity-specific BMI cutoffs to identify individuals affected with obesity in relation to type 2 diabetes risk in multi-ethnic populations based in the UK and North America. However, to date, there is yet to have any published work done to identify these cut-offs in Central Asia populations nor specify any difference for genders even though the fat distribution varies amongst the different ethnic groups as well as between the genders. To the best of the authors' knowledge, this is the first study exploring new BMI and WC cut-offs in this population.

METHODS

To address this gap, we used a database of secondary care electronic health records from the National Research Cardiac Surgery Center to identify BMI and waist circumference cutoffs for obesity based on the risk of developing diabetes and other cardiometabolic disorders among 297 adults in Kazakhstan. Bivariate and multivariable logistic regression analysis were utilized to investigate the relationships between risk factors and type 2 diabetes mellitus (T2DM). BMI and WC thresholds were predicted using the Youden index.

RESULTS

For an equivalent age-adjusted and sex-adjusted incidence of type 2 diabetes at a BMI of 30·0 kg/m² in White populations, we found higher BMI cutoffs for Kazakhstani women (30.5 kg/m²) but lower cut-offs for men (28·9 kg/m²). As for waist circumference, the cut-off points for females were 95cm and 104 cm for males.

CONCLUSIONS

For Central Asia populations, the current recommended BMI and WC cutoffs may not be suitable and further work is needed to establish specific cut-offs for this population.

Neck Circumference as a Predictor of Metabolic Syndrome in Koreans: A Cross-Sectional Study

Metabolic syndrome (MetS) is a complex metabolic disorder and a high-risk condition for type 2 diabetes and cardiovascular disease. Rapid screening of at-risk individuals using accurate and time-saving tools is effective in disease management. Using the Korea National Health and Nutrition Examination Survey (KNHANES) data, we collected data from 2234 participants suitable for the study design, of which 974 (43.6%) were men and 1260 (56.4%) were women. We used receiver operating characteristic (ROC) curve analysis to estimate the optimal sex-specific neck circumference (NC) cut-off point to predict the MetS risk. To analyze the risk of MetS according to the estimated NC, logistic regression analysis was performed to identify the confounding factors. The result of the ROC analysis showed that the optimal neck cut-off points for predicting the risk of MetS were 38.25 cm (AUC: 0.759, 95% CI: 0.729–0.790) in men and 33.65 cm (AUC: 0.811, 95% CI: 0.782–0.840) in women. In the upper NC cut-off point compared to the lower NC cut-off point, NC was associated with an increased MetS risk by 2.014-fold (p = 0.010) in men and 3.650-fold (p < 0.001) in women, after adjustments. The current study supports NC as an effective anthropometric indicator for predicting the risk of MetS. It is suggested that more studies should be conducted to analyze the disease prediction effect of the combined application of anthropometric indicators currently in use and NC.

Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados

INTRODUCTION

Body mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.

RESEARCH DESIGN AND METHODS

A cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A_1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs.

RESULTS

The prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m² and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m² (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%-46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3).

CONCLUSIONS

While BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.

New proposed cut-off of waist circumference for central obesity as risk factor for diabetes mellitus: Evidence from the Indonesian Basic National Health Survey

BACKGROUND

Waist circumference (WC) measurement is practical to define central obesity. However, WC cut-off point might be differ based on different race or ethnicity. This study aims to analyze the optimal WC cut-off point to identify T2DM risk among Indonesian population.

METHOD

We analyzed the secondary data of national based cross-sectional study of the Indonesian Basic National Health Research 2013, comprising 24,660 adults aged ≥ 18 years who were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). The new proposed cut-off point for WC was calculated using ROC curve analysis and Youden index. The odds ratio of having T2DM was calculated using logistic regression analysis.

RESULTS

Increased WC was associated with worsening dysglycemia status among men and women (p<0.001). The optimal cut-off point of WC for detecting T2DM from ROC analysis was 76 for men and 80 for women. Based on this WC cut-off point, the odds ratio for having T2DM was 1.64 [95% CI 1.45-1.86, p<0.01] for men and 1.90 [95% CI 1.71-2.11 p<0.01] for women.

CONCLUSION

The newly proposed WC cut-off point of 76 for men and 80 women can be used to screen the risk of T2DM among Indonesian population.

Serum klotho is inversely associated with metabolic syndrome in chronic kidney disease: results from the KNOW-CKD study

BACKGROUND

Metabolic syndrome (MS) is prevalent in chronic kidney disease (CKD). Klotho, a protein linked to aging, is closely associated with CKD. Each component of MS and klotho has an association. However, little is known about the association between klotho and MS per se. We investigated the association between serum klotho levels and MS using baseline cross-sectional data obtained from a large Korean CKD cohort.

METHODS

Of the 2238 subjects recruited in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) between 2011 and 2016, 484 patients with missing data on serum klotho and extreme klotho values (values lower than the detectable range or > 6000 pg/mL) or with autosomal dominant polycystic kidney disease patients were excluded. The data of the remaining 1754 subjects were included in the present study. MS was defined using the revised National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) III criteria. Serum klotho levels were measured using an enzyme-linked immunosorbent assay.

RESULTS

Mean patient age was 54.9 ± 12.1 years and 1110 (63.3%) were male. The prevalence of MS among all study subjects was 63.7% (n = 1118). The median serum klotho level was 527 pg/mL (interquartile range [IQR]: 418-656 pg/mL). Serum klotho level was significantly lower in MS patients than patients without MS (Median [IQR]; 521 pg/mL [413, 651] vs. 541 pg/mL [427, 676], respectively; P = 0.012). After adjusting for age, sex, estimated glomerular filtration rate, and overt proteinuria, serum klotho was independently associated with MS (adjusted odds ratio [OR], 0.44; 95% confidence interval, 0.23-0.82; P = 0.010). Furthermore, the adjusted OR for MS was found to be significantly increased at serum klotho levels of < 518 pg/mL (receiver operating characteristic curve cut-off value).

CONCLUSIONS

Serum klotho was inversely associated with the presence of MS in patients with CKD.

TRIAL REGISTRATION

This trial was registered on ClinicalTrials.gov on 26 June 2012 ( https://clinicaltrials.gov;NCT01630486 ).

Long Sleep Duration, Insomnia, and Insomnia With Short Objective Sleep Duration Are Independently Associated With Short Telomere Length

STUDY OBJECTIVES

We aimed to determine the association between short telomere length, sleep parameters, and sleep disorders in an adult general population sample.

METHODS

As part of the EPISONO cohort (São Paulo, Brazil), 925 individuals answered questionnaires, underwent a full-night polysomnography and clinical assessment, and had peripheral blood collected for DNA extraction. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition; and obstructive sleep apnea was defined according to apnea-hypopnea index. For the objective insomnia phenotype, we combined insomnia diagnosis with total sleep time from polysomnography with a cutoff of 360 minutes, allowing the classification of six groups. Self-reported sleep duration was used to classify the individuals as short (< 6 hours), average (6 to 8 hours) and long (> 8 hours) sleepers. The leukocyte telomere length was measured using quantitative real-time polymerase chain reaction. Based on its distribution, we considered leukocyte telomere length < 10th percentile as short telomere and leukocyte telomere length ≥ 10th percentile as non-short telomere.

RESULTS

After adjusting for sex, age, and body mass index, only insomnia disorder (odds ratio [OR] = 2.654, 95% confidence interval [CI] = 1.025-6.873, P = .044), insomnia disorder total sleep time < 360 minutes (OR = 4.205, 95% CI = 1.097-16.117, P = .036) and long sleepers (OR = 2.177, 95% CI = 1.189- 3.987, P = .012) were associated with short telomere.

CONCLUSIONS

Our findings support the existence of an association among insomnia, insomnia phenotype, and self-reported long sleep duration with the maintenance of telomere length.

COMMENTARY

A commentary on this article appears in this issue on page 1975.

The Association between Oligomenorrhea, Onset of Menopause and Metabolic Syndrome in Thai Postmenopausal Women

Objectives

This study explored the association between a history of oligomenorrhea and onset of menopause and metabolic parameters.

Methods

The study population was 605 postmenopausal women who were patients at the Menopause Clinic, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between February 2015 and December 2015. A questionnaire was used to ask all women about their history of oligomenorrhea. The study also collected medical data, including weight, height, waist circumference, blood pressure, and blood glucose and lipid profile.

Results

Of the 231 postmenopausal women with a complete data record, 31 had a history of oligomenorrhea and 200 did not. The age of onset of menopause was around 48 years in both groups. Prevalence of metabolic syndrome was 12.1%. More women with a waist circumference larger than 80 cm had a history of oligomenorrhea at the interview than women who had not, but a history of oligomenorrhea did not relate to other metabolic parameters. The adjusted odds ratio of a history of oligomenorrhea to waist circumference was 3.69 (95% confidence interval, 1.17–11.64).

Conclusions

A history of oligomenorrhea did not affect the age at menopause, but was associated with waist circumference during menopause.

Agreement between self-/home-measured and assessor-measured waist circumference at three sites in adolescents/children

The objective of this study was to assess the validity of the self-/home-measured waist circumference (WC) method in children/adolescents at three sites: at the level of the umbilicus, immediately above the iliac crest, and at the midpoint of the lower margin of the last palpable rib and top of the iliac crest. A cross-sectional study of 3360 Hong Kong Chinese children/adolescents was conducted, with 2980 (88.7%) participants included in the final analysis. The WC of children aged 6 to 9 was measured at the three sites by their parent/guardian at home followed by measurement by trained assessors at school within one week. Children/adolescents between the ages of 10 and 17 self-measured their WC at the three sites during school hours, followed by measurements by the trained assessors. Bland-Altman limits of agreement (LOA) analysis was performed to evaluate between-measurement agreement. The difference between assessor- and self-/home-measured WC was defined as ≤ ±2.5 cm for the upper and lower LOA at all three sites as an a priori criterion based on the assessor-measured inter-rater results. The results showed that most measurements (about 96%) at each site was within 95% of the LOA. Of the three measurement sites, the smallest LOA interval width was found at the umbilicus site, with an upper LOA of 5.08 and 7.13 and lower LOA of -2.61 and -3.43 in boys and girls, respectively. In conclusion, the range of LOA was relatively large, exceeding the acceptable limits of the predefined a priori criterion of upper and lower LOA, and thus suggesting disagreement between the two measurement methods. The use of WC as a measure of abdominal obesity in clinical practice/epidemiological studies should be restricted to measurement by trained health professionals/research staff.

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)

BACKGROUND

Waist 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.

METHODS

We 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.

RESULTS

We 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).

CONCLUSIONS

Sex-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.

"Metabolically Healthy" Obesity and Hyperuricemia Increase Risk for Hypertension and Diabetes: 5-year Japanese Cohort Study

OBJECTIVE

Whether obesity without metabolic syndrome (i.e., "metabolically healthy" obesity) confers similar or less metabolic risk remains controversial.

METHODS

A retrospective 5-year cohort study of 9,721 Japanese subjects (48.5 ± 10.5 years, 4,160 men) was conducted in 2004 and reevaluated 5 years later. Subjects were excluded if they were hypertensive or diabetic or were receiving medications for dyslipidemia and/or gout or hyperuricemia in 2004. Study subjects were categorized according to baseline BMI  ≥ 25 kg/m² (overweight/obesity) and < 25 kg/m² (lean/normal weight) and also whether they had metabolic syndrome. The cumulative incidence of hypertension and diabetes over 5 years between groups was assessed. A second analysis evaluated whether baseline hyperuricemia provided additional risk.

RESULTS

Subjects with overweight/obesity but without metabolic syndrome carried increased cumulative incidence of hypertension (14.6% vs. 7.2%, P < 0.001) and diabetes (2.6% vs. 1.1%, P = 0.004) over 5 years compared to lean/normal subjects without metabolic syndrome. Overweight/obesity conferred an increased risk for diabetes even in individuals with normal fasting blood glucose. Hyperuricemia became an independent risk factor for developing hypertension over 5 years in lean/normal subjects without metabolic syndrome. A 1 mg/dL increase in serum uric acid carried increased risk for hypertension (19%) and diabetes (27%).

CONCLUSIONS

Metabolically healthy obesity and hyperuricemia confer increased risk for hypertension and diabetes.

Comparison of coronary heart disease risk among four diagnostic definitions of metabolic syndrome

PURPOSE

Metabolic syndrome (MetS) is now well known as one of the major risk factors for coronary heart disease (CHD). Currently, there are several methods used to define MetS. The aim of this study was to determine to what extent current MetS definition reflects CHD risk using the probability of CHD in 10 years based on Framingham risk score algorithms.

METHODS

A total of 7575 adults, aged 16-93 years (2532 men and 5043 women), were recruited. We conducted a cross-sectional health survey in China using MetS criteria from four different definitions: modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), International Diabetes Federation (IDF), Chinese and Japanese.

RESULTS

Differences in the prevalence of MetS by each definition were small in males (22.9-25.9 %), whereas in females, MetS was three times more prevalent using the IDF definition (29.1 %) versus the Japanese definition (9.7 %). Framingham risk scores in participants with MetS were significantly higher than in those without MetS by all definition criteria (p < 0.001). The CHD risk scores for participants with MetS by each definition showed similar values in males (range 11.5-12.1 %) with no significant differences among definitions. Conversely, in females with MetS the risk score for CHD was low (range 3.5-4.3 %) by each MetS definition.

CONCLUSIONS

These findings suggest that further studies are required to establish appropriate criteria of MetS in females.

Prevalence of chronic disease and its controlled status according to income level

The relationship between the prevalence of chronic diseases and income level has now become a main theme in poor national economic situations. We examined the prevalence of well-controlled chronic diseases according to income level. Data from the 2008 to 2014 Korea National Health and Nutrition Examination Survey, conducted by using a stratified, multistage, probability-cluster sampling method, were used. Systolic blood pressure (SBP) inversely correlated with income level (P < 0.001). Diastolic blood pressure (DBP) showed no relationship. In the low-income group, the prevalence rates of hypertension and diabetes mellitus (DM) were highest but the proportion of patients with well-controlled chronic disease and the SBPs of the patients with hypertension showed a decreasing trend. In the high-income group, the proportions of patients with well-controlled DM and chronic kidney disease were higher than those in other groups. After adjusting for age, body mass index, SBP, DBP, HbA1c level, and serum creatinine level, income level significantly affected the prevalence of chronic diseases (for income, β=0.184; 95% confidence interval, 1.105-1.042). The daily sodium intake estimated by using spot urine samples was higher in the low- and low-to-mid-income groups. The prevalence of not using essential medical service for chronic disease was highest in the low- and low-to-mid-income groups for economic reasons. In the low- and low-to-mid-income groups, the prevalence of chronic disease was higher and the proportion of patients with well-controlled chronic disease was lower than in the other groups.

Neck circumference might predict gestational diabetes mellitus in Han Chinese women: A nested case-control study

AIMS/INTRODUCTION

A large neck circumference might be an indicator of metabolic syndrome and its components, and for certain patients is more practical as an index than waist circumference. The demarcation value for neck circumference that suggests metabolic syndrome appears to vary by ethnic group. Gestational diabetes mellitus is considered a component of metabolic syndrome in pregnant women. We investigated whether neck circumference in Han Chinese women is associated with gestational diabetes mellitus in early pregnancy, and determined a predictive demarcation value.

MATERIALS AND METHODS

A nested case-control study was carried out with 255 women aged 18-35 years. Gestational diabetes mellitus was diagnosed according to the criteria of the American Diabetes Association through a 2-h, 75-g oral glucose tolerance test.

RESULTS

Of the total population, 41 (16%) women developed gestational diabetes mellitus by 24-28 weeks of gestation. Neck circumference at gestational week 16 positively correlated with pre-pregnancy waist circumference, bodyweight and body mass index, and maternal age (P = 0.029) and hemoglobin A1c at gestational week 24 (P ≤ 0.001). By binary logistic regression, neck circumference was an independent predictor of gestational diabetes mellitus (odds ratio 1.840, 95% confidence interval 1.040-3.254; P = 0.036). According to the receiver operating characteristic curve, for predicting gestational diabetes mellitus the optimal demarcation for neck circumference at gestational week 16 was 35.15 cm.

CONCLUSIONS

Neck circumference is a viable tool to screen for gestational diabetes mellitus. In this population of pregnant Han Chinese women, a neck circumference of ≥35.15 cm was a predictor of gestational diabetes mellitus.

Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study

BACKGROUND

We sought to establish the optimal waist circumference (WC) cut-off point for predicting diabetes mellitus (DM) and to compare the predictive ability of the metabolic syndrome (MetS) criteria of the Joint Interim Statement (JIS) and the Japanese Committee of the Criteria for MetS (JCCMS) for DM in Japanese.

METHODS

Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20-69 years and free of DM at baseline (n = 54,980), were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria.

RESULTS

During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3-4 times increased hazard for developing DM in men and 7-9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women) had the highest sensitivity (54.5 % for men and 43.5 % for women) for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively.

CONCLUSION

Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

The Prevalence of Metabolic Syndrome Using Three Different Diagnostic Criteria among Low Earning Nomadic Kazakhs in the Far Northwest of China: New Cut-Off Points of Waist Circumference to Diagnose MetS and Its Implications

Background

Although the epidemic of metabolic syndrome (MetS) has aroused wide public concern, most studies on MetS tend to examine urban and high income settings, and few studies cover nomadic areas and low earning populations. This research aims to investigate the prevalence of MetS and explore the cut-off point of waist circumference in a nomadic minority typical of low income populations in the remote northwest region of China.

Methods

A cross-sectional study was performed in a representative sample of 3900 Kazakh adults aged 18–84 years from 2009–2010. Three widely used criteria (ATP III\IDF\JIS) were employed to estimate the prevalence of MetS in Kazakhs to compare them with other populations. Receiver operator characteristic (ROC) curve analysis was used to explore the optimal cut-off values of waist circumference.

Results

The age-adjusted prevalence of MetS was 13.8%, 20.9%, and 24.8% based on the ATP III, IDF, and JIS criteria, respectively. The prevalence of MetS was higher in women and increased with age. Except for reduced HDL-cholesterol, the risk of other components of MetS increased with waist circumference enlargement. The cut-off point of waist circumference in screening at least two other components of MetS was 88 cm in men (Sensitivity = 61.1%, Specificity = 62.1%, ROC Curve Distance = 0.54) and 83 cm in women (Sensitivity = 60.0%, Specificity = 59.6%, ROC Curve Distance = 0.57).

Conclusion

The prevalence of MetS in Kazakhs is higher than the national level of China and falls in between the Euro-American and Asia levels, as their cut-off points of waist circumference differ from that recommended for Chinese. We suggest a cost-effective strategy to screen for MetS and prevent cardiovascular disease using new cut-off points of waist circumference in low earning nomadic Kazakhs.

Proposed cut-off values of the waist circumference for metabolic syndrome based on visceral fat volume in a Japanese population

Aim/Introduction

Waist circumference (WC) is the most important parameter for diagnosis of metabolic syndrome. The present study was carried out to obtain optimal WC cut‐off values for diagnosis of metabolic syndrome in a Japanese population based on the measurement of total intra‐abdominal visceral fat volume (VFV), which could be expected to reflect visceral obesity more precisely than visceral fat area.

Materials and Methods

A total of 405 Japanese persons undergoing health screening were investigated. visceral fat volume was calculated from the data in 700–800 computed tomography slices from the top of the liver to the floor of the pelvic cavity. Then, receiver operating characteristic analysis was used to determine the cut‐off value of the VFV/height ratio. Subsequently, the corresponding WC value was obtained by linear regression analysis.

Results

The cut‐off value of the VFV/height ratio was 2,317 cm³/m in men and 1,425 cm³/m in women. The sensitivity and specificity of the ratio were 52.9 and 86.4% in men vs 63.4 and 82.2% in women, respectively. The corresponding cut‐off value of WC was 86.0 cm in men and 80.9 cm in women.

Conclusions

The proposed cut‐off values of WC for metabolic syndrome are 85 cm in Japanese men and 80 cm in Japanese women.

Hypoadiponectinemia and the presence of metabolic syndrome in patients with chronic kidney disease: results from the KNOW-CKD study

BACKGROUND

In patients with chronic kidney disease, metabolic syndrome has been demonstrated to be the culprit behind diverse complications. Adiponectin is known to have anti-atherogenic and cardio-protective effects. Meanwhile, the relationship between adiponectin and metabolic syndrome in patients with chronic kidney disease has not been clarified. The aim of this study was to elucidate the relationship between adiponectin level and metabolic syndrome in patients with chronic kidney disease.

METHODS

The KoreaN Cohort Study for Outcome in Patients with Chronic Kidney Disease is a cohort study that enrolled subjects with chronic kidney disease throughout South Korea. From February 2011 to July 2014, data were collected from 1332 patients with chronic kidney disease.

RESULTS

The mean age of the patients was 53.5 years and 803 patients (60.7%) were men. The median adiponectin level was 10.7 μg/mL and 585 (44.3%) patients had metabolic syndrome. In multiple linear regression analysis, log adiponectin was positively associated with high-density lipoprotein cholesterol levels (β = 0.006), whereas it was negatively associated with serum albumin (β = -0.284), triglyceride (log β = -0.288), high sensitivity C-reactive protein (log β = -0.058) levels and estimated glomerular filtration rate (β = -0.005). Multiple logistic regression analysis indicated that low adiponectin level was independently associated with a higher risk of metabolic syndrome (per 1 μg/mL increase; odds ratio = 0.953, 95% confidence interval = 0.898-0.970, P < 0.001) after adjustment for multiple confounding factors.

CONCLUSIONS

Hypoadiponectinemia is independently associated with the presence of metabolic syndrome in patients with chronic kidney disease.

Sensitivity and Specificity Improvement in Abdominal Obesity Diagnosis Using Cluster Analysis during Waist Circumference Cut-Off Point Selection

INTRODUCTION

The purpose of this study was to analyze the influence of metabolic phenotypes during the construction of ROC curves for waist circumference (WC) cutpoint selection.

MATERIALS AND METHODS

A total of 1,902 subjects of both genders were selected from the Maracaibo City Metabolic Syndrome Prevalence Study database. Two-Step Cluster Analysis (TSCA) was applied to select metabolically healthy and sick men and women. ROC curves were constructed to determine WC cutoff points by gender.

RESULTS

Through TSCA, metabolic phenotype predictive variables were selected: HOMA2-IR and HOMA2-βcell for women and HOMA2-IR, HOMA2-βcell, and TAG for men. Subjects were classified as healthy normal weight, metabolically obese normal weight, healthy and metabolically disturbed overweight, and healthy and metabolically disturbed obese. Final WC cutpoints were 91.50 cm for women (93.4% sensitivity, 93.7% specificity) and 98.15 cm for men (96% sensitivity, 99.5% specificity).

CONCLUSIONS

TSCA in the selection of the groups used in ROC curves construction proved to be an important tool, aiding in the detection of MOWN and MHO which cannot be identified with WC alone. The resulting WC cutpoints were <91.00 cm for women and <98.00 cm for men. Furthermore, anthropometry is insufficient to determine healthiness, and, biochemical analysis is needed to properly filter subjects during classification.

Optimal waist circumference cutoff values for the diagnosis of abdominal obesity in korean adults

Abdominal obesity is associated closely with insulin resistance, diabetes, and cardiovascular disease. Waist circumference (WC) is a useful surrogate marker commonly used for abdominal adiposity. The determination of WC cutoff levels is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases. Recent epidemiological evidence suggested that appropriate optimal cutoffs for Koreans ranged over 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. We analyzed the data from two large cohorts using receiver operating characteristic curve analysis with the incidences of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors as outcome variables. Optimal WC cutoff points for Koreans were 85 cm in males and 80 cm in females. However, considering the prevalence of abdominal obesity and the health costs for its prevention and management, 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity. These values may be modified once better research is performed through prospective studies using representative populations, common health outcomes, and proper analytical approaches.

Cardiovascular disease risk score prediction models for women and its applicability to Asians

PURPOSE

Although elevated cardiovascular disease (CVD) risk factors are associated with a higher risk of developing heart conditions across all ethnic groups, variations exist between groups in the distribution and association of risk factors, and also risk levels. This study assessed the 10-year predicted risk in a multiethnic cohort of women and compared the differences in risk between Asian and Caucasian women.

METHODS

Information on demographics, medical conditions and treatment, smoking behavior, dietary behavior, and exercise patterns were collected. Physical measurements were also taken. The 10-year risk was calculated using the Framingham model, SCORE (Systematic COronary Risk Evaluation) risk chart for low risk and high risk regions, the general CVD, and simplified general CVD risk score models in 4,354 females aged 20-69 years with no heart disease, diabetes, or stroke at baseline from the third Australian Risk Factor Prevalence Study. Country of birth was used as a surrogate for ethnicity. Nonparametric statistics were used to compare risk levels between ethnic groups.

RESULTS

Asian women generally had lower risk of CVD when compared to Caucasian women. The 10-year predicted risk was, however, similar between Asian and Australian women, for some models. These findings were consistent with Australian CVD prevalence.

CONCLUSION

In summary, ethnicity needs to be incorporated into CVD risk assessment. Australian standards used to quantify risk and treat women could be applied to Asians in the interim. The SCORE risk chart for low-risk regions and Framingham risk score model for incidence are recommended. The inclusion of other relevant risk variables such as obesity, poor diet/nutrition, and low levels of physical activity may improve risk estimation.

Aging attenuates the association of central obesity with the accumulation of metabolic risk factors when assessed using the waist circumference measured at the umbilical level (the Japanese standard method)

Objective:

The objective of this study was to clarify the generation and gender differences in the association between central obesity and the accumulation of metabolic risk factors (RFs) in the Japanese population.

Material and methods:

A total of 12 389 subjects (age: 18–80 years) without receiving medication for diabetes, dyslipidemia or hypertension were enrolled in this study and divided according to age and gender. In each group, we performed analyses as follows: (1) a receiver operating characteristic (ROC) analysis to evaluate the utility of the waist circumference (WC) for detecting subjects with multiple RFs of metabolic syndrome (MS); (2) a cross-sectional study to examine the relationship between the WC and the odds ratio (OR) for detecting those subjects and (3) a longitudinal study to examine how longitudinal changes (Δ) in WC over a 1-year period affected the values of each metabolic RF.

Results:

With age, the WC cutoff values yielding the maximum Youden index for detecting subjects with multiple RFs increased only in women, and the areas under the curves of the ROC analysis of WC for detecting those subjects decreased in both genders. The positive correlation between the WC and the OR for detecting subjects with multiple RFs became weaker with age, especially in women. In the longitudinal study, the significant correlation between ΔWC and Δ each metabolic RF, except for hypertension, and between ΔWC and Δ the number of RFs became weaker with age in women, whereas the significant correlation between ΔWC and Δ the number of RFs was not affected with age in men. In women aged ⩾60 years, none of the changes in each metabolic RF were significantly associated with ΔWC.

Conclusions:

Aging attenuates the association of central obesity with the accumulation of metabolic RFs, especially in women.

The current waist circumference cut point used for the diagnosis of metabolic syndrome in sub-Saharan African women is not appropriate

The waist circumference cut point for diagnosing the metabolic syndrome in sub-Saharan African subjects is based on that obtained from studies in European populations. The aim of this study was to measure the prevalence of obesity and related metabolic disorders in an urban population of African females, a group at high risk for such diseases, and to determine the appropriate waist cut point for diagnosing the metabolic syndrome. Anthropometry and fasting lipid, glucose and insulin levels were measured in a cohort of 1251 African females participating in the Birth to Twenty cohort study in Soweto, Johannesburg. The waist circumference cut points for diagnosing metabolic syndrome (as defined using the new harmonised guidelines), insulin resistance, dysglycaemia, hypertension and dyslipidaemia were obtained using receiver operator characteristic curve analysis. The prevalence of obesity, type 2 diabetes and metabolic syndrome were 50.1%, 14.3% and 42.1%, respectively. The appropriate waist cut point for diagnosing metabolic syndrome was found to be 91.5 cm and was similar to the cuts points obtained for detecting increased risk of insulin resistance (89.0 cm), dysglycaemia (88.4 cm), hypertension (90.1 cm), hypo-high density lipoproteinaemia (87.6 cm) and hyper-low density lipoproteinaemia (90.5 cm). The present data demonstrates that urban, African females have a high prevalence of obesity and related disorders and the waist cut point currently recommended for the diagnosis of the metabolic syndrome (80.0 cm) in this population should be increased to 91.5 cm. This latter finding demonstrates a clear ethnic difference in the relationship between abdominal adiposity and metabolic disease risk. The similar waist cut points identified for the detection of the individual components of the metabolic syndrome and related cardiovascular risk factors demonstrates that the risk for different metabolic diseases increases at the same level of abdominal adiposity suggesting a common aetiological pathway.

Impact of insulin resistance on silent and ongoing myocardial damage in normal subjects: the Takahata study

Background. Insulin resistance (IR) is part of the metabolic syndrome (Mets) that develops after lifestyle changes and obesity. Although the association between Mets and myocardial injury is well known, the effect of IR on myocardial damage remains unclear. Methods and Results. We studied 2200 normal subjects who participated in a community-based health check in the town of Takahata in northern Japan. The presence of IR was assessed by homeostasis model assessment ratio, and the serum level of heart-type fatty acid binding protein (H-FABP) was measured as a maker of silent and ongoing myocardial damage. H-FABP levels were significantly higher in subjects with IR and Mets than in those without metabolic disorder regardless of gender. Multivariate logistic analysis showed that the presence of IR was independently associated with latent myocardial damage (odds ratio: 1.574, 95% confidence interval 1.1–2.3) similar to the presence of Mets. Conclusions. In a screening of healthy subjects, IR and Mets were similarly related to higher H-FABP levels, suggesting that there may be an asymptomatic population in the early stages of metabolic disorder that is exposed to myocardial damage and might be susceptible to silent heart failure.

Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the Korean genome and epidemiology study

BACKGROUND

In this prospective cohort study, we estimated the risk of developing more than 1 metabolic risk factor, using different obesity indices. In addition, we investigated the relative usefulness of the obesity indices for predicting development of such risk factors and calculated optimal cutoffs for the obesity indices.

METHODS

The cohort comprised 10 038 representative residents of a small city and a rural county who were recruited in 2001-2002. Follow-up examinations were conducted every 2 years. Among the 3857 participants without metabolic syndrome at baseline, 1102 new cases occurred during the 6-year follow-up. Receiver operating characteristic (ROC) curves for the obesity indices were plotted to compare the usefulness of the obesity indices.

RESULTS

The numbers of new cases of multiple metabolic risk factors among people in the highest quintiles of body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio at the baseline examination were 2 to 3 times those in the lowest quintiles. The area under the ROC curve for WHR was significantly higher than that for BMI. The optimal BMI cutoff was 24 kg/m(2) in men and women, and the optimal WC cutoffs were 80 cm and 78 cm in men and women, respectively.

CONCLUSIONS

Both overall obesity and central obesity predicted risk of developing multiple metabolic risk factors, and WHR appeared to be a better discriminator than BMI. To prevent development of metabolic diseases among Koreans, it might be useful to lower the cutoff for abdominal obesity, as defined by WC.

BMI is strongly associated with hypertension, and waist circumference is strongly associated with type 2 diabetes and dyslipidemia, in northern Chinese adults

Background

Obesity is closely associated with chronic diseases such as hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia. We analyzed the optimal obesity index cut-off values for metabolic syndrome (MetS), and identified the obesity index that is more closely associated with these chronic diseases, in a population of northern Chinese.

Methods

We surveyed 8940 adults (age, 20–74 years) living in northern China for chronic diseases. Receiver operating characteristics (ROC) analysis, relative risk, and multivariate regression were used to develop an appropriate index and optimal cut-off values for MetS and obesity-related chronic diseases.

Results

Waist circumference (WC) and body mass index (BMI) were good markers for MetS, WC was a good marker for T2DM and dyslipidemia, and BMI was a good marker for hypertension. The optimal BMI cut-off value of MetS was 24 kg/m², and the optimal WC cut-offs were 86 cm and 78 cm in men and women, respectively. Relative risk regression models showed that BMI was associated with hypertension, T2DM, and hypertriglyceridemia and a higher prevalence ratio (PR) for hypertension: 2.35 (95% CI, 2.18–2.50). WC was associated with T2DM, hypertension, and hypertriglyceridemia, with PRs of 2.05 (1.63–2.55) for T2DM and 2.47 (2.04–2.85) for hypertriglyceridemia. In multivariate regression models, the standardized regression coefficients (SRCs) of BMI were greater for SBP and DBP, and the SRC of WC was greater for fasting blood glucose, 2-hour postload blood glucose, triglyceride, and total cholesterol.

Conclusions

Our analysis of a population of northern Chinese indicates that the optimal cut-off values for MetS are WCs of 86 cm in men and 78 cm in women and a BMI of 24 kg/m² in both sexes. BMI was strongly associated with hypertension, while WC was strongly associated with T2DM and dyslipidemia.

Proposed cutoff level of waist circumference in Japanese men: evaluation by homeostasis model assessment of insulin resistance levels

OBJECTIVE

The aim of this study is to propose the cutoff level of waist circumference (WC) on the basis of homeostasis model assessment of insulin resistance (HOMA-IR) levels in order to diagnose metabolic syndrome (MetS).

METHODS

We examined a total of 798 non-diabetic men (40-65 years of age) by using a receiver operating characteristic (ROC) curve to determine the cutoff level that yielded the maximum sensitivity plus specificity. According to the criteria proposed by the International Diabetes Federation (IDF), and the Japanese Society of Internal Medicine (JSIM), subjects with ≥ 2 metabolic components other than abdominal obesity, were considered to have MetS.

RESULTS

The overall prevalence rates of IDF- and JSIM-MetS were 17.4% (n=139) and 15.5% (n=124), respectively. The median levels of WC and HOMA-IR were 83.1 [interquartile range (IQR): 78.5-88.4] cm and 0.84 (IQR: 0.61-1.19), respectively. HOMA-IR was highly correlated with each metabolic parameter (each p<0.05), and in addition, multiple linear regression analysis of HOMA-IR (adjusted R²=0.459) showed that WC level was the strongest independent predictors of HOMA-IR level (F=141.1, p<0.05). According to ROC curve analysis, the cutoff level of HOMA-IR for predicting IDF- and JSIM-MetS was 0.92 for both (sensitivity: 79.9% and 78.2%, specificity: 64.9% and 63.6%). Based on the HOMA-IR level, the proposed WC cutoff level was 82.7 cm (sensitivity: 75.4%, specificity: 63.8%).

CONCLUSION

This study suggests that WC level should be more strictly managed than current criteria, for preventing the development of MetS in non-diabetic middle-aged Japanese men.

Changing definitions of metabolic syndrome

The first description of patients with clustering of various metabolic abnormalities was as early as 1923 but it was more than five decades later, in 1988, that Reaven coined the term 'syndrome X' for this entity. The last two decades have brought forth a number of definitions and criteria to identify this condition. Various studies have demonstrated disparities in these definitions and a few researchers have questioned the utility of these criteria and even the existence of such a syndrome. A few important definitions are reviewed in this paper and, at the end, a simplified clinical definition is given and a simple parameter - lipid accumulation product - is been described that can be used to identify this condition.

Obesity and metabolic syndrome in Korea

In Korea, a person with a body mass index (BMI) ≥25 kg/m(2) is considered obese, and a person with a BMI ≥30 kg/m(2) is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.

The prevalence of metabolic syndrome and determination of the optimal waist circumference cutoff points in a rural South african community

OBJECTIVE

To determine the prevalence of metabolic syndrome and to define optimal ethnic-specific waist-circumference cutoff points in a rural South African black community.

RESEARCH DESIGN AND METHODS

This was a cross-sectional survey conducted by random-cluster sampling of adults aged >15 years. Participants had demographic, anthropometric, and biochemical measurements taken, including a 75-g oral glucose tolerance test. Metabolic syndrome was defined using the 2009 Joint Interim Statement (JIS) definition.

RESULTS

Of 947 subjects (758 women) studied, the age-adjusted prevalence of metabolic syndrome was 22.1%, with a higher prevalence in women (25.0%) than in men (10.5%). Peak prevalence was in the oldest age-group (≥65 years) in women (44.2%) and in the 45- to 54-year age-group in men (25.0%). The optimal waist circumference cutoff point to predict the presence of at least two other components of the metabolic syndrome was 86 cm for men and 92 cm for women. The crude prevalence of metabolic syndrome was higher with the JIS definition (26.5%) than with the International Diabetes Federation (IDF) (23.3%) or the modified Third Report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII) (18.5%) criteria; there was very good agreement with the IDF definition (κ = 0.90 [95% CI 0.87-0.94]) and good concordance with ATPIII criteria (0.77 [0.72-0.82]).

CONCLUSIONS

There is a high prevalence of metabolic syndrome, especially in women, suggesting that this community, unlike other rural communities in Africa, already has entered the epidemic of metabolic syndrome. Waist circumference cutoff points differ from those currently recommended for Africans.

Cut-off values of body mass index, waist circumference, and waist-to-height ratio to identify excess abdominal fat: population-based screening of Japanese school children

Background

School-based screening and prevention programs for adiposity generally target school children in grades 4 and 6 (age 9–11 years). The aims of this study were to evaluate the validity of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in identifying abdominal adiposity in fifth-grade Japanese school children and to determine optimal cut-off values for anthropometric measures.

Methods

The target population was fifth-grade school children enrolled in 2 schools in Shizuoka, Japan between 2008 and 2010; 422 of the 466 children participated in the present study. Abdominal adiposity was defined as percent trunk fat in the 95th percentile or higher, as determined by dual-energy x-ray absorptiometry (DXA). We analyzed the validity of BMI, WC, and WHtR using receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values of BMI, WC, and WHtR that identify excess abdominal fat.

Results

Optimal cut-off values to identify abdominal adiposity were 20.8 kg/m² (BMI), 76.5 cm (WC), and 0.519 (WHtR) for boys, and 19.6 kg/m² (BMI), 73.0 cm (WC), and 0.499 (WHtR) for girls. Areas under the ROC curve were 0.983 (BMI), 0.987 (WC), and 0.981 (WHtR) for boys, and 0.981 (BMI), 0986 (WC), and 0.992 (WHtR) for girls.

Conclusions

BMI, WC, and WHtR successfully identified a high proportion of children with excess abdominal fat as measured by DXA, demonstrating that these measures are useful indices for school screening.

BMI, waist circumference, and clustering of cardiovascular risk factors in Japanese adults

OBJECTIVE

To examine whether the association between waist circumference (WC) and clustering of cardiovascular risk factors varies with obesity (BMI) status.

METHODS

Using the 2008 health examination data of a Japanese health service association, eligible 57,141 adults aged 20-65 years without coronary heart disease or stroke, whose blood sample had been taken in the fasting state, were enrolled in the study. The participants were classified as being underweight (BMI <18.5), normal weight (BMI 18.5-24.9), and overweight (BMI ≥25.0). Multiple logistic regression analysis was performed to calculate adjusted odds ratios (OR) for clustering of cardiovascular risk factors. Receiver operating characteristic analysis was performed to assess the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors.

RESULTS

Clustering of cardiovascular risk factors was found in 16.0% of men and 3.4% of women. The adjusted OR [95% confidence intervals (CI)] per 5-cm increase in WC of the underweight, normal weight, and overweight groups was 1.57 (1.12-2.20), 1.55 (1.49-1.62), and 1.34 (1.30-1.38), respectively, for men and 1.50 (0.84-2.69), 1.53 (1.40-1.68), and 1.32 (1.23-1.41), respectively, for women. The area under curve (95% CI) of the underweight, normal weight, and overweight groups was 0.68 (0.59-0.77), 0.70 (0.69-0.71), and 0.62 (0.61-0.63), respectively, for men and 0.70 (0.53-0.86), 0.75 (0.73-0.78), and 0.64 (0.61-0.68), respectively, for women.

CONCLUSION

High WC was associated with increased risk of clustering of cardiovascular risk factors independent of BMI. As well as the magnitude of the association, the ability of WC to discriminate subjects with and without a clustering of cardiovascular risk factors varied with obesity (BMI) status.

Optimal cutoff values of waist circumference and the discriminatory performance of other anthropometric indices to detect the clustering of cardiovascular risk factors for metabolic syndrome in Japanese men and women

OBJECTIVE

To evaluate the pertinent cutoffs of waist circumference (WC) and the discriminatory performance of other anthropometric indices to detect clustering cardiovascular risk factors for metabolic syndrome (MetS) in Japan, where the current WC cutoffs for MetS (85 cm for men and 90 cm for women) remain controversial.

METHODS

We analyzed the baseline data from 844 subjects (330 men and 514 women) aged 40-69 years who participated in a cohort study in Saga city, Japan, between November 2005 and December 2007. Receiver operating characteristic (ROC) analyses were performed to find an appropriate cutoff (defined as the point nearest to the upper left corner of the ROC curve) of each anthropometric index for the presence of multiple risk factors among dyslipidemia, hypertension, and hyperglycemia [which was defined as hemoglobin A1c (HbA1c) levels at and above 5.2, 5.5, or 5.8%, values approximately corresponding to fasting plasma glucose levels of 100, 110, and 120 mg/dL, respectively].

RESULTS

The optimal WC cutoff was 88 cm (sensitivity 60%, specificity 70%) for men and 82 cm (sensitivity 78%, specificity 62%) for women; changing the HbA1c cutoff affected the results in women only (~85 cm). For the currently defined WC cutoffs in Japan, specificity was low (53-57%) in men, whereas sensitivity was very low (32-42%) in women. Body mass index, proportion of body fat, waist-to-height ratio, and waist-to-hip ratio showed area under the curve values similar to that of WC.

CONCLUSION

The current Japanese criteria of WC for MetS may be low for men and too high and insensitive for women in our study population. Other anthropometric indices such as waist-to-height ratio did not confer an improved discriminatory performance compared with WC.

Optimal cut-off point of waist circumference for the diagnosis of metabolic syndrome in Japanese subjects

Metabolic syndrome (MetS) has been redefined by a new criterion in Japan, in which waist circumference cut-off points, that is 85 cm for men and 90 cm for women, are used; however, objections are rising against this criterion. The present study examined the criterion for waist circumference to predict the accumulation of the components of MetS. In the present study, we used data for 5972 Japanese people who received annual health examinations, and 621 men (16.3%) and 51 women (2.4%) were diagnosed as having MetS. A cut-off point as a predictor for two or more components of MetS was evaluated by the sensitivity/specificity and a receiver operating characteristic analysis. The optimal point of waist circumference was estimated as being approximately 84 cm for men and 80 cm for women. We therefore recommend revising the cut-off value for the criterion of MetS in women according to our results and studies from other investigators. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00020.x, 2010).

Abdominal circumference should not be a required criterion for the diagnosis of metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS) is an established concept. However, it is characterized by a number of different definitions as well as different cut-off points (COPs) for waist circumference (WC) and different modes for incorporating WC into the diagnostic criteria.

METHODS

Abdominal ultrasonography was performed in 2,333 subjects who also underwent comprehensive medical examinations between April and July 2006. The odds ratios for the number of MetS components were calculated by taking central obesity status into account and considering concurrent fatty liver as an independent variable. We compared the areas under the receiver operating characteristic (ROC) curves for fatty liver and MetS using several MetS criteria.

RESULTS

Regardless of the WC criterion selected, we observed a strong linear trend for an association (trend P < 0.0001) between MetS and the number of components. The odds ratio (OR) of subjects without central obesity but with all three MetS components was 9.69 (95% confidence interval 3.11-30.2) in men and 55.3 (6.34-483) in women. The COP for the largest area under the curve in men and women was ≥82 cm (OR 0.701) and ≥77 cm (OR 0.699), respectively, when WC was considered as a component. When WC distribution is taken into consideration, practical and appropriate COPs should be ≥85 cm for men and ≥80 cm for women.

CONCLUSION

We suggest that a WC of ≥85 cm for men and ≥80 cm for women would be optimal COPs for the central obesity criteria in the Japanese population. In addition, central obesity should be incorporated as a component of MetS rather than an essential requirement for the diagnosis of MetS.

Metabolic syndrome and anthropometric factors in Japanese patients with chronic kidney disease

A necessary condition for establishing new criteria for the metabolic syndrome (MetS) in Japan is waist circumference (WC), which varies among races. In the present study, we measured WC and visceral fat area (VFA) in patients with chronic kidney disease (CKD) and assessed the features of new MetS criteria in Japan. Two hundred and seventeen patients (M/F: 116/101, age: 59.1 +/- 13.0 years, body mass index: 24.1 +/- 3.9 kg/m(2)) who received abdominal computed tomography (CT) examinations were analyzed, and 93 subjects met the criteria for MetS. Average VFA was significantly larger in subjects with MetS (193.6 +/- 52.4 cm(2) versus 96.9 +/- 50.2 cm(2), P < 0.001). WC and VFA correlated significantly in both males (r = 0.71, P < 0.001) and females (r = 0.79, P < 0.001). Male and female CKD patients whose VFAs exceed 125 cm(2) have significantly more components of MetS, and the corresponding WC is 81.2 cm for males and 81.6 cm for females. From the ROC curve, 84 cm for males and 83 cm for females seemed to be suitable cut-off values in CKD patients. In conclusion, we propose suitable cut-off values of WC in Japanese CKD patients, with a high sensitivity for detecting the MetS, to be 84 cm for males and 83 cm for females. Further prospective analysis is required to validate these criteria and the clinical significance of MetS in Japanese CKD patients.

Japanese study to organize proper lifestyle modifications for metabolic syndrome (J-STOP-MetS): design and method

Prevalence of the metabolic syndrome is now a very serious health problem in Japan and a public preventive strategy is essential to reduce morbidity. A systematic interventional strategy for the metabolic syndrome remains to be established. In order to address this issue, a multi-center study; Japanese Study to Organize Proper lifestyle modification for the metabolic syndrome (J-STOP-MetS), has been established by nine preventive medical centers among Rosai hospital groups. This study comprises a cross-sectional study (J-STOP-MetS 1) and a prospective randomized control study (J-STOP-MetS 2). J-STOP-MetS 1 examines the causes of the metabolic syndrome by means of a questionnaire in a large cohort of patients with the metabolic syndrome and control subjects matched for age and sex. J-STOP-MetS 2 examines the hypothesis that guidance on lifestyle modifications will help at risk patients to reduce abdominal fat and cardiovascular risk factors. The metabolic syndrome patients are randomly assigned either to a single visit to a guidance group or multiple visits every two months. The individualized guidance is provided by the coordination of physician, trained nurse, dietician and exercise trainer. Several parameters are measured before and six months after the first guidance session, including, body weight, waist circumference, blood pressure, several blood markers and arterial stiffness. The J-STOP-MetS is the first large-scale clinical study of the metabolic syndrome in Japan and should provide important evidence for the practical management of the metabolic syndrome.

Metabolic syndrome mortality in a population-based cohort study: Jichi Medical School (JMS) Cohort Study

BACKGROUND

Metabolic syndrome is known to increase morbidity and mortality of cardiovascular disease. The National Cholesterol Education Program Adult Treatment Expert Panel III in 2001 (revised in 2005) and the Japanese definition of metabolic syndrome were launched in 2005. No study regarding the association between metabolic syndrome by Japanese definition and mortality has been performed. The aim of this study was to clarify the prevalence of metabolic syndrome and its effects to mortality in a population-based cohort study.

METHODS

A total of 2176 subjects who satisfied the necessary criteria for metabolic syndrome were examined between 1992 and 1995 as a part of Jichi Medical School Cohort Study by Japanese definition. Cox's proportional hazard models were used to analyze the association of metabolic syndrome with mortality.

RESULTS

The prevalence of metabolic syndrome was 9.0% in males and 1.7% in females. There were 17 deaths (14 males), including 6 cardiovascular deaths (5 males), during a 12.5-year follow-up period among metabolic syndrome subjects. After adjusting for age, smoking status, and alcohol drinking status, the hazard ratio (95% confidence interval) for all-cause mortality was 1.13 (0.64-1.98) in males and 1.31 (0.41-4.18) in females, and HR for cardiovascular mortality was 1.84 (0.68-4.96) in males, and 1.31 (0.17-9.96) in females.

CONCLUSION

No statistical significant relationship between metabolic syndrome by Japanese definition and all-cause mortality was observed in a population-based cohort study.

Appropriate waist circumference cutoff values for persons with multiple cardiovascular risk factors in Japan: a large cross-sectional study

BACKGROUND

In Japan, the current standard waist circumference cutoff value for persons with multiple cardiovascular risk factors remains controversial. In this study we aimed to analyze the health-check examination data from a large Japanese population and propose a revised waist circumference cutoff value.

METHODS

Subjects of this study were 12,725 adults who underwent a health-check by thorough medical examination between April 2006 and March 2007. Medical examinations included measurement of waist circumference, fasting blood triglycerides, HDL cholesterol, glucose concentrations, blood pressure and collection of demographic characteristics. Receiver operating characteristic (ROC) curve analysis was utilized to find appropriate waist circumference cutoff values in relation to multiple cardiovascular risk factors with two or more of the following: dyslipidemia (hypertriglyceridemia or low HDL cholesterol), hypertension, and hyperglycemia defined by the Japanese criteria of metabolic syndrome.

RESULTS

The average age of the subjects was 50.7 years (standard deviation [SD]: 8.8) for men and 49.7 years (SD: 8.6) for women. ROC curve analysis showed maximum sensitivity plus specificity at a waist circumference of 87 cm in men (0.66 and 0.62, respectively) and 83 cm in women (0.73 and 0.70). When analyzed by ten-year age groups, the ROC curves for younger age groups were shifted up and to the left compared to older age groups, but associations between cutoff values and age were not clear.

CONCLUSION

In Japan, the appropriate cutoff value of waist circumference for persons with multiple cardiovascular risk factors is 87 cm for men and 83 cm for women.

Clinical usefulness of quantitative evaluation of visceral fat by ultrasonography

PURPOSE

The aim of this work was to evaluate the usefulness of a proposed method for visceral fat volume assessment by ultrasonography (US) in identifying those at risk of metabolic syndrome, and also to establish the most suitable cutoff level of waist circumference for the diagnosis of visceral adiposity.

METHODS

One hundred and fifty-two outpatients with metabolic diseases such as hypertension, diabetes, or dyslipidemia were studied. The total visceral fat volume (total-VFA) was measured by computed tomography (CT), the visceral fat area at the level of the umbilicus was measured by CT (CT-VFA), and the visceral fat area was also measured by US (US-VFA), as we recently proposed.

RESULTS

Significant correlation coefficients were found between total-VFA and CT-VFA, US-VFA, and waist circumference in men but not in women. The correlation co-efficient between US-VFA and waist circumference was significantly positive in men and weakly positive in women. According to receiver-operator characteristic curves, the cutoff value of waist circumference yielding the maximal sensitivity plus specificity for predicting more than 100 cm(2) of US-VFA was 85 cm in men and 84 cm in women. The change in US-VFA was significantly larger than that in waist circumference after a 6-month interval.

CONCLUSION

The US-measured visceral fat area is more useful than waist circumference in a clinical setting.

Visceral Obesity in Japanese Patients with Metabolic Syndrome: Reappraisal of Diagnostic Criteria by CT Scan

To reappraise the cutoff level of abdominal circumference (AC) for diagnosis of visceral obesity in Japanese, we examined the association of visceral fat deposition with other constituents of metabolic syndrome and atherosclerotic cardiovascular disease (ASCD). CT was used for determination of visceral-fat area (VFA), subcutaneous-fat area (SFA) and AC on CT (AC(CT)) in 420 Japanese patients with (n=180) or without ASCD (n=240). VFA cutoff levels were calculated by receiver operating characteristic (ROC) analysis. AC(CT) correlated with VFA (r=0.828), SFA (r=0.795), and AC measured with an anthropometric tape (AC(M), r=0.96). The VFA cutoff levels yielding the maximum sensitivity and specificity to predict two or more components of metabolic syndrome were 92 cm(2) in males and 63 cm(2) in females, which correspond to AC(M) values of 83 cm and 78 cm, respectively. The male AC(M) cutoff level was similar to the AC in current Japanese criteria (85 cm), but the female AC(M) cutoff level was considerably smaller than the criteria, and this change in cutoff level increased the prevalence of metabolic syndrome in females three-fold. The cutoff levels of VFA for predicting presence of ASCD were 98 cm(2) in males and 75 cm(2) in females, corresponding to AC(M) values of 84 cm and 80 cm, respectively. The present results obtained by CT support the validity of the current Japanese criteria for visceral obesity in males but not in females. AC(M) of 78 cm appears to be a cutoff level suitable for diagnosing visceral obesity in Japanese females, though further confirmation is needed.