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Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan

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Abstract

BACKGROUND: The increased health risks associated with obesity have been found to occur in Asians at lower body mass indices (BMIs). To determine the optimal cut-off values for overweight or obesity in Taiwan, we examined the relationships between four anthropometric indices and cardiovascular risk factors.

METHODS: The data were collected from four health-screening centers from 1998 to 2000 in Taiwan. Included were 55 563 subjects (26 359 men and 29 204 women, mean age=37.3±10.9 and 37.0±11.1 y, respectively). None had known major systemic diseases or were taking medication. Individual body weight, height, waist circumference (WC), and a series of tests related to cardiovascular risk (blood pressure, fasting plasma glucose, triglycerides, total cholesterol, low- and high-density lipoprotein cholesterol) were assessed and their relationships were examined. Receiver operating characteristic (ROC) analysis was used to find out the optimal cut-off values of various anthropometric indices to predict hypertension, diabetes mellitus and dyslipidemia.

RESULTS: Of the four anthropometric indices we studied, waist-to-height ratio (WHtR) in women was found to have the largest areas under the ROC curve (women=0.755, 95% CI 0.748–0.763) relative to at least one risk factor (ie hypertension or diabetes or dyslipidemia). The optimal cut-off values for overweight or obesity from our study in men and women showed that BMIs of 23.6 and 22.1 kg/m2, WCs of 80.5 and 71.5 cm, waist-to-hip ratios (WHpR) of 0.85 and 0.76, and WHtR of 0.48 and 0.45, respectively, may be more appropriate in Taiwan.

CONCLUSIONS: WHtR may be a better indicator for screening overweight- or obesity-related CVD risk factors than the other three indexes (BMI, WC and WHpR) in Taiwan. Our study also supported the hypothesis that the cut-off values using BMI and WC to define obesity should be much lower in Taiwan than in Western countries.

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References

  1. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL . Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960 to 1991 JAMA 1994 272: 205–211.

    Article  CAS  Google Scholar 

  2. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL . Overweight and obesity in the United States: Prevalence and trends, 1960–1994 Int J Obes Relat Metab Disord 1998 22: 39–47.

    Article  CAS  Google Scholar 

  3. World Health Organization. Obesity: preventing and managing the global epidemic WHO: Geneva 1998.

  4. Kopelman . Obesity as a medical problem Nature 2000 404: 635–643.

    Article  CAS  Google Scholar 

  5. Pi-Sunyer X . Health implications of obesity Am J Clin Nutr 1991 53: 1595s–1603s.

    Article  CAS  Google Scholar 

  6. Hubert HB, Feinleib M, McNamara PM, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study Circulation 1983 67: 968–977.

    Article  CAS  Google Scholar 

  7. William BK, Ralph BD, Janet LC . Effect of weight on cardiovascular disease Am J Clin Nutr 1996 63: 419s–422s.

    Article  Google Scholar 

  8. Seidell JC, Verschu Ren WM, Van Leer EM, Kromhout D . Overweight, underweight, and mortality. A prospective study of 48,187 men and women Arch Intern Med 1996 156: 958–963.

    Article  CAS  Google Scholar 

  9. Björntorp P . Metabolic implications of body fat distribution Diabetes Care 1991 14: 1132–1143.

    Article  Google Scholar 

  10. Larsson B, Svardsud K, Welin L, Wilhelmsen L, Bjorntorp P, Tibblin G . Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 y follow up of participants in the study of men born in 1913 Br Med J 1984 288: 1401–1404.

    Article  CAS  Google Scholar 

  11. Kissebah AH, Vydelingum N, Murray R, Evans DJ, Hartz AJ, Kalkhoff RK, Adams PW . Relation of body fat distribution to metabolic complications of obesity J Clin Endocrinol Metab 1982 54: 254–260.

    Article  CAS  Google Scholar 

  12. Mazess RB, Barden HS, Bisek JP, Hanson J . Dual-energy X-ray absorptiometry for total body and regional bone mineral and soft tissue composition Am J Clin Nutr 1990 51: 1106–1112.

    Article  CAS  Google Scholar 

  13. Lukaski HC . Methods for the assessment of human body composition: Traditional and new Am J Clin Nutr 1987 46: 537–556.

    Article  CAS  Google Scholar 

  14. Friedl KE, Deluca JP, Marchitelli LJ, Vogel JA . Reliability of body-fat estimations from a four-compartment model by using density, body water, and bone mineral measurements Am J Clin Nutr 1992 55: 764–770.

    Article  CAS  Google Scholar 

  15. Kushner RF, Schoeller DA, Fjeld CR, Danford L . Is the impedance index (H2/R) significant in predicting total body water Am J Clin Nutr 1992 56: 835–839.

    Article  CAS  Google Scholar 

  16. Gallagher D, Visser M, Sepulveda D, Pierson RN, Harris T, Heymsfield SB . How useful is body mass index for comparison of body fatness across age, sex, and ethnic groups? Am J Epidemiol 1996 143: 228–239.

    Article  CAS  Google Scholar 

  17. Deurenberg P, Yap M, van Staveren WA . Body mass index and percent body fat: a meta-analysis among different ethnic groups Int J Obes Relat Metab Disord 1988 22: 1164–1171.

    Article  Google Scholar 

  18. Pouliot MC, Despres JP, Lemieux S et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women Am J Cardiol 1994 73: 460–468.

    Article  CAS  Google Scholar 

  19. Després J-P, Prud'homme, Pouliot MC, Trembley A, Bouchard C . Estimation of deep abdominal adipose-tissue accumulation from siimple anthropometric measurements in men Am J Clin Nutr 1991 54: 471–477.

    Article  Google Scholar 

  20. Hsieh SD, Yoshinaga H . Abdominal fat distribution and coronary heart disease risk factors in men—waist/height ratio as a simple and useful predictor Int J Obes Relat Metab Disord 1995 19: 585–589.

    CAS  PubMed  Google Scholar 

  21. Hsieh SD, Yoshinaga H . Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women Intern Med 1995 34: 1147–1152.

    Article  CAS  Google Scholar 

  22. Ko GTC, Chan JCN, Woo J, Lau E et al. Simple anthropometric indexes and cardiovascular risk factors in Chinese Int J Obes Relat Metab Disord 1997 21: 995–1001.

    Article  CAS  Google Scholar 

  23. Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S Jr, Pierson RN . Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements Am J Clin Nutr 1994 60: 23–28.

    Article  CAS  Google Scholar 

  24. Deurenberg-Yap M, Yian TB, Kai CS, Deurenberg P, van Staveren WA . Manifestation of cardiovascular risk factors at low levels of body mass index and waist-to-hip ratio in Singaporean Chinese Asia Pacific J Clin Nutr 1999 8: 177–183.

    Article  CAS  Google Scholar 

  25. Hsieh SD, Yo Shinaga H, Muto T, Sakurai Y, Kosaka K . Health risks among Japanese men with moderate body mass index Int J Obes Relat Metab Disord 2000 24: 358–362.

    Article  CAS  Google Scholar 

  26. Wang J, Russell-Aulet M, Mazariegos M et al. Body fat by dual photon absorptiometry (DPA): comparisons with traditional methods in Asians, Blacks and Caucasians Am J Hum Biol 1992 4: 501–510.

    Article  Google Scholar 

  27. World Health Organization. The Asia-Pacific perspective: redefining obesity and its treatment WHO: Geneva 2000.

  28. Department of Health. Taiwan Public Health Report 1998–2000 DOH: Taipei 1998–2000.

  29. van der Schouw YT, Verbeek ALM, Ruijs JHJ . ROC curves for the initial assessment of new diagnostic tests Fam Pract 1992 9: 506–511.

    Article  CAS  Google Scholar 

  30. Metz CE . Basic principles of ROC analysis Sem Nucl Med 1978 8: 283–298.

    Article  CAS  Google Scholar 

  31. Swets JA . The relative operating characteristics in psychology Science 1973 182: 990–1000.

    Article  CAS  Google Scholar 

  32. Hanley JA, McNeil BJ . The meaning and use of the area under a receiver operating characteristic (ROC) curve Radiology 1982 143: 29–36.

    Article  CAS  Google Scholar 

  33. World Health Organization. Obesity: preventing and managing the global epidemic eport of a WHO Consultation of Obesity, 3–5 June WHO: Geneva 1997.

  34. Rissanen P, Hamalainen P, Vanninen E, Tenhunen-Eskelinen M, Uusitupa M . Relationship of metabolic variables to abdominal adiposity measures by different anthropometric measurements and dual-energy X-ray absorptiometry in obese middle-aged women Int J Obes Relat Metab Disord 1997 21: 367–371.

    Article  CAS  Google Scholar 

  35. Hodge AM, Dowse GK, Gareeboo H, Tuomilehto J, Alberti KGMM . Incidence, increasing prevalence, and predictors of change in obesity and fat distribution over 5 years in the rapidly developing population of Mauritus Int J Obes Relat Metab Disord 1996 20: 137–146.

    CAS  PubMed  Google Scholar 

  36. Ko GTC, Chan JCN, Cockram CS, Woo J . Prediction of hypertension, diabetes or albuminuria using simple anthropometric indexes in Hong Kong Chinese Int J Obes Relat Metab Disord 1999 23: 1136–1142.

    Article  CAS  Google Scholar 

  37. Han TS, van Leer EM, Seidell JC, Lean MEJ . Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample Br Med J 1995 311: 1401–1405.

    Article  CAS  Google Scholar 

  38. Lean MEJ, Han TS, Morrison CE . Waist circumference as a measure for indicating need for weight management Br Med J 1995 311: 158–161.

    Article  CAS  Google Scholar 

  39. Kopelman . Obesity as a medical problem Nature 2000 404: 635–643.

    Article  CAS  Google Scholar 

  40. Pi-Sunyer X . Health implications of obesity Am J Clin Nutr 1991 53: 1595s–1603s.

    Article  CAS  Google Scholar 

  41. Reeder BA, Angel A, Ledoux M, Rabkin SW, Young TK, Sweet LE . Obesity and its relation to cardiovascular disease risk factors in Canadian adults Can Med Assoc J 1992 146: 2009–2019.

    CAS  Google Scholar 

  42. Kim SM, Lee DJ . What is the best simple anthropometric indexes of abdominal visceral fat in obese patients? J Korean Soc Study Obes 1998 7: 157–168.

    Google Scholar 

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Authors and Affiliations

  1. Department of Family Medicine, Obesity Research Group, National Taiwan University Hospital, Taipei, Taiwan

    W-Y Lin, L-T Lee, C-Y Chen, H Lo, H-H Hsia & K-C Huang

  2. Department of Family Medicine, China Medical College Hospital, Taichung, Taiwan

    W-Y Lin

  3. Health Care Administration, Chia-Nan University of Pharmacy and Science, Taipei, Taiwan

    H Lo

  4. MJ Health Screening Center, Taipei, Taiwan

    I-L Liu

  5. Graduate Institute of Preventive & Medicine, National Taiwan University, Taipei, Taiwan

    R-S Lin

  6. Graduate Institute of Clinical Medicine, Taipei, Taiwan

    W-Y Shau

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  1. W-Y Lin
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Correspondence to K-C Huang.

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Lin, WY., Lee, LT., Chen, CY. et al. Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes 26, 1232–1238 (2002). https://doi.org/10.1038/sj.ijo.0802040

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