Waist Circumference for the Clinical Diagnosis of Metabolic Syndrome in the Japanese Population: Optimal Cut-Point to Predict Early Arteriosclerosis

  • Yuka Matoba
  • Toyoshi Inoguchi
  • Atsushi Ogo
  • Ryoichi Takayanagi


Metabolic syndrome (MetS) has been proposed as a syndrome in an individual with clustered metabolic dysfunction including increased abdominal adiposity, raised blood pressure, raised triglyceride and/or reduced HDL cholesterol and raised fasting plasma glucose. At the time of writing, several definitions for clinical diagnosis of MetS have been proposed by different organizations. Clinical methods to evaluate visceral adiposity include abdominal computed tomography, body mass index, and waist and hip circumference; in which waist circumference is the most available, but is highly dependent on the ethnicity. Current MetS definitions include waist circumference as a surrogate marker for visceral adiposity and adapt cut-points of waist circumference for each ethnic group to optimize their predictive values. For Asians, the International Diabetes Federation (IDF), the American Heart Association and the National Heart, Lung and Blood Institute have provided the waist cut-points as 90 cm for men and 80 cm for women as recommended by the World Health Organization. By contrast, the previous IDF definition and the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome adopted waist cut-points of 85 cm for Japanese men and 90 cm for Japanese women which were derived from the cut-points of visceral fat area by computed tomography to identify clustered risk factors. After the MetS definitions were published, waist cut-points for the Japanese population have been re-evaluated in several studies. Our recent studies obtained optimal waist cut-points (87 cm for men and 80 cm for women) from the relation between waist circumference and risk factor clustering in a Japanese population. It showed superior sensitivity and specificity to the conventional IDF (90 cm), which is also the cut-points for Japanese women (90 cm), to predict intima-media thickening; it also agreed with the revised IDF definition (80 cm) for women. These studies suggest that the waist cut-points of 90 cm for men and 80 cm for women are relevant for Japanese population to define MetS with a short-term risk of development of atherosclerosis. Further studies with larger population and longer follow-up period may validate these waist cut-points for the clinical diagnosis of MetS with a substantial risk of cardiovascular events and/or onset of type 2 diabetes.


Metabolic Syndrome Waist Circumference International Diabetes Federation Abdominal Adiposity International Diabetes Federation Definition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Body mass index


Blood Pressure


Computed tomography


Fasting Plasma Glucose


High Density Lipoprotein Cholesterol




Intima-media thickness


Metabolic syndrome


Risk factor


Total cholesterol




Tumor Necrosis Factor-α


Waist circumference


  1. Alberti KG, Zimmet PZ. Diabet Med. 1998 Jul;15(7):539–53.PubMedCrossRefGoogle Scholar
  2. Alberti KG, Zimmet P, Shaw J. Lancet. 2005;366:1059–62.PubMedCrossRefGoogle Scholar
  3. Bermudez EA, Rifai N, Buring J, Manson JE, Ridker PM. Arterioscler Thromb Vasc Biol. 2002;22:1668–73.PubMedCrossRefGoogle Scholar
  4. Dekker JM, Girman C, Rhodes T, Nijpels G, Stehouwer CD, Bouter LM, Heine RJ. Circulation. 2005;112:666–73.PubMedCrossRefGoogle Scholar
  5. Despres JP, Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC, Skinner JS, Wilmore JH, Bouchard C. Arterioscler Thromb Vasc Biol. 2000;20:1932–8.PubMedCrossRefGoogle Scholar
  6. Despres JP, Lemieux I. Nature. 2006;444:881–7.PubMedCrossRefGoogle Scholar
  7. Deurenberg P, Yap M, van Staveren WA. Int J Obes Relat Metab Disord. 1998;22:1164–71.PubMedCrossRefGoogle Scholar
  8. Eckel RH, Grundy SM, Zimmet PZ. Lancet. 2005;365:1415–28.PubMedCrossRefGoogle Scholar
  9. Freeman DJ, Norrie J, Caslake MJ, Gaw A, Ford I, Lowe GD, O’Reilly DS, Packard CJ, Sattar N. Diabetes. 2002;51:1596–600.PubMedCrossRefGoogle Scholar
  10. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Jr., Spertus JA, Costa F. Circulation. 2005;112:2735–52.PubMedCrossRefGoogle Scholar
  11. Han TS, McNeill G, Seidell JC, Lean ME. Int J Obes Relat Metab Disord. 1997;21:587–93.PubMedCrossRefGoogle Scholar
  12. Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T. Diabetes Care. 2006;29:1123–4.PubMedCrossRefGoogle Scholar
  13. Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY. Diabetes Care. 2007;30:120–7.PubMedCrossRefGoogle Scholar
  14. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen MR, Groop L. Diabetes Care. 2001;24:683–9.PubMedCrossRefGoogle Scholar
  15. Japan Society for the Study of Obesity. Circ J. 2002;66:987–92.CrossRefGoogle Scholar
  16. Katzmarzyk PT, Janssen I, Ross R, Church TS, Blair SN. Diabetes Care. 2006;29:404–9.PubMedCrossRefGoogle Scholar
  17. Kawamoto R, Tomita H, Oka Y, Kodama A, Kamitani A. Intern Med. 2005;44:1232–8.PubMedCrossRefGoogle Scholar
  18. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. JAMA. 2002;288:2709–16.PubMedCrossRefGoogle Scholar
  19. Lemieux I, Drapeau V, Richard D, Bergeron J, Marceau P, Biron S, Mauriege P. Diabetes Care. 2006;29:1417–9.PubMedCrossRefGoogle Scholar
  20. Lemieux S, Prud’homme D, Nadeau A, Tremblay A, Bouchard C, Despres JP. Diabetes Care. 1996;19:983–91.PubMedCrossRefGoogle Scholar
  21. Matoba Y, Inoguchi T, Nasu S, Suzuki S, Yanase T, Nawata H, Takayanagi R. Diabetes Care. 2008;31:590–2.PubMedCrossRefGoogle Scholar
  22. Matoba Y, Inoguchi T, Suzuki S, Nasu S, Hashimoto T, Yanasa T, Nawata H, Takayanagi R. Diab Res Clin Pract. 2009 Dec;86(3):e50–3. Epub 2009 Oct 8.Google Scholar
  23. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, Ballantyne CM, Heiss G. Diabetes Care. 2005;28:385–90.PubMedCrossRefGoogle Scholar
  24. National Institutes of Health. Obes Res. 1998 Sep;6 Suppl 2:51S–209S.Google Scholar
  25. Misra A, Wasir JS, Vikram NK. Nutrition. 2005;21:969–76.PubMedCrossRefGoogle Scholar
  26. Miyawaki T, Hirata M, Moriyama K, Sasaki Y, Aono H, Saito N, Nakao K. Proc Japan Acad. 2005;81:471–9.CrossRefGoogle Scholar
  27. Pascot A, Lemieux S, Lemieux I, Prud’homme D, Tremblay A, Bouchard C, Nadeau A, Couillard C, Tchernof A, Bergeron J, Despres JP. Diabetes Care. 1999;22:1471–8.PubMedCrossRefGoogle Scholar
  28. Ridker PM, Buring JE, Cook NR, Rifai N. Circulation. 2003;107:391–7.PubMedCrossRefGoogle Scholar
  29. Takeuchi H, Saitoh S, Takagi S, Ohnishi H, Ohhata J, Isobe T, Shimamoto K. Hypertens Res. 2005;28:203–8.PubMedCrossRefGoogle Scholar
  30. Tan CE, Ma S, Wai D, Chew SK, Tai ES. Diabetes Care. 2004;27:1182–6.PubMedCrossRefGoogle Scholar
  31. The Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome. J Jpn Soc Intern Med. 2005;94:188–203.Google Scholar
  32. Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, Qizilbash N, Collins R, Peto R. Lancet. 2009;373:1083–96.PubMedCrossRefGoogle Scholar
  33. Wildman RP, Gu D, Reynolds K, Duan X, He J. Am J Clin Nutr. 2004;80:1129–36.PubMedGoogle Scholar
  34. Winter Y, Rohrmann S, Linseisen J, Lanczik O, Ringleb PA, Hebebrand J, Back T. Stroke. 2008;39:3145–51.PubMedCrossRefGoogle Scholar
  35. Yanase T, Nasu S, Mukuta Y, Shimizu Y, Nishihara T, Okabe T, Nomura M, Inoguchi T, Nawata H. Am J Hypertens. 2006;19:1206–12.PubMedCrossRefGoogle Scholar
  36. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L, Tanomsup S, Wangai P, Jr., Razak F, Sharma AM, Anand SS. Lancet. 2005;366:1640–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Yuka Matoba
    • 1
    • 2
  • Toyoshi Inoguchi
  • Atsushi Ogo
  • Ryoichi Takayanagi
  1. 1.Department of Metabolism and EndocrinologyClinical Research Institute, National Hospital Organization Kyushu Medical CenterFukuoka-shiJapan
  2. 2.Department of Medicine and Bioregulatory Science, Graduate School of Medical SciencesKyushu UniversityFukuoka-shiJapan

Personalised recommendations