Korean Journal of Community Nutrition (대한지역사회영양학회지)

The Korean Society of Community Nutrition (대한지역사회영양학회)
권호 표지

Optimal Waist Circumference for the Prevention of Cardiovascular Disease

심혈관계질환의 발병 위험을 선별할 수 있는 적정 허리둘레의 임계점

  • Baik, In-Kyung (Department of Foods and Nutrition, College of Natural Sciences, Kookmin University) ;
  • Shin, Chol (Department of Internal Medicine, Korea University Ansan Hospital)
  • 백인경 (국민대학교 자연과학대학 식품영양학과) ;
  • 신철 (고려대학교 의과대학 안산병원 내과학교실)
  • Received : 2010.02.23
  • Accepted : 2010.04.02
  • Published : 2010.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

There are few studies reporting optimal waist circumference that can be utilized to prevent the incidence of cardiovascular disease (CVD). We evaluated the association of waist circumference and waist and hip circumference ratio (WHR) with incident cases of CVD developed over 6 years in a population-based prospective study including Korean adults. Analyses for receiver-operating characteristic (ROC) curve were performed with data for 1,733 men and 1,579 women who were aged 40 to 69 years and were free of a physician-diagnosis of CVD at baseline. Information on the diagnosis of CVD was periodically reported using interviewer-administered questionnaires and anthropometric measures were obtained by biennial health examinations. We newly identified 77 cases of CVD during a follow-up period between 2003 and 2008. On the basis of measures of diagnostic accuracy including minimum distance to ROC curve and Youden index, waist circumference of 85 cm for men, in particular for male nonsmokers, and of 80 cm for women and WHR of 0.88 to 0.90 for men and of 0.83 for women were found to be optimal cutoff points to identify individuals at CVD risks. The study also found that the use of the suggested optimal values for waist circumference show higher sensitivity and lower specificity compared with 90 cm for men and 85 cm for women, which are waist cutoff points given by the Korean Society for the Study of Obesity to define abdominal obesity for Korean adults. Although lower cutoff points of waist circumference (83 cm) and WHR (0.87) were observed to be optimal for male smokers compared with male nonsmokers, whether suggesting waist cutoff points specific to smokers is needed warrants further studies. After taking into account other cardiovascular risk factors including smoking, men with waist circumference of 85 cm or greater and women with 80 cm or greater were at an increased risk of CVD. Thus, these cutoff points of waist circumference may be able to capture more individuals at CVD risks contributing to the prevention of future development of CVD.

Keywords

References

  1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr, International Diabetes Federation Task Force on Epidemiology and Prevention, National Heart, Lung, and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, International Association for the Study of Obesity (2009): Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 120(16): 1640-1645 https://doi.org/10.1161/CIRCULATIONAHA.109.192644
  2. Bao Y, Lu J, Wang C, Yang M, Li H, Zhang X, Zhu J, Lu H, Jia W, Xiang K (2008): Optimal waist circumference cutoffs for abdominal obesity in Chinese. Atherosclerosis 201(2): 378-384 https://doi.org/10.1016/j.atherosclerosis.2008.03.001
  3. Baik I (2009): Optimal cutoff points of waist circumference for the criteria of abdominal obesity: comparison with the criteria of the International Diabetes Federation. Circ J 73(11): 2068-2075 https://doi.org/10.1253/circj.CJ-09-0303
  4. Baik I, Shin C (2008): Prospective study of alcohol consumption and metabolic syndrome. Am J Clin Nutr 87(5): 1455-1463
  5. Doi Y, Ninomiya T, Hata J, Yonemoto K, Arima H, Kubo M, Tanizaki Y, Iwase M, Iida M, Kiyohara Y (2009): Proposed criteria for metabolic syndrome in Japanese based on prospective evidence: the Hisayama study. Stroke 40(4): 1187-1194 https://doi.org/10.1161/STROKEAHA.108.531319
  6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001): Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285(19): 2486-2497 https://doi.org/10.1001/jama.285.19.2486
  7. 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; American Heart Association; National Heart, Lung, and Blood Institute (2005): Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112(17): 2735-2752 https://doi.org/10.1161/CIRCULATIONAHA.105.169404
  8. Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY (2007): Minimum waist and visceral fat values for identifying Japanese Americans at risk for the metabolic syndrome. Diabetes Care 30(1): 120-127 https://doi.org/10.2337/dc06-0739
  9. Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T (2006): A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care 29(5): 1123-1124 https://doi.org/10.2337/dc05-2540
  10. International Diabetes Federation [IDF] (2009): Worldwide definition of the metabolic syndrome. Available at http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf. Accessed April 28, 2009
  11. Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissén M, Taskinen MR, Groop L (2001): Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 24(4): 683-689 https://doi.org/10.2337/diacare.24.4.683
  12. Kim JA, Choi CJ, Yum KS (2006): Cut-off values of visceral fat area and waist circumference: Diagnostic criteria for abdominal obesity in a Korean population. J Korean Med Sci 21(6): 1048-1053 https://doi.org/10.3346/jkms.2006.21.6.1048
  13. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT (2002): The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288(21): 2709-2716 https://doi.org/10.1001/jama.288.21.2709
  14. Lee K (2000): Waist circumference as a screening tool for cardiovascular risk factors in Korea: evaluations of receiver operating characteristics (ROC). J Korean Acd Fam Med 21(2): 395-405
  15. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ (2007): Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 75(1): 72-80 https://doi.org/10.1016/j.diabres.2006.04.013
  16. Li R, Lu W, Jia J, Zhang S, Shi L, Li Y, Yang Q, Kan H (2008): Relationship between indices of obesity and its cardiovascular comorbidities in a Chinese population. Circ J 72(6): 973-978 https://doi.org/10.1253/circj.72.973
  17. Narisawa S, Nakamura K, Kato K, Yamada K, Sasaki J, Yamamoto M (2008): Appropriate waist circumference cutoff values for persons with multiple cardiovascular risk factors in Japan: a large cross-sectional study. J Epidemiol 18(1): 37-42 https://doi.org/10.2188/jea.18.37
  18. Nishimura R, Nakagami T, Tominaga M, Yoshiike N, Tajima N (2007): Prevalence of metabolic syndrome and optimal waist circumference cut-off values in Japan. Diabetes Res Clin Pract 78(1):77-84 https://doi.org/10.1016/j.diabres.2007.02.015
  19. Oizumi T, Daimon M, Wada K, Jimbu Y, Kameda W, Susa S, Yamaguchi H, Ohnuma H, Kato T (2006): A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Circ J 70(12): 1663 https://doi.org/10.1253/circj.70.1663
  20. Sato A, Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R, Hara A, Hoshi H, Hashimoto J, Totsune K, Satoh H, Oka Y, Imai Y (2008): Optimal cutoff point of waist circumference and use of home blood pressure as a definition of metabolic syndrome: the Ohasama study. Am J Hypertens 21(5): 514-520 https://doi.org/10.1038/ajh.2007.88
  21. Tabata S, Yoshimitsu S, Hamachi T, Abe H, Ohnaka K, Kono S (2009): Waist circumference and insulin resistance: a crosssectional study of Japanese men. BMC Endocr Disord 9:1 https://doi.org/10.1186/1472-6823-9-1
  22. WHO Expert Consultation (2004): Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363(9403): 157-163 https://doi.org/10.1016/S0140-6736(03)15268-3
  23. WHO (1999): Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications, Report of a WHO Consultation
  24. Wildman RP, Gu D, Reynolds K, Duan X, He J (2004): Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults. Am J Clin Nutr 80(5): 1129-1136
  25. Zhou BF, Cooperative Meta-Analysis Group of the Working Group on Obesity in China (2002): Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15(1): 83-96