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Cut Points of Waist Circumference

Response to Sone and Colleagues

From the Department of Internal Medicine, Niigata Prefectural Yoshida Hospital, Yoshida, Nishikanbara, Niigata, Japan

Address correspondence to Eiji Oda, MD, Department of Internal Medicine, Niigata Prefectural Yoshida Hospital, Yoshida, Nishikanbara, Niigata, 959-0242, Japan. E-mail: ijie{at}venus.sannet.ne.jp

Sone and colleagues (1,2) adopted Japanese criteria of abdominal obesity (waist circumference 85 cm in men and 90 cm in women) for the diagnosis of metabolic syndrome. These Japanese criteria of abdominal obesity were proposed by the Examination Committee of Criteria for Obesity Disease in Japan set up by the Japan Society for the Study of Obesity (3). They proposed waist circumferences of 85 cm in men and 90 cm in women as equivalent values for visceral fat area (VFA) of 100 cm². However, these cut points of waist circumference resulted from the inappropriate presupposition that VFA is linearly proportional to waist circumference. They determined the values by linear regression lines without revealing the sensitivities and specificities of these cut points. In fact, the dots in their VFA–waist circumference graphs were not scattered along linear lines, though VFA and waist circumference correlated well (3). If they had determined the cut points of waist circumference by receiver operating characteristic curves as they did to determine the cut points of BMI and VFA and determined the cut points of VFA separately by sex, the cut points of waist circumference might have been equivalent to Asian criteria (90 cm in men and 80 cm in women). For example, Shiwaku et al. (4) reported that optimal cut points of waist circumference were 82 cm for men and 73 cm for women in Japan. If the Examination Committee calculated areas under receiver operating characteristic curves, waist circumference might reveal to be a poor discriminator of VFA especially in women. After all, waist circumference is a marker of abdominal (central) obesity not of visceral obesity, which is assessed by VFA using computer tomography scanning, exposing subjects to X-ray irradiation. Therefore, Sone et al. should reanalyze their data using Asian criteria of waist circumference (90 cm in men and 80 cm in women) before reaching conclusions on the prognostic significance of metabolic syndrome defined with both National Cholesterol Education Panel (1) and International Diabetes Federation (2) criteria in Asian diabetic patients.

References

1. Sone H, Mizuno S, Fujii H, Yoshimura Y, Yamasaki Y, Ishibashi S, Katayama S, Saito Y, Ito H, Ohashi Y, Akanuma Y, Yamada N, the Japan Diabetes Complications Study: Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in Asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care28 :1463 –1471,2005[Abstract/Free Full Text]
   
2. Sone H, Tanaka S, Ishibashi S, Yamasaki Y, Oikawa S, Ito H, Saito Y, Ohashi Y, Akanuma Y, Yamada N, the Japan Diabetes Complications Study Group: The new worldwide definition of metabolic syndrome is not a better diagnostic predictor of cardiovascular disease in Japanese diabetic patients than the existing definitions: additional analysis from the Japan Diabetes Complications Study. Diabetes Care29 :145 –147,2006[Free Full Text]
   
3. The Examination Committee of Criteria for "Obesity Disease" in Japan, Japan Society for the Study of Diabetes: New criteria for "Obesity Disease" in Japan. Circ J66 :987 –992,2002[Medline]
   
4. Shiwaku K, Anuurad E, Enkhmaa B, Nogi A, Kitajima K, Yamasaki M, Yoneyama T, Oyunsuren T, Yamane Y: Predictive values of anthropometric measurements for multiple metabolic disorders in Asian populations. Diabetes Res Clin Pract69 :52 –62,2005[Medline]
   

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				H. Sone, S. Tanaka, Y. Ohashi, and N. Yamada Cut Points of Waist Circumference: Response to Oda Diabetes Care, May 1, 2006; 29(5): 1189 - 1189. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Oda, E. Search for Related Content PubMed PubMed Citation Articles by Oda, E. Social Bookmarking                What's this?