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Diabetes Care 29:1986-1987, 2006
DOI: 10.2337/dc06-1018
© 2006 by the American Diabetes Association
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Letters: Observations

A Proposal for the Cutoff Point of Waist Circumference for the Diagnosis of Metabolic Syndrome in the Japanese Population

Takayoshi Ohkubo, MD, PHD1, Masahiro Kikuya, MD, PHD2, Kei Asayama, MD, PHD1 and Yutaka Imai, MD, PHD2

1 Department of Planning for Drug Development and Clinical Evaluation, Graduate School of Pharmaceutical Sciences and Medicine, Tohoku University, Sendai, Japan
2 Department of Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences and Medicine, Tohoku University, Sendai, Japan

Address correspondence to Takayoshi Ohkubo, MD, PhD, Clinical Pharmacology and Therapeutics, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai 980-8574, Japan. E-mail: tohkubo{at}mail.tains.tohoku.ac.jp

In a community-based cohort of 692 Japanese individuals, Hara et al. (1) investigated the relationship between cutoff values used for the waist circumference to define central obesity and rates of detection of subjects displaying multiple risk factors of metabolic syndrome. Using the receiver-operator characteristic (ROC) curve, they proposed an optimal cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population to yield maximal sensitivity plus specificity, with cutoffs of 85 cm in men and 78 cm in women.

In the Ohasama study, another Japanese general-population study (2,3), we also attempted to determine the most suitable cutoff level for waist circumference in terms of associations with insulin resistance (IR). We investigated relationships between the cutoff values used for waist circumference measured at the umbilical level and rates of subjects with IR among 329 residents (235 women) in Ohasama aged ≥35 years (mean age 64 years, mean BMI 24 kg/m2) without antidiabetes medication. Subjects participated in the diabetes screening program conducted, in addition to the home blood pressure measurement program (2), from 2002 to 2004. The ROC curve for waist circumference to predict the presence of IR, as defined by a homeostasis model assessment of IR >1.73 (4), was plotted using SAS version 9.2 software (SAS Institute, Cary, NC).

According to the ROC curve, the cutoff level yielding maximal sensitivity plus specificity for predicting the presence of IR was 83 cm in men and 75 cm in women. Sensitivity and specificity using these cutoff values were 80 and 63%, respectively, in men and 85 and 58%, respectively, in women.

These results, together with those by Hara et al. (1), suggest that the cutoff point for waist circumstance in Japanese women, which is used to predict metabolic syndrome or IR, is lower than that proposed by the International Diabetes Federation (90 cm).

References

  1. Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T: A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care 29:1123–1124, 2006[Free Full Text]
  2. Ohkubo T, Imai Y, Tsuji I, Nagai K, Kato J, Kikuchi N, Nishiyama A, Aihara A, Sekino M, Kikuya M, Ito S, Satoh H, Hisamichi S: Home blood pressure measurement has a stronger predictive power for mortality than dose screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 16:971–975, 1998[Medline]
  3. Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y: Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring: 10-year follow-up from the Ohasama study. J Am Coll Cardiol 46:508–515, 2005[Abstract/Free Full Text]
  4. Ohnishi H, Saitoh S, Takagi S, Ohata J, Takeuchi H, Isobe T, Katoh N, Chiba Y, Fujiwara T, Akasaka H, Shimamoto K: Incidence of insulin resistance in obese subjects in a rural Japanese population: the Tanno and Sobetsu study. Diabetes Obes Metab 7:83–87, 2005[Medline]

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This Article
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