title: Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease.
abstract: BACKGROUND
  Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned.
  
  
  OBJECTIVE
  To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations.
  
  
  METHODS
  We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points.
  
  
  RESULTS
  WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively.
  
  
  CONCLUSIONS
  WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.
authors.affiliation: Department of Population Health Sciences, University of Wisconsin, 610 Walnut Street, Madison, WI 53726-2397, USA.
authors.forename: V M
authors.initials: VM
authors.lastname: Herrera
authors.forename: J P
authors.initials: JP
authors.lastname: Casas
authors.forename: J J
authors.initials: JJ
authors.lastname: Miranda
authors.forename: P
authors.initials: P
authors.lastname: Perel
authors.forename: R
authors.initials: R
authors.lastname: Pichardo
authors.forename: A
authors.initials: A
authors.lastname: González
authors.forename: J R
authors.initials: JR
authors.lastname: Sanchez
authors.forename: C
authors.initials: C
authors.lastname: Ferreccio
authors.forename: X
authors.initials: X
authors.lastname: Aguilera
authors.forename: E
authors.initials: E
authors.lastname: Silva
authors.forename: M
authors.initials: M
authors.lastname: Oróstegui
authors.forename: L F
authors.initials: LF
authors.lastname: Gómez
authors.forename: J A
authors.initials: JA
authors.lastname: Chirinos
authors.forename: J
authors.initials: J
authors.lastname: Medina-Lezama
authors.forename: C M
authors.initials: CM
authors.lastname: Pérez
authors.forename: E
authors.initials: E
authors.lastname: Suárez
authors.forename: A P
authors.initials: AP
authors.lastname: Ortiz
authors.forename: L
authors.initials: L
authors.lastname: Rosero
authors.forename: N
authors.initials: N
authors.lastname: Schapochnik
authors.forename: Z
authors.initials: Z
authors.lastname: Ortiz
authors.forename: D
authors.initials: D
authors.lastname: Ferrante
authors.forename: M
authors.initials: M
authors.lastname: Diaz
authors.forename: L E
authors.initials: LE
authors.lastname: Bautista
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry / Q000379:methods; D044383:Black People; D015992:Body Mass Index; D002677:Chile / Q000208:ethnology; D003105:Colombia / Q000208:ethnology; D003327:Coronary Disease / Q000208:ethnology*; D004293:Dominican Republic / Q000208:ethnology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000208:ethnology*; D010568:Peru / Q000208:ethnology; D011237:Predictive Value of Tests; D011647:Puerto Rico / Q000208:ethnology; D018570:Risk Assessment; D012737:Sex Factors; D014481:United States; D014687:Venezuela / Q000208:ethnology; D055105:Waist Circumference / Q000208:ethnology*; D049629:Waist-Hip Ratio / Q000706:statistics & numerical data*; D044465:White People; D001741:Black or African American