title: Relationship between waist circumferences measured at the umbilical level and midway between the ribs and iliac crest - a solution to the debate on optimal waist circumference standards in the diagnostic criteria of metabolic syndrome in Japan.
abstract: OBJECTIVE
  The waist circumference (WC) cut-off values in the diagnostic criteria of metabolic syndrome (MetS) established in Japan (Japanese criteria) differ from those established by the International Diabetes Federation (IDF) for Asians (IDF criteria).
  
  
  METHODS
  To settle this contradiction, a cross-sectional study of Japanese aged 20-65 years was performed. After excluding subjects suffering from significant diseases other than those constituting MetS, excessive drinkers, and regular smokers, 835 males and 1,304 females were examined. WC was measured at the umbilical level (UWC) and midway between the ribs and iliac crest (MWC) according to both criteria in each subject.
  
  
  RESULTS
  Upper limits of reference intervals of MWC estimated in subjects free from MetS were 84.6 and 84.3 cm in older (40-65 years) and younger (20-39) males, and 78.4 and 70.5 cm in older and younger females, respectively; those of UWC were 86.4, 86.2, 87.9 and 78.9 cm, respectively. Receiver operating characteristic (ROC) curves for MWC to predict UWC reproduced the relationships of the two types of cut-off values in each population.
  
  
  CONCLUSIONS
  WC cut-off values in the Japanese and IDF criteria have the potential to be valid as cut-off values of UWC and MWC in Japanese, respectively. Their difference can be explained by the variation in the WC definition, and they can stand together without inconsistency. Acceptance of the recently prevailing view that the WC standard in IDF for Asian males should be 85 cm and the introduction of new criteria for younger females in consideration of their generation differences in both criteria could facilitate their higher compatibility.
authors.affiliation: Health Center, Keio University, Yokohama, Japan. wdphq489@yahoo.co.jp
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hirose
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kanda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawabe
authors.forename: Ikuo
authors.initials: I
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis*; D008875:Middle Aged; D012372:ROC Curve; D055105:Waist Circumference