title: Waist circumference and BMI cut-off points to predict risk factors for metabolic syndrome among outpatients in a district hospital.
abstract: BACKGROUND
  Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM). Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
  
  
  METHODS
  This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13-91 years. Youden's index was used to identify the optimal cut-off points.
  
  
  RESULTS
  The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5-91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m², and that for low level high-density lipoprotein cholesterol was 22.9 kg/m². For males, the corresponding cut-off points were 86.5-91.0 cm for WC and 20.75-25.5 kg/m² for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
  
  
  CONCLUSIONS
  WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI.
authors.affiliation: Department of Medicine, UniKL Royal College of Medicine, Perak, Malaysia. mraaye@hotmail.com
authors.forename: Mra
authors.initials: M
authors.lastname: Aye
authors.forename: Malek
authors.initials: M
authors.lastname: Sazali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D005260:Female; D006767:Hospitals, District; D006801:Humans; D006973:Hypertension; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis*; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000175:diagnosis*; D010045:Outpatients; D012016:Reference Values; D012307:Risk Factors; D055105:Waist Circumference; D055815:Young Adult