title: Age-related differences in recommended anthropometric cut-off point validity to identify cardiovascular risk factors in ostensibly healthy women.
abstract: OBJECTIVE
  To investigate validity of widely recommended anthropometric and total fat percentage cut-off points in screening for cardiovascular risk factors in women of different ages.
  
  
  METHODS
  A population-based sample of 1002 Swedish women aged 38, 50, 75 (younger, middle-aged and elderly, respectively) underwent anthropometry, health examinations and blood tests. Total fat was estimated (bioimpedance) in 670 women. Sensitivity, specificity of body mass index (BMI; ≥25 and ≥30), waist circumference (WC; ≥80 cm and ≥88 cm) and total fat percentage (TF; ≥35%) cut-off points for cardiovascular risk factors (dyslipidaemias, hypertension and hyperglycaemia) were calculated for each age. Cut-off points yielding high sensitivity together with modest specificity were considered valid. Women reporting hospital admission for cardiovascular disease were excluded.
  
  
  RESULTS
  The sensitivity of WC ≥80 cm for one or more risk factors was ~60% in younger and middle-aged women, and 80% in elderly women. The specificity of WC ≥80 cm for one or more risk factors was 69%, 57% and 40% at the three ages (p < .05 for age trends). WC ≥80 cm yielded ~80% sensitivity for two or more risk factors across all ages. However, specificity decreased with increasing age (p < .0001), being 33% in elderly. WC ≥88 cm provided better specificity in elderly women. BMI and TF % cut-off points were not better than WC.
  
  
  CONCLUSIONS
  Validity of recommended anthropometric cut-off points in screening asymptomatic women varies with age. In younger and middle-age, WC ≥80 cm yielded high sensitivity and modest specificity for two or more risk factors, however, sensitivity for one or more risk factor was less than optimal. WC ≥88 cm showed better validity than WC ≥80 cm in elderly. Our results support age-specific screening cut-off points for women.
authors.affiliation: Nordic School of Public Health, Gothenburg, Sweden Department of Public Health and Community Medicine; Sahlgrenska Academy, University of Gothenburg, Sweden subramoneys@gmail.com.
authors.forename: Sreevidya
authors.initials: S
authors.lastname: Subramoney
authors.affiliation: Department of Public Health and Community Medicine/Primary Health Care.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
authors.affiliation: Institute of Neurology and Physiology.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Guo
authors.affiliation: Institute of Neurology and Physiology.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
authors.affiliation: Department of Clinical Nutrition and Dietetics.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bosaeus
authors.affiliation: Department of Public Health and Community Medicine; Sahlgrenska Academy, University of Gothenburg, Sweden.
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D050171:Dyslipidemias / Q000175:diagnosis; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis; D006973:Hypertension / Q000175:diagnosis; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D055105:Waist Circumference
keywords: Anthropometric cut-off points; cardiovascular risk factors; dyslipidaemia; hypertension; public health; screening; sensitivity; specificity; total fat %; waist circumference