title: The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race.
abstract: OBJECTIVE
  Many studies have suggested that there is variation in the capabilities of BMI, WC and WHR in predicting cardiometabolic risk and that it might be confounded by gender, ethnicity and age group. The objective of this study is to examine the discriminative abilities of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (high blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and high fasting plasma glucose) among the adult Malaysian population by gender, age group and ethnicity.
  
  
  METHODS
  Data from 2572 respondents (1044 men and 1528 women) aged 25-64 years who participated in the Non Communicable Disease Surveillance 2005/2006, a population-based cross sectional study, were analysed. Participants' socio-demographic details, anthropometric indices (BMI, WC and WHR), blood pressure, fasting lipid profile and fasting glucose level were assessed. Receiver operating characteristics curves analysis was used to evaluate the ability of each anthropometric index to discriminate MetS cases from non-MetS cases based on the area under the curve.
  
  
  RESULTS
  Overall, WC had better discriminative ability than WHR for women but did not perform significantly better than BMI in both sexes, whereas BMI was better than WHR in women only. Waist circumference was a better discriminator of MetS compared to WHR in Malay men and women. Waist circumference and BMI performed better than WHR in Chinese women, men aged 25-34 years and women aged 35-44 years.
  
  
  CONCLUSIONS
  The discriminative ability of BMI and WC is better than WHR for predicting two or more non-adipose components of MetS. Therefore, either BMI or WC measurements are recommended in screening for metabolic syndrome in routine clinical practice in the effort to combat cardiovascular disease and type II diabetes mellitus.
authors.affiliation: Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia. Electronic address: kee@imr.gov.my.
authors.forename: Kee C
authors.initials: KC
authors.lastname: Cheong
authors.affiliation: Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Sumarni M
authors.initials: SM
authors.lastname: Ghazali
authors.affiliation: Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Lim K
authors.initials: LK
authors.lastname: Hock
authors.affiliation: Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Soobitha
authors.initials: S
authors.lastname: Subenthiran
authors.affiliation: Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Teh C
authors.initials: TC
authors.lastname: Huey
authors.affiliation: Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Lim K
authors.initials: LK
authors.lastname: Kuay
authors.affiliation: Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Putrajaya, Malaysia.
authors.forename: Feisul I
authors.initials: FI
authors.lastname: Mustapha
authors.affiliation: Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Ahmad F
authors.initials: AF
authors.lastname: Yusoff
authors.affiliation: Institute for Medical Research, Ministry of Health, Kuala Lumpur, Malaysia.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Mustafa
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000032:analysis; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity; D012372:ROC Curve; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D055105:Waist Circumference; D049629:Waist-Hip Ratio
chemical_list: D015415:Biomarkers; D008055:Lipids
keywords: Adult; Body mass index; Metabolic syndrome; Waist circumference; Waist–hip ratio