title: Utility of current obesity thresholds in signaling diabetes risk in the James Bay Cree of Eeyou Istchee.
abstract: OBJECTIVE
  The anthropometric thresholds signaling type 2 diabetes risk have not been well defined for Aboriginal communities. This study examined current thresholds in terms of ability to capture diabetes risk in the Cree of Eeyou Istchee in northern Quebec, Canada.
  
  
  METHODS
  The study cohort for this analysis included adult participants from the Nituuchischaayihtitaau Aschii Multi-Community Environment and Health Study with complete data on anthropometric measures, fasting glucose, and insulin. Diabetes risk was defined as Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) value >2. Positive and negative likelihood ratios (PLR, NLR) of existing obesity thresholds were evaluated (WHO; International Diabetes Federation, IDF; Adult Treatment Panel III, ATP III). Receiver operating curves were examined to estimate optimal thresholds. In a sensitivity analysis, diabetes risk was defined as HOMA-IR >2.7.
  
  
  RESULTS
  The WHO 30 kg/m(2) body mass index (BMI) threshold performed well in women (PLR 5.56, 95% CI 1.95 to 15.9; NLR 0.24, 95% CI 0.19 to 0.31) and men (PLR 7.51, 95% CI 2.94 to 19.2; NLR 0.33, 95% CI 0.27 to 0.41). It was close to the estimated optimal threshold (28.5 kg/m(2)). The ATP III waist circumference threshold (102 cm) performed well in men (PLR 4.64, 95% CI 2.47 to 8.71; NLR 0.21, 95% CI 0.16 to 0.28) and was close to the estimated optimal threshold (101 cm). With diabetes risk defined at HOMA-IR >2.7, PLR values were slightly lower with narrower 95% CIs and optimal thresholds were slightly higher; PLR values remained above 3. For other current thresholds, estimated optimal values were higher and none had a PLR above 2.
  
  
  CONCLUSIONS
  A BMI of 30 kg/m(2) in women and men, and a 102 cm waist circumference in men, are meaningful obesity thresholds in this Aboriginal population. Other thresholds require a further evaluation.
authors: Department of Medicine , University of Victoria , Victoria, British Columbia , Canada.
authors: Priya
authors: P
authors: Manjoo
authors: Department of Family Medicine , McGill University , Montreal, Quebec , Canada ; Public Health Department of the Cree Territory , Cree Board of Health & Social Services of James Bay , Chisasibi, Quebec , Canada.
authors: David
authors: D
authors: Dannenbaum
authors: Department of Medicine , McGill University , Montreal, Quebec , Canada.
authors: Lawrence
authors: L
authors: Joseph
authors: Public Health Department of the Cree Territory , Cree Board of Health & Social Services of James Bay , Chisasibi, Quebec , Canada.
authors: Jill
authors: J
authors: Torrie
authors: Department of Medicine , McGill University , Montreal, Quebec , Canada.
authors: Kaberi
authors: K
authors: Dasgupta
keywords: Aboriginal Health; Obesity and Type 2; Type 2 Diabetes