title: Maximum accuracy obesity indices for screening metabolic syndrome in Nigeria: A consolidated analysis of four cross-sectional studies.
abstract: BACKGROUND
  In sub-Saharan Africa, there is no precise use of metabolic syndrome (MetS) definitions and risk factors screening indices in many clinical and public health services. Methods proposed and used in Western populations are adopted without validation within the local settings. The aim of the study is to assess obesity indices and cut-off values that maximise screening of MetS and risk factors in the Nigerian population.
  
  
  METHODS
  A consolidated analysis of 2809 samples from four population-based cross-sectional study of apparently healthy persons≥18 years was carried out. Optimal waist circumference (WC) and waist-to-height ratio (WHtR) cut points for diagnosing MetS and risk factors were determined using Optimal Data Analysis (ODA) model. The stability of the predictions of the models was also assessed.
  
  
  RESULTS
  Overall mean values of BMI, WC and WHtR were 24.8±6.0kgm(-2), 84.0±11.3cm and 0.52±0.1 respectively. Optimal WC cut-off for discriminating MetS and diabetes was 83cm in females and 85cm in males, and 82cm in females and 89cm in males, respectively. WC was stable in discriminating diabetes than did WHtR and BMI, while WHtR showed better stability in predicting MetS than WC and BMI.
  
  
  CONCLUSIONS
  The study shows that the optimal WC that maximises classification accuracy of MetS differs from that currently used for sub-Saharan ethnicity. The proposed global WHtR of 0.50 may misclassify MetS, diabetes and hypertension. Finally, the WC is a better predictor of diabetes, while WHtR is a better predictor of MetS in this sample population.
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Northern Territory, Australia. Electronic address: victormaduabuchi.oguoma@cdu.edu.au.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Oguoma
authors.affiliation: School of Community Health, Charles Sturt University, New South Wales, Australia; Department of Public and Community Health, Novena University Ogume, Delta State, Nigeria.
authors.forename: Ezekiel U
authors.initials: EU
authors.lastname: Nwose
authors.affiliation: College of Medicine, University of Nigeria and University of Nigeria Teaching Hospital, Nigeria.
authors.forename: Ifeoma I
authors.initials: II
authors.lastname: Ulasi
authors.affiliation: Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.
authors.forename: Adeseye A
authors.initials: AA
authors.lastname: Akintunde
authors.affiliation: Department of Chemical Pathology, College of Medicine, University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria.
authors.forename: Ekene E
authors.initials: EE
authors.lastname: Chukwukelu
authors.affiliation: Department of Internal Medicine, Benue State University, Makurdi, Benue State, Nigeria.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Araoye
authors.affiliation: Department of Medicine, Federal Medical Centre, Ido-Ekiti, Ekiti State, Nigeria.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Edo
authors.affiliation: College of Medicine, University of Nigeria and University of Nigeria Teaching Hospital, Nigeria.
authors.forename: Chinwuba K
authors.initials: CK
authors.lastname: Ijoma
authors.affiliation: Onyx Hospital and Maternity Ltd, Lagos State, Nigeria.
authors.forename: Innocent C
authors.initials: IC
authors.lastname: Onyia
authors.affiliation: Department of Medical Laboratory Sciences, Nnamdi Azikiwe University, Awka, Nigeria.
authors.forename: Innocent I
authors.initials: II
authors.lastname: Ogbu
authors.affiliation: Department of Medical laboratory sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu, Nigeria.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Onyeanusi
authors.affiliation: Department of Public and Community Health, Novena University Ogume, Delta State, Nigeria.
authors.forename: Kester A
authors.initials: KA
authors.lastname: Digban
authors.affiliation: College of Medicine, University of Nigeria and University of Nigeria Teaching Hospital, Nigeria.
authors.forename: Obinna D
authors.initials: OD
authors.lastname: Onodugo
authors.affiliation: Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.
authors.forename: Olufemi
authors.initials: O
authors.lastname: Adediran
authors.affiliation: Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.
authors.forename: Oladimeji G
authors.initials: OG
authors.lastname: Opadijo
authors.affiliation: School of Community Health, Charles Sturt University, New South Wales, Australia.
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Bwititi
authors.affiliation: School of Community Health, Charles Sturt University, New South Wales, Australia.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Richards
authors.affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Northern Territory, Australia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Skinner
mesh_terms: D000328:Adult; D001827:Body Height; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D009765:Obesity / Q000175:diagnosis* / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055105:Waist Circumference
keywords: Diabetes; Metabolic syndrome; Sub-Sahara Africa; Waist circumference; Waist-to-height ratio