Waist circumference as a screening tool for cardiovascular risk factors in Korea: Evaluation of receiver operating characteristics(ROC)

Lee, Keum Mi

Abstract

BACKGROUND
Epidemiologic studies indicate that the central fat distribution rather than obesity itself may be an independant predictor for cardiovascular disease and metabolic disorders. The purpose of this study was to investigate the significance of waist circumference as index of central obesity and to investigate waist circumference as a measure for increased risk of cardiovascular disease in Korean adults using the ROC curve. METHOD: Four hundreds seventy-six subjects(339 men and 137 women) were included for this study. Subjects were selected among patients who visited the Health Promotion Center of Yeungnam University Hospital for general health evaluation from January to June 1999. Self-reported questionnaire of socioeconomic, health and lifestyle were recorded followed by measurement of height, weight, waist and hip circumference, percent body fat, blood pressure, blood chemistry. We analysed best cut-off point of waist circumference for those with highest sensitivity and specificity of cardiovascular risk factors using the ROC curve.
RESULTS
Waist circumference was related with blood pressure, total cholesterol, HDL and LDL cholesterol, triglyceride, but not with glucose in men. In women, waist circumference was related with blood pressure, glucose, total cholesterol, triglyceride, but not with HDL and LDL cholesterol. Waist circumference at risk of cardiovascular disease seems different in Koreans compared to those of caucasians. ROC curves showed that 84cm in men(sensitivity and specificity were 66.4% and 58.7%) and 78cm (Sensitivity and specificity were 78.3% and 53.4%) in women were useful in identifying those with at least one risk factor. There were some differences according to disease, age, smoking state, and alcohol intake. Cut-off point of waist circumference with at least one risk factor was about 3cm higher in age over 45years men, age over 55 years or postmenopausal women, smoker, and alcoholics
CONCLUSIONS
Measurement of waist circumference 84cm in men and 78cm in women could be adopted as a simple index for health promotion, to alert those at risk of cardiovascular disease, and as a guide to risk avoidance by self-weight management in Korea.