Endocrinol Metab.  2014 Dec;29(4):418-426. 10.3803/EnM.2014.29.4.418.

Optimal Waist Circumference Cutoff Values for the Diagnosis of Abdominal Obesity in Korean Adults

• Yoon YS
• Oh SW

• KMID: 2384236
• DOI: http://doi.org/10.3803/EnM.2014.29.4.418

Abstract

Abdominal obesity is associated closely with insulin resistance, diabetes, and cardiovascular disease. Waist circumference (WC) is a useful surrogate marker commonly used for abdominal adiposity. The determination of WC cutoff levels is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases. Recent epidemiological evidence suggested that appropriate optimal cutoffs for Koreans ranged over 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. We analyzed the data from two large cohorts using receiver operating characteristic curve analysis with the incidences of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors as outcome variables. Optimal WC cutoff points for Koreans were 85 cm in males and 80 cm in females. However, considering the prevalence of abdominal obesity and the health costs for its prevention and management, 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity. These values may be modified once better research is performed through prospective studies using representative populations, common health outcomes, and proper analytical approaches.

Keyword

Obesity, abdominal; Waist circumference; Metabolic syndrome; Cohort studies; ROC curve; Sensitivity and specificity

MeSH Terms

Adiposity
Adult*
Cardiomyopathies
Cardiovascular Diseases
Cohort Studies
Coronary Artery Disease
Diagnosis*
Dyslipidemias
Female
Health Care Costs
Humans
Hypertension
Incidence
Insulin Resistance
Male
Obesity
Obesity, Abdominal*
Prevalence
Risk Factors
ROC Curve
Sensitivity and Specificity
Waist Circumference*
Biomarkers

Figure

• 

  Fig. 1 Hazard ratios for the development of one or more metabolic risk factors or incidence of diabetes for a 5-cm increase in the waist circumference. (A) Men, ≥1, 2, or 3 metabolic risk factors. (B) Women, ≥1, 2, or 3 metabolic risk factors. (C) Men, diabetes mellitus. (D) Women, diabetes mellitus.

Reference

1. Statistics Korea. 2013 Causes of Death Statistics [Internet]. Daejeon: Statistics Korea;c2008. cited 2014 Dec 8. Available from:http://www.index.go.kr.

2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421.

3. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998; 6:Suppl 2. 51S–209S.

4. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. American Heart Association. National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752.

5. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization;2000. p. 256.

6. Khan NA, McAlister FA, Rabkin SW, Padwal R, Feldman RD, Campbell NR, Leiter LA, Lewanczuk RZ, Schiffrin EL, Hill MD, Arnold M, Moe G, Campbell TS, Herbert C, Milot A, Stone JA, Burgess E, Hemmelgarn B, Jones C, Larochelle P, Ogilvie RI, Houlden R, Herman RJ, Hamet P, Fodor G, Carruthers G, Culleton B, Dechamplain J, Pylypchuk G, Logan AG, Gledhill N, Petrella R, Tobe S, Touyz RM. Canadian Hypertension Education Program. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: part II: therapy. Can J Cardiol. 2006; 22:583–593.

7. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL. ESC Committee for Practice Guidelines. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis. 2007; 194:1–45.

8. Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T. A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2006; 29:1123–1124.

9. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80.

10. Oka R, Kobayashi J, Yagi K, Tanii H, Miyamoto S, Asano A, Hagishita T, Mori M, Moriuchi T, Kobayashi M, Katsuda S, Kawashiri MA, Nohara A, Takeda Y, Mabuchi H, Yamagishi M. Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome. Diabetes Res Clin Pract. 2008; 79:474–481.

11. Examination Committee of Criteria for 'Obesity Disease' in Japan. Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J. 2002; 66:987–992.

12. Zhou BF. Cooperative Meta-Analysis Group of the Working Group on Obesity in China. Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults: study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci. 2002; 15:83–96.

13. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr. 1998; 68:899–917.

14. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995; 311:158–161.

15. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005; 366:1059–1062.

16. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. International Diabetes Federation Task Force on Epidemiology and Prevention. Hational Heart, Lung, and Blood Institute. American Heart Association. World Heart Federation. International Atherosclerosis Society. International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120:1640–1645.

17. Khang YH, Yun SC. Trends in general and abdominal obesity among Korean adults: findings from 1998, 2001, 2005, and 2007 Korea National Health and Nutrition Examination Surveys. J Korean Med Sci. 2010; 25:1582–1588.

18. Lee S, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, Cho GJ, Han JH, Kim SR, Park CY, Oh SJ, Lee CB, Kim KS, Oh SW, Kim YS, Choi WH, Yoo HJ. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obes. 2006; 15:1–9.

19. Lee OG, Hur YI, Kang JH, Park HA, Kim KW, Cho YG, Choi WY, Park H, Lee HA. The cutoff value of waist circumference for predicting metabolic risks in pre- and post-menopausal korean women: analysis of 2010 korean national health and nutrition examination survey data. Korean J Fam Med. 2013; 34:307–318.

20. Lim S, Kim JH, Yoon JW, Kang SM, Choi SH, Park YJ, Kim KW, Cho NH, Shin H, Park KS, Jang HC. Optimal cut points of waist circumference (WC) and visceral fat area (VFA) predicting for metabolic syndrome (MetS) in elderly population in the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr. 2012; 54:e29–e34.

21. Ko KP, Oh DK, Min H, Kim CS, Park JK, Kim Y, Kim SS. Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the Korean genome and epidemiology study. J Epidemiol. 2012; 22:433–439.

22. Yoo HJ, Park MS, Lee CH, Yang SJ, Kim TN, Lim KI, Kang HJ, Song W, Yeon JE, Baik SH, Choi DS, Choi KM. Cutoff points of abdominal obesity indices in screening for non-alcoholic fatty liver disease in Asians. Liver Int. 2010; 30:1189–1196.

23. Park YM, Kwon HS, Lim SY, Lee JH, Yoon KH, Son HY, Yim HW, Lee WC. Optimal waist circumference cutoff value reflecting insulin resistance as a diagnostic criterion of metabolic syndrome in a nondiabetic Korean population aged 40 years and over: the Chungju Metabolic Disease Cohort (CMC) study. Yonsei Med J. 2010; 51:511–518.

24. Koh JH, Koh SB, Lee MY, Jung PM, Kim BH, Shin JY, Shin YG, Ryu SY, Lee TY, Park JK, Chung CH. Optimal waist circumference cutoff values for metabolic syndrome diagnostic criteria in a Korean rural population. J Korean Med Sci. 2010; 25:734–737.

25. Choi SJ, Keam B, Park SH, Park HY. Appropriate waist circumference cut-offs to predict diabetes in the Korean population: the Korean Genome and Epidemiology Study. Circ J. 2010; 74:1357–1363.

26. Seo JA, Kim BG, Cho H, Kim HS, Park J, Baik SH, Choi DS, Park MH, Jo SA, Koh YH, Han C, Kim NH. The cutoff values of visceral fat area and waist circumference for identifying subjects at risk for metabolic syndrome in elderly Korean: Ansan Geriatric (AGE) cohort study. BMC Public Health. 2009; 9:443.

27. Baik I. Optimal cutoff points of waist circumference for the criteria of abdominal obesity: comparison with the criteria of the International Diabetes Federation. Circ J. 2009; 73:2068–2075.

28. Hyun YJ, Kim OY, Jang Y, Ha JW, Chae JS, Kim JY, Yeo HY, Paik JK, Lee JH. Evaluation of metabolic syndrome risk in Korean premenopausal women: not waist circumference but visceral fat. Circ J. 2008; 72:1308–1315.

29. Kim JA, Choi CJ, Yum KS. Cut-off values of visceral fat area and waist circumference: diagnostic criteria for abdominal obesity in a Korean population. J Korean Med Sci. 2006; 21:1048–1053.