Derivation and validation of a waist circumference optimal cutoff for diagnosing metabolic syndrome in a South African mixed ancestry population

Matsha, Tandi E.; Hassan, Mogamat Shafick; Hon, Gloudina Mary; Soita, David Jonah; Kengne, André Pascal; Erasmus, Rajiv T

doi:10.1016/j.ijcard.2013.03.150

Cited by 39 publications

(45 citation statements)

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“…Recent studies have suggested WC and BP cut-off points for various African populations [6, 39–41], however, more epidemiological studies are needed to confirm that these suggested cut-off points can actually be used with confidence in the African population. Peer et al [13] reported optimal WC cut-off values based on a black population from Cape Town (83.9 cm men and 94 cm women) and confirmed the findings from Motala et al (2011) [6].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of the metabolic syndrome in a farm worker community in the Boland district, South Africa

Kruger

Nell

2017

BMC Public Health

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BackgroundIn South Africa, not much is known about MetS in farm working communities. This study aimed to describe the prevalence of the MetS in a farm working population from the Boland winelands district of the Western Cape, South Africa.MethodsA cross-sectional study was followed among farm workers (aged 20–60 years) from surrounding wine estates. The questionnaires used described socio-demographic status, ethnic background, alcohol consumption, smoking, exercise and daily medication. Anthropometric assessments were performed and blood pressure measurements taken prior to blood sampling for serum insulin, glucose and fasting lipogram profiles.ResultsThe prevalence of the MetS was higher in women (46.3 vs 29.3%). Both men and women in the MetS group had a significantly higher waist circumferences (WC; p < 0.001 for both), whilst higher glucose levels were only significantly higher in the women (p < 0.001). Correlations showed significant differences between body mass index (BMI), WC and waist to hip ratio (W:H) and the different MetS risk factors.ConclusionsThe female population in this study showed higher prevalence rates for the individual risk factors and the MetS overall. There is an urgent need to develop culturally sensitive health promotion programs addressing risk factors for metabolic syndrome among farm workers.

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Section: Discussionmentioning

confidence: 99%

The prevalence of the metabolic syndrome in a farm worker community in the Boland district, South Africa

Kruger

Nell

2017

BMC Public Health

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“…The small variations among the African-specific thresholds could be attributed at least in part to differences in methodological approaches. For example, while Matsha et al, [ 7 ] Peer et al, [ 8 ] and Motala et al [ 6 ] determined the optimal WC cut-off points for the presence of ≥2 MS components, [ 6 – 8 ] Crowther and Norris determined the optimal WC cut-off points for ≥3 out of 4 MS components, [ 5 ] Prinsloo et al used raised BP, [ 16 ] Kalk et al used insulin resistance (IR) and triglycerides-to-HDL-C ratio, [ 17 ] while Mabchour et al used elevated BP, total cholesterol-to-HDL-C ratio and IR as the outcome [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Optimal waist circumference threshold for diagnosing metabolic syndrome in African people living with HIV infection

et al. 2017

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BackgroundThe applicability of the internationally advocated cut-off points of waist circumference (WC) derived from Caucasians to diagnose metabolic syndrome (MS) in HIV-infected Africans is unknown. This study aimed to determine the optimal WC cutoffs for MS diagnosis in HIV-infected people receiving care at public healthcare facilities in the Western Cape Province in South Africa.MethodsData from 748 randomly selected participants (591 women), with a median age of 38 years, were analysed. The Youden’s index and the top-left-point approaches were used to determine the optimal cutoffs of WC for predicting ≥2 non-adipose MS components.ResultsThe two approaches generated the same WC cut-off point in women, 92 cm (sensitivity 64%, specificity 64%) but different cut-off points in men: 87 cm (sensitivity 48%, specificity 85%) based on the Younden’s index and 83 cm (sensitivity 59%, specificity 74%) by the top-left-point method. The advocated thresholds of 94 cm in men had low sensitivity (30%) but high specificity (92%) whereas 80 cm in women showed low specificity (32%) but high sensitivity (85%) for diagnosing MS in this sample. Most African-specific cut-off points performed well, with 90 cm providing acceptable performance in both men (sensitivity 43%, specificity 88%) and women (sensitivity 66%, specificity 59%).ConclusionsThis study underlines the sub-optimal performance of internationally recommended WC thresholds for MS diagnosis in HIV-infected Africans, and supports the need to revisit the guidelines on WC criterion in African population across the board. A single threshold of 90 cm for both genders would be a practical suggestion.

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“…Above average ABSI was associated with substantially higher risk of death in the United States (USA) National Health and Nutrition Examination Survey (NHANES) 1999–2004 sample, and the excess mortality hazard associated with high ABSI was greater than that associated with above-average body mass index (BMI) or waist circumference (WC) [1]. Several studies have sought to quantify associations between ABSI and adverse outcomes other than death, including diabetes [2], metabolic syndrome [3], and high blood pressure [4], [5]. ABSI seems a promising metric of health risk associated with abdominal adiposity [6].…”

Section: Introductionmentioning

confidence: 99%

Dynamic Association of Mortality Hazard with Body Shape

Krakauer

2014

PLoS ONE

123

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BackgroundA Body Shape Index (ABSI) had been derived from a study of the United States National Health and Nutrition Examination Survey (NHANES) 1999–2004 mortality data to quantify the risk associated with abdominal obesity (as indicated by a wide waist relative to height and body mass index). A national survey with longer follow-up, the British Health and Lifestyle Survey (HALS), provides another opportunity to assess the predictive power for mortality of ABSI. HALS also includes repeat observations, allowing estimation of the implications of changes in ABSI.Methods and FindingsWe evaluate ABSI z score relative to population normals as a predictor of all-cause mortality over 24 years of follow-up to HALS. We found that ABSI is a strong indicator of mortality hazard in this population, with death rates increasing by a factor of 1.13 (95% confidence interval, 1.09–1.16) per standard deviation increase in ABSI and a hazard ratio of 1.61 (1.40–1.86) for those with ABSI in the top 20% of the population compared to those with ABSI in the bottom 20%. Using the NHANES normals to compute ABSI z scores gave similar results to using z scores derived specifically from the HALS sample. ABSI outperformed as a predictor of mortality hazard other measures of abdominal obesity such as waist circumference, waist to height ratio, and waist to hip ratio. Moreover, it was a consistent predictor of mortality hazard over at least 20 years of follow-up. Change in ABSI between two HALS examinations 7 years apart also predicted mortality hazard: individuals with a given initial ABSI who had rising ABSI were at greater risk than those with falling ABSI.ConclusionsABSI is a readily computed dynamic indicator of health whose correlation with lifestyle and with other risk factors and health outcomes warrants further investigation.

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Derivation and validation of a waist circumference optimal cutoff for diagnosing metabolic syndrome in a South African mixed ancestry population

Cited by 39 publications

References 10 publications

The prevalence of the metabolic syndrome in a farm worker community in the Boland district, South Africa

The prevalence of the metabolic syndrome in a farm worker community in the Boland district, South Africa

Optimal waist circumference threshold for diagnosing metabolic syndrome in African people living with HIV infection

Dynamic Association of Mortality Hazard with Body Shape

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