Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

• Type of Material: Article
• Authors: Cria O Gregory, Emory University; Camila Corvalan, Emory University; Manuel Ramirez-Zea, Institute of Nutrition of Central American and Panama; Reynaldo Martorell, Emory University; Aryeh D Stein, Emory University
• Language: English
• Date: 2008-10
• Publisher: Cambridge University Press (CUP)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © The Authors 2007
• Final Published Version (URL): http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=2185292
• Title of Journal or Parent Work: Public Health Nutrition
• ISSN: 1368-9800
• Volume: 11
• Issue: 10
• Start Page: 1037
• End Page: 1045
• Grant/Funding Information: Funding was provided by the National Institutes of Health (TW005598, principal investigator: R.M.; HD046125, principal investigator: A.D.S.) and the American Heart Association (pre-doctoral fellowship: C.O.G.). C.O.G. carried out the statistical analysis and drafted the manuscript.
• Keywords: Cut-off point; Receiver operating characteristic curve; Cardio-metabolic risk factors; BMI; Waist circumference
• Research Categories: Health Sciences, Public Health; Health Sciences, Nutrition

Abstract

Background BMI and waist circumference (WC) are used to screen for cardio-metabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting. Objectives To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points among 1325 Guatemalan adults (44 % stunted: ≤150 cm women; ≤162 cm men). Methods Cardio-metabolic risk factors were systolic/diastolic blood pressure ≥130/≥85 mmHg, glucose ≥5.5 mmol/l, TAG ≥1.7 mmol/l, ratio of total cholesterol to HDL-cholesterol ≥5.0, and the presence of two or more and three or more of the preceding risk factors. Receiver operating characteristic (ROC) curve analysis was used. Results Areas under the ROC curve were in the range of 0.59–0.77 for BMI and 0.59–0.78 for WC among men and 0.66–0.72 and 0.64–0.72 among women, respectively. Optimal cut-off points for BMI were 24.7–26.1 kg/m2 among men (24.5–26.1 kg/m2 stunted; 24.8–26.3 kg/m2 non-stunted) and 26.5–27.6 kg/m2 among women (26.3–27.8 kg/m2 stunted; 26.6–27.9 kg/m2 non-stunted). Optimal cut-off points for WC were 87.3–91.1 cm among men (85.3–89.4 cm stunted; 88.5–93.3 cm non-stunted) and 91.3–95.3 cm among women (90.9–94.4 cm stunted; 91.8–95.6 cm non-stunted). Conclusion Optimal cut-off points for BMI were slightly higher among women than men with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.