Appropriate waist circumference cutoff points for central obesity in Korean adults☆
Introduction
Metabolic syndrome is closely related to increased cardiovascular morbidity and mortality [1]. In 2005, the International Diabetes Federation (IDF) in a global consensus statement formulated a new, clinically accessible, worldwide definition of metabolic syndrome [2] built on earlier definitions formulated by the World Health Organization (WHO) [3] and the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel, ATP III) [4]. The IDF defined metabolic syndrome as central obesity plus two of the following four additional factors: elevated plasma triacylglycerol, reduced HDL cholesterol, elevated blood pressure, and elevated fasting plasma glucose [2].
A prominent feature of the IDF definition is that central obesity is an essential, not an optional, component of metabolic syndrome, with central obesity defined according to ethnically specific values of waist circumference (WC) [2]. The cutoff point for central obesity in the United States was defined as ≥102 cm for men and ≥88 cm for women [4], whereas, for Europeans, the cutoff was ≥94 cm for men and ≥80 cm for women [5]. Asians are more prone to obesity-related co-morbidities than Caucasians, even at lower BMI and/or smaller WC values [6], [7]. Therefore, cutoff values of ≥90 cm for men and ≥80 cm for women were adopted for South Asians and Chinese [8], and the Japanese used cutoff points of ≥85 cm for men and ≥90 cm for women [9].
Using the NCEP ATP III definition of central obesity [5] (men, >102 cm; women, >88 cm), the prevalence of central obesity in Korea was only 1.3% for men and 15.3% for women [10], whereas the prevalence of central obesity among US adults was 29.8% in men and 46.3% in women [11]. Using Asian-Pacific guidelines for central obesity [8] (men, >90 cm; women, >80 cm), the prevalence of central obesity in Korea was 19.5% in men and 39.0% in women [12]. These findings suggest the importance of applying ethnically appropriate cutoff values of WC for assessing central obesity. In agreement with the IDF proposal, the Committee on Metabolic Syndrome of the Korean Society for the Study of Obesity (KSSO) investigated the appropriate WC cutoff points for central obesity in Koreans.
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Study population
The Korean Ministry of Health and Welfare conducted the Korean National Health and Nutrition Examination Survey of noninstitutionalized Korean civilians in 1998. A stratified, multistage probability sampling design was used, with selections made from sampling units based on geographic area, sex, and age groups using household registries. The staff conducted surveys in households and administered questionnaires, which included the demographic, socioeconomic, dietary, and medical history of each
Basic characteristics of the study subjects
The basic characteristics of the study subjects and the prevalence of metabolic risk factors are shown in Table 1. The mean age of all participants was 45.1 years, and the mean BMI was 23.2 kg/m2. The mean waist circumference was 82.8 cm in men and 78.6 cm in women. Almost 26% of men and 16% of women had >12 years of education. About 66% of the men and 7% of the women were smokers. Twenty-two percent of the men and 1% of the women consumed more than 30 g of alcohol per day.
Elevated triacylglycerol
Discussion
Since Reaven first suggested a definition of metabolic syndrome in 1988 [15], many diagnostic criteria have been established for metabolic syndrome, including those proposed by the WHO [3], NCEP ATP III [4], European Group for the Study of Insulin Resistance (EGIR) [5], American Association of Clinical Endocrinologists (AACE) [16], and IDF [2]. The pathophysiology of metabolic syndrome was focused primarily on insulin resistance and hyperinsulinemia, but the importance of metabolic risk factors
Acknowledgments
We thank the members of the Korea Institute for Health and Social Affairs, who conducted the national survey. HJY and HSP were involved in the conception and design of the study; SYL, DJK, SMK, JHH, and HSP performed data analysis; SRK, HSK, CBL, SJO, CYP, GJC, and DYK contributed to the interpretation of the data; SYL, DJK, and HSP drafted the manuscript.
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This study was supported by a grant from the Korean Society for the Study of Obesity 2005.