Skip to main content
Top
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Optimal cut-off of obesity indices to predict cardiovascular disease risk factors and metabolic syndrome among adults in Northeast China

Authors: Jianxing Yu, Yuchun Tao, Yuhui Tao, Sen Yang, Yaqin Yu, Bo Li, Lina Jin

Published in: BMC Public Health | Issue 1/2016

Login to get access

Abstract

Background

CVD risk factors (hypertension, dyslipidemia and diabetes) and MetS are closely related to obesity. The selection of an optimal cut-off for various obesity indices is particularly important to predict CVD risk factors and MetS.

Methods

Sixteen thousand seven hundred sixty-six participants aged 18–79 were recruited in Jilin Province in 2012. Five obesity indices, including BMI, WC, WHR, WHtR and BAI were investigated. ROC analyses were used to evaluate the predictive ability and determine the optimal cut-off values of the obesity indices for CVD risk factors and MetS.

Results

BMI had the highest adjusted ORs, and the adjusted ORs for hypertension, dyslipidemia, diabetes and MetS were 1.19 (95 % CI, 1.17 to 1.20), 1.20 (95 % CI, 1.19 to 1.22), 1.12 (95 % CI, 1.10 to 1.13), and 1.40 (95 % CI, 1.38 to 1.41), respectively. However, BMI did not always have the largest adjusted AUROC. In general, the young age group (18 ~ 44) had higher ORs and AUROCs for CVD risk factors and MetS than those of the other age groups. In addition, the optimal cut-off values for WC and WHR in males were relatively higher than those in females, whereas the BAI in males was comparatively lower than that in females.

Conclusions

The appropriate obesity index, with the corresponding optimal cut-off values, should be selected in different research studies and populations. Generally, the obesity indices and their optimal cut-off values are: BMI (24 kg/m2), WC (male: 85 cm; female: 80 cm), WHR (male: 0.88; female: 0.85), WHtR (0.50), and BAI (male: 25 cm; female: 30 cm). Moreover, WC is superior to other obesity indices in predicting CVD risk factors and MetS in males, whereas, WHtR is superior to other obesity indices in predicting CVD risk factors and MetS in females.
Appendix
Available only for authorised users
Literature
1.
go back to reference Wang Z, Hao G, Wang X, Chen Z, Zhang L, Guo M, Tian Y, Shao L, Zhu M. Current prevalence rates of overweight, obesity, central obesity, and related cardiovascular risk factors that clustered among middle-aged population of China. Zhonghua Liu Xing Bing Xue Za Zhi. 2014;35(4):354–8.PubMed Wang Z, Hao G, Wang X, Chen Z, Zhang L, Guo M, Tian Y, Shao L, Zhu M. Current prevalence rates of overweight, obesity, central obesity, and related cardiovascular risk factors that clustered among middle-aged population of China. Zhonghua Liu Xing Bing Xue Za Zhi. 2014;35(4):354–8.PubMed
2.
go back to reference Andegiorgish AK, Wang J, Zhang X, Liu X, Zhu H. Prevalence of overweight, obesity, and associated risk factors among school children and adolescents in Tianjin, China. Eur J Pediatr. 2012;171(4):697–703.CrossRefPubMed Andegiorgish AK, Wang J, Zhang X, Liu X, Zhu H. Prevalence of overweight, obesity, and associated risk factors among school children and adolescents in Tianjin, China. Eur J Pediatr. 2012;171(4):697–703.CrossRefPubMed
3.
go back to reference Dankel SJ, Loenneke JP, Loprinzi PD. The impact of overweight/obesity duration on the association between physical activity and cardiovascular disease risk: an application of the “fat but fit” paradigm. Int J Cardiol. 2015;201:88–9.CrossRefPubMed Dankel SJ, Loenneke JP, Loprinzi PD. The impact of overweight/obesity duration on the association between physical activity and cardiovascular disease risk: an application of the “fat but fit” paradigm. Int J Cardiol. 2015;201:88–9.CrossRefPubMed
5.
go back to reference Lee SY, Chang HJ, Sung J, Kim KJ, Shin S, Cho IJ, Shim CY, Hong GR, Chung N. The Impact of Obesity on Subclinical Coronary Atherosclerosis According to the Risk of Cardiovascular Disease. Obesity. 2014;22(7):1762–8.CrossRefPubMed Lee SY, Chang HJ, Sung J, Kim KJ, Shin S, Cho IJ, Shim CY, Hong GR, Chung N. The Impact of Obesity on Subclinical Coronary Atherosclerosis According to the Risk of Cardiovascular Disease. Obesity. 2014;22(7):1762–8.CrossRefPubMed
6.
go back to reference Yu DH, Huang JF, Hu DS, Chen JC, Cao J, Li JX, Gu DF. Association Between Prehypertension and Clustering of Cardiovascular Disease Risk Factors Among Chinese Adults. J Cardiovasc Pharm. 2009;53(5):388–400.CrossRef Yu DH, Huang JF, Hu DS, Chen JC, Cao J, Li JX, Gu DF. Association Between Prehypertension and Clustering of Cardiovascular Disease Risk Factors Among Chinese Adults. J Cardiovasc Pharm. 2009;53(5):388–400.CrossRef
7.
go back to reference Murakami Y, Okamura T, Nakamura K, Miura K, Ueshima H: The clustering of cardiovascular disease risk factors and their impacts on annual medical expenditure in Japan: community-based cost analysis using Gamma regression models. BMJ Open. 2013;3(3). doi:10.1136/bmjopen-2012-002234 Murakami Y, Okamura T, Nakamura K, Miura K, Ueshima H: The clustering of cardiovascular disease risk factors and their impacts on annual medical expenditure in Japan: community-based cost analysis using Gamma regression models. BMJ Open. 2013;3(3). doi:10.​1136/​bmjopen-2012-002234
8.
go back to reference Bennasar-Veny M, Lopez-Gonzalez AA, Tauler P, Cespedes ML, Vicente-Herrero T, Yanez A, Tomas-Salva M, Aguilo A. Body Adiposity Index and Cardiovascular Health Risk Factors in Caucasians: A Comparison with the Body Mass Index and Others. Plos One. 2013;8(5):e63999.CrossRefPubMedPubMedCentral Bennasar-Veny M, Lopez-Gonzalez AA, Tauler P, Cespedes ML, Vicente-Herrero T, Yanez A, Tomas-Salva M, Aguilo A. Body Adiposity Index and Cardiovascular Health Risk Factors in Caucasians: A Comparison with the Body Mass Index and Others. Plos One. 2013;8(5):e63999.CrossRefPubMedPubMedCentral
9.
go back to reference Park SH, Choi SJ, Lee KS, Park HY. Waist Circumference and Waist-to-Height Ratio as Predictors of Cardiovascular Disease Risk in Korean Adults. Circ J. 2009;73(9):1643–50.CrossRefPubMed Park SH, Choi SJ, Lee KS, Park HY. Waist Circumference and Waist-to-Height Ratio as Predictors of Cardiovascular Disease Risk in Korean Adults. Circ J. 2009;73(9):1643–50.CrossRefPubMed
10.
go back to reference Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23(2):247–69.CrossRefPubMed Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23(2):247–69.CrossRefPubMed
11.
go back to reference Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ. Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore. Plos One. 2015;10(4):e0122985.CrossRefPubMedPubMedCentral Lam BCC, Koh GCH, Chen C, Wong MTK, Fallows SJ. Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore. Plos One. 2015;10(4):e0122985.CrossRefPubMedPubMedCentral
12.
go back to reference Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A Better Index of Body Adiposity. Obesity. 2011;19(5):1083–9.CrossRefPubMedPubMedCentral Bergman RN, Stefanovski D, Buchanan TA, Sumner AE, Reynolds JC, Sebring NG, Xiang AH, Watanabe RM. A Better Index of Body Adiposity. Obesity. 2011;19(5):1083–9.CrossRefPubMedPubMedCentral
13.
go back to reference Zeng Q, He Y, Dong SY, Zhao XL, Chen ZH, Song ZY, Chang G, Yang F, Wang YJ. Optimal cut-off values of BMI, waist circumference and waist: height ratio for defining obesity in Chinese adults. Brit J Nutr. 2014;112(10):1735–44.CrossRefPubMed Zeng Q, He Y, Dong SY, Zhao XL, Chen ZH, Song ZY, Chang G, Yang F, Wang YJ. Optimal cut-off values of BMI, waist circumference and waist: height ratio for defining obesity in Chinese adults. Brit J Nutr. 2014;112(10):1735–44.CrossRefPubMed
14.
go back to reference Mbanya VN, Kengne AP, Mbanya JC, Akhtar H. Body mass index, waist circumference, hip circumference, waist-hip-ratio and waist-height-ratio: Which is the better discriminator of prevalent screen-detected diabetes in a Cameroonian population? Diabetes Res Clin Pr. 2015;108(1):23–30.CrossRef Mbanya VN, Kengne AP, Mbanya JC, Akhtar H. Body mass index, waist circumference, hip circumference, waist-hip-ratio and waist-height-ratio: Which is the better discriminator of prevalent screen-detected diabetes in a Cameroonian population? Diabetes Res Clin Pr. 2015;108(1):23–30.CrossRef
15.
go back to reference Gao B, Xu QT, Li YB. Dynamic Change and Analysis of Driving Factors of Carbon Emissions from Traffic and Transportation Energy Consumption in Jilin Province. Appl Mech Mater. 2014;472:851–5.CrossRef Gao B, Xu QT, Li YB. Dynamic Change and Analysis of Driving Factors of Carbon Emissions from Traffic and Transportation Energy Consumption in Jilin Province. Appl Mech Mater. 2014;472:851–5.CrossRef
16.
go back to reference Yip GWK, Li AM, So HK, Choi KC, Leung LCK, Fong NC, Lee KW, Li SPS, Wong SN, Sung RYT. Oscillometric 24-h ambulatory blood pressure reference values in Hong Kong Chinese children and adolescents. J Hypertens. 2014;32(3):606–19.CrossRefPubMed Yip GWK, Li AM, So HK, Choi KC, Leung LCK, Fong NC, Lee KW, Li SPS, Wong SN, Sung RYT. Oscillometric 24-h ambulatory blood pressure reference values in Hong Kong Chinese children and adolescents. J Hypertens. 2014;32(3):606–19.CrossRefPubMed
17.
go back to reference Gu DF, Gupta A, Muntner P, Hu SS, Duan XF, Chen JC, Reynolds RF, Whelton PK, He J. Prevalence of cardiovascular disease risk factor clustering among the adult population of china - Results from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia). Circulation. 2005;112(5):658–65.CrossRefPubMed Gu DF, Gupta A, Muntner P, Hu SS, Duan XF, Chen JC, Reynolds RF, Whelton PK, He J. Prevalence of cardiovascular disease risk factor clustering among the adult population of china - Results from the International Collaborative Study of Cardiovascular Disease in Asia (InterAsia). Circulation. 2005;112(5):658–65.CrossRefPubMed
18.
go back to reference Gao BX, Zhang LX, Wang HY. D CNSCK: Clustering of Major Cardiovascular Risk Factors and the Association with Unhealthy Lifestyles in the Chinese Adult Population. Plos One. 2013;8(6):e66780.CrossRefPubMedPubMedCentral Gao BX, Zhang LX, Wang HY. D CNSCK: Clustering of Major Cardiovascular Risk Factors and the Association with Unhealthy Lifestyles in the Chinese Adult Population. Plos One. 2013;8(6):e66780.CrossRefPubMedPubMedCentral
19.
go back to reference Wu YH, Yu Q, Wang SB, Shi JP, Xu ZQ, Zhang QQ, Fu YL, Qi Y, Liu JW, Fu R, et al. Zinc Finger Protein 259 (ZNF259) Polymorphisms are Associated with the Risk of Metabolic Syndrome in a Han Chinese Population. Clin Lab. 2015;61(5–6):615–21.PubMed Wu YH, Yu Q, Wang SB, Shi JP, Xu ZQ, Zhang QQ, Fu YL, Qi Y, Liu JW, Fu R, et al. Zinc Finger Protein 259 (ZNF259) Polymorphisms are Associated with the Risk of Metabolic Syndrome in a Han Chinese Population. Clin Lab. 2015;61(5–6):615–21.PubMed
20.
go back to reference Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith Jr SC. 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(16):1640–5.CrossRefPubMed Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith Jr SC. 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(16):1640–5.CrossRefPubMed
21.
go back to reference Dong XL, Liu Y, Yang J, Sun Y, Chen L. Efficiency of anthropometric indicators of obesity for identifying cardiovascular risk factors in a Chinese population. Postgrad Med J. 2011;87(1026):251–6.CrossRefPubMed Dong XL, Liu Y, Yang J, Sun Y, Chen L. Efficiency of anthropometric indicators of obesity for identifying cardiovascular risk factors in a Chinese population. Postgrad Med J. 2011;87(1026):251–6.CrossRefPubMed
22.
go back to reference Chen FY, Xue YQ, Tan MT, Chen PY. Efficient statistical tests to compare Youden index: accounting for contingency correlation. Stat Med. 2015;34(9):1560–76.CrossRefPubMed Chen FY, Xue YQ, Tan MT, Chen PY. Efficient statistical tests to compare Youden index: accounting for contingency correlation. Stat Med. 2015;34(9):1560–76.CrossRefPubMed
23.
24.
go back to reference Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13(3):275–86.CrossRefPubMed Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13(3):275–86.CrossRefPubMed
25.
go back to reference Hsieh SD, Muto T. The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med. 2005;40(2):216–20.CrossRefPubMed Hsieh SD, Muto T. The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med. 2005;40(2):216–20.CrossRefPubMed
26.
go back to reference Li CY, Ford ES, Zhao GX, Kahn HS, Mokdad AH. Waist-to-thigh ratio and diabetes among US adults: The Third National Health and Nutrition Examination Survey. Diabetes Res Clin Pr. 2010;89(1):79–87.CrossRef Li CY, Ford ES, Zhao GX, Kahn HS, Mokdad AH. Waist-to-thigh ratio and diabetes among US adults: The Third National Health and Nutrition Examination Survey. Diabetes Res Clin Pr. 2010;89(1):79–87.CrossRef
27.
go back to reference Hsieh SD, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Int J Obesity. 2003;27(5):610–6.CrossRef Hsieh SD, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Int J Obesity. 2003;27(5):610–6.CrossRef
28.
go back to reference Ashwell M, Gibson S. Waist to Height Ratio Is a Simple and Effective Obesity Screening Tool for Cardiovascular Risk Factors: Analysis of Data from the British National Diet and Nutrition Survey of Adults Aged 19–64 Years. Obes Facts. 2009;2(2):97–103.CrossRefPubMed Ashwell M, Gibson S. Waist to Height Ratio Is a Simple and Effective Obesity Screening Tool for Cardiovascular Risk Factors: Analysis of Data from the British National Diet and Nutrition Survey of Adults Aged 19–64 Years. Obes Facts. 2009;2(2):97–103.CrossRefPubMed
29.
go back to reference Tseng CH, Chong CK, Chan TT, Bai CH, You SL, Chiou HY, Su TC, Chen CJ. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis. 2010;210(2):585–9.CrossRefPubMed Tseng CH, Chong CK, Chan TT, Bai CH, You SL, Chiou HY, Su TC, Chen CJ. Optimal anthropometric factor cutoffs for hyperglycemia, hypertension and dyslipidemia for the Taiwanese population. Atherosclerosis. 2010;210(2):585–9.CrossRefPubMed
30.
go back to reference Ho SY, Lam TH, Janus ED, Fact HKCR. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol. 2003;13(10):683–91.CrossRefPubMed Ho SY, Lam TH, Janus ED, Fact HKCR. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol. 2003;13(10):683–91.CrossRefPubMed
31.
go back to reference Haun DR, Pitanga FJG, Lessa I. Waist-Height Ratio Compared to Other Indicators of Obesity as Predictosr of High Coronary Risk. Rev Assoc Med Bras. 2009;55(6):705–11.CrossRefPubMed Haun DR, Pitanga FJG, Lessa I. Waist-Height Ratio Compared to Other Indicators of Obesity as Predictosr of High Coronary Risk. Rev Assoc Med Bras. 2009;55(6):705–11.CrossRefPubMed
32.
go back to reference Hadaegh F, Zabetian A, Harati H, Azizi F. Waist/height ratio as a better predictor of type 2 diabetes compared to body mass index in tehranian adult men - A 3.6-year prospective study. Exp Clin Endocr Diab. 2006;114(6):310–5.CrossRef Hadaegh F, Zabetian A, Harati H, Azizi F. Waist/height ratio as a better predictor of type 2 diabetes compared to body mass index in tehranian adult men - A 3.6-year prospective study. Exp Clin Endocr Diab. 2006;114(6):310–5.CrossRef
33.
go back to reference Lee CMY, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61(7):646–53.CrossRefPubMed Lee CMY, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61(7):646–53.CrossRefPubMed
34.
go back to reference Zhou BF. 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(1):83–96.PubMed Zhou BF. 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(1):83–96.PubMed
35.
go back to reference Pua YH, Ong PH. Anthropometric indices as screening tools for cardiovascular risk factors in Singaporean women. Asia Pac J Clin Nutr. 2005;14(1):74–9.PubMed Pua YH, Ong PH. Anthropometric indices as screening tools for cardiovascular risk factors in Singaporean women. Asia Pac J Clin Nutr. 2005;14(1):74–9.PubMed
36.
go back to reference Ito H, Nakasuga K, Ohshima A, Maruyama T, Kaji Y, Harada M, Fukunaga M, Jingu S, Sakamoto M. Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obesity. 2003;27(2):232–7.CrossRef Ito H, Nakasuga K, Ohshima A, Maruyama T, Kaji Y, Harada M, Fukunaga M, Jingu S, Sakamoto M. Detection of cardiovascular risk factors by indices of obesity obtained from anthropometry and dual-energy X-ray absorptiometry in Japanese individuals. Int J Obesity. 2003;27(2):232–7.CrossRef
Metadata
Title
Optimal cut-off of obesity indices to predict cardiovascular disease risk factors and metabolic syndrome among adults in Northeast China
Authors
Jianxing Yu
Yuchun Tao
Yuhui Tao
Sen Yang
Yaqin Yu
Bo Li
Lina Jin
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3694-5

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue