Determining the Waist Circumference Cut off which Best Predicts the Metabolic Syndrome components in urban Africans: The SABPA study

Abstract

Various studies have shown that the relationship between waist circumference (WC) and abdominal obesity is age, gender as well as ethnicity-dependent. WC criteria for Sub Saharan Africans have not been defined by the International Diabetes Federation (IDF). The aim was to determine which WC cut off best predicted Metabolic Syndrome (MetS) in a group of urban African teachers (80 males and 93 females). We determined sphygmomanometer blood pressure, WC, glucose, high density lipoprotein cholesterol (HdL) and triglyceride (TRIG) values. The males′ MetS profile was less favourable as their glucose, TRIG and blood pressure levels were higher than the proposed cut off for MetS. The females could be classified as obese, based on their mean BMI (32.78±6.36) and WC (93.48±15.68). Receiver operating characteristic (ROC) WC cut offs of 90, 91, 94 and 96 cm for the respective MetS components in males (blood pressure, HdL, glucose and TRIG) were suggested. In the females, cut offs of 92, 98, 94 and 94 cm for TRIG, blood pressure, HdL and glucose respectively, were put forward. Odds ratios revealed that increased blood pressure best predicted ROC WC in both males (OR 9.59; 95% CI 3.14–29.32) and females (OR 3.11; 95% CI 1.30–7.42) irrespective of age. We suggest that the optimal cut off point for the males be set at 90 cm, as opposed to the current 94 cm; whilst the female cut off be set at 98 cm as opposed to the existing cut off of 80 cm. Larger sample groups are recommended to justify our data.

Key words

metabolic syndrome - central obesity - Setswana - black Africans - ROC

• References

• 1 Agyemang C, Bhopal R. Is the blood pressure of people from african origin adults in the uk higher or lower than that in european origin white people? A review of cross-sectional data. J Hum Hypertens 2003; 17: 523-534
• 2 Alberti KGMM, Eckel RH, Grundy SM. 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 arteriosclerosis society; and international association for the study of obesity. Circulation 2009; 120: 1640-1645
• 3 Astrup A, Dyerberg J, Selleck M. Nutrition transition and its relationship to the development of obesity and related chronic diseases. Obes Rev 2008; 9 (01:) 48-52
• 4 Berber A, Gomez-Santos R, Fanghanel G. Anthropometric indexes in the prediction of type 2 diabetes mellitus, hypertension and dyslipidemia in a Mexican population. Int J Obes 2001; 25: 1794-1799
• 5 Björntorp P. Do stress reactions cause abdominal obesity and comorbidities?. Obesity Rev 2001; 2: 73-86
• 6 Björntorp P. Obesity. Lancet 1997; 350: 423-426
• 7 Brainin M, Teusch Y, Kalra L. Acute treatment and long-term management of stroke in developing countries. Lancet Neurol 2007; 6: 553-561
• 8 Cameron AJ, Boyko EJ, Sicree RA. Central obesity as a precursor to the metabolic syndrome in the Ausdiab study and Mauritius. Obesity (Silver Spring) 2008; 16: 2707-2716
• 9 Cameron AJ, Sicree RA, Zimmet PZ. Cut-points for waist circumference in Europids and South Asians. Obesity 2009; 455: 1-8
• 10 Cappuccio FP, Cook DG, Atkinson RW. Prevalence, detection and management of cardiovascular risk factors in different ethnic groups in South London. Heart 1997; 78: 555-563
• 11 Connor M, Rheeder P, Bryer A. The South African stroke risk in general practice study. SAMJ 2005; 95: 334-339
• 12 Després J, Couillard C, Gagnon J. visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the health, risk factors, exercise training, and genetics (heritage) family study. Arterioscler Thromb Vasc Biol 2000; 20: 1932-1938
• 13 Després J, Lemieux I, Bergeron J. Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler Thromb Vasc Biol 2008; 28: 1039-1049
• 14 Després J, Lemieux I, Prudʼhomme D. Treatment of obesity: need to focus on high risk abdominally obese patients. BMJ 2001; 322 (7288:) 716-720
• 15 Du Plessis A, Malan L, Malan NT. Coping and metabolic syndrome indicators in urban black South African men: the SABPA study. Cardiovasc J Afr 2010; 21 (05) 268-273
• 16 Duckrow RB, Beard DC, Brennan RW. Regional cerebral blood flow decreases during chronic and acute hyperglycemia. Stroke 1987; 18: 52-58
• 17 Ezzati M, Vander Hoorn S, Rodgers A. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 2003; 362: 271-280
• 18 Faraggi D. Adjusting receiver operating curves and related indices for covariates. The Statistician 2003; 52 (02:) 179-192
• 19 Han TS, Mcneill G, Seidell JC. Predicting intra-abdominal fatness from anthropometric measures: the influence of stature. Int J Obes Relat Metab Disord 1997; 21: 587-593
• 20 Kannel WB, Mcgee DL. Diabetes and cardiovascular risk factors: the Framingham study. Circulation 1979; 59 (01:) 8-13
• 21 Kohara K., Nishida W, Maguchi M. Autonomic nervous function in non-dipper essential hypertensive participants: evaluation by power spectral analysis of heart rate variability. Hypertension 1995; 26: 808
• 22 Kudielka BM, Bellingrath S, Hellhammer DH. Cortisol in burnout and vital exhaustion: an overview. G Ital Med Lav Ergon 2006; 28 (01:) 34-42
• 23 Malan L, Malan NT, Wissing MP. Coping with urbanization: a cardiometabolic risk?. Biol Psychol 2008; 79 (03) 323-328
• 24 Malan L, Schutte AE, Malan NT. Specific coping strategies of Africans during urbanization: comparing cardiovascular responses and perception of health data. Biol Psychol 2006; 72: 305-310
• 25 Marfell-Jones M, Olds T, Steward A. International standards for anthropometric assessment. New Zealand: ISAK; 2006: 137
• 26 McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. EurJ Pharmacol 2008; 583: 174-185
• 27 Misra A, Wasir JS, Vikram NK. Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups. Nutrition 2005; 21: 969-976
• 28 Okusun IS, Rotimi CN, Forrester TE. Predictive value of abdominal obesity cut-off points for hypertension in blacks from West African and Caribbean island nations. Int J Obes 2000; 24: 180-186
• 29 Sliwa K, Wilkinson D, Hansen C. Spectrum of heart disease and risk factors in a black urban population in south africa (the heart of soweto study): a cohort study. Lancet 2008; 371: 915-922
• 30 Sumner AE, Sen S, Ricks M. Determining the waist circumference in African Americans which best predicts insulin resistance. Obesity 2008; 16: 841-846
• 31 Van Der Merwe M, Pepper MS. National prevalence of obesity: obesity in South Africa. Obes Reviews 2006; 7: 315-322
• 32 Vorster HH, Venter CS, Wissing MP. The nutrition and health transition in the north west province of South Africa: a review of the THUSA (Transition and Health during Urbanisation of South Africans) study Public Health Nutr. 2005; 8 (05:) 480-490
• 33 Vorster HH, Wissing MP, Venter CS. The impact of urbanization on physical, physiological and mental health of Africans in the north west province of South Africa: the THUSA study. S Afr J Sci 2000; 95: 505-513
• 34 Vorster HH. The emergence of cardiovascular disease during urbanisation of africans. Public Health Nutr 2002; 5 (1a:) 239-243
• 35 Walker ARP, Walker BF, Walker AJ. Low frequency of adverse sequelae of obesity in South African rural black women. Int J Vitam Nutr Res 1989; 59: 224-228
• 36 Wild SH, Fischbacher C, Brock A. Mortality from all causes and circulatory disease by country of birth in England and Whales 2001-2003. J Public Health 2007; 29 (02:) 191-198
• 37 Wild S, Mckeigue P. Mortality by country of birth in England and Whales, 1970-1992. BMJ 1997; 314: 689-762
• 38 Zhang C, Rexrode KM, Van Dam RM. Abdominal obesity and the risk of all-cause, cardiovascular, and cancer mortality" sixteen years of follow-up in us women. Circulation 2008; 117: 1658-1667
• 39 Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chemistry 1993; 39 (04:) 561-577