Research Article: Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals

Date Published: April 29, 2019

Publisher: Public Library of Science

Author(s): Ryuichi Kawamoto, Asuka Kikuchi, Taichi Akase, Daisuke Ninomiya, Teru Kumagi, Tatsuo Shimosawa.


This study examined a range of anthropometric indices and their relationships with metabolic syndrome (MetS). Despite recommendations that central obesity assessment should be employed as a marker of metabolic health, there is no consensus regarding the protocol for measurement. The present study included 720 men aged 71 ± 8 years and 919 women aged 71 ± 7 years from a rural village. We examined the relationship between anthropometric indices {e.g., body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHpR)}, and MetS based on the modified criteria of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP) III report in a cross-sectional (N = 1,639) and cohort (N = 377) data. A receiver operating curve (ROC) analysis was performed to determine the optimal cut-off value and best discriminatory value of each of these anthropometric indices to predict MetS. In the cross-sectional study, WHtR as well as BMI and WHpR showed significantly predictive abilities for MetS in both genders; and WHtR showed the strongest predictive ability for the presence of MetS. Also in the cohort study, WHtR as well as BMI and WHpR showed significantly predictive abilities for incident MetS in both genders, and in men WHtR showed the strongest predictive ability for incident MetS, but in women BMI showed the strongest predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.52 (sensitivity, 71.0%; specificity, 77.9%) for men and 0.53 (sensitivity, 79.8%; specificity, 75.7%) for women. In the cohort study, the optimal WHtR values were 0.50 (sensitivity, 60.7%; specificity, 73.2%) for men and 0.50 (sensitivity, 75.0%; specificity, 56.1%) for women. Increased WHtR was significantly and independently associated with prevalence of MetS in both genders. These results suggest that WHtR is a useful screening tool for determining metabolic risk in Japanese elderly community dwelling individuals.

Partial Text

The underlying mechanism of metabolic syndrome (MetS), or a clustering of cardiovascular risk factors, such as hypertension, glucose intolerance, hypertriglyceridemia, and low high-density lipoprotein cholesterol (HDL-C) levels, is insulin resistance, which is also known as a pre-disease state that leads to an increased risk of cardiovascular disease (CVD) [1], [2], and type 2 diabetes [3], [4]. The incidence of MetS is increasing worldwide with the continuous increase in obesity prevalence [5]. Obesity is the most important underlying cause of insulin resistance, which has also been suggested as a pathogenetic mechanism of abdominal obesity because visceral fat plays an important role in lipid metabolism and insulin sensitivity [6], [7], [8], [9]. Various obesity-related anthropometric indices, such as body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHpR), have been used to predict incident MetS in epidemiological studies [10], [11], [12], [13], [14]. BMI is a measurement of body fat by height and weight, while WC reflects abdominal obesity. WHtR and WHpR further reflect the fat distribution by WC, and all three indices are considered to be specific options to evaluate abdominal fat.

In this study where data from the Nomura study of 2014 and 2017 was used, the AUC analyses indicated that WHtR as well as BMI and WHpR had significant predictive ability for MetS in both genders, and that WHtR was significantly and independently associated with the prevalence of MetS in this cross-sectional study as well as the incidence of MetS in this cohort study. The usefulness of this cutoff value as a screening tool for the prediction of MetS was superior to those of BMI and WHpR, which are conventional obesity indices among both genders. This study showed that WHtR might be an appropriate definition from the point of view of knowing the presence and incidence of MetS. To the best of our knowledge, few epidemiologic studies have quantified the relevance between WHtR and incident MetS in Japanese elderly community-dwelling individuals.




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