Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

K Ekoru; GAV Murphy; EH Young; H Delisle; CS Jerome; F Assah; B Longo-Mbenza; JPD Nzambi; JBK On'Kin; F Buntix; +33 more... MC Muyer; DL Christensen; CS Wesseh; A Sabir; C Okafor; ID Gezawa; F Puepet; O Enang; T Raimi; E Ohwovoriole; OO Oladapo; P Bovet; W Mollentze; N Unwin; WK Gray; R Walker; K Agoudavi; S Siziya; J Chifamba; M Njelekela; CM Fourie; S Kruger; AE Schutte; C Walsh; D Gareta; A Kamali; J Seeley ORCID logo; SA Norris; NJ Crowther; D Pillay; P Kaleebu ORCID logo; AA Motala; MS Sandhu; (2017) Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa. Int J Obes (Lond), 42 (3). pp. 487-494. ISSN 1476-5497 DOI: 10.1038/ijo.2017.240
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BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.


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