School of Medicine, Centre for Chronic Disease, University of Queensland, Brisbane, Australia.
Nutr Res Rev. 2010 Dec;23(2):191-9. doi: 10.1017/S0954422410000120. Epub 2010 Jul 20.
Abdominal obesity is a risk factor for cardiometabolic disease, and has become a major public health problem in the world. Waist circumference is generally used as a simple surrogate marker to define abdominal obesity for population screening. An increasing number of publications solely rely on the method that maximises sensitivity and specificity to define 'optimal' cut-off values. It is well documented that the optimal cut-off values of waist circumference vary across different ethnicities. However, it is not clear if the variation in cut-off values is a true biological phenomenon or an artifact of the method for identifying optimal cut-off points. The objective of the present review was to assess the relationship between optimal cut-offs and population waist circumference levels. Among sixty-one research papers, optimal cut-off values ranged from 65·5 to 101·2 cm for women and 72·5 to 103·0 cm for men. Reported optimal cut-off values were highly correlated with population means (correlation coefficient: 0·91 for men and 0·93 for women). Such a strong association was independent of waist circumference measurement techniques or the health outcomes (dyslipidaemia, hypertension or hyperglycaemia), and existed in some homogeneous populations such as the Chinese and Japanese. Our findings raised some concerns about applying the sensitivity and specificity approach to determine cut-off values. Further research is needed to understand whether the differences among populations in waist circumference were genetically or environmentally determined, and to understand whether using region-specific cut-off points can identify individuals with the same absolute risk levels of metabolic and cardiovascular outcomes among different populations.
腹型肥胖是心血管代谢疾病的一个风险因素，已成为全球主要的公共卫生问题。腰围通常被用作人群筛查中定义腹型肥胖的简单替代标志物。越来越多的文献仅依赖于最大化敏感性和特异性的方法来定义“最佳”截断值。已有大量文献记录表明，腰围的最佳截断值在不同种族之间存在差异。然而，目前尚不清楚这种截断值的变化是真正的生物学现象还是确定最佳截断点方法的人为产物。本综述的目的是评估最佳截断值与人群腰围水平之间的关系。在 61 篇研究论文中，女性的最佳截断值范围为 65.5-101.2cm，男性为 72.5-103.0cm。报告的最佳截断值与人群平均值高度相关（男性的相关系数为 0.91，女性为 0.93）。这种强相关性独立于腰围测量技术或健康结果（血脂异常、高血压或高血糖），在一些同质人群中存在，如中国和日本。我们的研究结果引发了一些关于应用敏感性和特异性方法来确定截断值的担忧。需要进一步研究，以了解人群之间腰围的差异是由遗传还是环境决定的，以及了解使用特定于区域的截断值是否可以在不同人群中识别出具有相同代谢和心血管结局绝对风险水平的个体。
