Optimal Waist Circumference Cutoff Values for the Diagnosis of Abdominal Obesity in Korean Adults

Yeong Sook Yoon; Sang Woo Oh

doi:10.3803/EnM.2014.29.4.418

Journal List > Endocrinol Metab > v.29(4) > 1086112

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yoon and Oh: Optimal Waist Circumference Cutoff Values for the Diagnosis of Abdominal Obesity in Korean Adults

Review Article

Endocrinology and Metabolism 2014; 29(4): 418-426.

Published online: 29 December 2014

DOI: https://doi.org/10.3803/EnM.2014.29.4.418

Optimal Waist Circumference Cutoff Values for the Diagnosis of Abdominal Obesity in Korean Adults

Yeong Sook Yoon¹, Sang Woo Oh²

¹Department of Family Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

²Department of Family Medicine, Center for Obesity, Metabolism and Nutrition, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.

Corresponding author: Sang Woo Oh. Department of Family Medicine, Center for Obesity, Metabolism and Nutrition. Dongguk University Ilsan Hospital, Dongguk University College of Medicine, 27 Dongguk-ro, Ilsandong-gu, Goyang 410-773, Korea. Tel: +82-31-961-7495, Fax: +82-31-961-7496, osw6021@yahoo.co.kr

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Abdominal obesity is associated closely with insulin resistance, diabetes, and cardiovascular disease. Waist circumference (WC) is a useful surrogate marker commonly used for abdominal adiposity. The determination of WC cutoff levels is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases. Recent epidemiological evidence suggested that appropriate optimal cutoffs for Koreans ranged over 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. We analyzed the data from two large cohorts using receiver operating characteristic curve analysis with the incidences of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors as outcome variables. Optimal WC cutoff points for Koreans were 85 cm in males and 80 cm in females. However, considering the prevalence of abdominal obesity and the health costs for its prevention and management, 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity. These values may be modified once better research is performed through prospective studies using representative populations, common health outcomes, and proper analytical approaches.

Keywords: Obesity, abdominal, Waist circumference, Metabolic syndrome, Cohort studies, ROC curve, Sensitivity and specificity

INTRODUCTION

Malignant neoplasms, cerebrovascular disease, heart disease, and diabetes have been the major causes of mortality in Korea over the last 10 years [1]. All of these are closely related to an obesity epidemic. The body mass index (BMI) is the most widely used method for the diagnosis of obesity and is correlated directly with the risk of comorbidities and mortality. Evidence from epidemiological studies has demonstrated the importance of body fat distribution and the strong association of excess abdominal fat with insulin resistance, dyslipidemia, hypertension, and diabetes, and their essential roles in the pathogenesis of cardiovascular disease, metabolic syndrome, and certain cancers. However, BMI has important limitations, because it neither discriminates fat from lean mass nor fully reflects the distribution of body fat. Waist circumference (WC) has been commonly used as a simple and clinically useful surrogate marker for central adiposity. The determination of WC cutoff values is important in the prevention and treatment of obesity, type 2 diabetes, and related cardiovascular diseases.

This review focused on the current WC cutoff levels used in different ethnic groups and Koreans and suggested optimal WC cutoff values to identify abdominal obesity and predict disease risk in Koreans based on the analysis of large cohort data.

CURRENT THRESHOLDS FOR ABDOMINAL OBESITY IN DIFFERENT POPULATIONS/ETHNIC GROUPS

Abdominal obesity is highly correlated to insulin resistance. Because abdominal obesity was a major component of metabolic syndrome in the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) [2], the determination of the WC cutoff level to identify abdominal obesity has been performed by numerous organizations [3,4,5,6,7,8,9,10,11,12]. In the 2001 NCEP ATP III guidelines, abdominal obesity was defined as a WC ≥102 cm in males and ≥88 cm in females [3,13]. However, these cutoffs corresponded to BMI values of 30 kg/m² based on studies performed in populations of European origin [14].

The International Diabetes Federation consensus proposed ethnicity-specific WC cutoff values, which have been incorporated into the definition of metabolic syndrome [15,16]. Likewise, the 2005 revised NCEP criteria proposed by the American Heart Association/National Heart, Lung, and Blood Institute [4] indicated a minor lowering of the WC cutoff levels to ≥90 and ≥80 cm in males and females, respectively, which appeared to be appropriate for Asian Americans.

WC thresholds for abdominal obesity are not uniformly applicable to all populations and ethnic groups, because variations in disease risk may occur with the same WC in different ethnic groups. The 2009 joint statement harmonizing metabolic syndrome recommended the use of ethnicity-specific WC thresholds. Table 1 lists WC thresholds recommended for different populations and ethnic groups.

CHANGES IN WC CUTOFF LEVELS FOR ABDOMINAL OBESITY IN THE KOREAN POPULATION

Until 2005, WC thresholds of ≥90 cm (36 inches) in males and ≥80 cm (32 inches) in females were used as the diagnostic criteria for abdominal obesity in Korea. These were determined from results that obesity-related disorders may begin to increase rapidly from a WC of 90 to 92 cm (36 inches) in males and from 80 to 82 cm (30 inches) in females. These were in accordance with the definition from the 2000 Western Pacific Region of the World Health Organization, International Association for the Study of Obesity, and International Obesity Taskforce guidelines based on epidemiological data from Chinese living in Hong Kong and Singapore [5]. These criteria raised several issues, and re-evaluation of the threshold for abdominal obesity criteria was required. In brief, the cutoff level of 80 cm in females was considered to be low and very near to the mean WC of 78.31 cm according to the 1998 National Health and Nutrition Examination Survey of Korean females. Furthermore, the 40.3% prevalence of obesity in females was relatively high compared with the 19.9% morbidity in males [17].

In 2006, the Korea Society for the Study of Obesity updated the WC cutoff levels for defining abdominal obesity to 90 cm in males and 85 cm in females [18]. These cutoffs were defined by receiver operating characteristics (ROC) curve analysis, odds ratios, and the prevalence of abdominal obesity based on representative sample data from the 1998 Korean National Health and Nutrition Examination Survey [18]. The WC cutoff levels in Koreans using ROC curve analysis for two or more metabolic syndrome risk factors as a reference were 82 to 84 cm in males and 79 to 82 cm in females. The odds ratio of having more than two metabolic abnormalities was approximately 5 in males and females with a WC ≥90 and ≥80 cm, respectively. WC values in the 80th percentile in the Korean population were 90 and 86.5 cm in males and females, respectively.

There have been numerous studies attempting to identify the optimal WC cutoff in the Korean population since 2006 [19,20,21,22,23,24,25,26,27,28,29]. Table 2 shows those studies that proposed thresholds for abdominal obesity in Koreans [19,20,21,22,23,24,25,26,27,29]. The range of optimal WC cutoffs were determined to be 80 to 89.8 cm in males and 76.1 to 86.5 cm in females. However, most studies were cross-sectional in design [19,20,22,23,24,26,27,28,29], which have an inherent shortcoming potentially leading to incorrect conclusions regarding the relationship between obesity and disease. Further prospective studies using representative populations, common health outcomes, and proper analytical approaches are needed to identify optimal cutoff levels.

OPTIMAL WC CUTOFF LEVELS TO IDENTIFY ABDOMINAL OBESITY USING THE ANSUNG-ANSAN AND NATIONAL HEALTH INSURANCE CORPORATION COHORTS

We analyzed the data from two large cohorts using ROC curve analysis to maximize the sensitivity and specificity for identifying optimal WC cutoff levels and to overcome the limitations of a cross-sectional design. The outcome variables were incidence of diabetes, hypertension, dyslipidemia, cerebrovascular disease, myocardial infarct, angina, coronary artery disease, and multiple metabolic risk factors. Tables 3, 4 show the area under the curve and optimal cutoff levels with corresponding validity parameters for WC in predicting different types of obesity-related diseases in males and females, respectively.

Among males, the optimal WC cutoff points identifying the presence of two or more metabolic risk factors were 80.3 and 80.5 cm in the Ansung-Ansan and National Health Insurance Corporation (NHIC) cohorts, respectively. The optimal cutoff values for identifying the incidence of diabetes, hypertension, hypercholesterolemia, and hypertriglyceridemia were 84.0, 83.8, 83.2, and 82.7 cm, respectively, in the Ansung-Ansan cohort. These results were similar to those from the NHIC cohort. An area under the curve value of 0.66 for a WC of 90 cm identified myocardial infarction with a corresponding 52% sensitivity and 79% specificity. The optimal cutoffs for identifying coronary artery disease and cardiovascular accident (CVA) were 83.3 and 84.6 cm, respectively, in the Ansung-Ansan cohort, and 85.5 and 83.5 cm, respectively, in the NHIC cohort. Among females, the optimal cutoff values for predicting various types of obesity-related diseases, including high levels of fasting blood glucose, high blood pressure, high triglyceride, and low high density lipoprotein cholesterol, and at least one, two, or three metabolic risk factors, diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, angina, and coronary artery disease, ranged from 73.4 to 81.7 cm in the Ansung-Ansan cohort and 73.5 to 77.5 cm in the NHIC cohort. These values were approximately 5 cm less than those in males. According to the Ansung-Ansan cohort, the optimal cutoff levels for myocardial infarct and CVA (84.9 and 85.9 cm, respectively) were higher than those used to predict other diseases. Based on the above results, the optimal cutoff values for diagnosing abdominal obesity in males and females were approximately 85 and 80 cm, respectively.

We performed a Cox proportional hazard analysis to calculate the hazard ratio (HR) for having metabolic risk factors or an incidence of diabetes for different WC cutoff values. Fig. 1 shows the HRs for the incidences of one, two, three, or more metabolic risk factors and for the incidence of diabetes for a 5-cm increase in the WC according to the Ansung-Ansan cohort. The risks of having one, two, three, or more metabolic risk factors were significantly increased with increasing WC. The HRs and 95% confidence intervals (CI) from the lowest to the highest 5-cm interval WC category (5-cm interval category from <70 to ≥100 cm) for males were 0.88, 1.00, 1.46, 1.90, 2.34, 2.81, 2.76, and 2.95, respectively, (95% CI, 2.24 to 3.88) for the development of one or more metabolic risk factors; 0.73, 1.00, 1.67, 2.35, 3.15, 4.23, 4.66, and 5.16, respectively, (95% CI, 3.78 to 7.04) for the development of two or more metabolic risk factors; and 0.83, 1.00, 3.31, 5.04, 7.44, 10.76, 13.50, and 12.81, respectively, (95% CI, 7.65 to 21.45) for the development of three or more metabolic risk factors (all P<0.001 for trend). Females displayed similar HR trends for the development of one, two, three, or more metabolic risk factors. The HRs for the incidence of diabetes were significantly increased from WC cutoff values of ≥85 cm for males (HR, 1.89; 95% CI, 1.32 to 2.70; P<0.001) and ≥80 cm for females (HR, 1.89; 95% CI, 1.37 to 2.60; P<0.001).

The prevalence of abdominal obesity varied depending on the selected WC cutoff values (Table 5). According to the Korea National Health and Nutrition Examination IV data, the prevalence of abdominal obesity was 46.3% when a WC cutoff ≥85 cm was used to diagnose abdominal obesity in males and 41.6% when a WC cutoff ≥80 cm was used in females (Table 5). It is of interest that ≥60% of females aged ≥50 years were abdominally obese when 80 cm was applied as the WC cutoff level. Otherwise, the prevalence of abdominal obesity was 25.4% in males and 25.0% in females when WC values of 90 and 85 cm, respectively, were applied for the definition of abdominal obesity.

CONCLUSIONS

The optimal WC cutoff value determined should be that which can identify populations at a predefined level of risk of future health problems consistently. The optimal WC cutoff levels were 85 cm in males and 80 cm in females, based on data from large prospective cohorts using various health outcomes. However, when considering the prevalence of abdominal obesity and the health costs for its prevention and management, WC of 90 cm in males and 85 cm in females are probably more appropriate thresholds for abdominal obesity.

Figures and Tables

Fig. 1

Hazard ratios for the development of one or more metabolic risk factors or incidence of diabetes for a 5-cm increase in the waist circumference. (A) Men, ≥1, 2, or 3 metabolic risk factors. (B) Women, ≥1, 2, or 3 metabolic risk factors. (C) Men, diabetes mellitus. (D) Women, diabetes mellitus.

Table 1

Current Recommended Waist Circumference Thresholds for Abdominal Obesity

IDF, International Diabetes Federation; WHO, World Health Organization; AHA, American Heart Association; NHLBI, National Heart, Lung, and Blood Institute; ATP III, Adult Treatment Panel III; KSSO, Korean Society for the Study of Obesity.

Table 2

Studies Evaluating Suggested Thresholds for Abdominal Obesity in Koreans

KNHANES, The Korea National Health and Nutrition Examination Survey; ROC, receiver-operating characteristic; CHD, coronary heart disease.

Table 3

Area Under the Receiver-Operating Characteristic Curve, Optimal Cutoff Values, and Validity Parameters Predicting Obesity-Related Diseases in Males

High fasting blood sugar (FBS) was diagnosed when the FBS was ≥100 mg/dL or the subject was receiving glucose-lowering medications. High blood pressure (BP) was diagnosed when the systolic BP was ≥130 mm Hg, diastolic BP was ≥85 mm Hg, or the subject was receiving antihypertensive medications. High triglycerides (TG) were diagnosed when the TG level was ≥150 mg/dL. Low high density lipoprotein cholesterol (HDL-C) was diagnosed when the HDL-C level was 40 mg/dL. Metabolic risk factors included high BP, high FBS, high TG, and low HDL-C of the modified National Cholesterol Education Program Adult Treatment Panel III criteria other than waist circumference. Hypertension was diagnosed when the systolic BP was ≥140 mm Hg, diastolic BP was ≥90 mm Hg, or the subjects were receiving antihypertensive medications. Diabetes was diagnosed when the FBS was ≥100 mg/dL, 2-hour postprandial blood sugar was ≥200 mg/dL, or the subjects were receiving glucose-lowering medications. Hypercholesterolemia was diagnosed when the total cholesterol was ≥200 mg/dL. Hypertriglyceridemia was diagnosed when the TG level was ≥200 mg/dL.

AUC, area under the curve; SE, standard error.

Table 4

Area Under the Receiver-Operating Characteristic Curve, Optimal Cutoff Points, and Validity Parameters Predicting Obesity-Related Disease in Females

High fasting blood sugar (FBS) was diagnosed when the FBS was ≥100 mg/dL or the subjects were receiving glucose-lowering medications. High blood pressure (BP) was diagnosed when the systolic BP was ≥130 mm Hg, diastolic BP was ≥85 mm Hg, or the subjects were receiving antihypertensive medications. High triglycerides (TG) were diagnosed when the TG level was ≥150 mg/dL. Low high density lipoprotein cholesterol (HDL-C) was diagnosed when the HDL-C level was <50 mg/dL. Metabolic risk factors included high BP, high FBS, high TG, and low HDL-C of the modified National Cholesterol Education Program Adult Treatment Panel III criteria other than waist circumference. Hypertension was diagnosed when the systolic BP was ≥140 mm Hg, diastolic BP was ≥90 mm Hg, or the subjects were receiving antihypertensive medications. Diabetes was diagnosed when the FBS was ≥100 mg/dL, 2-hour postprandial blood sugar was ≥200 mg/dL, or the subjects were receiving glucose-lowering medications. Hypercholesterolemia was diagnosed when the total cholesterol was ≥200 mg/dL. Hypertriglyceridemia was diagnosed when the TG was ≥200 mg/dL.

AUC, area under the curve; SE, standard error.

Table 5

Prevalence of Abdominal Obesity according to Different Cutoff Values by Sex and Age Using Data from NHANES 2007 to 2009

ACKNOWLEDGEMENT

We thank the National Health Insurance Corporation and Korea Centers for Disease Control and Prevention for providing the cohort data.

Notes

No potential conflict of interest relevant to this article was reported.

References

1. Statistics Korea. 2013 Causes of Death Statistics [Internet]. Daejeon: Statistics Korea;c2008. cited 2014 Dec 8. Available from:http://www.index.go.kr.

2. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421.

3. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998; 6:Suppl 2. 51S–209S.

4. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F. American Heart Association. National Heart, Lung, and Blood Institute. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752.

5. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: World Health Organization;2000. p. 256.

6. Khan NA, McAlister FA, Rabkin SW, Padwal R, Feldman RD, Campbell NR, Leiter LA, Lewanczuk RZ, Schiffrin EL, Hill MD, Arnold M, Moe G, Campbell TS, Herbert C, Milot A, Stone JA, Burgess E, Hemmelgarn B, Jones C, Larochelle P, Ogilvie RI, Houlden R, Herman RJ, Hamet P, Fodor G, Carruthers G, Culleton B, Dechamplain J, Pylypchuk G, Logan AG, Gledhill N, Petrella R, Tobe S, Touyz RM. Canadian Hypertension Education Program. The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: part II: therapy. Can J Cardiol. 2006; 22:583–593.

7. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL. ESC Committee for Practice Guidelines. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis. 2007; 194:1–45.

8. Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, Kadowaki T. A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2006; 29:1123–1124.

9. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, Kim DY, Kwon HS, Kim SR, Lee CB, Oh SJ, Park CY, Yoo HJ. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract. 2007; 75:72–80.

10. Oka R, Kobayashi J, Yagi K, Tanii H, Miyamoto S, Asano A, Hagishita T, Mori M, Moriuchi T, Kobayashi M, Katsuda S, Kawashiri MA, Nohara A, Takeda Y, Mabuchi H, Yamagishi M. Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome. Diabetes Res Clin Pract. 2008; 79:474–481.

11. Examination Committee of Criteria for 'Obesity Disease' in Japan. Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J. 2002; 66:987–992.

12. Zhou BF. Cooperative Meta-Analysis Group of the Working Group on Obesity in China. 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; 15:83–96.

13. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: executive summary. Am J Clin Nutr. 1998; 68:899–917.

14. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995; 311:158–161.

15. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet. 2005; 366:1059–1062.

16. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. International Diabetes Federation Task Force on Epidemiology and Prevention. Hational Heart, Lung, and Blood Institute. American Heart Association. World Heart Federation. International Atherosclerosis Society. International Association for the Study of Obesity. 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; 120:1640–1645.

17. Khang YH, Yun SC. Trends in general and abdominal obesity among Korean adults: findings from 1998, 2001, 2005, and 2007 Korea National Health and Nutrition Examination Surveys. J Korean Med Sci. 2010; 25:1582–1588.

18. Lee S, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, Cho GJ, Han JH, Kim SR, Park CY, Oh SJ, Lee CB, Kim KS, Oh SW, Kim YS, Choi WH, Yoo HJ. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obes. 2006; 15:1–9.

19. Lee OG, Hur YI, Kang JH, Park HA, Kim KW, Cho YG, Choi WY, Park H, Lee HA. The cutoff value of waist circumference for predicting metabolic risks in pre- and post-menopausal korean women: analysis of 2010 korean national health and nutrition examination survey data. Korean J Fam Med. 2013; 34:307–318.

20. Lim S, Kim JH, Yoon JW, Kang SM, Choi SH, Park YJ, Kim KW, Cho NH, Shin H, Park KS, Jang HC. Optimal cut points of waist circumference (WC) and visceral fat area (VFA) predicting for metabolic syndrome (MetS) in elderly population in the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr. 2012; 54:e29–e34.

21. Ko KP, Oh DK, Min H, Kim CS, Park JK, Kim Y, Kim SS. Prospective study of optimal obesity index cutoffs for predicting development of multiple metabolic risk factors: the Korean genome and epidemiology study. J Epidemiol. 2012; 22:433–439.

22. Yoo HJ, Park MS, Lee CH, Yang SJ, Kim TN, Lim KI, Kang HJ, Song W, Yeon JE, Baik SH, Choi DS, Choi KM. Cutoff points of abdominal obesity indices in screening for non-alcoholic fatty liver disease in Asians. Liver Int. 2010; 30:1189–1196.

23. Park YM, Kwon HS, Lim SY, Lee JH, Yoon KH, Son HY, Yim HW, Lee WC. Optimal waist circumference cutoff value reflecting insulin resistance as a diagnostic criterion of metabolic syndrome in a nondiabetic Korean population aged 40 years and over: the Chungju Metabolic Disease Cohort (CMC) study. Yonsei Med J. 2010; 51:511–518.

24. Koh JH, Koh SB, Lee MY, Jung PM, Kim BH, Shin JY, Shin YG, Ryu SY, Lee TY, Park JK, Chung CH. Optimal waist circumference cutoff values for metabolic syndrome diagnostic criteria in a Korean rural population. J Korean Med Sci. 2010; 25:734–737.

25. Choi SJ, Keam B, Park SH, Park HY. Appropriate waist circumference cut-offs to predict diabetes in the Korean population: the Korean Genome and Epidemiology Study. Circ J. 2010; 74:1357–1363.

26. Seo JA, Kim BG, Cho H, Kim HS, Park J, Baik SH, Choi DS, Park MH, Jo SA, Koh YH, Han C, Kim NH. The cutoff values of visceral fat area and waist circumference for identifying subjects at risk for metabolic syndrome in elderly Korean: Ansan Geriatric (AGE) cohort study. BMC Public Health. 2009; 9:443.

27. Baik I. Optimal cutoff points of waist circumference for the criteria of abdominal obesity: comparison with the criteria of the International Diabetes Federation. Circ J. 2009; 73:2068–2075.

28. Hyun YJ, Kim OY, Jang Y, Ha JW, Chae JS, Kim JY, Yeo HY, Paik JK, Lee JH. Evaluation of metabolic syndrome risk in Korean premenopausal women: not waist circumference but visceral fat. Circ J. 2008; 72:1308–1315.

29. Kim JA, Choi CJ, Yum KS. Cut-off values of visceral fat area and waist circumference: diagnostic criteria for abdominal obesity in a Korean population. J Korean Med Sci. 2006; 21:1048–1053.

TOOLS

Similar articles