Waist-to-hip ratio is a better anthropometric index than body mass index for predicting the risk of type 2 diabetes in Taiwanese population

Nutrition Research

Volumn 30, Issue 9, 2010, Pages 585-593

  Cheng, Chien Hsiang ^a   Ho, Chien Chang ^b   Yang, Chin Feng ^c   Huang, Yi Chia ^c   Lai, Cheng Hsiu ^b   Liaw, Yung Po ^c,d  

^a TAICHUNG VETERANS GENERAL HOSPITAL   (Taiwan)

^b UNIVERSITY OF TAIPEI   (Taiwan)

^c CHUNG SHAN MEDICAL UNIVERSITY   (Taiwan)

^d CHUNG SHAN MEDICAL UNIVERSITY HOSPITAL   (Taiwan)

Author keywords

Human; Optimal cutoff value; Receiver operating characteristic curve; Taiwan; Type 2 diabetes; Waist to hip ratio

Indexed keywords

CHOLESTEROL; HIGH DENSITY LIPOPROTEIN; LOW DENSITY LIPOPROTEIN; TRIACYLGLYCEROL;

ABDOMINAL OBESITY; ADULT; AGED; ARTICLE; BODY FAT DISTRIBUTION; BODY HEIGHT; BODY MASS; BODY WEIGHT; CHOLESTEROL BLOOD LEVEL; CONTROLLED STUDY; DRINKING BEHAVIOR; ETHNICITY; FEMALE; HEALTH STATUS; HEALTH SURVEY; HUMAN; HYPERTENSION; INTERMETHOD COMPARISON; LIPOPROTEIN BLOOD LEVEL; MAJOR CLINICAL STUDY; MALE; NON INSULIN DEPENDENT DIABETES MELLITUS; POPULATION RESEARCH; PREDICTION; PREVALENCE; PRIORITY JOURNAL; RISK ASSESSMENT; SENSITIVITY AND SPECIFICITY; SEX DIFFERENCE; SMOKING HABIT; TAIWAN; TRIACYLGLYCEROL BLOOD LEVEL; WAIST HIP RATIO;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; ANTHROPOMETRY; AREA UNDER CURVE; ASIAN CONTINENTAL ANCESTRY GROUP; BIOLOGICAL MARKERS; BODY MASS INDEX; CROSS-SECTIONAL STUDIES; DIABETES MELLITUS, TYPE 2; FEMALE; HUMANS; HYPERTENSION; MALE; MIDDLE AGED; ODDS RATIO; RISK FACTORS; ROC CURVE; TAIWAN; WAIST-HIP RATIO;

EID: 77957657946     PISSN: 02715317     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.nutres.2010.08.007     Document Type: Article

References (66)

1. Field A.E., Coakley E.H., Must A., Spadano J.L., Laird N., Dietz W.H., et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001, 161:1581-1586.
2. Lin S., Cheng T.O., Liu X., Mai J., Rao X., Gao X., et al. Impact of dysglycemia, body mass index, and waist-to-hip ratio on the prevalence of systemic hypertension in a lean Chinese population. Am J Cardiol 2006, 97:839-842.
3. Young T.K., Sevenhuysen G., Ling N., Moffatt M. Determinants of plasma glucose levels and diabetic status in a northern Canadian Indian population. Can Med Assoc J 1990, 142:821-830.
4. Bray G.A., Jablonski K.A., Fujimoto W.Y., Barrett-Connor E., Haffner S., Hanson R.L., et al. Relation of central adiposity and body mass index to the development of diabetes in the Diabetes Prevention Program. Am J Clin Nutr 2008, 87:1212-1218.
5. Kissebah A.H., Krakower G.R. Regional adiposity and morbidity. Physical Rev 1994, 74:761-811.
6. Blair D., Habicht J.P., Sims E.A., Sylwester D., Abraham S. Evidence for an increased risk for hypertension with centrally located body fat and the effect of race and sex on this risk. Am J Epidemiol 1984, 119:526-540.
7. Feldstein C.A., Akopian M., Olivieri A.O., Kramer A.P., Nasi M., Garrido D.A. Comparison of body mass index and waist-to-hip ratio as indicators of hypertension risk in an urban Argentine population: a hospital-based study. Nutr Metab Cardio Dis 2005, 15:310-315.
8. Stevens J., Couper D., Pankow J., Folsom A.R., Duncan B.B., Nieto F.J., et al. Sensitivity and specificity of anthropometrics for the prediction of diabetes in a biracial cohort. Obes Res 2001, 9:696-705.
9. Weinsier R.L., Norris D.J., Birch R., Bernstein R.S., Wang J., Yang M.U., et al. The relative contribution of body fat and fat pattern to blood pressure level. Hypertension 1985, 7:578-585.
10. Daniel M., Marion S., Sheps S.B., Hertzman C., Gamble D. Variation by body mass index and age in waist-to-hip ratio associations with glycemic status in an aboriginal population at risk for type 2 diabetes in British Columbia, Canada. Am J Clin Nutr 1999, 69:455-460.
11. Chu N.F., Wang D.J., Shieh S.M., Rimm E.B. Plasma leptin concentrations and obesity in relation to insulin resistance syndrome components among school children in Taiwan: the Taipei Children Heart Study. Int Obes Relat Metab Disord 2000, 24:1265-1271.
12. Woo J., Ho S.C., Yu A., Sham A. Is waist circumference a useful measure in predicting health outcomes in the elderly?. Int J Obes 2002, 26:1349-1355.
13. Meisinger C., Döring A., Thorand B., Heier M., Löwel H. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg Cohort Study. Am J Clin Nutr 2006, 84:483-489.
14. Bell A.C., Adair L.S., Poplin B.M. Ethnic differences in the association between body mass index and hypertension. Am Jepidemiol 2002, 155:346-353.
15. Ko G.T.C., Chan J.C.N., Cockram C.S., Woo J. Prediction of hypertension, diabetes, dyslipidaemia or albuminemia using simple anthropometric indexes in Hong Kong Chinese. Int J Obes Relat Metab Disord 1999, 23:1136-1142.
16. Tseng C.H. Body composition as a risk factor for coronary artery disease in Chinese type 2 diabetic patients in Taiwan. Circ J 2003, 67:479-484.
17. Granner D.K., O'Brien R.M. Molecular physiology and genetics of NIDDM: importance of metabolic staging. Diabetes Care 1992, 15:369-395.
18. Hamman R.F. Genetic and environmental determinants of non-insulin-dependent diabetes mellitus (NIDDM). Diabetes Metab Rev 1992, 8:287-338.
19. Molarius A., Seidell J.C., Visscher T.L., Hofman A. Misclassification of high-risk older subjects using waist action levels established for young and middle-aged adults-results from the Rotterdam Study. J Am Geriatr Soc 2000, 48:1638-1645.
20. Seidell J.C., Oosterlee A., Deurenberg P., Hautvast J.G., Ruijs J.H. Abdominal fat depots measured with computed tomography: effects of degree of obesity, sex, and age. Eur J Clin Nutr 1988, 42:805-815.
21. Seidell J.C., Bouchard C. Visceral fat in relation to health: is it a major culprit or simply an innocent bystander?. Int J Obes Relat Metab Disord 1997, 21:626-631.
22. Hsieh S.D., Yoshinaga H. Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women. Inter Med 1995, 34:1147-1152.
23. Hsieh S.D., Yoshinaga H. Abdominal fat distribution and coronary heart disease risk factors in men-waist/height ratio as a simple and useful predictor. Int J Obes 1995, 19:585-589.
24. Hsieh S.D., Muto T. The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 2005, 40:216-220.
25. Deurenberg P., Yap M., van Staveren W.A. Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 1998, 22:1164-1171.
26. Deurenberg P., Yap M.D., Wang J., Lin F.P., Schmidt G. The impact of body build on the relationship between body mass index and percent body fat. Int J Obes Relat Metab Disord 1999, 23:537-542.
27. Mckeigue P.M., Shah B., Marmot M.G. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991, 337:382-386.
28. Department of Health. The abstract of statistics on cause of mortality in Taiwan area in 2002 (P.1). 2003.
29. Swets J.A. Measuring the accuracy of diagnostic systems. Science 1988, 240:1285-1293.
30. Pan W.H., Kao M.D., Tzeng M.S., Yen L.L., Hung Y.T., Li L.A., et al. Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996: design, contents, and operations. Nutr Sci J 1999, 24:1-10.
31. Chang H.Y., Yeh W.T., Chang Y.H., Tai K.S., Pan W.H. Prevalence of dyslipidemia and mean blood lipid values in Taiwan: results from the Nutrition and Health Survey in Taiwan (NAHSIT, 1993-1996). Chin J Physiol 2002, 45:187-197.
32. Lin Y.C., Yen L.L., Chen S.Y., Kao M.D., Tzeng M.S., Huang P.C., et al. Prevalence of overweight and obesity and its associated factors: findings from National Nutrition and Health Survey in Taiwan, 1993-1996. Prev Med 2003, 37:233-241.
33. Pan W.H., Yeh W.T., Hwu C.M., Ho L.T. Undiagnosed diabetes mellitus in Taiwanese subjects with impaired fasting glycemia: impact of female sex, central obesity, and short stature. Chin J Physiol 2001, 44:44-51.
34. Department of Health Identification, evaluation, and treatment of overweight and obesity in adults in Taiwan 2003, Department of Health, Washington, DC.
35. Pan W.H., Flegal K.M., Chang H.Y., Yeh W.T., Yeh C.J., Lee W.C. Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr 2004, 79:31-39.
36. Department of Health, Taiwan. Available at: [Accessed on February 14, 2010]. http://www.doh.gov.tw/dohenglish/index.asp.
37. Lin W.Y., Lee L.T., Chen C.Y., Lo H., Hsia H.H., Liu I.L., et al. Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes Relat Metab Disord 2002, 26:1232-1238.
38. Plutzky J. Emerging concepts in metabolic abnormalities associated with coronary artery disease. Curr Opin Cardiol 2000, 15:416-421.
39. Meisinger C., Thorand B., Schneider A., Stieber J., Doring A., Lowel H. Sex differences in risk factors for incident type 2 diabetes mellitus: the MONICA Augsburg cohort study. Arch Intern Med 2002, 162:82-89.
40. Riserus U., Arnlov J., Berglund L. Long-term predictors of insulin resistance: role of lifestyle and metabolic factors in middle-aged men. Diabetes Care 2007, 30:2928-2933.
41. Stolk R.P., Suriyawongpaisal P., Aekplakorn W., Woodward M., Neal B. Fat distribution is strongly associated with plasma glucose levels and diabetes in Thai adults-the InterASIA study. Diabetologia 2005, 48:657-660.
42. Ohlson L.O., Larsson B., Svärdsudd K., Welin L., Eriksson H., Wilhelmsen L., et al. The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 1985, 34:1055-1058.
43. Bjorntop P. Metabolic implications of body fat distribution. Diabetes Care 1991, 14:1132-1143.
44. Kahn B.B., Flier J.S. Obesity and insulin resistance. J Clin Invest 2000, 104:473-481.
45. Harris T.B., Visser M., Everhart J., Cauley J., Tylavsky F., Fuerst T., et al. Waist circumference and sagittal diameter reflect total body fat better than visceral fat in older men and women. The health, aging and body composition study. Ann NY Acad Sci 2000, 904:462-473.
46. Chien L.Y., Liou Y.M., Chen J.J. Association between indices of obesity and fasting hyperglycemia in Taiwan. Int J Obes Relat Metab Disord 2004, 28:690-696.
47. Lee S., Bacha F., Gungor N., Arslanian S.A. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr 2006, 148:188-194.
48. Mamtani M.R., Kulkarni H.R. Predictive performance of anthropometric indexes of central obesity for the risk of type 2 diabetes. Archiv Med Res 2005, 36:581-589.
49. Sánchez-Castillo C.P., Velásquez-Monroy O., Lara-Esqueda A., Berber A., Sepulveda J., Tapia-Conyer R., et al. Diabetes and hypertension increases in a society with abdominal obesity: results of the Mexican National Health Survey 2000. Public Health Nutr 2005, 8:53-60.
50. Seidell J.C., Han T.S., Feskens E.J., Lean M.E. Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. Intern Med 1997, 242:401-406.
51. Seidell J.C., Perusse L., Despres J.P., Bouchard C. Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. Am J Clin Nutr 2001, 74:315-321.
52. Snijder M.B., Dekker J.M., Visser M., Bouter L.M., Stehouwer C.D., Kostense P.J., et al. Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am J Clin Nutr 2003, 77:1192-1197.
53. Snijder M.B., Dekker J.M., Visser M., Yudkin J.S., Stehouwer C.D., Bouter L.M., et al. Larger thigh and hip circumferences are associated with better glucose tolerance: the Hoorn study. Obes Res 2003, 11:104-111.
54. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med 1998, 158:1855-1867.
55. Rexrode K.M., Buring J.E., Manson J.E. Abdominal and total adiposity and risk of coronary heart disease in men. Int J Obes Relat Metab Disord 2001, 25:1047-1056.
56. Kiernan M., Winkleby M.A. Identifying patients for weight-loss treatment: an empirical evaluation of the NHLBI obesity education initiative expert panel treatment recommendations. Arch Intern Med 2000, 160:2169-2176.
57. Sakurai M., Miura K., Takamura T., Ota T., Ishizaki M., Morikawa Y., et al. Gender differences in the association between anthropometric indices of obesity and blood pressure in Japanese. Hypertens Res 2006, 29:75-80.
58. Nyamdorj R., Qiao Q., Söderberg S., Pitkäniemi J., Zimmet P., Shaw J., et al. Comparison of body mass index with waist circumference, waist-to-hip ratio, and waist-to-stature ratio as a predictor of hypertension incidence in Mauritius. J Hypertens 2008, 26:866-870.
59. Dalton M., Cameron A.J., Zimmet P.Z., Shaw J.E., Jolley D., Dunstan D.W., et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med 2003, 254:555-563.
60. Lamarche B. Abdominal obesity and its metabolic complications: implications for the risk of ischaemic heart disease. Coron Artery Dis 1998, 9:473-481.
61. Kroke A., Bergmann M., Klipstein-Grobusch K., Boeing H. Obesity, body fat distribution and body build: their relation to blood pressure and prevalence of hypertension. Int J Obes Relat Metab Disord 1998, 22:1062-1070.
62. Siani A., Cappuccio F.P., Barba G., Trevisan M., Farinaro E., Lacone R., et al. The relationship of waist circumference to blood pressure: the Olivetti Heart Study. Am J Hypertens 2002, 15:780-786.
63. Fuchs F.D., Gus M., Moreira L.B., Moraes R.S., Wiehe M., Pereira G.M., et al. Anthropometric indices and the incidence of hypertension: a comparative analysis. Obes Res 2005, 13:1515-1517.
64. Gus M., Fuchs S.C., Moreira L.B., Moraes R.S., Wiehe M., Silva A.F., et al. Association between different measurements of obesity and the incidence of hypertension. Am J Hypertens 2004, 17:50-53.
65. Lean M.E., Han T.S., Morrison C.E. Waist circumference as a measure for indicating need for weight management. BMJ 1995, 311:158-161.
66. National Institutes of Health, National Heart, Lung, and Blood Institute Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res 1998, 6:51-210.