Body Mass Index (BMI) is the most established anthropometric indicator used for assessment of nutritional status. Other anthropometric indicators which are related closely to BMI are waist hip ratio (WHR) and waist circumference. In this paper, receiver operating characteristics (ROC) curves were constructed to assess the value of waist circumference and waist hip ratio as a screening measure for the need of weight management using BMI as the reference test. Sensitivity and specificity were calculated at several cut-offs.
The areas under the ROC curve calculated by comparing waist circumference with BMI were high (0.70 - 0.86) while the areas calculated for WHR were low (0.46 - 0.67). Sensitivities of 0.745 and 0.800 were observed at cut-off points of waist circumference at 90cm and 80cm for males and females respectively, while the false positive rates were 0.233 for males and 0.250 for females. These cut-off points could be considered as a fair trade-off.
Therefore it is concluded that waist circumference performed better than WHR as a screening test. It is indicative that waist circumference could be used as a tool in raising awareness of weight management in this population. Asia
Pac JPublic Health 2003; 15(2): 99-104.
Malaysian Ministry of Health.Report of the National Health and Morbidity Survey 2. Kuala Lumpur, 1997.
2.
Ismail MN, Zawiah H., Chee SS, Ng KKPrevalence and obesity and chronic energy deficiency (CED) in adult Malaysians. MalJ Nutr1995; 1: 1-9.
3.
Teo PH, Chong YH, Zaini ARCoronary risk factors among Malaysian male executives in two urban areas. Med J Malaysia1988; 43: 125-33.
4.
International Obesity Task Force.About obesity. Internet communication on 6th October 2000. http:\\www.obesity.chair.ulaval.ca/IOTF.html.
5.
Flegal, KM, Carroll MD, Kuczmarski RJ, Johnson CLOverweight and obesity in the United States. Prevalence and trends, 1960 - 1994. J of the International Assoc for the Study of Obesity1998; 22: 39 - 47.
6.
St Jeor STNew trends in weight management. J Am Diet Assoc1997; 97(10):1096-8.
7.
National Heart, Lung, and Blood Institute (NHLBI).Clinical Guidelines on the Identification, Evaluation, and Treatment of Obesity in Adults: The Evidence Report. Washington, DC: US Department of Health and Human Services , 1998.
8.
Manson JE, Willet WC, Stampfer MJ, et al. Body weight and mortality among women. New Engl J Med1995; 333: 677-85.
9.
Lee IM, Manson JE, Hennekens CH, Paffenbarger RSBody weight and mortality: a 27 year follow up of middle aged men . J Am Med Assoc1993; 270: 2823-8.
10.
Wolf AM, Colditz GACurrent estimates of the economic cost of obesity in the United States . Obes Res1998; 6(2): 97-106.
11.
Heymsfield SB, Allison DB, Heshka S., Pierson RN Jr.Assenssment of human body composition. In: Allison DB, editor. Handbook of assessment methods for eating behaviors and weight related problems: measures, theory and research. Thousand Oaks, CA: Sage Publications. 1995.
12.
Taylor JW, Keil D., Gold EJ, et al. Body mass index, waist girth and waist to hip ratio as indexes of total and regional adiposity in women: evaluation using receiver operating characteristics curves. Am J Clin Nutr2000 ; 67: 44-9.
13.
Sackett D., Haynes R., Tugwell P.Clinical epidemiology: a basic science for clinical medicine. Boston: Little Brown and Co.1985 .
14.
Who.Obesity: preventing and managing the global epidemic. Report of a WHO consultation on Obesity . Geneva: World Health Organisation . 1998.
15.
Inoure S., Zimmet P., Caterson I., et al. Redefining Obesity and its treatment. 2000. Internet communication, on 9th October 2000 http://www.obesityasiapacific.com/title.html.
16.
Ko Vtc, Chan Jcn, Cockram CS et al. Prediction of hypertension, diabetes, dyslipidaemia or albuminuria using simple anthropometric indexes in Hong Kong. Chinese Int J Obes1999; 23(ii): 1136-42.
17.
Deurenberg-Yap M., Yian TB, Kai CS, et al. Manisfestation of cardiovascular risk factors at low levels of body mass index and waist-to-hip ratio in Singaporean Chinese. Asia-Pacific JClin Nutr1999; 8(3): 177-83.
18.
Han TS, van Leer EM, Seidell JC, Lean Mej.Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ1995; 311: 1401-5.
19.
Lemieux S., Prud'homme D., Bouchard C., Trambleay A., Despres J-P.A single threshold value of waist girth identifies normal weight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr1996; 64: 685-9.
20.
Ley CJ, Lees B., Stevenson JCSex and menopause-associated changes in body fat distribution. Am J Clin Nutr1992; 55: 950-4.
21.
Goran MI, Allison DB, Poehlman ETIssues relating to normalization of body fat content in men and women . Int J Obes1995; 19: 638-43.
22.
Lean Mej, Han TS, Morrison CEWaist circumference as a measure for indicating need for weight management . BMJ1995; 311: 158-61.
23.
Lazarus R., Baur L., Webb K., Blyth F.Body mass index in screening for adiposity in children and adolescents: systematic evaluation using receiver operating characteristic curves. Am J Clin Nutr1996; 63: 500-6.
24.
Molarius A. , Seidell JC, Sans S., Tuomilehto J., Kuulasmaa K.Varying sensitivity of waist action levels to identify subjects with overweight or obesity in 19 populations of the WHO MONICA Project. J Clin Epidemiol1999; 52(12): 1213-24.
