Determination of the Optimal Waist Circumference Cut-Off Points in Benin Adults

Abstract

Obesity is an independent risk factor for chronic diseases such as diabetes, cardiovascular diseases and certain cancers. Early detection of abdominal obesity followed by appropriate interventions will prevent associated diseases. The objective was to determine optimal waist circumference (WC) cut-off points predictive of at least one other component of metabolic syndrome in Benin adults. This longitudinal and observational study included at the baseline 541 apparently healthy subjects aged 25 - 60 years randomly selected in the largest city of Cotonou (n = 200), the smaller-size city of Ouidah (n = 171) and rural surroundings of Ouidah (n = 170) in Benin. Components of the metabolic syndrome considered along with abdominal obesity were high blood pressure, high fasting glycaemia, low HDL-cholesterol and high triglycerides as defined by the Joint Interim Statement. After the baseline survey, the subjects were followed-up for four years. Complete data at baseline and four years later were available in 416 subjects. The receiver operating characteristic (ROC) curve for waist circumference to predict at least one other component of the metabolic syndrome was plotted and the Youden index was used to define the optimal cut-offs of WC. At the baseline of the study, the optimal WC cut-off point to predict the presence of at least one other component of the metabolic syndrome was 80 cm for men (sensitivity = 0.62, specificity = 0.65); the area under the ROC curve was 0.67 (IC 95%: 0.61-0.74). In women, the optimal WC cut-off point was 90 cm (sensitivity = 0.54, specificity = 0.80), and the area under the ROC curve was 0.68 (IC 95%: 0.62-0.75). These optimal cut-offs were similar four years later. Optimum WC cut-off points for both men and women in Benin differ from those currently recommended for sub-Saharan Africans. Therefore, waist circumference cut-off points for abdominal obesity need to be reconsidered for these populations.

Share and Cite:

Agueh, V. , Sossa, C. , Ouendo, D. , Paraizo, N. , Azandjemè, C. , Kpozehouen, A. , Metonnou, C. , Saizonou, J. , Ouédraogo, L. , Makoutodé, M. and Delisle, H. (2015) Determination of the Optimal Waist Circumference Cut-Off Points in Benin Adults. Open Journal of Epidemiology, 5, 217-228. doi: 10.4236/ojepi.2015.54026.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Calle, E.E. (2007) Obesity and Cancer. BMJ, 335, 1107-1108.
http://dx.doi.org/10.1136/bmj.39384.472072.80
[2] Dyer, A.R., Stamler, J., Garside, D.B. and Greenland, P. (2004) Long-Term Consequences of Body Mass Index for Cardiovascular Mortality: The Chicago Heart Association Detection Project in Industry Study. Annals of Epidemiology, 14, 101-108.
http://dx.doi.org/10.1016/S1047-2797(03)00121-2
[3] Narayan, K.M., Boyle, J.P., Thompson, T.J., Gregg, E.W. and Williamson, D.F. (2007) Effect of BMI on Lifetime Risk for Diabetes in the U.S. Diabetes Care, 30, 1562-1566.
http://dx.doi.org/10.2337/dc06-2544
[4] Girman, C.J., Rhodes, T., Mercuri, M., Pyorala, K., Kjekshus, J., Pedersen, T.R., et al. (2004) The Metabolic Syndrome and Risk of Major Coronary Events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/ Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). American Journal of Cardiology, 93, 136- 141.
http://dx.doi.org/10.1016/j.amjcard.2003.09.028
[5] Popkin, B.M. (2002) An Overview on the Nutrition Transition and Its Health Implications: The Bellagio Meeting. Public Health Nutrition, 5, 93-103.
[6] Després, J.P., Lemieux, I., Bergeron, J., Pibarot, P., Mathieu, P., Larose, E., et al. (2008) Abdominal Obesity and the Metabolic Syndrome: Contribution to Global Cardiometabolic Risk. Arteriosclerosis, Thrombosis, and Vascular Biology, 28, 1039-1049.
http://dx.doi.org/10.1161/ATVBAHA.107.159228
[7] Zhu, S., Heymsfield, S.B., Toyoshima, H., Wang, Z., Pietrobelli, A. and Heshka, S. (2005) Race-Ethnicity-Specific Waist Circumference Cutoffs for Identifying Cardiovascular Disease Risk Factors. American Journal of Clinical Nutrition, 81, 409-415.
[8] Després, J.P., Arsenault, B.J., Cote, M., Cartier, A. and Lemieux, I. (2008) Abdominal Obesity: The Cholesterol of the 21st Century? Canadian Journal of Cardiology, 24, 7D-12D.
http://dx.doi.org/10.1016/S0828-282X(08)71043-2
[9] Charbonnel, B. (2005) Metabolic Syndrome and Cardiovascular Risk. Review of Practitioner, 55, 1765-1771.
[10] McNeill, A.M., Katz, R., Girman, C.J., Rosamond, W.D., Wagenknecht, L.E., Barzilay, J.I., et al. (2006) Metabolic Syndrome and Cardiovascular Disease in Older People: The Cardiovascular Health Study. Journal of the American Geriatrics Society, 54, 1317-1324.
http://dx.doi.org/10.1111/j.1532-5415.2006.00862.x
[11] Ogbera, A.O. (2010) Prevalence and Gender Distribution of the Metabolic Syndrome. Diabetology & Metabolic Syndrome, 2, 1.
http://dx.doi.org/10.1186/1758-5996-2-1
[12] Despres, J.P. (2001) Health Consequences of Visceral Obesity. Annals of Medicine, 33, 534-541.
http://dx.doi.org/10.3109/07853890108995963
[13] Stevens, J., Couper, D., Pankow, J., Folsom, A.R., Duncan, B.B., Nieto, F.J., et al. (2001) Sensitivity and Specificity of Anthropometrics for the Prediction of Diabetes in a Biracial Cohort. Obesity Research, 9, 696-705.
http://dx.doi.org/10.1038/oby.2001.94
[14] Yusuf, S., Hawken, S., Ounpuu, S., Bautista, L., Franzosi, M.G., Commerford, P., et al. (2005) Obesity and the Risk of Myocardial Infarction in 27,000 Participants from 52 Countries: A Case-Control Study. Lancet, 366, 1640-1649.
http://dx.doi.org/10.1016/S0140-6736(05)67663-5
[15] Despres, J.P. and Lemieux, I. (2006) Abdominal Obesity and Metabolic Syndrome. Nature, 444, 881-887.
http://dx.doi.org/10.1038/nature05488
[16] Govindarajan, G., Whaley-Connell, A., Mugo, M., Stump, C. and Sowers, J.R. (2005) The Cardiometabolic Syndrome as a Cardiovascular Risk Factor. American Journal of the Medical Sciences, 330, 311-318.
http://dx.doi.org/10.1097/00000441-200512000-00009
[17] Klein, S., Allison, D.B., Heymsfield, S.B., Kelley, D.E., Leibel, R.L., Nonas, C., et al. (2007) Waist Circumference and Cardiometabolic Risk: A Consensus Statement from Shaping America’s Health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Diabetes Care, 30, 1647-1652.
http://dx.doi.org/10.2337/dc07-9921
[18] Lean, M.E., Han, T.S. and Morrison, C.E. (1995) Waist Circumference as a Measure for Indicating Need for Weight Management. BMJ, 311, 158-161.
http://dx.doi.org/10.1136/bmj.311.6998.158
[19] Lean, M.E., Han, T.S. and Seidell, J.C. (1998) Impairment of Health and Quality of Life in People with Large Waist Circumference. Lancet, 351, 853-836.
http://dx.doi.org/10.1016/S0140-6736(97)10004-6
[20] Alberti, K.G., Eckel, R.H., Grundy, S.M., Zimmet, P.Z., Cleeman, J.I., Donato, K.A., et al. (2009) 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, 120, 1640-1645.
http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192644
[21] Gaillard, T., Schuster, D. and Osei, K. (2009) Metabolic Syndrome in Black People of the African Diaspora: The Paradox of Current Classification, Definition and Criteria. Ethnicity & Disease, 19, 1-7.
[22] Ervin, R.B. (2009) Prevalence of Metabolic Syndrome among Adults 20 Years of Age and Over, by Sex, Age, Race and Ethnicity, and Body Mass Index: United States, 2003-2006. National Health Statistics Reports, No. 13, 1-7.
[23] Motala, A.A., Esterhuizen, T., Pirie, F.J. and Omar, M.A. (2011) The Prevalence of Metabolic Syndrome and Determination of the Optimal Waist Circumference Cutoff Points in a Rural South African Community. Diabetes Care, 34, 1032-1037.
http://dx.doi.org/10.2337/dc10-1921
[24] Delisle, H., Ntandou-Bouzitou, G., Agueh, V., Sodjinou, R. and Fayomi, B. (2011) Urbanisation, Nutrition Transition and Cardiometabolic Risk: The Benin Study. British Journal of Nutrition, 107, 1534-1544.
http://dx.doi.org/10.1017/S0007114511004661
[25] Hendriks, M.E., Wit, F.W., Roos, M.T., Brewster, L.M., Akande, T.M., de Beer, I.H., et al. (2012) Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities. PLoS ONE, 7, e32638.
http://dx.doi.org/10.1371/journal.pone.0032638
[26] World Health Organisation (2008) Final Report of the STEPS Survey in Benin, Cotonou.
[27] World Health Organisation (2009) Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization, Geneva.
[28] Sodjinou, R., Agueh, V., Fayomi, B. and Delisle, H. (2008) Obesity and Cardio-Metabolic Risk Factors in Urban Adults of Benin: Relationship with Socio-Economic Status, Urbanisation, and Lifestyle Patterns. BMC Public Health, 8, 84-97.
http://dx.doi.org/10.1186/1471-2458-8-84
[29] Lohman, T., Roche, A. and Martorel, R., Eds. (1988) Anthropometric Standardization Reference Manual. Human Kinetics Publishers, Champaign.
[30] McAlister, F.A., Zarnke, K.B., Campbell, N.R., Feldman, R.D., Levine, M., Mahon, J., et al. (2002) The 2001 Canadian Recommendations for the Management of Hypertension: Part Two—Therapy. Canadian Journal of Cardiology, 18, 625-641.
[31] World Health Organization (1999) The Metabolic Syndrome. In: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Experts Report, World Health Organization, Geneva.
[32] Youden, W.J. (1950) Index for Rating Diagnostic Tests. Cancer, 3, 32-35.
http://dx.doi.org/10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3
[33] Sossa, C., Delisle, H., Agueh, V., Sodjinou, R., Ntandou, G. and Makoutode, M. (2013) Lifestyle and Dietary Factors Associated with the Evolution of Cardiometabolic Risk Over Four Years in West-African Adults: The Benin Study. Journal of Obesity, 2013, Article ID: 298024.
http://dx.doi.org/10.1155/2013/298024
[34] Fezeu, L., Balkau, B., Sobngwi, E., Kengne, A.P., Vol, S., Ducimetiere, P., et al. (2010) Waist Circumference and Obesity-Related Abnormalities in French and Cameroonian Adults: The Role of Urbanization and Ethnicity. International Journal of Obesity, 34, 446-453.
http://dx.doi.org/10.1038/ijo.2009.256
[35] Kalk, W.J., Joffe, B.I. and Sumner, A.E. (2011) The Waist Circumference of Risk in Black South African Men Is Lower than in Men of European Ancestry. Metabolic Syndrome and Related Disorders, 9, 491-495.
http://dx.doi.org/10.1089/met.2011.0063
[36] Prinsloo, J., Malan, L., de Ridder, J.H., Potgieter, J.C. and Steyn, H.S. (2011) Determining the Waist Circumference Cut Off Which Best Predicts the Metabolic Syndrome Components in Urban Africans: The SABPA Study. Experimental and Clinical Endocrinology and Diabetes, 119, 599-603.
http://dx.doi.org/10.1055/s-0031-1280801
[37] Lemieux, S., Prud’homme, D., Bouchard, C., Tremblay, A. and Despres, J.P. (1993) Sex Differences in the Relation of Visceral Adipose Tissue Accumulation to Total Body Fatness. American Journal of Clinical Nutrition, 58, 463-467.
[38] Fontbonne, A., Cournil, A., Cames, C., Mercier, S., Ndiaye Coly, A., Lacroux, A., et al. (2011) Anthropometric Characteristics and Cardiometabolic Risk Factors in a Sample of Urban-Dwelling Adults in Senegal. Diabetes & Metabolism, 37, 52-58.
http://dx.doi.org/10.1016/j.diabet.2010.07.008
[39] Evangelista, O. and McLaughlin, M.A. (2009) Review of Cardiovascular Risk Factors in Women. Gender Medicine, 6, 17-36.
http://dx.doi.org/10.1016/j.genm.2009.02.004
[40] Polk, D.M. and Naqvi, T.Z. (2005) Cardiovascular Disease in Women: Sex Differences in Presentation, Risk Factors, and Evaluation. Current Cardiology Reports, 7, 166-172.
http://dx.doi.org/10.1007/s11886-005-0072-9
[41] Kwawukume, E.Y., Ghosh, T.S. and Wilson, J.B. (1993) Menopausal Age of Ghanaian Women. International Journal of Gynecology & Obstetrics, 40, 151-155.
http://dx.doi.org/10.1016/0020-7292(93)90376-8
[42] Deurenberg, P., Yap, M. and van Staveren, W.A. (1998) Body Mass Index and Percent Body Fat: A Meta-Analysis among Different Ethnic Groups. International Journal of Obesity, 22, 1164-1171.
http://dx.doi.org/10.1038/sj.ijo.0800741
[43] Despres, J.P., Couillard, C., Gagnon, J., Bergeron, J., Leon, A.S., Rao, D.C., et al. (2000) Race, Visceral Adipose Tissue, Plasma Lipids, and Lipoprotein Lipase Activity in Men and Women: The Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) Family Study. Arteriosclerosis, Thrombosis, and Vascular Biology, 20, 1932-1938.
http://dx.doi.org/10.1161/01.ATV.20.8.1932
[44] Desilets, M.C., Garrel, D., Couillard, C., Tremblay, A., Despres, J.P., Bouchard, C., et al. (2006) Ethnic Differences in Body Composition and Other Markers of Cardiovascular Disease Risk: Study in Matched Haitian and White Subjects from Quebec. Obesity, 14, 1019-1027.
http://dx.doi.org/10.1038/oby.2006.117
[45] Lovejoy, J.C., Smith, S.R. and Rood, J.C. (2001) Comparison of Regional Fat Distribution and Health Risk Factors in Middle-Aged White and African American Women: The Healthy Transitions Study. Obesity Research, 9, 10-16.
http://dx.doi.org/10.1038/oby.2001.2
[46] Diaz, V.A., Mainous 3rd, A.G., Baker, R., Carnemolla, M. and Majeed, A. (2007) How Does Ethnicity Affect the Association between Obesity and Diabetes? Diabetic Medicine, 24, 1199-1204.
http://dx.doi.org/10.1111/j.1464-5491.2007.02244.x
[47] Evans, J., Micklesfield, L., Jennings, C., Levitt, N.S., Lambert, E.V., Olsson, T., et al. (2011) Diagnostic Ability of Obesity Measures to Identify Metabolic Risk Factors in South African Women. Metabolic Syndrome and Related Disorders, 9, 353-360.
http://dx.doi.org/10.1089/met.2011.0034

Journals Menu
Follow SCIRP
Contact us
customer@scirp.org
WhatsApp +86 18163351462(WhatsApp)
Click here to send a message to me 1655362766
Paper Publishing WeChat

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.