J Korean Med Sci.  2016 Jan;31(1):61-66. 10.3346/jkms.2016.31.1.61.

Optimal Cutoff Points of Anthropometric Parameters to Identify High Coronary Heart Disease Risk in Korean Adults

Affiliations
  • 1Department of Family Medicine, Graduate School, Kyung Hee University, Seoul, Korea. fmdrchoi@gmail.com

Abstract

Several published studies have reported the need to change the cutoff points of anthropometric indices for obesity. We therefore conducted a cross-sectional study to estimate anthropometric cutoff points predicting high coronary heart disease (CHD) risk in Korean adults. We analyzed the Korean National Health and Nutrition Examination Survey data from 2007 to 2010. A total of 21,399 subjects aged 20 to 79 yr were included in this study (9,204 men and 12,195 women). We calculated the 10-yr Framingham coronary heart disease risk score for all individuals. We then estimated receiver-operating characteristic (ROC) curves for body mass index (BMI), waist circumference, and waist-to-height ratio to predict a 10-yr CHD risk of 20% or more. For sensitivity analysis, we conducted the same analysis for a 10-yr CHD risk of 10% or more. For a CHD risk of 20% or more, the area under the curve of waist-to-height ratio was the highest, followed by waist circumference and BMI. The optimal cutoff points in men and women were 22.7 kg/m2 and 23.3 kg/m2 for BMI, 83.2 cm and 79.7 cm for waist circumference, and 0.50 and 0.52 for waist-to-height ratio, respectively. In sensitivity analysis, the results were the same as those reported above except for BMI in women. Our results support the re-classification of anthropometric indices and suggest the clinical use of waist-to-height ratio as a marker for obesity in Korean adults.

Keyword

Obesity; Body Mass Index; Waist Circumference; Receiver-Operating Characteristic (ROC) Curve; Coronary Heart Disease

MeSH Terms

Adult
Aged
Anthropometry
Area Under Curve
Body Mass Index
Coronary Disease/*diagnosis/*pathology
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Nutrition Surveys
Obesity/pathology
ROC Curve
Republic of Korea
Risk Factors
Waist Circumference
Waist-Hip Ratio
Young Adult

Figure

  • Fig. 1 ROC curve of anthropometric indices and their areas under the curve (AUCs) to predict a 10-yr CHD risk of 20% or more. (A) Men. (B) Women. CHD, coronary heart disease; BMI, body mass index.


Cited by  1 articles

Trends and Cut-Point Changes in Obesity Parameters by Age Groups Considering Metabolic Syndrome
Hyung Jun Park, Young Ho Hong, Yun Jung Cho, Ji Eun Lee, Jae Moon Yun, Hyuktae Kwon, Sang Hyuck Kim
J Korean Med Sci. 2018;33(7):.    doi: 10.3346/jkms.2018.33.e47.


Reference

1. Lim D, Ha M, Song I. Trends in the leading causes of death in Korea, 1983-2012. J Korean Med Sci. 2014; 29:1597–1603.
2. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Yoon JW, Choi SH, Cho SI, Park KS, Lee HK, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care. 2011; 34:1323–1328.
3. Ahn BC, Joung H. Socioeconomic cost of obesity in Korea (Korean). Korean J Nutr. 2005; 38:786–792.
4. World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation (WHO Technical Report Series 894). World Health Organization;2000.
5. World Health Organization. The Asia-Pacific perspective: Redefining obesity and its treatment. World Health Organization;2000.
6. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome--a new worldwide definition. Lancet. 2005; 366:1059–1062.
7. Lee S, Park HS, Kim SM, Kwon HS, Kim DY, Kim DJ, Cho GJ, Han JH, Kim SR, Park CY, et al. Cut-off points of waist circumference for defining abdominal obesity in the Korean population. Korean J Obes. 2006; 15:1–9.
8. Al-Lawati JA, Barakat NM, Al-Lawati AM, Mohammed AJ. Optimal cut-points for body mass index, waist circumference and waist-to-hip ratio using the Framingham coronary heart disease risk score in an Arab population of the Middle East. Diab Vasc Dis Res. 2008; 5:304–309.
9. Nguyen TT, Adair LS, He K, Popkin BM. Optimal cutoff values for overweight: using body mass index to predict incidence of hypertension in 18- to 65-year-old Chinese adults. J Nutr. 2008; 138:1377–1382.
10. Lee JW, Lim NK, Baek TH, Park SH, Park HY. Anthropometric indices as predictors of hypertension among men and women aged 40-69 years in the Korean population: the Korean Genome and Epidemiology Study. BMC Public Health. 2015; 15:140.
11. Dorner TE, Rieder A. Obesity paradox in elderly patients with cardiovascular diseases. Int J Cardiol. 2012; 155:56–65.
12. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008; 117:743–753.
13. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The 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). JAMA. 2001; 285:2486–2497.
14. Böhning D, Böhning W, Holling H. Revisiting Youden's index as a useful measure of the misclassification error in meta-analysis of diagnostic studies. Stat Methods Med Res. 2008; 17:543–554.
15. Low S, Chin MC, Ma S, Heng D, Deurenberg-Yap M. Rationale for redefining obesity in Asians. Ann Acad Med Singapore. 2009; 38:66–69.
16. Nakamura K, Nanri H, Hara M, Higaki Y, Imaizumi T, Taguchi N, Sakamoto T, Horita M, Shinchi K, Tanaka K. Optimal cutoff values of waist circumference and the discriminatory performance of other anthropometric indices to detect the clustering of cardiovascular risk factors for metabolic syndrome in Japanese men and women. Environ Health Prev Med. 2011; 16:52–60.
17. 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.
18. Park JH. Measuring BMI cutoff points of Korean adults using morbidity of BMI-related diseases. Korean J Obes. 2011; 20:36–43.
19. Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circ J. 2009; 73:1643–1650.
20. Klein BE, Klein R, Knudtson MD, Lee KE. Frailty, morbidity and survival. Arch Gerontol Geriatr. 2005; 41:141–149.
21. Miller SL, Wolfe RR. The danger of weight loss in the elderly. J Nutr Health Aging. 2008; 12:487–491.
22. Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med. 2009; 25:643–659.
23. Artham SM, Lavie CJ, Milani RV, Ventura HO. Obesity and hypertension, heart failure, and coronary heart disease-risk factor, paradox, and recommendations for weight loss. Ochsner J. 2009; 9:124–132.
24. Asia Pacific Cohort Studies Collaboration. Barzi F, Patel A, Gu D, Sritara P, Lam TH, Rodgers A, Woodward M. Cardiovascular risk prediction tools for populations in Asia. J Epidemiol Community Health. 2007; 61:115–121.
25. Choi SY, Kim D, Kim HJ, Kang JH, Chung SJ, Park MJ, Kim YS, Kim CH, Choi SH, Kim W, et al. The relation between non-alcoholic fatty liver disease and the risk of coronary heart disease in Koreans. Am J Gastroenterol. 2009; 104:1953–1960.
26. Seo SM, Baek SH, Jeon HK, Kang SM, Kim DS, Kim WS, Kim HS, Rha SW, Park JS, Seong IW, et al. Correlations between the level of high-sensitivity C-reactive protein and cardiovascular risk factors in Korean adults with cardiovascular disease or diabetes mellitus: the CALLISTO study. J Atheroscler Thromb. 2013; 20:616–622.
27. Quirke TP, Gill PS, Mant JW, Allan TF. The applicability of the Framingham coronary heart disease prediction function to black and minority ethnic groups in the UK. Heart. 2003; 89:785–786.
28. Eichler K, Puhan MA, Steurer J, Bachmann LM. Prediction of first coronary events with the Framingham score: a systematic review. Am Heart J. 2007; 153:722–731.e8.
29. Park GM, Yun SC, Cho YR, Gil EH, Her SH, Kim SH, Jo MW, Lee MS, Lee SW, Kim YH, et al. Prevalence of coronary atherosclerosis in an Asian population: findings from coronary computed tomographic angiography. Int J Cardiovasc Imaging. 2015; 31:659–668.
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr