Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan

Int J Obes Relat Metab Disord. 2002 Sep;26(9):1232-8. doi: 10.1038/sj.ijo.0802040.


Background: The increased health risks associated with obesity have been found to occur in Asians at lower body mass indices (BMIs). To determine the optimal cut-off values for overweight or obesity in Taiwan, we examined the relationships between four anthropometric indices and cardiovascular risk factors.

Methods: The data were collected from four health-screening centers from 1998 to 2000 in Taiwan. Included were 55 563 subjects (26 359 men and 29 204 women, mean age=37.3+/-10.9 and 37.0+/-11.1 y, respectively). None had known major systemic diseases or were taking medication. Individual body weight, height, waist circumference (WC), and a series of tests related to cardiovascular risk (blood pressure, fasting plasma glucose, triglycerides, total cholesterol, low- and high-density lipoprotein cholesterol) were assessed and their relationships were examined. Receiver operating characteristic (ROC) analysis was used to find out the optimal cut-off values of various anthropometric indices to predict hypertension, diabetes mellitus and dyslipidemia.

Results: Of the four anthropometric indices we studied, waist-to-height ratio (WHtR) in women was found to have the largest areas under the ROC curve (women=0.755, 95% CI 0.748-0.763) relative to at least one risk factor (ie hypertension or diabetes or dyslipidemia). The optimal cut-off values for overweight or obesity from our study in men and women showed that BMIs of 23.6 and 22.1 kg/m(2), WCs of 80.5 and 71.5 cm, waist-to-hip ratios (WHpR) of 0.85 and 0.76, and WHtR of 0.48 and 0.45, respectively, may be more appropriate in Taiwan.

Conclusions: WHtR may be a better indicator for screening overweight- or obesity-related CVD risk factors than the other three indexes (BMI, WC and WHpR) in Taiwan. Our study also supported the hypothesis that the cut-off values using BMI and WC to define obesity should be much lower in Taiwan than in Western countries.

MeSH terms

  • Adult
  • Anthropometry*
  • Area Under Curve
  • Body Constitution / physiology
  • Body Height / physiology
  • Body Mass Index
  • Body Weight / physiology
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology*
  • Diabetes Complications*
  • Female
  • Humans
  • Hyperlipidemias / complications*
  • Hypertension / complications*
  • Male
  • Obesity / complications*
  • Obesity / epidemiology*
  • Odds Ratio
  • Predictive Value of Tests
  • ROC Curve
  • Risk Factors
  • Taiwan