CAN OBESITY INDICES PREDICT METABOLIC SYNDROME AND DIABETES? IMPACT OF INTENSIVE DIET, PHYSICAL EXERCISE AND LIFESTYLE INTERVENTION
Abdulbari Bener*, Mustafa Eliaç?k, Mustafa Öztürk , Kaleem U. Rajput
Aim: The aim of study was to evaluate different obesity indices [body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), waist height ratio (WHtR)] to identify one that best predicts metabolic syndrome (MetS) among Turkish population. Design: Cross sectional study. Setting: Primary health care (PHC) Centres and Hospital. Subjects and methods: The survey was conducted from February to November 2016 among Turkish citizens above 25 years of age. Data was collected using pre-tested questionnaire from 1,811 subjects approached; 1,393 gave consent via interviews, followed by blood sampling for laboratory investigations. MetS was defined according to the National Cholesterol Education Program – Third Adult Treatment Panel (ATP III) as well as International Diabetes Federation (IDF) guidelines. Receiver operating characteristics (ROC) curve analysis was used to determine the obesity index with corresponding gender specific cut-off value that better predicts MetS among Turkish population. Results : MetS was 25.9% in relation to ATP III and 38.2% according to IDF. Levels of education, consumption of fast food and physical activity revealed significant differences between groups with and without MetS. Subjects with MetS were older, predominantly female and were either retired/not working or housewives as compared to those without MetS using ATPIII criteria. Among men, WC followed by both WHR and WHtR yielded the highest area under the curve (AUC) (0.83; 95%CI 0.74-0.86; 0.78 95%CI 0.73-0.82 and 0.80; 95%CI 0.71-0.84 respectively). Unlike men, among women WC followed by WHtR yielded highest AUC (0.81; 95%CI 0.78-0.85; 0.79; 95%CI 0.76-0.83 and 0.75; 95%CI 0.72-0.79). Among men, WC at a cut-off value of 99.0 cm resulted in highest Youden index with corresponding sensitivity of 81.6% and 63.9% specificity. In a similar way, among women, WC at a cut-off point of 90 cm resulted in highest Youden index with the corresponding sensitivity and specificity of 93.0% and 82.6% respectively. Among both men and women, the BMI at a cut-off value of 28 kg/m2 and the traditional cut-off value of 30kg/m2 was found to be having the lowest Youden index and corresponding sensitivity and specificity. Conclusion: The prevalence of MetS was found to be high in Turkey according to both ATP III and IDF criteria. The waist circumference at a cut-off point of 99cm among men and 92cm among women observed to be the best predictor of metabolic syndrome in the Turkish population. ATP III criteria for the Turkish population might result in underestimation of MetS among men and overestimation among women.
Keywords: Obesity, Metabolic syndrome, Waist-hip-ratio, Weight-height-ratio, Waist circumference, Turkey.
[Full Text Article]