Waist circumference measurement identifies metabolic syndrome

The International Diabetes Federation (IDF) waist circumference parameters can effectively be used to screen patients for the metabolic syndrome, reported Joseph Cherian, MD, during the American College of Cardiology's 56th annual scientific session.

He and colleagues at Advocate Lutheran General Hospital, Park Ridge, Ill., conducted a screening study to determine the efficacy of using only the IDF waist circumference criteria to identify inpatients with the syndrome.

The IDF diagnostic criteria for metabolic syndrome emphasize central obesity as the core measure and use a waist circumference limit of 94 cm in men and 80 cm in women. The National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria for a diagnosis of metabolic syndrome differ from the IDF criteria in that ATP III does not emphasize one characteristic of the syndrome. ATP III instead requires that a patient have at least three of the following five components: hypertension, an elevated level of serum triglycerides, a low level of high-density lipoprotein cholesterol, an elevated blood glucose, and a waist circumference >102 cm in men and >88 cm in women.

This study included 468 adult inpatients hospitalized between January and March 2006. During admission assessments, nurses calculated body mass index and properly measured waist circumference. Monitoring for other metabolic syndrome components was also conducted.

The prevalence of the metabolic syndrome in the inpatient cohort was 72% using IDF criteria and 59% using ATP III criteria. "The higher prevalence of the metabolic syndrome using IDF criteria was due to the reduced waist size criteria," Dr. Cherian said. The number of men correctly identified with the syndrome increased by 28% and the number of women identified increased by 14% using the IDF criteria for waist circumference rather than the ATP III criteria.

"Waist measurement is an effective screening tool for the metabolic syndrome using IDF criteria," he said. "This simple and inexpensive test allows for quick identification of individuals who are likely to have the syndrome." He added that the sensitivity of IDF waist circumference criteria was 88% in this study.

The study had limitations, including the possibility of overestimating the incidence of the metabolic syndrome. "The prevalence of the metabolic syndrome is expected to be higher in hospitalized patients who may have higher blood pressure and fasting blood glucose levels because of acute pain and illness," Dr. Cherian said. Also, 20% of the study population had preexisting heart disease and 29% had diabetes.