Minimum waist and visceral fat values for identifying Japanese Americans at risk for the metabolic syndrome: response to Hayashi et al.

OBJECTIVE Japanese American is an ethnic group with a high risk for type 2 diabetes, which is linked to the metabolic syndrome. Central adiposity is considered to play a key role in the metabolic syndrome. Not known are the optimal cut point values for central and visceral adiposity to identify Japanese Americans at risk for the metabolic syndrome. RESEARCH DESIGN AND METHODS Study subjects included 639 Japanese Americans. The nonadipose variables of the metabolic syndrome were defined using modified International Diabetes Federation criteria, and the accuracy of identifying at least two of these by intra-abdominal fat area (IAFA) as measured by computed tomography and waist circumference was cross-sectionally assessed using area under receiver operating characteristic (ROC) curves. The values for IAFA and waist circumference that resulted in maximizing the Youden index were defined as "optimal." RESULTS The area under the ROC curve for IAFA exceeded that for waist circumference (men 0.787 vs. 0.686; women 0.792 vs. 0.721). For women, the optimal cut points for IAFA and waist circumference were 51.5 cm(2) and 80.8 cm (age < or = 56 years) and 86.3 cm(2) and 89.0 cm (age > 56 years). For men, the optimal cut points for IAFA and waist circumference were 88.6 cm(2) and 90.0 cm (age < or = 57 years) and 96.1 cm(2) and 87.1 cm (age > 57 years). CONCLUSIONS These results argue that current Japanese waist circumference cut points for the metabolic syndrome need to be revised. Moreover, the waist circumference and IAFA cut points should be age specific, especially in women. Appropriate waist circumference cut points are from 80 to 90 cm in women and from 87 to 90 cm in men.