Cutoff Point of TyG Index for Metabolic Syndrome in Brazilian Farmers

Abstract Objectives The determination of Insulin Resistance (IR) requires sophisticated and costly methods, for this reason the TyG Index was proposed. However, there are still no studies in Brazil using Metabolic Syndrome (MetS) as a predictor of IR. Thus, the aim of this study was to determine the cutoff point for TyG as one of the indirect indices for MetS in a rural Brazilian population. Methods Cross-sectional observational epidemiological study conducted in a rural municipality in Brazil. The study population were 790 adult family farmers. The TyG index was calculated: Ln [fasting triglycerides (mg/dL) x fasting glycemia (mg/dL)]/2, and MetS was defined using the NCEP-ATPIII and IDF criteria. To describe the study variables, measures of central tendency and dispersion measures were used. For association analysis, the Mann-Whitney U test was used and the comparison between means was made using the Kruskal-Wallis test. For correlations, Spearman's correlation test was used. The cutoff values of TyG Index for MetS were obtained using the Receiver Operating Characteristic (ROC) curve analysis with the area under the curve (AUC) and the Youden Index. Results The median TyG values were higher among individuals diagnosed with MetS (P < 0.001), and increased according to the aggregation of the components of MetS. All MetS components were correlated with TyG (P < 0.001). The AUC for NCEP was 0.873 (0.848–0.896; P < 0.001), with Youden's cutoff point of Ln 4.52 (sensitivity: 84.30%; specificity: 75.75%). The AUC for IDF was 0.867 (0.842–0.890; P < 0.001), with Youden's cutoff point of Ln 4.55 (sensitivity: 80.0%; specificity: 79.82%). A cutoff point of Ln 4.52 was defined. Conclusions The TyG Index is a reliable marker for identifying insulin-resistant individuals, and correlates with the metabolic changes present in MetS. A cutoff point of Ln 4,52 has good sensitivity and specificity in both diagnostic criteria of MetS, being useful both in clinical practice and epidemiological studies, and can represent an important tool for the creation of protocols for promotion, protection and recovery health of rural populations. Funding Sources Research Program of the Unified Health System (PPSUS), through the notice FAPES/CNPq/Decit-SCTIE-MS/SESA No. 05/2015 – PPSUS.

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Muscle strength cut-points for metabolic syndrome detection among adults and the elderly from Brazil

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2020-0758 ◽

2021 ◽

Vol 46 (4) ◽

pp. 379-388

Author(s):

Tiago Rodrigues de Lima ◽

David Alejandro González-Chica ◽

Eleonora D’Orsi ◽

Xuemei Sui ◽

Diego Augusto Santos Silva

Keyword(s):

Metabolic Syndrome ◽

Muscle Strength ◽

Lifestyle Modification ◽

Handgrip Strength ◽

Area Under The Curve ◽

Roc Curves ◽

The Elderly ◽

Youden Index ◽

Cross Sectional ◽

Cut Points

We aimed to determine cut-points for muscle strength based on metabolic syndrome diagnosis. This cross-sectional analysis comprised data from 2 cohorts in Brazil (EpiFloripa Adult, n = 626, 44.0 ± 11.1 years; EpiFloripa Aging, n = 365, 71.6 ± 6.1 years). Metabolic syndrome was assessed by relative handgrip strength (kgf/kg). Metabolic syndrome was defined as including ≥3 of the 5 metabolic abnormalities according to the Joint Interim Statement. Optimal cut-points from Receiver Operating Characteristic (ROC) curves were determined. Adjusted logistic regression was used to test the association between metabolic syndrome and the cut-points created. The cut-point identified for muscle strength was 1.07 kgf/kg (Youden index = 0.310; area under the curve (AUC)) = 0.693, 95% CI 0.614–0.764) for men and 0.73 kgf/kg (Youden index = 0.481; AUC = 0.768, 95% confidence interval (CI) = 0.709–0.821) for women (age group 25 to < 50 years). The best cut-points for men and women aged 50+ years were 0.99 kgf/kg (Youden index = 0.312; AUC = 0.651; 95% CI = 0.583–0.714) and 0.58 kgf/kg (Youden index = 0.378; AUC = 0.743; 95% CI = 0.696–0.786), respectively. Cut-points derived from ROC analysis have good discriminatory power for metabolic syndrome among adults aged 25 to <50 years but not for adults aged 50+ years. Novelty: First-line management recommendation for metabolic syndrome is lifestyle modification, including improvement of muscle strength. Cut-points for muscle strength levels according to sex and age range based on metabolic syndrome were created. Cut-points for muscle strength can assist in the identification of adults at risk for cardiometabolic disease.

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Endocan: A Biomarker for Hepatosteatosis in Patients with Metabolic Syndrome

Mediators of Inflammation ◽

10.1155/2020/3534042 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Hande Erman ◽

Engin Beydogan ◽

Seher Irem Cetin ◽

Banu Boyuk

Keyword(s):

Metabolic Syndrome ◽

Fatty Liver ◽

Liver Steatosis ◽

Cutoff Point ◽

Healthy Controls ◽

Roc Curve Analysis ◽

Cross Sectional ◽

Nonalcoholic Fatty Liver ◽

Fatty Liver Index ◽

Hepatic Steatosis Index

Background. Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, which has recently been mentioned as an independent cardiovascular risk factor. Objectives. Endocan is a novel molecule of endothelial dysfunction. We aimed to evaluate the associations of serum endocan levels with the hepatic steatosis index (HSI), fatty liver index (FLI), and degrees of hepatosteatosis in patients with metabolic syndrome with NAFLD. Design and Setting. This cross-sectional prospective study was performed in the outpatient clinic of an internal medicine department. Methods. The study included 40 patients with metabolic syndrome with NAFLD as noted using hepatic ultrasound and 20 healthy controls. Secondary causes of fatty liver were excluded. FLI and HSI calculations were recorded. Serum endocan level values were obtained after overnight fasting. Results. Higher values of HSI and FLI were found in the NAFLD groups than in the control groups (p<0.001). Five (12.5%) of 20 patients with liver steatosis had grade 1 liver steatosis, 15 (37.5%) patients had grade 2 liver steatosis, and 20 (50%) patients had grade 3 liver steatosis. Serum endocan levels were lower in patients with NAFLD compared with the healthy controls (146.56±133.29 pg/mL vs. 433.71±298.01 pg/mL, p<0.001). ROC curve analysis suggested that the optimum endocan value cutoff point for NAFLD was 122.583 pg/mL (sensitivity: 71.79%, specificity: 90%, PPV: 93.3%, and NPV: 62.1%). Conclusion. Serum endocan concentrations are low in patients with NAFLD, and the optimum cutoff point is 122.583 pg/mL. HSI and FLI were higher in patients with NAFLD; however, there was no correlation with serum endocan.

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Triglycerides and Glucose Index as Potential Marker of Metabolic Syndrome

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v5i1.239 ◽

2020 ◽

Vol 5 (1) ◽

pp. 85

Author(s):

Mariya Tabassum ◽

Miliva Mozaffor ◽

Md Matiur Rahman ◽

Reaz Mahmud Huda

Keyword(s):

Metabolic Syndrome ◽

Predictive Value ◽

Area Under The Curve ◽

Roc Curves ◽

Cross Sectional Study ◽

Serum Glucose ◽

Cross Sectional ◽

Tyg Index ◽

Potential Marker ◽

Sensitivity Specificity

Background:Triglycerides and Glucose Index (TyG index), a product from fasting levels of triglycerides and glucose, presented promising results as apotential marker of metabolic syndrome in different ethnicity. However, no such reports are available in our population to date.Objective: To see the effectiveness of ‘Triglycerides and Glucose Index’ to predict metabolic syndromein a Bangladeshi population.Methods: This cross-sectional study was carried out in Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2016 to February 2017. A total of 200 apparently healthy subjects (127 men and 73 women) were selected for the study, who attended the out-patient-departments of the same institution. Anthropometric measurements were recorded – height, weight, waist circumference (WC) and body mass index (BMI). Overnight fasting blood samples were collected to estimate fasting serum glucose andlipid profile. Then TyG index was calculated and evaluated as a tool in diagnosis of metabolic syndrome in the study subjects.Receiver operating characteristic (ROC) curves were plotted to assess the performance of TyG index in MetS prediction by gender. The power of MetS prediction was quantified by the area under the curve (AUC) with 95% confidence intervals.Results: Sensitivity, specificity, positive predictive value and negative predictive value of TyG index to predict metabolic syndrome were 70.45%, 82.14%, 75.61% and 77.97%in males and 25.00%, 97.32%, 88.00% and 62.29%in females respectively. ROC curve showed optimal cut off value 8.72 and area under the curve 0.72 in male study subjects; in female study subjects, the values were 8.72 and 0.96 respectively (P<0.001).Conclusion:Triglycerides and Glucose Index (TyG index) represents a simple,accessible and effective tool for assessment of metabolic syndrome in Bangladeshi population.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 85-89

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The Cut-Off Values of Anthropometric Indices for Identifying Subjects at Risk for Metabolic Syndrome in Iranian Elderly Men

Journal of Obesity ◽

10.1155/2014/907149 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Mojgan Gharipour ◽

Masoumeh Sadeghi ◽

Minoo Dianatkhah ◽

Shirin Bidmeshgi ◽

Alireza Ahmadi ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Area Under The Curve ◽

Roc Curves ◽

Metabolic Risk Factors ◽

Youden Index ◽

Elderly Subjects ◽

Metabolic Risk ◽

Anthropometric Indices ◽

Cross Sectional

Aim. This study aimed to investigate which anthropometric indices could be a better predictor of metabolic syndrome (MetS) and the cut-off points for these surrogates to appropriately differentiate MetS in the Iranian elderly.Method. The present cross-sectional study was conducted on a sample of Isfahan Healthy Heart Program (IHHP). MetS was defined according to Third Adult Treatment Panel (ATPIII). In total, 206 elderly subjects with MetS criteria were selected. Anthropometric indices were measured and plotted using receiver operating characteristic (ROC) curves.Results. WC followed by WHtR yielded the highest area under the curve (AUC) (0.683; 95% CI 0.606–0.761 and 0.680; 95% CI 0.602–0.758, resp.) for MetS. WC at a cut of 94.5 cm resulted in the highest Youden index with sensitivity 64% and 68% specificity to predict the presence of ≥2 metabolic risk factors. BMI had the lowest sensitivity and specificity for MetS and MetS components. WC has the best ability to detect MetS which followed by WHtR and BMI had a lower discriminating value comparatively.Conclusion. WC is the best predictor for predicting the presence of ≥2 metabolic risk factors among Iranian elderly population and the best value of WC is 94.5 cm. This cut-off values of WC should be advocated and used in Iranian men until larger cross-sectional studies show different results.

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Lipid Accumulation Product: An Effective Obesity Index to Predict Metabolic Syndrome

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v40i1.57053 ◽

2022 ◽

Vol 40 (1) ◽

pp. 5-9

Author(s):

Mariya Tabassum ◽

Miliva Mozaffor ◽

Md Matiur Rahman ◽

Reaz Mahmud Huda

Keyword(s):

Metabolic Syndrome ◽

Lipid Accumulation ◽

Predictive Value ◽

Significant Risk ◽

Area Under The Curve ◽

Lipid Accumulation Product ◽

Roc Curve Analysis ◽

Cross Sectional ◽

Obesity Index ◽

Apparently Healthy

Background: Obesity is a significant risk factor in the development of metabolic syndrome (MetS). Lipid Accumulation Product (LAP) is an obesity index and has been proposed to be a predictor of metabolic syndrome. The present study aims to see the effectiveness of Lipid Accumulation Product as an obesity index to predict metabolic syndrome in a Bangladeshi population. Methods: This cross-sectional study was conducted in Department of Biochemistry and Molecular Biology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between March 2016 and February 2017. A total of 200 apparently healthy subjects (127 men and 73 women) were selected for the study, attending out-patient-departments of the same institution. Anthropometric measurements were recorded, which included their height, weight, waist circumference (WC) and body mass index (BMI). Overnight fasting blood samples were collected to estimate fasting serum glucose and lipid profile. Then LAP was calculated and evaluated as a tool in prediction of MetS in the study subjects. Receiver operating characteristic (ROC) curves were plotted to assess the performance of LAP in MetS prediction by gender. The power of MetS prediction was quantified by the area under the curve (AUC) with 95% confidence intervals. Results: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NVP) of LAP in predicting MetS were 70.45%, 78.57%, 72.09% and 77.19% in male study subjects and 20.45%, 96.43%, 81.82% and 60.67% in female subjects respectively. ROC curve analysis showed that the optimal cutoff value of LAP in male study subjects was 40.72, while area under the curve was 0.92; in female study subjects, the values were 51.69 and 0.91 respectively (P<0.001). Conclusion: Lipid Accumulation Product was found simple, accessible and effective obesity index to predict metabolic syndrome in apparently healthy adults. J Bangladesh Coll Phys Surg 2022; 40: 5-9

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To which extent are per-and poly-fluorinated substances associated to metabolic syndrome?

Reviews on Environmental Health ◽

10.1515/reveh-2020-0144 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maryam Zare Jeddi ◽

Rozita Soltanmohammadi ◽

Giulia Barbieri ◽

Aline S. C. Fabricio ◽

Gisella Pitter ◽

...

Keyword(s):

Metabolic Syndrome ◽

General Population ◽

Meta Analysis ◽

Small Body ◽

Epidemiological Studies ◽

Cross Sectional ◽

Random Effects Models ◽

Epidemiologic Evidence ◽

Adults And Children ◽

Meta Analyses

Abstract Exposure to per- and polyfluoroalkyl substances (PFAS), ubiquitous persistent environmental contaminants, has led to substantial global concern due to their potential environmental and human health effects. Several epidemiological studies have assessed the possible association between PFAS exposure and risk of metabolic syndrome (MetS), however, the results are ambiguous. The aim of this study was to assess the current human epidemiologic evidence on the association between exposure to PFAS and MetS. We performed a systematic search strategy using three electronic databases (PubMed, Scopus, and Web of Science) for relevant studies concerning the associations of PFAS with MetS and its clinical relevance from inception until January 2021. We undertook meta-analyses where there were five or more studies with exposure and outcomes assessments that were reasonably comparable. The pooled odd ratios (ORs) were calculated using random effects models and heterogeneity among studies was assessed by I2 index and Q test. A total of 12 cross-sectional studies (10 studies on the general population and two studies in the occupational settings) investigated the association between PFAS exposure and MetS. We pooled data from seven studies on the general population for perfluorooctanoic acid (PFOA) and perfluorooctanesulfonate (PFOS) and five studies for perfluorohexanesulfonate (PFHxS) and perfluorononanoic acid (PFNA). Predominately, most studies reported no statistically significant association between concentrations of PFAS and MetS. In the meta-analysis, the overall measure of effect was not statistically significant, showing no evidence of an association between concentrations of PFOA, PFOS, PFNA, and PFHxS and the risk of MetS. Based on the results of the meta-analysis, current small body of evidence does not support association between PFAS and MetS. However, due to limited number of studies and substantial heterogeneity, results should be interpreted with caution. Further scrutinizing cohort studies are needed to evaluate the association between various and less well-known PFAS substances and their mixture with MetS and its components in both adults and children in different settings.

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Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201400040001 ◽

2014 ◽

Vol 17 (4) ◽

pp. 805-817 ◽

Cited By ~ 10

Author(s):

Edna Cunha Vieira ◽

Maria do Rosário Gondim Peixoto ◽

Erika Aparecida da Silveira

Keyword(s):

Metabolic Syndrome ◽

Health System ◽

Health Workers ◽

The Elderly ◽

World Health ◽

Fat Percentage ◽

Cross Sectional ◽

Factors Associated ◽

Unified Health System ◽

The Metabolic Syndrome

OBJECTIVE: To evaluate the prevalence and factors associated with metabolic syndrome in the elderly. METHODS: Cross-sectional study, with 133 individuals randomly selected in the Unified Health System in Goiania, Goiás. The following variables were researched: anthropometric (BMI, waist circumference, fat percentage by Dual X-ray absorptiometry), sociodemographic (gender, age, color, income, marital status and years of schooling), lifestyle (physical activity, smoking and risk alcohol consumption) and food intake (risk and protective foods). The metabolic syndrome was assessed according to harmonized criteria proposed by the World Health Organization (WHO). The combinations were tested by Poisson regression for confounding factors. RESULTS: The prevalence of metabolic syndrome was 58.65% (95%CI 49.8 - 67.1), with 60.5% (95%CI 49.01 - 71.18) for females and 55.7% (95%CI 41.33 - 69.53) for males. Hypertension was the most prevalent component of the syndrome in both men, with 80.8% (95%CI 64.5 - 90.4), and women, with 85.2% (95%CI 75.5 - 92.1). After the multivariate analysis, only the excess of weight measured by body mass index (prevalence ratio = 1.66; p < 0.01) remained associated with the metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in this sample was high, indicating the need for systematic actions by health workers in the control of risk factors through prevention strategies and comprehensive care to the elderly.

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Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults

Public Health Nutrition ◽

10.1017/s1368980009991637 ◽

2009 ◽

Vol 13 (4) ◽

pp. 488-495 ◽

Cited By ~ 10

Author(s):

Ahmet Selçuk Can ◽

Emine Akal Yıldız ◽

Gülhan Samur ◽

Neslişah Rakıcıoğlu ◽

Gülden Pekcan ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Syndrome ◽

Risk Factor ◽

Cardiometabolic Risk ◽

Roc Curves ◽

Cross Sectional Study ◽

Cardiometabolic Risk Factors ◽

Youden Index ◽

Cross Sectional ◽

Men And Women

AbstractObjectiveTo identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.DesignCross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).SettingTurkey, 2003.SubjectsAdults (1121 women and 571 men) aged 18 years and over were examined.ResultsAnalysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.ConclusionsWe show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

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An Approach to Early Detection of Metabolic Syndrome through Non-Invasive Methods in Obese Children

Children ◽

10.3390/children7120304 ◽

2020 ◽

Vol 7 (12) ◽

pp. 304

Author(s):

Rafael Molina-Luque ◽

Natalia Ulloa ◽

Andrea Gleisner ◽

Martin Zilic ◽

Manuel Romero-Saldaña ◽

...

Keyword(s):

Metabolic Syndrome ◽

Early Detection ◽

Decision Trees ◽

Area Under The Curve ◽

Cost Effective ◽

Clinical Decision ◽

Obese Children ◽

Predictive Capacity ◽

Cross Sectional ◽

Non Invasive

Background: Metabolic Syndrome (MetS) has a high prevalence in children, and its presence increases in those with a high BMI. This fact confirms the need for early detection to avoid the development of other comorbidities. Non-invasive variables are presented as a cost-effective and easy to apply alternative in any clinical setting. Aim: To propose a non-invasive method for the early diagnosis of MetS in overweight and obese Chilean children. Methods: We conducted a cross-sectional study on 221 children aged 6 to 11 years. We carried out multivariate logistic regressions, receiver operating characteristic curves, and discriminant analysis to determine the predictive capacity of non-invasive variables. The proposed new method for early detection of MetS is based on clinical decision trees. Results: The prevalence of MetS was 26.7%. The area under the curve for the BMI and waist circumference was 0.827 and 0.808, respectively. Two decision trees were calculated: the first included blood pressure (≥104.5/69 mmHg), BMI (≥23.5 Kg/m2) and WHtR (≥0.55); the second used BMI (≥23.5 Kg/m2) and WHtR (≥0.55), with validity index of 74.7% and 80.5%, respectively. Conclusions: Early detection of MetS is possible through non-invasive methods in overweight and obese children. Two models (Clinical decision trees) based on anthropometric (non-invasive) variables with acceptable validity indexes have been presented. Clinical decision trees can be applied in different clinical and non-clinical settings, adapting to the tools available, being an economical and easy to measurement option. These methods reduce the use of blood tests to those patients who require confirmation.

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Neck Circumference as an Anthropometric Indicator of Central Obesity in Patients with Prediabetes: A Cross-Sectional Study

BioMed Research International ◽

10.1155/2019/4808541 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Thunyarat Anothaisintawee ◽

Nakarin Sansanayudh ◽

Sangsulee Thamakaison ◽

Dumrongrat Lertrattananon ◽

Ammarin Thakkinstian

Keyword(s):

Waist Circumference ◽

Central Obesity ◽

Cross Sectional Study ◽

Neck Circumference ◽

Youden Index ◽

Sectional Study ◽

Roc Curve Analysis ◽

Cross Sectional ◽

Pairwise Correlation ◽

Glucose Levels

Measurement of waist circumference has substantial variability and some limitations, while neck circumference is a simple and reliable anthropometric measure. This study aimed to assess the association between neck circumference and waist circumference and to identify the best cutoff of neck circumference that could predict central obesity in prediabetic patients. This cross-sectional study included adult patients with prediabetes, defined as having fasting plasma glucose levels ranging from 100 to 125 mg/dL or HbA1c ranging from 5.7 to 6.49%, who visited the outpatient clinic of Family Medicine Department, Ramathibodi Hospital, Thailand, during October 2014 and March 2016. Neck circumference was measured from the level just below the laryngeal prominence perpendicular to the long axis of the neck. Central obesity was defined as having waist circumference measurements greater than 90 and 80 cm for males and females, respectively. The correlation between neck circumference and waist circumference was explored by applying pairwise correlation coefficient. Receiver operating characteristic (ROC) curve analysis was performed and Youden index equal to “sensitivity – (1-specificity)” was calculated. Neck circumference that yielded the maximum Youden index was determined as the optimal cutoff point for prediction of central obesity. There were 1,534 patients eligible for this study. After adjusting for covariables, neck circumference was found to be significantly associated with waist circumference in both females and males, with β-coefficients of 1.01 (95% CI: 0.83, 1.20) and 0.65 (95% CI: 0.46, 0.85), respectively. After applying the ROC analysis, neck circumferences ≥ 32 cm in females and ≥ 38 cm in males were determined as the best cutoff values to predict central obesity. Neck circumference is strongly correlated with waist circumference in prediabetics and should be considered as an alternative to the waist circumference measurement in screening for central obesity.

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