Sensibility and specificity analysis for waist to height ratio, body mass index and waist circumference as a screening criterion for metabolic syndrome in an adult North East Portuguese population
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Obesity is a central component of Metabolic Syndrome (MetS) and a major public health concern. A harmonizing MetS definition was developed to aggregate the different criteria used by the umbrella organizations, however there is still controversy over the most sensitive and specific parameter to characterize each MetS component
Obesity is a central component of Metabolic Syndrome (MetS) and a major public health concern. A harmonizing MetS definition was developed to aggregate the different criteria used by the umbrella organizations, however there is still controversy over the most sensitive and specific parameter to characterize each MetS component. The aim of this study was to compare the sensibility and specificity for waist-toheight ratio (WHtR), body mass index (BMI) and waist circumference (WC) to discriminate subjects with and without MetS in an adult North-East Portuguese population.
Methods: A cross-sectional retrospective analysis was conducted between January 2019 and December 2020 from patients’ clinical records of two primary health care centers in a North-East Portuguese region. A total of 6570 individuals aged 18–102 years were included for analysis, among which 3865 women (57.37±18.67 years) and 2705 men (59.97±16.76 years). MetS was defined according to HARM2009 statement set by Alberti et al. (2009). Standardized cut-off points were used to measure WHtR (≥0.5), BMI (≥30 kg/m2) and WC (>88 cm in women and >102 cm in men). A binary logistic regression was performed for the areas under receiver operating characteristic curves (AUC) and adjusted odd ratios (OR) with a 95% confidence interval (CI).
Results: MetS was present in 3,581 (54.51%) subjects, where 1,914 (49,52%) were women and 1,667 (61.63%) men. AUC demonstrated that WHtR was significantly more powerful than WC and BMI (p<0.05) for
screening MetS (AUCWHtR = 0.785, 95% CI: 0.774–0.796; AUCWC = 0.768, 95% CI: 0.757–0.779; AUCBMI = 0.751, 95% CI: 0.703–0.796). Men are 1.53 (95% CI: 1.37–1.72, p<0.001) times more likely of having MetS
compared to women. Also, the discriminative power of the three criteria for predicting MetS is higher in men (AUCWHtR = 0.795, 95% CI: 0.778–0.812; AUCWC = 0.783, 95% CI: 0.766–0.801; AUCBMI = 0.740, 95% CI: 0.722–0.759) than women (AUCWHtR = 0.782, 95% CI: 0.768–0.797; AUCWC = 0.760, 95% CI: 0.744–0.775; AUCBMI = 0.699, 95% CI: 0.683–0.716). However, WHtR is still the most powerfull screening criterion for MetS in both sexes.
Conclusion: Adjusting individual’s waist circumference to height revealed a greater sensitivity and specificity for MetS screening than isolated WC and BMI. Current research suggests that WHtR is as a better predictor for MetS, specifically in its obesity component.
