Appropriate Body Mass Index and Waist Circumference Cutoff for Overweight and Central Obesity among Adults in Cambodia

et al. (2013) Appropriate Body Mass Index and Waist Circumference Cutoff for Overweight and Central Obesity among Adults in Cambodia. PLoS ONE 8(10): e77897. doi:10.1371/journal.pone.0077897 Appropriate Body Mass Index and Waist Circumference Cutoff for Overweight and Central Obesity among Adults in Cambodia Yom An 0 Siyan Yi 0 Annette Fitzpatrick 0 Vinay Gupta 0 Piseth Raingsey Prak 0 Sophal Oum 0 James P. LoGerfo 0 Melania Manco, Scientific Directorate, Bambino Hospital, Italy 0 1 School of Public Health, the National Institute of Public Health, Phnom Penh, Cambodia, 2 Institute of Biology, Medicine and Agriculture, Royal Academy of Cambodia , Phnom Penh , Cambodia , 3 Asia Health Policy Program, Walter H. Shorenstein Asia-Pacific Research Center, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, United States of America, 4 University of Washington Medical Center, Departments of Internal Medicine and Global Health , Seattle , Washington, United States of America, 5 Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia, 6 University of Health Sciences , Phnom Penh , Cambodia Background: Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of noncommunicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease. Methodology/Principal Findings: We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher's Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n = 1,786) were men, and 64.4% (n = 3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI $23.0 kg/m2 and with WC .80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all pvalues ,0.001) when BMI of 23.0 kg/m2 was used as the cutoff point for overweight compared to that using WHO BMI classification for overweight (BMI $25.0 kg/m2) for detecting the three cardiovascular risk factors. Similarly, AUC was also significantly higher in men (p-value ,0.001) when using WC of 80.0 cm as the cutoff point for central obesity compared to that recommended by WHO (WC $94.0 cm in men). Conclusion: Lower cutoffs for BMI and WC should be used to identify of risks of hypertension, diabetes, and hypercholesterolemia for Cambodian aged between 25 and 64 years. - Body mass index (BMI) and waist circumference (WC) have been widely used to predict risks of cardiovascular disease including type II diabetes, hypertension, and dyslipidemia [14]. The World Health Organization (WHO) has classified BMI ,18.5 kg/m2 as underweight, between 18.524.9 kg/m2 as normal weight, between 25.029.9 kg/m2 as overweight, and $30.0 kg/m2 as obese, WHO cut points for WC are classified as $94.0 cm for men and WC $80.0 cm for women to reflect central obesity [5]. These classifications are based mainly on studies from Western populations [5]. Increasingly, epidemiological and clinical studies have shown a significant association of BMI and WC at lower cutoff points with risks of metabolic disorders among Asian populations [4,68]. A BMI threshold of $23.0 kg/m2 has been found to be associated with diabetes among Indian people [7]. In China, BMI of 22.5 24.0 kg/m2 was found to be associated with hypertension [1,9], while this association was found at a lower BMI cutoff in Indonesia (from 21.522.5 kg/m2) and Vietnam (from 20.521.0 kg/m2) [9]. To define central obesity, measures of WC $90.0 cm for men and $80.0 cm for women are widely used for Asian people [10,11]. In India, diabetes was found to be associated with those who had even lower WC (85.0 cm and 80.0 cm for men and women, respectively) [7]. In China, WC of 80.0 cm for both men and women was found as the threshold to confer risks of cardiovascular disease [6]. In Cambodia, BMI classification from the WHO [5] (BMI cutoff point of $25.0 kg/m2 for overweight) still has been used to identify people at greater risks of non-communicable diseases (NCDs). Men with WC of 85.094.0 cm and women with WC of 81.088.0 cm are classified as having moderate risk of NCDs. Using these classifications, a national STEP survey of risk factors for NCDs conducted by Department of Preventive Medicine, Ministry of Health, Cambodia in 2010 found that 10.5% of men and 16.3% of women were classified as overweight; and 11.8% of men and 16.9% of women were classified as having central obes (...truncated)