@article{a874c5b577b74cf5a24be7f8e99070c6,
title = "Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease",
abstract = "Background:Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned.Objective:To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations.Methods:We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk ≥20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points.Results:WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m2). In women, cut points for WC (94cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91cm in Latin Americans to 102cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively.Conclusion: WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.",
keywords = "Coronary heart disease, Ethnic group, Latin America, NHANES, Sscreening",
author = "Herrera, {V. M.} and Casas, {J. P.} and Miranda, {J. J.} and P. Perel and R. Pichardo and A. Gonz{\'a}lez and Sanchez, {J. R.} and C. Ferreccio and X. Aguilera and E. Silva and M. Or{\'o}stegui and G{\'o}mez, {L. F.} and Chirinos, {J. A.} and J. Medina-Lezama and P{\'e}rez, {C. M.} and E. Su{\'a}rez and Ortiz, {A. P.} and L. Rosero and N. Schapochnik and Z. Ortiz and D. Ferrante and M. Diaz and Bautista, {L. E.}",
note = "Funding Information: We thank Dr Paula Margozzini (Pontificia Universidad Cat{\'o}lica de Chile); Claudia Gonz{\'a}lez (Ministerio de Salud de Chile); Dr Luis A Santa Mar{\'i}a (Instituto Nacional de Salud, Per{\'u}); Dr Manuel Guzm{\'a}n and Dr Lillian Haddock (University of Puerto Rico, School of Medicine, Puerto Rico); and Professors Jos{\'e} Villasmil and Mairelis Nuv{\'a}ez (Universi-dad del Zulia). The {\textquoteleft}Encuesta Nacional de Salud 2003{\textquoteright} was funded by the Ministerio de Salud de Chile. The {\textquoteleft}Encuesta Nacional de Indicadores Nutricionales, Bioqu{\'i}micos, Socio-econ{\'o}micos y Culturales Relacionados con las Enfermedades Cr{\'o}nico Degenerativas{\textquoteright} was funded by the Instituto Nacional de Salud, Lima, Per{\'u}. The study of the {\textquoteleft}Prevalence of Metabolic Syndrome and its Individual Components in the adult population of the San Juan Metropolitan Area in Puerto Rico{\textquoteright} was funded by an unrestricted grant from Merck Sharp & Dohme Corporation with additional support from the National Institutes of Health/National Center for Research Resources (NCRR/NIH) grant awards G12RR03051 and P20RR011126. CARMEN-Bucaramanga was funded by the Secretar{\'i}a de Salud Municipal de Bucaramanga and the Secretar{\'i}a Departamental de Salud de Santander. The {\textquoteleft}Prueba de Validaci{\'o}n de la Encuesta Nacional de Factores de Riesgo{\textquoteright} was funded by the Ministerio de Salud de la Rep{\'u}blica Argentina and the Gobierno de la Provincia de Tierra del Fuego, Ant{\'a}rtida e Islas del Atl{\'a}ntico Sur, Argentina. The {\textquoteleft}Encuesta Nacional de Factores de Riesgo{\textquoteright} was funded by the Ministerio de Salud de la Rep{\'u}blica Argentina. The {\textquoteleft}Estudio CARMEN Santa Fe{\textquoteright} was funded by the Secretar{\'i}a Distrital de Salud de Bogot{\'a}. The Zulia Coronary Heart Disease Risk Factor Study was funded by the Fondo Nacional de Ciencia, Tecnolog{\'i}a e Innovaci{\'o}n (FONACIT) and the Fundaci{\'o}n Venezolana de Hipertensi{\'o}n Arterial (FUNDAHIPERTENSION).",
year = "2009",
month = may,
doi = "10.1038/ijo.2009.35",
language = "Ingl{\'e}s",
volume = "33",
pages = "568--576",
journal = "International Journal of Obesity",
issn = "0307-0565",
publisher = "Nature Publishing Group",
number = "5",
}