Korean Journal of Family Medicine (가정의학회지)

The Korean Academy of Family Medicine (대한가정의학회)
권호 표지
DOI QR코드

DOI QR Code

Cut-Off Values for Visceral Fat Area Identifying Korean Adults at Risk for Metabolic Syndrome

  • Lee, Arang (Department of Family Medicine, Seoul National University College of Medicine) ;
  • Kim, Ye Ji (Department of Family Medicine, Seoul National University College of Medicine) ;
  • Oh, Seung-Won (Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital) ;
  • Lee, Cheol Min (Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital) ;
  • Choi, Ho Chun (Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital) ;
  • Joh, Hee-Kyung (Seoul National University Health Service Center) ;
  • Oh, Bumjo (Department of Family Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Hwang, Seung-Sik (Department of Public Health Science, Seoul National University Graduate School of Public Health) ;
  • Kim, Seung Jae (Department of Family Medicine, Seoul National University College of Medicine) ;
  • Kwon, Oh Deog (Department of Family Medicine, Seoul National University College of Medicine)
  • Received : 2017.07.27
  • Accepted : 2017.10.21
  • Published : 2018.07.30
⟨ Previous Next ⟩

Abstract

Background: Cut-off values for visceral fat area (VFA) measured by computed tomography (CT) for identifying individuals at risk of metabolic syndrome (MetS) have not been clearly established in Korean adults, particularly for large populations. We aimed to identify optimal VFA and waist circumference (WC) cut-off values and compare the ability of VFA and WC to predict the presence of ${\geq}2$ metabolic risk factors. Methods: We included 36,783 subjects aged 19-79 years undergoing abdominal fat CT during regular health checkups between January 2007 and February 2015 in Seoul. The risk factors for MetS except WC were based on the International Diabetes Federation criteria. Receiver operating characteristic curve analyses were used to determine the appropriate VFA and WC cut-off values for MetS. Results: VFA was a more significant predictor of metabolic risk factors than WC and body mass index (BMI). The optimal cut-off values for VFA and WC were $134.6cm^2$ and 88 cm for men and $91.1cm^2$ and 81 cm for women, respectively. We estimated age-specific cut-off values for VFA, WC, and BMI. VFA cut-off values increased with age, particularly among women. Conclusion: This large population study proposed the cut-off values for VFA and WC for identifying subjects at risk of MetS among Korean adults. For more accurate diagnosis, different age-specific cut-off values for VFA and WC may be considered.

Keywords

Acknowledgement

Grant : Business Model Development for Personalized Medicine Based on Integrated Genome and Clinical Information

Supported by : Ministry of Trade, Industry and Energy (M)

References

  1. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644
  2. Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract 2014;2014:943162.
  3. Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program-Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 2007;30:8-13. https://doi.org/10.2337/dc06-1414
  4. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002;156:1070-7. https://doi.org/10.1093/aje/kwf145
  5. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382-6. https://doi.org/10.1016/0140-6736(91)91164-P
  6. Ascaso JF, Romero P, Real JT, Lorente RI, Martinez-Valls J, Carmena R. Abdominal obesity, insulin resistance, and metabolic syndrome in a southern European population. Eur J Intern Med 2003;14:101-6. https://doi.org/10.1016/S0953-6205(03)00022-0
  7. Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett D, et al. Harmonizing the definition of the metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European populations. Am J Cardiol 2007;99:541-8. https://doi.org/10.1016/j.amjcard.2006.08.045
  8. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome: a new world-wide definition: a consensus statement from the International Diabetes Federation. Diabet Med 2006;23:469-80. https://doi.org/10.1111/j.1464-5491.2006.01858.x
  9. Oh JY, Hong YS, Sung YA, Barrett-Connor E. Prevalence and factor analysis of metabolic syndrome in an urban Korean population. Diabetes Care 2004;27:2027-32. https://doi.org/10.2337/diacare.27.8.2027
  10. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Yoon JW, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care 2011;34:1323-8. https://doi.org/10.2337/dc10-2109
  11. Lee SY, Park HS, Kim DJ, Han JH, Kim SM, Cho GJ, et al. Appropriate waist circumference cutoff points for central obesity in Korean adults. Diabetes Res Clin Pract 2007;75:72-80. https://doi.org/10.1016/j.diabres.2006.04.013
  12. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes 1996;45:633-8. https://doi.org/10.2337/diab.45.5.633
  13. Brochu M, Starling RD, Tchernof A, Matthews DE, Garcia-Rubi E, Poehlman ET. Visceral adipose tissue is an independent correlate of glucose disposal in older obese postmenopausal women. J Clin Endocrinol Metab 2000;85:2378-84.
  14. Ross R, Leger L, Morris D, de Guise J, Guardo R. Quantification of adipose tissue by MRI: relationship with anthropometric variables. J Appl Physiol (1985) 1992;72:787-95. https://doi.org/10.1152/jappl.1992.72.2.787
  15. Seo JA, Kim BG, Cho H, Kim HS, Park J, Baik SH, et al. The cutoff values of visceral fat area and waist circumference for identifying subjects at risk for metabolic syndrome in elderly Korean: Ansan Geriatric (AGE) cohort study. BMC Public Health 2009;9:443. https://doi.org/10.1186/1471-2458-9-443
  16. Lim S, Kim JH, Yoon JW, Kang SM, Choi SH, Park YJ, et al. Optimal cut points of waist circumference (WC) and visceral fat area (VFA) predicting for metabolic syndrome (MetS) in elderly population in the Korean Longitudinal Study on Health and Aging (KLoSHA). Arch Gerontol Geriatr 2012;54:e29-34. https://doi.org/10.1016/j.archger.2011.07.013
  17. Borkan GA, Gerzof SG, Robbins AH, Hults DE, Silbert CK, Silbert JE. Assessment of abdominal fat content by computed tomography. Am J Clin Nutr 1982;36:172-7. https://doi.org/10.1093/ajcn/36.1.172
  18. Kvist H, Chowdhury B, Grangard U, Tylen U, Sjostrom L. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988;48:1351-61. https://doi.org/10.1093/ajcn/48.6.1351
  19. Goodpaster BH. Measuring body fat distribution and content in humans. Curr Opin Clin Nutr Metab Care 2002;5:481-7. https://doi.org/10.1097/00075197-200209000-00005
  20. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47:458-72. https://doi.org/10.1002/bimj.200410135
  21. Han JH, Park HS, Kim SM, Lee SY, Kim DJ, Choi WH. Visceral adipose tissue as a predictor for metabolic risk factors in the Korean population. Diabet Med 2008;25:106-10.
  22. Tran BT, Jeong BY, Oh JK. The prevalence trend of metabolic syndrome and its components and risk factors in Korean adults: results from the Korean National Health and Nutrition Examination Survey 2008-2013. BMC Public Health 2017;17:71. https://doi.org/10.1186/s12889-016-3936-6
  23. Kim HI, Kim JT, Yu SH, Kwak SH, Jang HC, Park KS, et al. Gender differences in diagnostic values of visceral fat area and waist circumference for predicting metabolic syndrome in Koreans. J Korean Med Sci 2011;26:906-13. https://doi.org/10.3346/jkms.2011.26.7.906
  24. Examination Committee of Criteria for 'Obesity Disease' in Japan; Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J 2002;66:987-92. https://doi.org/10.1253/circj.66.987
  25. Oka R, Kobayashi J, Yagi K, Tanii H, Miyamoto S, Asano A, et al. Reassessment of the cutoff values of waist circumference and visceral fat area for identifying Japanese subjects at risk for the metabolic syndrome. Diabetes Res Clin Pract 2008;79:474-81. https://doi.org/10.1016/j.diabres.2007.10.016
  26. Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: potential mechanisms and clinical implications. Clin Geriatr Med 2009;25:643-59. https://doi.org/10.1016/j.cger.2009.07.005
  27. Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY. Minimum waist and visceral fat values for identifying Japanese Americans at risk for the metabolic syndrome. Diabetes Care 2007;30:120-7. https://doi.org/10.2337/dc06-0739
  28. Yumi M, Toru N, Shuichiro Y, Yoshihiko T, Tetsuji Y, Tetsuya M, et al. Visceral fat area cutoff for the detection of multiple risk factors of metabolic syndrome in Japanese: the Hitachi Health Study. Obesity (Silver Spring) 2012;20:1744-9. https://doi.org/10.1038/oby.2011.285

Cited by

  1. Metabolic Syndrome, as Defined Based on Parameters Including Visceral Fat Area, Predicts Complications After Surgery for Rectal Cancer vol.30, pp.1, 2018, https://doi.org/10.1007/s11695-019-04163-1
  2. CT-defined visceral adipose tissue thresholds for identifying metabolic complications: a cross-sectional study in the United Arab Emirates vol.10, pp.8, 2018, https://doi.org/10.1136/bmjopen-2019-031181
  3. Optimal Cut-Off Values of Visceral Fat Area for Predicting Metabolic Syndrome Among Type 2 Diabetes Patients in Ningbo, China vol.14, pp.None, 2018, https://doi.org/10.2147/dmso.s304164
  4. 최근 10년간 한국인 대상 대사증후군 예측 모델에 대한 체계적 문헌고찰 vol.21, pp.8, 2018, https://doi.org/10.5392/jkca.2021.21.08.662
  5. Novel Adiposity and Biochemical-Anthropometric Indices to Identify Cardiometabolic Risk and Metabolic Syndrome in Mexican Adults vol.9, pp.11, 2021, https://doi.org/10.3390/healthcare9111561
  6. Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults vol.21, pp.1, 2018, https://doi.org/10.1186/s12872-021-02100-8