Waist circumference and BMI cut-off points to predict risk factors for metabolic syndrome among outpatients in a district hospital

Oct 12, 2026

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Study examines waist circumference (WC) and body mass index (BMI) cut-off points for predicting metabolic syndrome (MS) risk factors in outpatients at a district hospital. Conducted as a cross-sectional study over six months with 355 participants aged 13–91 years, using Youden’s index to identify optimal thresholds. Results show WC and BMI associate with metabolic outcomes, with WC performing better for predicting individual and multiple risk factors. Screening is proposed when WC meets gender-independent criteria.

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Introduction

Methods

Results

Conclusion

O riginal A rticle Singapore Med J 2012; 53(8) : 545 Waist circumference and BMI cut-off points to predict risk factors for metabolic syndrome among outpatients in a district hospital Mra Aye1, MBBS, MMSc, Malek Sazali2, MBBS, MPH | INTRODUCTION Metabolic syndrome (MS) is a cluster of risk factors that increases the risk of cardiovascular disease and type 2 diabetes mellitus (DM) . Waist circumference (WC), a surrogate indicator of abdominal fat mass, is used to measure central obesity associated with increased risk of hypertension, insulin resistance and type 2 DM, whereas body mass index (BMI) is traditionally used to measure somatic obesity. This study aimed to identify the WC and BMI cut-off points to predict the metabolic risk factors for MS and to determine which is a better predictor.
METHODS This was a cross-sectional study conducted over a period of six months. The study involved 355 subjects aged 13–91 years. Youden’s index was used to identify the optimal cut-off points.
RESULTS The optimal cut-off point of WC to predict individual metabolic risk in females was 84.5–91.0 cm. The BMI cut-off point to predict hypertension and raised fasting blood sugar was 23.7 kg/m2 , and that for low level high-density lipoprotein cholesterol was 22.9 kg/m2. For males, the corresponding cut-off points were 86.5–91.0 cm for WC and 20.75–25.5 kg/m2 for BMI, with corresponding sensitivities and specificities. Area under the curve and the odds of developing individual and ≥ 2 metabolic risk factors for MS were higher for WC than for BMI.
CONCLUSION WC is a better predictor of metabolic risk factors for developing MS than BMI. Therefore, we propose that metabolic risk factors be screened when WC ≥ 80 cm is found in both genders regardless of BMI. | | | --- | --- | | Keywords: BMI, metabolic risk factors, metabolic syndrome, waist circumference Singapore Med J 2012; 53(8): 545–550
INTRODUCTION
Obesity is a well-known risk factor for developing diabetes mellitus (DM), hypertension, dyslipidaemia and coronary heart disease (CHD) .(1-3) The Malaysian National Health Morbidity Survey (NHMS) II (1996) and III (2006) reported an increasing prevalence of obesity from 4.4% to 14.0% and overweight from 16.6% to 29.1% among Malaysians. 29.7% of males were reported to be overweight and 10.0% obese. Women were found to have a higher prevalence of obesity (17.4%) but a slightly lower prevalence of overweight (28.6%) .(4) The NHMS reports were based on body mass index (BMI), the conventional method for measuring obesity.(5) Although BMI is commonly used to measure somatic obesity, recent findings have reported its conflicting association with cardiovascular and obesity-related health risks.(6,7) Besides, body fat distribution is another important risk factor for obesity-related diseases. Excess abdominal fat (also known as central or upper body fat) is associated with an increased risk of hypertension, insulin resistance and type 2 DM.(1) Waist circumference (WC) is often used as a surrogate indicator of abdominal fat mass, as it correlates with both subcutaneous and intra-abdominal fat. Several studies have found WC to bean important predictor of DM, CHD and its mortality rate, and clinical tests such as blood pressure, blood glucose and lipoproteins.(1,3,8,9) Cut-off points of WC for health outcomes | Table I. Demographic distribution of study samples (n = 355) . | | | Variable No. (%) | | | Age (yrs)
13–19 20–29 30–39 40–49 50–59 ≥ 60
18 (5 . 1)
35 (9 .9)
38 (10 .7)
73 (20 .0)
100 (28 .0)
91 (25 .0)
Gender
Male
Female
Ethnicity
Malay Indian Chinese
174 (49 .0)
181 (51 .0)
139 (39 .2)
136 (38 .3)
80 (22 .5) | | | are affected by demographic variables, including gender and ethnicity.(10-12)
Metabolic syndrome (MS) is a cluster of metabolic factors that increases the risk of cardiovascular disease and DM.(2) Presently, there are three sets of criteria for MS: the Internatio

FAQs

What was the aim of the study regarding waist circumference and BMI?

To identify WC and BMI cut-off points for predicting metabolic risk factors related to metabolic syndrome, and to determine which measure is the better predictor.

How was the optimal cut-off point determined?

Youden’s index was used to identify the optimal cut-off points for WC and BMI.

Which is a better predictor, waist circumference or BMI?

Waist circumference was a better predictor of metabolic risk factors for developing metabolic syndrome than BMI, with higher odds for individual and multiple risk factors.

Oct 12, 2026

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