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Title: Optimal waist circumference threshold for diagnosing metabolic syndrome in African people living with HIV infection
Authors: Nguyen,Kim A 
Peer, Nasheeta 
de Villiers, Anniza 
Mukasa, Barbara 
Matsha, Tandi 
Mills, Edward J 
Kengne, Andre Pascal 
Keywords: Waist circumference;Metobolic syndrome;HIV-infected Africans;Healthcare facilities;Western Cape Province;South Africa
Issue Date: 2017
Publisher: PLOS One
Source: Nguyen KA, Peer N, de Villiers A, Mukasa B, Matsha TE, Mills EJ, et al. (2017) Optimal waist circumference threshold for diagnosing metabolic syndrome in African people living with HIV infection. PLoS ONE 12(9): e0183029.
Journal: Plos One 
Abstract: Background The applicability of the internationally advocated cut-off points of waist circumference (WC) derived from Caucasians to diagnose metabolic syndrome (MS) in HIV-infected Africans is unknown. This study aimed to determine the optimal WC cutoffs for MS diagnosis in HIV-infected people receiving care at public healthcare facilities in the Western Cape Province in South Africa. Methods Data from 748 randomly selected participants (591 women), with a median age of 38 years, were analysed. The Youden’s index and the top-left-point approaches were used to determine the optimal cutoffs of WC for predicting ≥2 non-adipose MS components. Results The two approaches generated the same WC cut-off point in women, 92 cm (sensitivity 64%, specificity 64%) but different cut-off points in men: 87 cm (sensitivity 48%, specificity 85%) based on the Younden’s index and 83 cm (sensitivity 59%, specificity 74%) by the top-left-point method. The advocated thresholds of 94 cm in men had low sensitivity (30%) but high specificity (92%) whereas 80 cm in women showed low specificity (32%) but high sensitivity (85%) for diagnosing MS in this sample. Most African-specific cut-off points performed well, with 90 cm providing acceptable performance in both men (sensitivity 43%, specificity 88%) and women (sensitivity 66%, specificity 59%). Conclusions This study underlines the sub-optimal performance of internationally recommended WC thresholds for MS diagnosis in HIV-infected Africans, and supports the need to revisit the guidelines on WC criterion in African population across the board. A single threshold of 90 cm for both genders would be a practical suggestion.
ISSN: 1932-6203
Appears in Collections:HWSci - Journal Articles (DHET subsidised)

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