Relationship between waist circumferences measured at the umbilical level and midway between the ribs and iliac crest: A solution to the debate on optimal waist circumference standards in the diagnostic criteria of Metabolic Syndrome in Japan

Hirokazu Yokoyama, Hiroshi Hirose, Takeshi Kanda, Hiroshi Kawabe, Ikuo Saito

Research output: Contribution to journalArticle

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Aim: The waist circumference (WC) cut-off values in the diagnostic criteria of metabolic syndrome (MetS) established in Japan (Japanese criteria) differ from those established by the International Diabetes Federation (IDF) for Asians (IDF criteria). Methods: To settle this contradiction, a cross-sectional study of Japanese aged 20-65 years was performed. After excluding subjects suffering from significant diseases other than those constituting MetS, excessive drinkers, and regular smokers, 835 males and 1,304 females were examined. WC was measured at the umbilical level (UWC) and midway between the ribs and iliac crest (MWC) according to both criteria in each subject. Results: Upper limits of reference intervals of MWC estimated in subjects free from MetS were 84.6 and 84.3 cm in older (40-65 years) and younger (20-39) males, and 78.4 and 70.5 cm in older and younger females, respectively; those of UWC were 86.4, 86.2, 87.9 and 78.9 cm, respectively. Receiver operating characteristic (ROC) curves for MWC to predict UWC reproduced the relationships of the two types of cut-off values in each population. Conclusion: WC cut-off values in the Japanese and IDF criteria have the potential to be valid as cutoff values of UWC and MWC in Japanese, respectively. Their difference can be explained by the variation in the WC definition, and they can stand together without inconsistency. Acceptance of the recently prevailing view that the WC standard in IDF for Asian males should be 85 cm and the introduction of new criteria for younger females in consideration of their generation differences in both criteria could facilitate their higher compatibility.

Original languageEnglish
Pages (from-to)735-743
Number of pages9
JournalJournal of atherosclerosis and thrombosis
Issue number9
Publication statusPublished - 2011 Sep 30



  • Generation difference
  • Metabolic syndrome
  • Reference interval
  • Umbilical line
  • Waist circumference

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Biochemistry, medical

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