Predictive value of abdominal obesity cut-off points for hypertension in Blacks from West African and Caribbean island nations

BACKGROUND: Waist circumferences (WC) greater than or equal to 94 cm for me n and greater than or equal to 80 cm for women (action level I) and greater than or equal to 102 cm for men and greater than or equal to 88 cm for wom en (action level II) have been suggested as limits for health promotion pur poses to alert the general public to the need for weight loss. In this anal ysis we examined the ability of the above cut-off points to correctly ident ify subjects with or without hypertension in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, We also determined population- and gender-specific abd ominal adiposity cut-off points for epidemiological identification of risk of hypertension. METHODS: Waist measurement was made at the narrowest part of the torso as s een from the front or at midpoint between the bottom of the rib cage and 2c m above the top of the iliac crest. Sensitivity and specificity of the esta blished WC cut-off points for hypertension were compared across sites. With receiver operating characteristics (ROC), population- and gender-specific cut-off points associated with risk of hypertension were determined over th e entire range of WC values. RESULTS: Predictive abilities of the established WC cut-off points for hype rtension were poor compared to the specific cut-off points estimated for ea ch population. Different values of WC were associated with increased risk o f hypertension in these populations. In men, WC cut-off points of 76, 81, 8 0, 83 and 87 cm provided the highest sensitivity for identifying hypertensi ves in Nigeria, Cameroon, Jamaica, St Lucia and Barbados, respectively. The analogous cut-off points in women were 72, 82, 85, 86 and 88 cm. CONCLUSIONS: The waist cut-off points from this study represent values for epidemiological identification of risk of hypertension, For the purpose of health promotion, the decision on what cut-off points to use must be made b y considering other additional factors including overall impact on health d ue to intervention (e.g. weight reduction) and potential burden on health s ervices if a low cut-off point is employed. There is a need to develop abdo minal adiposity cut-off points associated with increased risks for cardiova scular diseases in different societies, especially for those populations wh ere the distribution of obesity and associated risk factors tends to be ver y different from those of the technologically advanced nations.