Detection of cardio-metabolic risk by BMI and waist circumference among a population of Guatemalan adults

Background: BMI and waist circumference (WC) are used to screen for cardiometabolic risk; however it is unclear how well these indices perform in populations subject to childhood stunting. Objectives: To evaluate BMI and WC as indicators of cardio-metabolic risk and to determine optimal cut-off points amont 1325 Guatemalan adults (44% STUNTED: <= 150 cm women; <= 162 cm men). Methods: Cardio-metabolic risk factors were systolic/diastolic blood pressure >= 130/>= 85 mmHg, glucose >= 5.5 mmol/l, TAG >= 1.7 mmol/l, ratio of total cholesterol to HDL-cholesterol >= 5.0, and the presence of two or more three or more of the preceding risk factors. REceiver operating characteristic (ROC) curve analysis was used. Results: Areas under the ROC curve were in the range of 0.59-0.77 for BMI and 0.59-0.78 for WC among men and 0.66-0.72 and 0.64-0.72 among women, respectively. Optimal cut-off points for BMI were 24.7-26.1 kg/m(2) among men (24.5-26.1 kg/m(2) stunted; 24.8-26.3 kg/m(2) non-stunted) and 26.5-27.6 kg/m(2) among women (26.3-27.8 kg/m(2) studned; 26.6-27.9 kg/m(2) non-stunted). Optimal cut-off points for WC were 87.3-91.1 cm among men (85.3-89.4 cm stunted; 88.5-93.3 cm non-stunted) and 91.3-95.3 cm among women (90.9-94.4 cm stunted; 91.8-95.6 cm non-stunted). Conclusion: Optimal cut-off points for BMI were slightly higher among women than men than no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted comapred with non-stunted men, and both were substantially lower than the current recommendations among Western populations. Cut-off points derived from Western populations may not be appropriate for developing countries with a high prevalence of stunting.