Research article

Optimal cut-offs of five anthropometric indices and their predictive ability of type 2 diabetes in a nationally representative Kenyan study

  • Received: 06 May 2021 Accepted: 06 July 2021 Published: 09 July 2021
  • Background

    Type 2 diabetes (T2D) is one of the top non-communicable diseases in Kenya and prevention strategies are urgently needed. Intervening to reduce obesity is the most common prevention strategy. However, black populations develop T2D at lower obesity levels and it is unclear which anthropometric cut-offs could provide the best predictive ability for T2D risk. This study, therefore, aimed to determine the optimal anthropometric cut-offs and their predictive ability of T2D in Kenya.

    Methods

    The study included 2159 participants (59% women) aged 35–70 years from the Kenya STEPwise survey conducted in 2014. Five anthropometric indices were used—body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist divided by height0.5(WHt.5R). Diabetes was defined as a fasting blood glucose of ≥7.0 mmol/l or a previous diagnosis by a health worker. Optimal anthropometric cut-offs and their receiver operating characteristics, such as the area under the curve (AUC), were computed.

    Results

    Overall, the optimal cut-off for BMI, WC, WHR, WHtR and WHt.5R were 24.8 kg.m−2, 90 cm, 0.88, 0.54 and 6.9. On disaggregation by sex, the optimal cut-off for BMI, WC, WHR WHtR and WHt.5R was 27.1 kg.m−2, 87 cm, 0.85, 0.55 and 6.9 in women, and 24.8 kg.m−2, 91 cm, 0.88, 0.54 and 6.9 in men. Overall, WC (AUC 0.71 (95% confidence interval 0.65, 0.76)) WHtR (AUC 0.71 (0.66, 0.76)) and WHt.5R (AUC 0.70 (0.65,0.75)) had a better predictive ability for T2D than BMI (AUC 0.68 (0.62, 0.73)).

    Conclusions

    WC, WHtR and WHt.5R were better predictors of T2D than BMI and should be used for risk stratification in Kenya. A WC cut-off of 87cm in women and 91cm in men, a WHtR cut-off of 0.54 or a WHt.5R of 6.9 in both men and women should be used to identify individuals at an elevated risk of T2D.

    Citation: Anthony Muchai Manyara. Optimal cut-offs of five anthropometric indices and their predictive ability of type 2 diabetes in a nationally representative Kenyan study[J]. AIMS Public Health, 2021, 8(3): 507-518. doi: 10.3934/publichealth.2021041

    Related Papers:

  • Background

    Type 2 diabetes (T2D) is one of the top non-communicable diseases in Kenya and prevention strategies are urgently needed. Intervening to reduce obesity is the most common prevention strategy. However, black populations develop T2D at lower obesity levels and it is unclear which anthropometric cut-offs could provide the best predictive ability for T2D risk. This study, therefore, aimed to determine the optimal anthropometric cut-offs and their predictive ability of T2D in Kenya.

    Methods

    The study included 2159 participants (59% women) aged 35–70 years from the Kenya STEPwise survey conducted in 2014. Five anthropometric indices were used—body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR) and waist divided by height0.5(WHt.5R). Diabetes was defined as a fasting blood glucose of ≥7.0 mmol/l or a previous diagnosis by a health worker. Optimal anthropometric cut-offs and their receiver operating characteristics, such as the area under the curve (AUC), were computed.

    Results

    Overall, the optimal cut-off for BMI, WC, WHR, WHtR and WHt.5R were 24.8 kg.m−2, 90 cm, 0.88, 0.54 and 6.9. On disaggregation by sex, the optimal cut-off for BMI, WC, WHR WHtR and WHt.5R was 27.1 kg.m−2, 87 cm, 0.85, 0.55 and 6.9 in women, and 24.8 kg.m−2, 91 cm, 0.88, 0.54 and 6.9 in men. Overall, WC (AUC 0.71 (95% confidence interval 0.65, 0.76)) WHtR (AUC 0.71 (0.66, 0.76)) and WHt.5R (AUC 0.70 (0.65,0.75)) had a better predictive ability for T2D than BMI (AUC 0.68 (0.62, 0.73)).

    Conclusions

    WC, WHtR and WHt.5R were better predictors of T2D than BMI and should be used for risk stratification in Kenya. A WC cut-off of 87cm in women and 91cm in men, a WHtR cut-off of 0.54 or a WHt.5R of 6.9 in both men and women should be used to identify individuals at an elevated risk of T2D.


    Abbreviations

    BMI

    Body Mass Index

    WC

    Waist Circumference

    WHrR

    Waist-to-Height Ratio

    WHR

    Waist-to-Hip Ratio

    WHt.5R

    waist divided by height0.5

    ROC

    Receiver Operating Curve

    T2D

    Type 2 Diabetes

    AUC

    Area Under the Curve

    SSA

    Sub-Saharan Africa

    CI

    Confidence Intervals

    SD

    Standard Deviation

    WHO

    World Health Organisation

    加载中

    Acknowledgments



    The authors would like to thank the three anonymous reviewers whose input improved the quality of this article. The views expressed are those of the authors and not necessarily those of the University of Glasgow.

    Availability of data and materials



    The Kenya STEPwise survey 2014 data can be assessed from the Kenya National Bureau of Statistics using this link: http://statistics.knbs.or.ke/nada/index.php/catalog/90.

    Conflict of interest



    The authors declare that they have no competing interests.

    Authors' contributions



    AMM conceptualised the study, analysed and interpreted the data, and drafted the manuscript.

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