Int J Med. Public Health. 2016; 6(2): 69-72 A Multifaceted Peer Reviewed Journal in the feld of Medicine and Public Health www.ijmedph.org | www.journalonweb.com/ijmedph Review Article International Journal of Medicine and Public Health, Vol 6, Issue 2, Apr-Jun, 2016 69 INTRODUCTION Metabolic syndrome is a complex disorder and is characterized by clustering of a number of inter- related factors increasing the risk of coronary heart disease (CHD) and Type 2 Diabetes mellitus (T2DM). Te defning components of metabolic syndrome include dyslipidemia (elevated triglycerides and apolipoprotein B (apoB)-containing lipoproteins, and low high-density lipoproteins (HDL)), eleva- tion of arterial blood pressure (BP), dysregulated glucose homeostasis, abdominal obesity and/or insulin resistance (IR). 1 Abdominal obesity is one of the pivotal features in the pathogenesis of metabolic syndrome. In order to clearly defne metabolic syn- drome, it is the matter of prime importance to device simple clinical measures for precise measurement of abdominal obesity. Since the frst defnition of metabolic syndrome by WHO, 2 to the most recent Harmonized defnition, 3 various clinical tools ranging from waist –hip ratio to waist circumference have been used to quantify central obesity. Among the measures of central obe- sity waist circumference is considered to be simple & inexpensive measure with excellent correlation with abdominal imaging and is used in all defnitions of metabolic syndrome except WHO criteria, as surro- gate marker of central obesity. 4 Waist circumference appears to better central obe- sity indicator than BMI and waist hip ratio. 5 Despite waist circumference being one of the basic compo- nents of every defnition of metabolic syndrome, the ideal site & size which can defne all the CV risk is still a matter of debate. Site or Size of Waist Circumference, Which one is More important in Metabolic Syndrome? ABSTRACT Abdominal obesity is one of the pivotal factors in defning the metabolic syndrome. Abdominal obesity is assessed by the various clinical surrogates among which waist circum- ference is considered to be simple, inexpensive & sensitive tool. But various controversies surround the exact cut offs and the ideal sites of waist circumference measurement, so in this review we discussed these issues. Key words: Metabolic syndrome, Waist circumference, Cardio metabolic risk, Abdominal obesity, Harmonized Defnition. Syed Mohd Razi Gutch Manish, Gupta Kumar Keshav, Kumar Sukriti, Abhinav Gupta Syed Mohd Razi Gutch Manish 1 , Gupta Kumar Keshav 2 , Kumar Sukriti 1 , Abhinav Gupta 1 1 Dept of endocrinology, LLRM Medical College, Meerut, UP, INDIA. 2 Department of Radiodiagnosis, SGPGI, Lucknow, INDIA. Correspondence Manish Gutch, D-15, LLRM Medical College, Meerut, Uttar Pradesh, INDIA. Phone no: 945-342-9252 Email: manish07gutch@gmail.com History • Submission Date: 31-12-15; • Review completed: 03-05-16; • Accepted Date: 06-05-16. DOI : 10.5530/ijmedph.2016.2.4 Article Available online http://www.ijmedph.org/v6/i2 Copyright © 2016 Phcog.Net. This is an open-ac- cess article distributed under the terms of the Creative Commons Attribution 4.0 International license. Cite this article : Syed Mohd Razi Gutch Manish, Keshav GK, Sukriti K, Gupta A. Site or Size of Waist Circumference, Which one is More important in Metabolic Syndrome?. Int. J. Med. Public Health, 2016; 6(2):69-72. FINDING THE MAGICAL NUMBERS Te ideal waist measurement above which the risk of CVD & T2 DM increases signifcantly is not well defned since its introduction in the various defnitions of the metabolic syndrome. Te diagnos- tic cut ofs of waist circumference used in the vari- ous guidelines are the result of expert deliberations but not the evidence based process & epidemiologi- cal studies. 6 “Same doesn’t ft all”, so the same cut of for metabolic syndrome can’t be applied to all the ethnicities of the world having diferent genetic makeup, body fat content & distribution, envi- ronmental factors and life style which afect their susceptibility for metabolic syndrome. For example Asians tend to have greater body fat for the same BMI when compared with Caucasians so Asians develop hypertension, T2DM and dyslipidemia at a lower BMI. 5 Tis fact was realized very late in 2005 when IDF, 7 proposed diferent cut of for the waist circumference for the frst time, as all previous defnitions had same cut of for all the ethnicities. Tough all the defnitions coming afer IDF, 7 defni- tion have diferent cut ofs for diferent ethnicities but the exact increase in the risk of CVD & T2DM is not well defned. A study entitled “Comparisons of waist circumferences measured at 4 sites” done by J. Wang et al. in 2003compared waist circumference at four diferent sites in 49 males and 62 females. In this study author measured the waist circumference at following sites: 1. Immediately below the lowest rib (WC1); 2. At the narrowest waist (WC2, recom- mended in the Anthropometric Standardization Reference Manual); 3. Midpoint between the low- est rib and iliac crest (WC3, recommended in the World Health Organization (WHO) guidelines) and 4. Immediately above the iliac crest (WC4, Recom- mended in the National Institutes of Health (NIH)