ORIGINAL ARTICLE Waist Perimeter Cutoff Points and Prediction of Metabolic Syndrome Risk. A Study in a Mexican Population Ana Lucia Alonso, Catarina Munguı ´a-Miranda, David Ramos-Ponce, Daniel Hernandez-Saavedra, Jesus Kumate, and Miguel Cruz Biochemical Medical Research Unit, Specialty Hospital, XXI Century National Medical Center, Mexican Social Security Institute, Mexico, D.F., Mexico Received for publication August 3, 2007; accepted November 6, 2007 (ARCMED-D-07-00361). Background. Association between metabolic syndrome (MS) risk factors was analyzed to establish optimum waist perimeter (WP) cutoff points for a Latin American cluster. Methods. There were 1036 clinically healthy Mexican subjects without a history of CVD. Their full medical history and anthropometric and biochemical parameters were ana- lyzed. Diagnosis of MS was classified by both the International Diabetes Federation (IDF) and the American Heart Association (AHA-NHLBI) definitions. The optimum WP cutoff point was defined through one-way ANOVA, homogeneity and c 2 test of dependency, and receiver operator characteristic analysis (ROC). Results. WP cutoff points suggested by the IDF ($90 cm in men, $80 cm in women) and AHA-NHLBI ($102 cm in men, $88 cm in women) showed a weak association with the other MS risk factors. By using the cutoff point of $98 cm for men and $84 cm for women, we obtained maximum sensitivity and specificity values by ROC analysis. These cutoff points defined as the Mexican Waist Perimeter Proposal (MxWPP) significantly change the prevalence of MS in contrast with the IDF and AHA-NHLBI. Conclusions. Applying the MxWPP new criteria enhances the capability to more accurately detect subjects with MS risk in an apparent healthy Latin American cluster. Ó 2008 IMSS. Published by Elsevier Inc. Key Words: Clinical care, Risk factors, Diagnosis, Epidemiology, Biostatistics. Introduction Metabolic syndrome (MS) represents a series of metabolic abnormalities. The risk factors that describe such a syndrome include central obesity, glucose intolerance, hyperinsuline- mia, decreased high-density lipoproteins, hypertriglyceride- mia, and hypertension. Subjects with MS have a higher probability of suffering from diabetes (1) and increased mortality due to cardiovascular disease (2). The main risk factors in developing MS are abdominal obesity (3) and insulin resistance (4,5). Most MS definitions suggest the use of common param- eters. However, the threshold values and the combination of their manifestations are specific for each proposal. The World Health Organization (WHO) definition for MS uses the body mass index as an obesity indicator (O30 kg/m 2 ) as a parameter to diagnose MS in both genus, in addition to the waist-to-hip ratio (O0.90 for men and O0.85 for women) (6). Currently, waist perimeter (WP) constitutes the first MS tracing test, and its measurement is a necessary requirement for the diagnosis of the MS. The International Diabetes Federation (IDF) suggested that central obesity, measured through WP, is a requirement to define MS, spe- cific to different ethnic groups (7). The cutoff points estab- lished by the IDF regarding WP are $94 and $80 cm for European men and women, respectively, and $90 and $80 cm for the south Asian, and South and Central American ethnic groups (6,7). The National Cholesterol Education Program (NCEP) introduced the definition of the Adult Treatment Panel III (ATP III), which is popular Address reprint requests to: Miguel Cruz, Biochemical Medical Research Unit. Specialty Hospital, XXI Century National Medical Center, Mexican Social Security Institute, Av. Cuauhte ´moc 330, Col. Doctores, 06720 Me ´xico, D.F., Me ´xico; E-mail: mcruz@yahoo.com 0188-4409/08 $esee front matter. Copyright Ó 2008 IMSS. Published by Elsevier Inc. doi: 10.1016/j.arcmed.2007.11.002 Archives of Medical Research 39 (2008) 346e351