Abstract

Background: BMI and waist circumference (WC) are used to screen for cardio-metabolic 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 among 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 and 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/m2 among men (24.5%26.1 kg/m2 stunted; 24.8%26.3 kg/m2 non-stunted) and 26.5%27.6 kg/m2 among women (26.3%27.8 kg/m2 stunted; 26.6%27.9 kg/m2 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 with no meaningful differences by stature. Optimal cut-off points for WC were several centimetres lower for stunted compared 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. © The Authors 2007.