Cutoff Point Measurement of the waist circumference for the diagnosis of Metabolic Syndrome in Iraqi university students


Alaa Hasoon Zamil*, Seenaa Sadiq Amin

Department of Clinical Laboratory Sciences, College of Pharmacy, University of Baghdad, Baghdad, Iraq.

*Corresponding Author E-mail:



Background: Metabolic syndrome (MetS) is a collection of connected cardiovascular risk factors that characterizes the complicated illness. The waist circumference cutoff point fluctuation has so far defined Mets. Objective: This study aimed to determine the cutoff point for WC in healthy Iraqi adults. Methods: This cross-sectional survey establishes the standard value for WC among 300 healthy university students in Wasit city, Iraq. They are aged between 18-25 years. The receiver operator characteristic (ROC) curve was used WC to predict the presence of two or more risk factors for MetS, as defined by IDF. Results: The cutoff level yielding maximum sensitivity and specificity for predicting the presence of multiple risk factors was 82.5cm in females (sensitivity 65%, specificity 70%) and 91cm in males(sensitivity 50%, specificity 75%). Conclusion: Results propose that 82.5cm for females and 91cm for males represent the ideal WC cutoff points for diagnosing MetS in young adult participants from Iraq.


KEYWORDS: Metabolic syndrome, Waist circumference.




Metabolic syndrome (MetS) is a complex disorder categorized by a group of interrelated factors that rise the risk of cardiovascular disease (CVD) and type 2 diabetes (T2DM)1-5. The etiology of MetS contributes to numerous factors upon which genetic and environmental factors have a  critical role in the disposition of the disease6-8; several health organizations have defined the syndrome and published diagnostic criteria  using five parameters, including elevation of waist circumference (WC), blood pressure (BP), triglycerides (TG), fasting blood glucose (FBG), and reduced HDL-C level to define MetS9-11. A critical component in the pathogenesis of MetS is elevated WC, which is characterized by the accumulation of fat in the visceral region of the abdomen12-14.


WC is recommended by many organizations and professional groups as a criterion to define MetS.


Before suitable cutoff levels are established for use in clinical practice, the International Diabetes Federation (IDF) definition of MetS considers WC to be ethnically specific and strongly advises that more in-depth investigations be carried out15.


The determination of cutoff points for healthy waist circumference (WC) is of chief importance for the prevention and controlling of obesity, metabolic syndrome (MetS), type 2 diabetes mellitus, and coronary heart disease16. WC is widely regarded as the most accurate anthropometric measure of abdominal adiposity17. and is one of the five anthropometric indices for diagnosing obesity18. Additionally, it serves as a more accurate indicator of obesity than the body mass index (BMI). Because BMI alone is not a sufficient biomarker of abdominal adiposity, it falls short of accurately capturing cardiometabolic risk. Waist circumference is a straight forward, standard, and clinically applicable way to measure abdominal adiposity19. The IDF advised using European data for populations in the eastern Mediterranean and Middle East (Arab) until more specific data became available. For Europeans, the cutoff was ≥94cm for males and ≥80 cm for females15. The purpose of this study was to estimate the cutoff level for WC in  healthy university students in Iraq as one of the diagnostic criteria of MetS.



Design and samples:

This cross-sectional study was conducted between October 2021 and February 2022 at Wasit University in Wasit, Iraq. by participant 300 adult university students aged between (18-25) years.


Data collection:

Anthropometric, blood pressure, and biochemical parameters were measured and self-administered standard questionnaires were used to collect the data. Measurements of blood pressure was taken after the participants had rested for at least five minutes. At the level of the heart, the left arm was used to take the measurements. The analysis in each case used the average of two results20. BMI was calculated as weight (kg) divided by height squared (m2). The non-elastic measuring tape was placed halfway between the lower rib margin and the iliac crest, where the WC was measured. To the nearest 0.5cm, it was measured21. 5 mL of blood samples were drawn with the subjects, following an overnight 8-10hr. fast.  The serum was separated within 30minutes (3000rpm, 5minutes) to measure FBG, TG, and HDL-C.


Multiple risk factors were defined in this study as subjects who had two or more of the following four IDF criteria risk factors:

·      Elevated TG level: >150mg/dL (1.7mmol/L);

·      Elevated blood pressure: systolic BP ≥130mmHg or diastolic BP ≥85mmHg;

·      Elevated fasting plasma glucose (FPG) ≥100mg/dL  (5.6mmol/L);

·      Reduced HDL cholesterol: <40mg/dL (0.9mmol/L) in males and <50mg/dL (1.1mmol/L) in females.


Statistical procedure:

The data analysis was done separately for males and females by using SPSS version 25 for windows. The receiver operator characteristic (ROC) curve for WC to predict the presence of two or more risk factors for MetS as defined by IDF was plotted. The WC value was calculated by plotting the true positive rate (sensitivity) against the false-positive rate (1-specificity).



Plotting the ROC curves allowed for the determination of the WC cutoff values in relation to the study of different risk factors in the Iraqi population. Based on ROC curve analysis, the WC value for predicting metabolic risk factors—the best combination of sensitivity and specificity for identifying subjects with multiple risk factors—was determined. The cutoff level yielding maximum sensitivity and specificity for predicting the presence of multiple risk factors was 82.5 cm in female (sensitivity 65%, specificity 70%) (Fig. 1) and 91cm in males (sensitivity 50%, specificity 75%) (Fig. 2) (table 1).


Table 1: ROC curve results for waist circumference of the participant for both genders.


cutoff values cm)


Sensitivity (%)

Specificity (100%)

Waist circumference in male





Waist circumference in female






Fig 1. ROC curve for cut-off value of waist circumference for females.


Fig 2. ROC curve for cut-off value of waist circumference for males.



The IDF determined that the presence of central obesity plus any two of the following four factors is required for the diagnosis of MetS: increased TG level, decreased HDL cholesterol, increased blood pressure, increased FBG (or prior type 2 diabetes)15.


The IDF proposed that the diagnosis of MetS must include central obesity as measured by WC cutoff values specific to ethnicity and gender22. A key aspect of the IDF definition is that central obesity is an important element of MetS and should have an ethnically specific value.


In Iraq, the study associating a cutoff point for WC with increased risk of cardiovascular disease suggested values was 97cm for males and 99cm for females23. Another study in Iraq's Erbil city determined the cutoff point to be 94.7cm for males and 97 cm for females24. While in this study, the cutoff point in Wasit, Iraq for healthy university students was near to IDF cutoff point at 82.5cm for females and 91cm for males. This data will allow us to study the prevalence of MetS in Iraq with far greater accuracy.


Several studies that have been carried out in Middle East countries showed that the cutoff values of waist circumference of the participant for both genders25-30 (Table 2). Regarding to the finding of these studies, Middle East countries are likely to obtain special criteria for diagnosing metabolic syndrome and optimal cut-off value for WC in more in accordance with the population in this region.


Table 2: Cutoff values of waist circumference of the participant for both genders.


Cutoff point for male

Cutoff point for female


83 cm

93 cm


85 cm

85 cm

Iran 27

91 cm

89 cm


100.5 cm

96.25 cm

Omani Arabs29

80 cm

84.5 cm


102 cm

94 cm




97 cm

94.7 cm

91 cm

99 cm

97 cm

82.5 cm



As a result, we recommended 82.5 cm for females and 91 cm for males as the ideal WC cutoff point for the diagnosis of MetS in the adult population attending an Iraqi university.



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Received on 17.08.2022           Modified on 12.06.2023

Accepted on 05.12.2023          © RJPT All right reserved

Research J. Pharm. and Tech 2024; 17(1):127-130.

DOI: 10.52711/0974-360X.2024.00020