Prescreening tools for diabetes and obesityassociated dyslipidaemia: comparing BMI, waist and waist hip ratio. The DESIR Study

Objective: To compare the sensitivities of BMI, waist circumference and waist hip ratio (WHR) in identifying subjects who should be screened for diabetes and/or for obesity-associated dyslipidaemia. Design: Cross-sectional study. Setting: Central-western France. Participants: More than 3000 men and women, aged 40 - 64 years, from the French study: data from an epidemiological study on the insulin resistance syndrome ( D. E. S. I. R.). Main outcome measures: Sensitivity and specificity for screened diabetes ( fasting plasma glucose >= 7.0 mmol/l) and screened dyslipidaemia (triglycerides >= 2.3 mmol/l and/or HDL-cholesterol <0.9/1.1 mmol/l ( men/women)) according to BMI, waist circumference and WHR. Results: Sensitivities increased as more corpulent subjects were screened, but they increased slowly after screening the top 30%: body mass index ( BMI) >= 27/26 kg/ m(2) (men/women) or waist >= 96/83 cm or WHR >= 0.96/0.83. These values were chosen as thresholds. In men, BMI had a nonsignificantly higher sensitivity than waist or WHR for both diabetes and dyslipidaemia (77 vs 74 and 66% P<0.3, 0.09; 56 vs 54 and 49% P<0.5, 0.16). For women, waist had a slightly higher sensitivity than BMI or WHR ( 82 vs 77 and 77% P<0.8, 0.7) for diabetes; for dyslipidaemia, waist and WHR had similar sensitivities, higher than for BMI ( 65 and 67 vs 54% P<0.16, 0.13). Conclusions: We propose that for screening in a French population 40 - 64 years of age, the more obese 30% of the population, identified either by BMI, waist or WHR be screened for diabetes and obesity-associated dyslipidaemia.