Visceral obesity in Japanese patients with metabolic syndrome: Reappraisal of diagnostic criteria by CT scan

To reappraise the cutoff level of abdominal circumference (AC) for diagnosis of visceral obesity in Japanese, we examined the association of visceral fat deposition with other constituents of metabolic syndrome and atherosclerotic cardiovascular disease (ASCD). CT was used for determination of visceral-fat area (VFA), subcutaneous-fat area (SFA) and AC on CT (AC(CT)) in 420 Japanese patients with (n=180) or without ASCD (n=240). VFA cutoff levels were calculated by receiver operating characteristic (ROC) analysis. AC(CT) correlated with VFA (r=0.828), SFA (r=0.795), and AC measured with an anthropometric tape (AC(M), r=0.96). The VFA cutoff levels yielding the maximum sensitivity and specificity to predict two or more components of metabolic syndrome were 92 cm(2) in males and 63 cm(2) in females, which correspond to AC(M) values of 83 cm and 78 cm, respectively. The male AC(M) cutoff level was similar to the AC in current Japanese criteria (85 cm), but the female AC(M) cutoff level was considerably smaller than the criteria, and this change in cutoff level increased the prevalence of metabolic syndrome in females three-fold. The cutoff levels of VFA for predicting presence of ASCD were 98 cm(2) in males and 75 cm(2) in females, corresponding to AC(M) values of 84 cm and 80 cm, respectively. The present results obtained by CT support the validity of the current Japanese criteria for visceral obesity in males but not in females. AC(M) of 78 cm appears to be a cutoff level suitable for diagnosing visceral obesity in Japanese females, though further confirmation is needed.