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Do current guidelines for waist circumference apply to black Africans? Prediction of insulin resistance by waist circumference among Africans living in America
  1. J Damascene Kabakambira1,2,
  2. Rafeal L Baker Jr1,
  3. Sara M Briker1,
  4. Amber B Courville3,
  5. Lilian S Mabundo1,
  6. Christopher W DuBose1,
  7. Stephanie T Chung1,
  8. Robert H Eckel4,
  9. Anne E Sumner1,2
  1. 1 Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
  2. 2 National Institute of Minority Health and Health Disparities, Bethesda, Maryland, USA
  3. 3 Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
  4. 4 University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  1. Correspondence to Dr Anne E Sumner; annes{at}


Background To lower the risk of diabetes and heart disease in Africa, identification of African-centred thresholds for inexpensive biomarkers of insulin resistance (IR) is essential. The waist circumference (WC) thresholds that predicts IR in African men and women have not been established, but investigations recently conducted in Africa using indirect measures of IR suggest IR is predicted by WC of 80–95 cm in men and 90–99 cm in women. These WC cannot be used for guidelines until validated by direct measurements of IR and visceral adipose tissue (VAT). Therefore, we determined in a group of African-born black people living in America (A) the WC, which predicts IR and (B) the influence of abdominal fat distribution on IR.

Methods The 375 participants (age 38±10  years (mean±SD), 67% men) had IR determined by HOMA-IR and Matsuda index. VAT and subcutaneous adipose tissue (SAT) were measured by abdominal CT scans. Optimal WC for the prediction of IR was determined in sex-specific analyses by area under the receiver operating characteristic (AUC-ROC) and Youden index.

Results Women had more SAT (203±114 vs 128±74  cm2) and less VAT than men (63±48 vs 117±72  cm2, p<0.001). Optimal WC for prediction of IR in men and women were: 91 cm (AUC-ROC: 0.80±0.03 (mean±SE)) and 96 cm (AUC-ROC: 0.81±0.08), respectively. Regression analyses revealed a significant sex–VAT interaction (p<0.001). Therefore, for every unit increase in VAT, women had a 0.94 higher unit increase in SAT and 0.07 higher unit increase in WC than men.

Conclusion Working with a group of African-born black people living in America, we accessed technology, which validated observations made in Africa. Higher SAT at every level of VAT explained why the WC that predicted IR was higher in women (96 cm) than men (91 cm). For Africans to benefit from WC measurements, convening a panel of experts to develop evidence-based African-centred WC guidelines may be the way forward.

  • waist circumference
  • insulin resistance
  • Africans
  • visceral adiposity

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  • JDK and RLB are joint first authors.

  • JDK and RLB contributed equally.

  • Handling editor Seye Abimbola

  • Contributors JDK, RLB, RHE and AES did the literature search. ABC and AES designed the study. JDK, RLB, SMB, LSM, CWD, STC and AES contributed to enrolment. JDK, RLB, SMB, ABC, LSM, CWD, STC and AES collected the data. JDK, RLB, SMB, ABC, LSM, CWD, STC and AES analysed the data. JDK and AES made the figures. JDK, RLB and AES made the tables. JDK, RLB, SMB, ABC, LSM, CWD, STC, RHE and AES wrote the manuscript and JDK, RLB, SMB, ABC, LSM, CWD, STC, RHE and AES provided critical rewrites of the manuscript.

  • Funding The study was funded by the intramural research program of two NIH institutes: NIDDK, NIMHD and the NIH Clinical Center. JDK and AES are supported by the intramural programs of both NIDDK and NIMHD. RLB, SMB, CWB, LSM and STC are supported by the intramural programme of NIDDK. ABC is supported by the NIH Clinical Center.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval NIDDK Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We do not refer to any unpublished data.

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