Prescreening tools for diabetes and obesity-associated dyslipidaemia: comparing BMI, waist and waist hip ratio. The D.E.S.I.R. 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/m2 (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.