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SA JOURNAL OF DIABETES & VASCULAR DISEASE
RESEARCH ARTICLE
VOLUME 14 NUMBER 2 • DECEMBER 2017
47
off points for WC (98 cm in men; 85 cm in women) that correspond
to a BMI of 30 kg/m
2
. Europid WC cut-off points (≥ 80 cm in women;
≥ 94 cm in men), as recommended by the IDF9 and currently used
in sub-Saharan Africa to define central obesity do not appear to
correlate with BMI ≥ 30 kg/m
2
in Botswana. Elsewhere, there is a
strong correlation between BMI of 25–34.9 kg/m
2
, WC ≥ 102 cm
for men and ≥ 88 cm for women, and greater risk of hypertension,
type 2 diabetes, dyslipidaemia and coronary heart disease.
20
Western countries derived cut-off values of WC from
correlation with BMI, whereas Asians tried to define WC cut-off
values produced by receiver-operating characteristics (ROC) curve
analysis.
21,22
Measurements of skinfold thickness are less accurate,
particularly in obese individuals and are therefore discouraged
in routine screening exercises, except in epidemiological studies.
Precise measurements of body fat using computed tomography
(CT) or magnetic resonance imaging (MRI) scans or biochemical
barometers such as adipokines are unlikely to be used outside
research settings in Botswana. However, measurement of fasting
insulin and glucose levels may help in the calculation of HOMA-IR
in individuals with features of insulin resistance syndromes.
In the Diabetes and Macrovascular Complications study of
258 adult diabetic patients in Botswana,
1
the MetS defined using
IDF criteria
9
was more prevalent in diabetic women compared to
diabetic men. Depending on which set of parameters in the IDF
criteria was used for the definition, the prevalence of the MetS
ranged from 41.7–83.7% in men, and 37.8–88.6% in women.
Obesity, defined by waist:hip ratio (> 0.9 in men, > 0.85 in women)
was present in 87.9% of diabetics, and by WC (> 94 cm men, > 80
cm in women) in 79.0% of diabetics, but prevalence of the MetS
dropped to 38.3% using BMI (> 30 kg/m
2
). Large disparities in
estimates of the MetS based on different parameters complicated
its true prevalence estimates in that study. BMI was viewed as an
insensitive indicator of the MetS, especially in diabetic women.
Garrido
et al.
2
conducted a small cross-sectional, observational
study of 150 hospital workers at a peripheral facility in Botswana,
representing nearly half of the hospital workforce, women
comprising over 70% of the group. The investigators applied any
three or more of the ATP III criteria for definition of the MetS.
23
Low high-density lipoprotein (HDL) cholesterol affected 80% of the
group, dysglycaemia 73.3%, hypertension 44%, central obesity
42% and hypertriglyceridaemia 14%. A third of the participants
met the ATP III criteria for the MetS and 28.7% had a BMI > 30
kg/m
2
. That over 40% of hospital employees had central obesity,
using higher cut-off points for WC raises the possibility of a high
prevalence of abdominal obesity in the community.
Another cross-sectional study by Malangu
3
looked at 190
adult HIV-infected patients on highly active antiretroviral therapy
(HAART) at Princess Marina Hospital in Gaborone in 2010. Their
mean age was 42 ± 9.04 years and nearly threequarters of the
group were women (74.2%). Using IDF criteria, the investigator
showed an overall prevalence of the MetS in 11.1% of participants.
Risk factors for the MetS included increased age, male gender
Table 1.
Relative risks of hypertension, dysglycaemia and
dyslipidaemia for different BMI categories versus normal weight
(BMI < 25 kg/m
2
) among 418 patients
(1) Hypertension, (2) dysglycaemia,
(3) dyslipidaemia
WHO BMI category (kg/m
2
) Relative risk 95% CI
p
-value
Overweight (25–29.9)
(1) 0.99
(0.78–1.27)
0.95
(2) 0.94
(0.61–1.45)
0.78
(3) 1.24
(0.79–1.96)
0.36
Grade I (30–34.9)
(1) 1.09
(0.87–1.38)
0.45
(2) 0.88
(0.57–1.36)
0.57
(3) 1.24
(0.79–1.95)
0.36
Grade II (35–39.9)
(1) 1.12
(0.88–1.43)
0.45
(2) 1.01
(0.65–1.59)
0.95
(3) 1.07
(0.66–1.74)
0.77
Grade III (> 40)
(1) 1.06
(0.82–1.38)
0.64
(2) 1.02
(0.64–1.62)
0.94
(3) 1.23
(0.76–1.98)
0.40
WHO, World Health Organisation; BMI, body mass index.
Table 2.
Relative risks of any cardiovascular disease for different
waist circumference categories versus current reference waist
circumferences (< 80 cm in women; < 94 cm in men)
Any CVD relative risk
Waist circumference
category (cm)
Relative risk
95% CI
p
-value
Category 2
Men (94–101.9)
1.04
(0.91–1.18)
0.61
Women (80–87.9)
1.15
(0.84–1.59)
0.39
Category 3
Men (> 102)
1.10
(0.99–1.22)
0.08
Women (> 88)
1.17
(0.86–1.58)
0.32
CVD, cardiovascular disease refers to hypertension, dysglycaemia and dysli-
pidaemia.
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