BACKGROUND: Body mass index (BMI) and waist circumference are highly correlated. One or the other predicts the metabolic syndromes better, depending on characteristic of the population studied, such as age, gender, and ethnicity. We examined the impact of isolated central obesity, isolated BMI elevation, and the combined type of obesity on metabolic disorders, in order to shed lights on the strategy of obesity screening. METHODS: The study subjects were Chinese aged 20 or above residing in Taiwan. Their data were derived from two large- scale studies: the Nutrition and Health Survey in Taiwan (NAHSIT 1993 - 1996) and the Cardiovascular Disease Risk Factor Two-township Study (CVDFACTS, 1994 - 1997). In evaluating the relations between obesity and health risks, the cut- points of BMI (>= 24 kg/m(2) for overweight) and waist circumference (>= 80cm for women and >= 90cm for men) recommended by Department of Health in Taiwan for Taiwanese people were used to define various types of obesity. RESULTS: We found that there was a small but nontrivial proportion (1.7% for men and 4.0% for women) of Taiwanese people for whom BMI was in the normal range but their waist circumferences were above normal. These people were at a higher risk of developing metabolic syndromes than those with isolated BMI elevation. Their risks were close to that of the combined type. CONCLUSIONS: In order to screen out high- risk obese individuals, isolated centrally obese subjects should not be overlooked. Therefore, we recommend to assess waist circumference in parallel to, not just sequential to the measurement of BMI in Chinese.
