Annals of Nutrition & Food Science

Editorial
Published: 11 Jun, 2018

Waist Circumference in the Diagnosis of Metabolic Syndrome
Debate and Solution
Shaw Watanabe*
Asia Pacific Clinical Nutrition Society and Life Science Promoting Association, Japan

Editorial
In response to increasing rates of obesity and associated chronic disease, Japan has implemented
several policies, guidelines and programs [1]. Kenko Nippon 21 (Health Japan 21) began in 2000,
followed by the Shokuiku (eating education) Basic Law which was passed in 2005. Subsequently,
in 2008, the government launched a special health check-up (tokuteikenkoshinsa), involving
measurement of Waist Circumference (WC) and nutrition counseling to reduce metabolic
syndrome.

Concept of Metabolic Syndrome
The concept of metabolic syndrome was proposed by several committees, although there had
considerable disagreement over the definition and diagnostic criteria. The use of the definitions
to conduct research into the metabolic syndrome resulted in wide ranging prevalence rates,inconsistencies and confusion, and spurred on the vigorous debate regarding how the metabolic
syndrome should be defined [2-4].
The first definition of criteria referring to abdominal obesity was proposed by the National
Cholesterol Education Program Adult Treatment (ATPIII) in 2001. ATPIII adopted abdominalobesity estimated by the Waist Circumference (WC) rather than by Body Mass Index (BMI) inaddition to hypertriglyceridemia, low HDL-cholesterol, high blood pressure, and hyperglycemia.

OPEN ACCESS*Correspondence:
Shaw Watanabe, Asia Pacific ClinicalNutrition Society and Life Science
Promoting Association, Japan,
E-mail: watashaw@lifescience.or.jp
Received Date: 07 May 2018
Accepted Date: 29 May 2018
Published Date: 11 Jun 2018
Citation:
Watanabe S. ISSN: Waist
Circumference in the Diagnosis of
Metabolic Syndrome: Debate andSolution. Ann Nutr Food Sci. 2018; 2(3):1022.
Copyright © 2018 Shaw Watanabe.
This is an open access article
distributed under the Creative
Commons Attribution License, which
permits unrestricted use, distribution,and reproduction in any medium,provided the original work is properly
cited.

Remedy Publications LLC.

In 2005, the International Diabetes Foundation (IDF) reported a new diagnostic criterion of
metabolic syndrome, making abdominal obesity an essential factor required in the diagnosis [5].
The representatives of the IDF, the International Atherosclerosis Society, and the American Heart
Association/National Heart, Lung and Blood Institute agreed that abdominal obesity should not bea prerequisite for the diagnosis, requiring the present of any three of five factors. They also suggested
that abdominal obesity should be defined based on the national cutoff point of each country [1,3].
Most countries accept the criteria of IDF, but in China, central obesity is defined as WC >90 cm
for men and >80 cm to >85 cm for women. It may cause over diagnosis for women and underdiagnosis for men.
Controversies on the significance and cutoff point of WC may have arisen from amisunderstanding of the purpose and the significance of the measurement of WC [4]. So far,visceral adiposity measured by CT scan is a golden standard, and it fit to the pathophysiology ofmetabolic syndrome.
As developing countries are simultaneously facing increasing obesity and lifestyle diseases,
collaboration in research and programs is urgently needed to prevent disease through dietaryintervention [6].

Intervention of Metabolic Syndrome to Show Plausible WC

Matsuzawa [3] accumulated data of abdominal CT scan in relationship to adiposity anddiseases, and the Japanese committee adopted a cutoff point of 100 cm2 of visceral fat area for both
men and women, because the risk of metabolic syndrome increased over this point in both men andwomen simultaneously. WC that corresponded to visceral fat of 100 cm2 was 85 cm in men and 90
cm in women. The cutoff point in Japan was the only one that was based upon visceral fat area forthe prevalence of diseases. The first nationwide lifestyle intervention program to improve the risk
factors for metabolic syndrome in healthy adults was recently reported by Tushita et al. [7].
They used the registry of Specific Health Checkups and Specific Health Guidance focusing
on metabolic syndrome in middle aged adults, 40 years to 74 years of age, beginning in 2008
with follow-up period of 3 years. Number of participants to the program was 31,790 and non-1

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Shaw Watanabe

Annals of Nutrition & Food Science

participated controls were 189,726. Body weight reduction was 1.98
kg (participants) and 0.42 kg (non-participants), and WC reduction
was 2.34 cm in men and 2.98 cm in women by the intervention, whileamong controls it was unchanged for 3 years [7].

Widespread adoption and utilization of this food icon by foodproducers, suppliers and consumers will support people who want tocontrol body weight [17].

References

It could be conclusive that the WC of Japanese criteria isappropriate avoiding both over diagnosis and under diagnosis. WC
reflects both visceral fat and subcutaneous fat of the abdominal wall,
so women in middle life usually have more subcutaneous fat thanvisceral fat. Similar distribution is found among sumou wrestlers.

1. Tsugane S, Sasaki S, Tsubono Y. Under- and overweight impact onmortality among middle-aged Japanese men and women: A 10-y follow-upof JPHC study cohort I. Int J Obes Relat Metab Disord. 2002;26(4):529-37.
2. Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The Metabolic
Syndrome: A Global Public Health Problem and a New Definition. JAtherosclerosis Thromb. 2005;12:295-300.

We also confirmed the WC of 85 cm for men and 90 cm for
women was fit to 100 cm2 visceral fat areas by CT scan in the SCOP
study, and intervention to improve obesity was associated with theincrease of adiponectin and decrease of leptin [8-10]. The inverse
relationship of leptin and adiponectin during successful intervention
supported the central role of abdominal fat in metabolic syndrome[11].

3. Matsuzawa Y. Pathophysiology and molecular mechanisms of visceral fat
syndrome: the Japanese experience. Diabetes Metab Rev. 1997;13:3-13.
4. Examination Committee of Criteria for 'Obesity Disease' in Japan; Japan
Society for the Study of Obesity. New criteria for ‘obesity disease’ in Japan.
Cir J. 2002;66(11):987-92.
5. The IDF consensus worldwide definition of the metablolic syndrome.
Volume 2005. International Diabetes Federation. 2005.

Dietary Intervention to Solve MetabolicSyndrome

6. Melby MK, Utsugi M, Miyosh M, Watanabe S. Overview of nutritionreference and dietary recommendations in Japan: Application to nutrition
policy in Asian countries. Asia Pacific J Clin Nutr. 2008;17(2):S394-8.

Since the seven countries study, several dietary habits arerecommended. Japanese cuisine is one of good example. Unpolishedbrown rice contains various functional ingredients, and it could becalled “medical rice” for preventing various diseases [12].

7. Tsushita K, Hosler AS, Miura K, Ito Y, Fukuda T, Kitamura A, et al.
Rationale and descriptive analysis of specific health guidance: theNationwide lifestyle intervention program targeting metabolic syndromein Japan. J Atheroscler Thromb. 2018;25(4):308-22.

Obesity is given to one of big causes of type 2 diabetes; TheJapanese risk of diabetes from obesity is several times higher thanthat of Western white [13]. At BMI 30, prevalence of diabetes among
Caucasians was only 8%, while it is almost 25% among Japanese.

8. Watanabe S, Morita A, Aiba N, Miyachi M, Sasaki S, Masahiko Noda, et al.
Study design of the SAKU Control Obesity Program (SCOP). Anti-aging
Med. 2007;4:70-71.
9. Nakade M, Aiba N, Suda N, Morita A, Miyachi M, Sasaki S, et al. Behavioral
change during weight loss program and one-year follow-up: Saku Control
Obesity Program (SCOP) in Japan. Asia Pac J Clin Nutr. 2012;21(1):22-34.

To reduce the incidence of diabetes, it becomes important
to control the obesity. We started the Genki Study (genmaiepidemiology and nutrition kenko innovation) to find the healtheffects of unpolished brown rice [14]. Baseline analysis showed thatbrown rice eaters are very healthy, and the odds ratio of drug use
such as diabetes, hypertension, hyperlipidemia and angina was 0.2 to
0.3. On the contrary, obese people had diabetes, hypertension, gout,
hyperlipidemia with the odds ratio of 2-3 times. Brown rice eating is abasis of healthy dietary habit to cause wellness [15,16].

Tailor Made Nutrition:
Metabolic Syndrome

Solution

10. Nakade M, Aiba N, Morita A, Miyachi M, Sasaki S, Watanabe S, et al.
What behaviors are important for successful weight maintenance? J Obes.
2012;2012:202037.
11. Kawashima N, Watanabe S, Morita A, Aiba N, Miyachi M, Sakai T, et al.
Changes of fat volume and adipocytokines by the randomized intervention
program for obesity control program (SCOP). Diabetes Res Open J.
2015;1(5):136-46.

for12. Watanabe S, Hirakawa A, Nishijima C, Otsubo K, Nakamura K, Shigeru
Beppu, et al. Food as medicine: The new concept of “medical rice”. Adv
Food Technol Nutr Sci Open J. 2016;2(2):38-50.

Control of energy intake is essential to maintain healthy bodyweight. However, the units of kcal or MJ are not easily used or
measured in daily life. Serving size or portion size is used in many
food guidelines, but these do not provide quantitatively accurate bases
for consumption. Use of a new energy unit (1E-Unit=80 kcal) leads
to a simple equation where the necessary energy units=body weight(kg) x 0.4 for daily intake throughout most of adult life including bothsexes, the elderly and even pregnant women. For example, a 60 kgman needs 24 E-units, so 8 E-units can be eaten at breakfast, lunchand dinner. For growing children, the coefficient is modified from 1to 0.4 for body weight ranges starting at 10 kg and going up to 60 kg.

13. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, etal. Global, regional and national prevalence of overweight and obesity inchildren and adults during 1980-2013: A systematic analysis for the Global
Burden of Disease Study 2013. Lancet. 2014;384(9945):766-81.
14. Watanabe S, Mizuno S, Hirakawa A. Effects of Brown Rice on Obesity:
GENKI Study I (Cross Sectional Epidemiological Study). J Obes Chronic
Dis. 2018; 2(1):12-19.
15. Watanabe S. Evidence of Brown Rice for Health. Kirajenne, Tokyo, Japan.
2015.
16. Shimabukuro M, Higa M, Kinjo R, Yamakawa K, Tanaka H, Kozuka C,
et al. Effects of the brown rice diet on visceral obesity and endothelial
function: the BRAVO study. Br J Nutr. 2014;111(2):310-20.

The Comprehensive Food Icon (FI) includes information about
energy units, balance of major nutrients and Antioxidant Units(AOU) as a surrogate marker of vegetables and fruits.

Remedy Publications LLC.

17. Hirakawa A, Melby MK, Watanabe S. Comprehensive Food Labeling for
Obesity Control. Adv Obes Weight Manag Control. 2016; 4(3):00088.

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