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Background  The aim of this study was to identify corresponding body mass index (BMI) and waist circumference cut-offs for equivalent levels of insulin sensitivity in a Middle Eastern immigrant population compared with native Swedes.    Methods  Citizens of Malmö, Sweden aged 30 to 75 years, who were born in Iraq or Sweden, were in 2010–2012 invited to participate in a health examination including anthropometrics, oral glucose tolerance test, fasting samples and interviews concerning sociodemographic factors and lifestyle behaviours.    Results  In total, 1176 individuals born in Iraq and 688 born in Sweden, without previously diagnosed type 2 diabetes, participated in the study. In normal weight participants (BMI < 25 kg/m 2 ), 21.2% of Iraqis vs 9.3% of Swedes were insulin resistant. Corresponding figures in participants without abdominal obesity (waist circumference, men < 94 cm, women < 80 cm) were 28.2% of Iraqis vs 9.4% of Swedes.  The age-adjusted insulin sensitivity index (ISI) for obese Swedes (BMI 30 kg/m 2 ) corresponded in Iraqi men with BMI of 28.5 kg/m 2 , and in Iraqi women with BMI of 27.5 kg/m 2 . The ISI level in abdominally obese Swedes corresponded with waist circumference cut-offs of 84.0 cm and 71.0 cm in Iraqi men and women, respectively.  In men only, larger waist circumference ( P   interaction  = 0.026) presented a stronger association with impaired ISI in Iraqis as compared to Swedes.    Conclusions  Our data shows that the impact of BMI and waist circumference on ISI is ethnic- and gender-specific, indicating a disturbed fat metabolism in Iraqi males in particular. Our data suggests that 10 cm lower cut-off values for abdominal obesity, than is currently recommended by major organisations, should be considered when estimating diabetes risk in Middle Eastern populations.    Electronic supplementary material  The online version of this article (doi:10.1186/s12889-016-3892-1) contains supplementary material, which is available to authorized users.

bmc public health

BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study