To the Editor.—
In the report by Hiramatsu et al1 describing a method of screening and monitoring patients with Cushing's syndrome on the basis of circumference measurements, the authors state that "a simple evaluation technique for central obesity has not been reported previously." However, several methods of measuring central or android obesity, similar to their central obesity index (COI), have been published.2-4 For example, Hartz and colleagues2 used the ratio of waist girth to hip girth (WHR) as an index of central obesity in their study of body fat distribution and diabetes in 15,532 women. This study by Hartz et al and other studies of body fat distribution and disease,3,5 suggested that an altered fat distribution may contribute to diabetes, whereas in Cushing's syndrome, fat distribution seems to be influenced by the disease.In addition, the suggestion by Hiramatsu et al that their COI be used
Lanska DJ, Hartz AJ, Lanska MJ, Rimm AA. Screening for Cushing's Syndrome. JAMA. 1984;252(3):344. doi:10.1001/jama.1984.03350030018010
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