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Index of Central Obesity (ICO) is the ratio of waist circumference and height first proposed by a Parikh et al. in 2007   as a better substitute to the widely used waist circumference in defining metabolic syndrome .  The National Cholesterol Education Program Adult Treatment Panel III suggested cut off of 102 cm (40 in) and 88 cm (35 in) for males and females as a marker of central obesity.  The same was used in defining metabolic syndrome .  Misra et al. suggested that these cutoffs are not applicable among Indians and the cutoffs be lowered to 90 cm (35 in) and 80 cm (31 in) for males and females.  Various race specific cutoffs were suggested by different groups. [ citation needed ] The International Diabetes Federation defined central obesity based on these various race and gender specific cutoffs.  The other limitation of waist circumference is that it can not be applied in children. [ dubious – discuss ]