Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis
Open accessAbstract
Objective To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors. Study design and setting This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area under the ROC curves (AUC) for overweight and obesity indices with hypertension, type-2 diabetes, and/or dyslipidemia were included. The AUC for each of the four indices, with each risk factor, was pooled using a random-effects model; male and female data were analyzed separately. Results Ten studies met the inclusion criteria. Body mass index (BMI) was the poorest discriminator for cardiovascular risk factors. Waist-to-height ratio (WHtR) was the best discriminator for hypertension, diabetes, and dyslipidemia in both sexes; its pooled AUC (95% confidence intervals) ranged from 0.67 (0.64, 0.69) to 0.73 (0.70, 0.75) and from 0.68 (0.63, 0.72) to 0.76 (0.70, 0.81) in males and females, respectively. Conclusion Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women.
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Body mass index does not take into account the distribution of body fat, limiting its representation of abdominal adiposity.
“since BMI does not take into account the distribution of body fat, it has limitations in representing abdominal adiposity, which is an important aspect of body composition that would be linked to metabolic diseases [4].”
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- Authors
- Lee, C. M. Y., Huxley, R. R., Wildman, R. P., & Woodward, M.
- Affiliations
- The University of Sydney (AU)
- Albert Einstein College of Medicine (US)
- Mount Sinai Hospital (US)
- Corresponding author
- Lee, Crystal Man Ying
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 61
- Issue
- 7
- Pages
- 646-653
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2018503115
- Cited by
- 1,173
- References
- 1
- Citations by year
- 2026: 38 · 2025: 64 · 2024: 55 · 2023: 57 · 2022: 73 · 2021: 78 · 2020: 77 · 2019: 82 · 2018: 73 · 2017: 71 · 2016: 79 · 2015: 84 · 2014: 76 · 2013: 69 · 2012: 60
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- eSpace (Curtin University) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- abdominal obesity, waist-to-height ratio, body mass index, cardiovascular risk factors, hypertension, type 2 diabetes, dyslipidemia, obesity indices, diagnostic accuracy
- MeSH terms
- Body Composition, Body Height, Body Weight, Cardiovascular Diseases, Female, Humans, Male, Obesity, Risk Factors, ROC Curve, Body Mass Index, Abdominal Fat
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