Waist‐to‐height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta‐analysis
Abstract
Summary: Our aim was to differentiate the screening potential of waist‐to‐height ratio (WHtR) and waist circumference (WC) for adult cardiometabolic risk in people of different nationalities and to compare both with body mass index (BMI). We undertook a systematic review and meta‐analysis of studies that used receiver operating characteristics (ROC) curves for assessing the discriminatory power of anthropometric indices in distinguishing adults with hypertension, type‐2 diabetes, dyslipidaemia, metabolic syndrome and general cardiovascular outcomes (CVD). Thirty one papers met the inclusion criteria. Using data on all outcomes, averaged within study group, WHtR had significantly greater discriminatory power compared with BMI. Compared with BMI, WC improved discrimination of adverse outcomes by 3% ( P < 0.05) and WHtR improved discrimination by 4–5% over BMI ( P < 0.01). Most importantly, statistical analysis of the within‐study difference in AUC showed WHtR to be significantly better than WC for diabetes, hypertension, CVD and all outcomes ( P < 0.005) in men and women. For the first time, robust statistical evidence from studies involving more than 300 000 adults in several ethnic groups, shows the superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in both sexes. Waist‐to‐height ratio should therefore be considered as a screening tool.
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WHtR could be useful for defining abdominal obesity because it is easy to calculate and has a simple cutoff value of ≥0.5.
“WHtR could be useful for defining abdominal obesity because it is easy to calculate and has a simple cutoff value of ≥0.5.29”
From Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents (2022) · cites this paper as [29]
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Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009) · doi:10.1002/9780470743386 · Cited by 14,225 · see citing works
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2020 International Society of Hypertension Global Hypertension Practice Guidelines
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., et al. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.15026 · Cited by 4,132 · see citing works
Ross, R., Neeland, I. J., Yamashita, S., Shai, I., Seidell, J., Magni, P., Santos, R. D., Arsenault, B., Cuevas, A., Hu, F. B., et al. (2020) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0310-7 · Cited by 1,966 · see citing works
Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastreboff, A. M., Nadolsky, K., Pessah-Pollack, R., & Plodkowski, R. (2016) · Endocrine Practice · doi:10.4158/ep161365.gl · Cited by 1,914 · see citing works
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Obesity · doi:10.1002/oby.20461 · Cited by 1,650 · see citing works
2020 International Society of Hypertension global hypertension practice guidelines
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., et al. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002453 · Cited by 1,283 · see citing works
Bray, G. A., Frühbeck, G., Ryan, D. H., & Wilding, J. P. H. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00271-3 · Cited by 1,036 · see citing works
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.10.025 · Cited by 608 · see citing works
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2019) · Endocrine Practice · doi:10.4158/gl-2019-0406 · Cited by 510 · see citing works
A new framework for the diagnosis, staging and management of obesity in adults
Busetto, L., Dicker, D., Frühbeck, G., Halford, J. C. G., Sbraccia, P., Yumuk, V., & Goossens, G. H. (2024) · Nature Medicine · doi:10.1038/s41591-024-03095-3 · Cited by 501 · see citing works
Woolcott, O. O., & Bergman, R. N. (2018) · Scientific Reports · doi:10.1038/s41598-018-29362-1 · Cited by 399 · see citing works
Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., Heinberg, L. J., Kushner, R., Adams, T. D., Shikora, S., et al. (2013) · Endocrine Practice · doi:10.4158/ep12437.gl · Cited by 395 · see citing works
Lam, B. C. C., Koh, G. C. H., Chen, C., Wong, M. T. K., & Fallows, S. J. (2015) · PLOS ONE · doi:10.1371/journal.pone.0122985 · Cited by 338 · see citing works
Favieri, F., Forte, G., & Casagrande, M. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02126 · Cited by 170 · see citing works
Teufel, F., Seiglie, J. A., Geldsetzer, P., Theilmann, M., Marcus, M. E., Ebert, C., Arboleda, W. A. L., Agoudavi, K., Andall-Brereton, G., Aryal, K. K., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00844-8 · Cited by 159 · see citing works
Gortan Cappellari, G., Guillet, C., Poggiogalle, E., Ballesteros Pomar, M. D., Batsis, J. A., Boirie, Y., Breton, I., Frara, S., Genton, L., Gepner, Y., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.02.018 · Cited by 113 · see citing works
Yao, D., Chang, Q., Wu, Q.-J., Gao, S.-Y., Zhao, H., Liu, Y.-S., Jiang, Y.-T., & Zhao, Y.-H. (2020) · Journal of Diabetes Research · doi:10.1155/2020/6303820 · Cited by 106 · see citing works
Body Composition in Asians and Caucasians
Haldar, S., Chia, S. C., & Henry, C. J. (2015) · Advances in Food and Nutrition Research · doi:10.1016/bs.afnr.2015.07.001 · Cited by 100 · see citing works
Woolcott, O. O., & Bergman, R. N. (2020) · International Journal of Obesity · doi:10.1038/s41366-019-0516-8 · Cited by 97 · see citing works
Child Eating Behaviors and Caregiver Feeding Practices in Children with Autism Spectrum Disorders
Kral, T. V. E., Souders, M. C., Tompkins, V. H., Remiker, A. M., Eriksen, W. T., & Pinto‐Martin, J. A. (2015) · Public Health Nursing · doi:10.1111/phn.12146 · Cited by 90 · see citing works
Body composition indices of a load-capacity model: gender- and BMI-specific reference curves
Siervo, M., Prado, C. M., Mire, E., Broyles, S., Wells, J. C., Heymsfield, S., & Katzmarzyk, P. T. (2015) · Public Health Nutrition · doi:10.1017/s1368980014001918 · Cited by 86 · see citing works
Tian, S., Zhang, X., Xu, Y., & Dong, H. (2016) · Medicine · doi:10.1097/md.0000000000004642 · Cited by 85 · see citing works
Waist-to-height ratio index for predicting incidences of hypertension: the ARIRANG study
Choi, J. R., Koh, S. B., & Choi, E. (2018) · BMC Public Health · doi:10.1186/s12889-018-5662-8 · Cited by 77 · see citing works
Pasdar, Y., Moradi, S., Moludi, J., Saiedi, S., Moradinazar, M., Hamzeh, B., Jafarabadi, M. A., & Najafi, F. (2020) · Scientific Reports · doi:10.1038/s41598-020-73224-8 · Cited by 64 · see citing works
Batista-Jorge, G. C., Barcala-Jorge, A. S., Silveira, M. F., Lelis, D. F., Andrade, J. M. O., de Paula, A. M. B., Guimarães, A. L. S., & Santos, S. H. S. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.117962 · Cited by 55 · see citing works
Lechner, K., Lechner, B., Crispin, A., Schwarz, P. E. H., & von Bibra, H. (2021) · Scientific Reports · doi:10.1038/s41598-021-87266-z · Cited by 46 · see citing works
Jamar, G., Almeida, F. R. D., Gagliardi, A., Sobral, M. R., Ping, C. T., Sperandio, E., Romiti, M., Arantes, R., & Dourado, V. Z. (2017) · Sao Paulo Medical Journal · doi:10.1590/1516-3180.2016.0358280417 · Cited by 38 · see citing works
Nederveen, J. P., Mastrolonardo, A. J., Xhuti, D., Di Carlo, A., Manta, K., Fuda, M. R., & Tarnopolsky, M. A. (2023) · Nutrients · doi:10.3390/nu15173693 · Cited by 33 · see citing works
Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents
Lee, J., Kang, S.-C., Kwon, O., Hwang, S.-S., Moon, J. S., & Kim, J. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes22033 · Cited by 33 · see citing works
Chang, J. S., Kim, T. H., Kim, H., Choi, E. H., Kim, N., & Kong, I. D. (2017) · Geriatrics & Gerontology International · doi:10.1111/ggi.12681 · Cited by 21 · see citing works
Eng, P. C., Teo, A. E. D., Leow, M. K. S., Tai, E. S., & Khoo, C. M. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.16601 · Cited by 22 · see citing works
Al-Hussaini, I., Nakajima An, D., Lee, A. J., Bi, S., & Mitchell, C. S. (2022) · 2022 IEEE International Conference on Big Data (Big Data) · doi:10.1109/bigdata55660.2022.10020807 · Cited by 10 · see citing works
- Authors
- Ashwell, M., Gunn, P., & Gibson, S.
- Affiliations
- Oxford Brookes University (GB)
- Corresponding author
- Ashwell, M.
- Venue
- Obesity Reviews
- Publisher
- Wiley
- Published
- 2011-11-23
- Volume
- 13
- Issue
- 3
- Pages
- 275-286
- ISSN
- 1467-7881 (ISSN-L)
- 1467-789X
- OpenAlex
- W1574715084
- Cited by
- 2,130
- References
- 1
- Citations by year
- 2026: 214 · 2025: 222 · 2024: 179 · 2023: 179 · 2022: 161 · 2021: 161 · 2020: 189 · 2019: 143 · 2018: 133 · 2017: 113 · 2016: 139 · 2015: 103 · 2014: 97 · 2013: 72 · 2012: 21
- FWCI
- 8.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Reviews (publishedVersion)
- PubMed (publishedVersion)
- Open Research (University of Surrey) (submittedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- 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
- waist-to-height ratio, waist circumference, body mass index, cardiometabolic risk, cardiovascular risk screening, hypertension, type 2 diabetes, dyslipidemia, metabolic syndrome, cardiovascular outcomes, anthropometric indices, ethnic differences, sex differences
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Body Height, Cardiovascular Diseases, Female, Humans, Male, Mass Screening, Middle Aged, Obesity, ROC Curve, Body Mass Index, Waist Circumference, Young Adult
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