A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value
Open Access
- 7 September 2010
- journal article
- review article
- Published by Cambridge University Press (CUP) in Nutrition Research Reviews
- Vol. 23 (2), 247-269
- https://doi.org/10.1017/s0954422410000144
Abstract
This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from cross-sectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being stronger than, and independent of, BMI. To make firmer statistical comparison, a meta-analysis is required. The AUROC analyses indicate that WHtR may be a more useful global clinical screening tool than WC, with a weighted mean boundary value of 0·5, supporting the simple public health message ‘keep your waist circumference to less than half your height’.Keywords
This publication has 100 references indexed in Scilit:
- The Predictive Value of Different Measures of Obesity for Incident Cardiovascular Events and MortalityJournal of Clinical Endocrinology & Metabolism, 2010
- Harmonizing the Metabolic SyndromeCirculation, 2009
- General and Abdominal Adiposity and Risk of Stroke in Chinese WomenStroke, 2009
- Abdominal obesity and the prevalence of diabetes and intermediate hyperglycaemia in Chinese adultsPublic Health Nutrition, 2009
- Prediction of Type 2 Diabetes Using Alternate Anthropometric Measures in a Multi-Ethnic CohortDiabetes Care, 2009
- Measures of Obesity and Cardiovascular Risk Among Men and WomenJournal of the American College of Cardiology, 2008
- Cardiovascular risk factor levels and their relationships with overweight and fat distribution in children: The Fleurbaix Laventie Ville Santé II studyMetabolism, 2007
- Relationship of Body Size and Shape to the Development of Diabetes in the Diabetes Prevention ProgramObesity, 2006
- A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youthThe Journal of Pediatrics, 2005
- Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and womenInternational Journal of Obesity, 2003