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.
Level 2 - randomized trial
Systematic review composed of prospective and cross-sectional observational studies.
PubMed 20819243 · doi:10.1017/S0954422410000144
What was done
A systematic review evaluated 78 studies published in English between 1950 and 2008 examining waist-to-height ratio (WHtR), waist circumference (WC), and BMI as predictors of diabetes and cardiovascular disease. The review synthesized 22 prospective analyses, 44 cross-sectional adult analyses, and 13 cross-sectional child analyses from 14 countries covering Caucasian, Asian, and Central American populations.
What was found
WHtR and WC predicted diabetes and cardiovascular disease more frequently than BMI with similar odds ratios, sometimes remaining significant after adjusting for BMI. Receiver operator characteristic analysis demonstrated mean AUROC values of 0.704 for WHtR, 0.693 for WC, and 0.671 for BMI. Mean boundary values for WHtR across all cardiometabolic outcomes were 0.50 for men and 0.50 for women.
Why it matters
The findings support using waist-to-height ratio as a universal screening metric that outperforms BMI for cardiometabolic risk across diverse global populations, supporting the public health guidance to keep waist circumference below half of height.
Limits
The review did not conduct a formal quantitative meta-analysis to evaluate heterogeneity or pooled effect sizes. Included studies were restricted to English-language publications, and the majority of evidence came from cross-sectional designs rather than prospective cohorts.
Cited by
- supports A person's waist circumference should measure less than half of their height.
- supports Having a waist circumference less than half your height is a recognized screening measure for good metabolic health.