Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of diagnostic/screening accuracy studies
PubMed 22106927 · doi:10.1111/j.1467-789X.2011.00952.x
What was done
The authors conducted a systematic review and meta-analysis of studies assessing the discriminatory power of anthropometric indices using receiver operating characteristic (ROC) curves. They compared waist-to-height ratio (WHtR), waist circumference (WC), and body mass index (BMI) for detecting adult cardiometabolic risk factors—specifically hypertension, type-2 diabetes, dyslipidaemia, metabolic syndrome, and general cardiovascular outcomes (CVD)—across multiple nationalities and ethnic groups.
What was found
Across 31 included papers covering more than 300,000 adults, WHtR had significantly greater discriminatory power than BMI. Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P < 0.05) and WHtR improved discrimination by 4% to 5% (P < 0.01). Statistical analysis of within-study differences in area under the curve (AUC) demonstrated that WHtR was significantly superior to WC for diabetes, hypertension, CVD, and all outcomes combined (P < 0.005) in both men and women.
Why it matters
This review provides quantitative evidence that waist-to-height ratio outperforms both standard BMI and waist circumference as an adult cardiometabolic screening tool across diverse ethnic groups.
Limits
The abstract provides relative percentage improvements in discriminatory power and P-values but does not report absolute AUC values, sensitivity, specificity, or specific cutoff thresholds. It also does not separate results by underlying study design (prospective vs. cross-sectional) or detail specific ethnic subgroups.
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.