Waist‐to‐height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta‐analysis

  title={Waist‐to‐height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta‐analysis},
  author={Margaret Ashwell and P. Gunn and Sigrid Gibson},
  journal={Obesity Reviews},
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… 
Waist‐to‐height ratio, body mass index and waist circumference for screening paediatric cardio‐metabolic risk factors: a meta‐analysis
Although not being superior in discriminatory power, WHtR is convenient in terms of measurement and interpretation, which is advantageous in practice and allows for the quick identification of children with cardio‐metabolic risk factors at an early age.
Comparison of Body Mass Index, Waist Circumference, and Waist-to-Height Ratio for Predicting the Clustering of Cardiometabolic Risk Factors by Age in Japanese Workers
The screening performance of WHtR for detecting the clustering cardiometabolic risk factors was not superior to that of BMI for age in a large-scale multicenter study of Japanese workers.
Comparison of body mass index, waist circumference, and waist-to-height ratio for predicting the clustering of cardiometabolic risk factors by age in Japanese workers--Japan Epidemiology Collaboration on Occupational Health study.
  • A. Hori, A. Nanri, S. Dohi
  • Medicine
    Circulation journal : official journal of the Japanese Circulation Society
  • 2014
The screening performance of WHtR for detecting the clustering cardiometabolic risk factors was not superior to that of BMI.
Accuracy of different cutoffs of the waist‐to‐height ratio as a screening tool for cardiometabolic risk in children and adolescents: A systematic review and meta‐analysis of diagnostic test accuracy studies
The meta‐analysis identified optimal cutoff values of WHtR for use in children and adolescents from different regions and indicated that a single cutoff value of WHTR may be inappropriate.
Waist-to-Height Ratio Compared to Standard Obesity Measures as Predictor of Cardiometabolic Risk Factors in Asian Indians in North India.
In the northern Asian Indian population with high prevalence of cardiometabolic risk factors, a combination of WC and WHtR appeared to be having better clinical utility than BMI and WHR in identifying individuals with cardiometric risk factors.
Optimum cutoff values of anthropometric indices of obesity for predicting hypertension: more than one decades of follow-up in an Iranian population
The results suggest that gender and age differences in the association between anthropometric indices and hypertension should be considered.
Comparison of the ability to identify cardiometabolic risk factors between two new body indices and waist-to-height ratio among Chinese adults with normal BMI and waist circumference
WHtR was a simple and effective index in the assessment of cardiometabolic risk factors, BRI could be used as an alternative body index to WHtR, while ABSI could not.
Predictive Ability of Waist Circumference and Waist-to-Height Ratio for Cardiometabolic Risk Screening among Spanish Children
The main result of the present study suggests that both WtHR and WC could be used as a screening tool to identify children with cardiometabolic abnormalities.


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
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’.
[Waist-height ratio compared to other anthropometric indicators of obesity as predictors of high coronary risk].
Indicators of abdominal obesity are better for discriminating HCR than the usual obesity indicator (BMI).
Waist to Height Ratio Is a Simple and Effective Obesity Screening Tool for Cardiovascular Risk Factors: Analysis of Data from the British National Diet and Nutrition Survey of Adults Aged 19–64 Years
WHtR is a simple and effective, non-invasive screening tool for CVD risk factors and was more closely associated with CVDrisk factors among both men and women than BMI.
Measuring Abdominal Obesity: Effects of Height on Distribution of Cardiometabolic Risk Factors Risk Using Waist Circumference and Waist-to-Height Ratio
It is hypothesized that short subjects with a WC at a specified cutoff-point will have more abdominal fat and associated cardiovascular risk factors than tall subjects with an WC at the same cutoff- point and that this will not be the case if WHtR is used instead of WC.
Which Obesity Indicators Are Better Predictors of Metabolic Risk?: Healthy Twin Study
This study validates the usefulness of anthropometry over direct body fat measures to predict metabolic risks through comparison with direct body composition measures in Korean adults.
Is central obesity a better discriminator of the risk of hypertension than body mass index in ethnically diverse populations?
Blood pressure is similarly associated with each of the four measures of overweight chosen, but the associations were stronger among Asians, and WHR has advantages in terms of consistency of thresholds for hypertension across ethnic groups in the Asia–Pacific.
Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study.
BMI-for-age and waist-to-height ratio do not differ in their abilities to identify children with adverse risk factors and additional longitudinal data are needed to examine its relation to disease.
The Increasing Importance of Waist-to-Height Ratio to Assess Cardiometabolic Risk: A Plea for Consistent Terminology
It is indicated that waist-to-height ratio could be a useful global clinical screening tool, 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".
Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults.
WC or WHtR may be a better predictor of CVD risk factors than BMI in Korean adults and was a better predictors for low high-density lipoprotein cholesterol in men.