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Waist-to-height ratio more accurate than BMI in predicting CVD risk

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Waist-to-height ratio is superior to using BMI as a first-stage screening tool for health risks related to obesity, such as cardiovascular disease, according to research presented at the European Obesity Conference in Prague.

In a study of more than 2,900 people aged at least 16 years, researchers found that by using waist-to-height ratio measurements, more adults were successfully identified as being at high risk for CVD than by using BMI measurements alone. The practice of measuring waist-to-height ratio also was more efficient, according to researchers.

Margaret Ashwell, OBE, PhD, of Ashwell Associates at Hertfordshire and Oxford Brookes University, U.K., and Sigrid Gibson, MS, RPHNutr, of Sig-Nuture Ltd., analyzed data from 2,917 participants aged at least 16 years in the Health Survey for England 2009. In the cohort, 41% of men and 29% of women classified as “normal” by BMI measurements had waist-to-height ratios exceeding 0.5, meaning 12% of the total population would be misclassified by using BMI measurement alone.

Researchers classified the study participants into four groups using standard boundary values of BMI (above or below 25 kg/m²) and waist-to-height ratio (above or below 0.5). The group with low or average BMI but a high waist-to-height ratio had higher total cholesterol and HbA1c levels than the group with high BMI but low waist-to-height ratio (P < .0001). Differences were significant in both sexes.

Mean total cholesterol was lowest in the group with low BMI and low waist-to-height ration, and highest in the group with high BMI and high waist-to-height ratio.

The study echoes the researchers’ previous findings from a meta-analysis of 300,000 adults in 2012, showing that waist-to-height ratio improved discrimination of adverse outcomes by 4% to 5%.

“This study not only supports our previous findings on the superiority of [waist-to-height ratio] over BMI as a primary screening method for mor­bidity and mortality risk, but also demonstrates the potentially severe im­plications of misclassification by BMI alone in screening for cardiometa­bolic risk factors,” the researchers wrote. “Checking that waist-to-height ratio is less than 0.5 could not be simpler: All that is needed is a piece of string, not even a tape measure.

“The assessment is clearly ideal for primary stage screening for large populations where resources are limited,” the researchers wrote. “It could also save time and money in primary care in Europe, but at the moment there is resistance to move away from BMI and/or waist circumference because that is the convention.” – by Regina Schaffer

Reference:

Gibson S. Poster T7:PO.052. Presented at: European Congress on Obesity; May 6-9, 2015; Prague.

Disclosure: Ashwell and Gibson report no relevant financial disclosures.