Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis

J Clin Epidemiol. 2008 Jul;61(7):646-53. doi: 10.1016/j.jclinepi.2007.08.012. Epub 2008 Mar 21.


Objective: To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors.

Study design and setting: This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area under the ROC curves (AUC) for overweight and obesity indices with hypertension, type-2 diabetes, and/or dyslipidemia were included. The AUC for each of the four indices, with each risk factor, was pooled using a random-effects model; male and female data were analyzed separately.

Results: Ten studies met the inclusion criteria. Body mass index (BMI) was the poorest discriminator for cardiovascular risk factors. Waist-to-height ratio (WHtR) was the best discriminator for hypertension, diabetes, and dyslipidemia in both sexes; its pooled AUC (95% confidence intervals) ranged from 0.67 (0.64, 0.69) to 0.73 (0.70, 0.75) and from 0.68 (0.63, 0.72) to 0.76 (0.70, 0.81) in males and females, respectively.

Conclusion: Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Abdominal Fat
  • Body Composition
  • Body Height
  • Body Mass Index
  • Body Weight
  • Cardiovascular Diseases / etiology*
  • Female
  • Humans
  • Male
  • Obesity / complications*
  • Obesity / diagnosis
  • ROC Curve
  • Risk Factors