Evaluation of waist-to-height ratio as a predictor of insulin resistance in non-diabetic obese individuals. A cross-sectional study

Sao Paulo Med J. 2017 Sep-Oct;135(5):462-468. doi: 10.1590/1516-3180.2016.0358280417. Epub 2017 Nov 6.


Background: Insulin resistance (IR) and progressive pancreatic β-cell dysfunction have been identified as the two fundamental features in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus. We aimed to investigate correlations between anthropometric indices of obesity and IR in non-diabetic obese individuals, and the cutoff value from receiver operating characteristic (ROC) curve analysis.

Design and setting: Cross-sectional study conducted in a private clinic.

Methods: We included obese individuals (body mass index, BMI ≥ 30 kg/m2) with no diabetes mellitus (fasting glucose levels ≤ 126 mg/dl). The participants were evaluated for the presence of cardiovascular risk factors and through anthropometric measurements and biochemical tests. Furthermore, IR was assessed indirectly using the homeostatic model assessment (HOMA)-IR and HOMA-β indexes. The area underthe curve (AUC) of the variables was compared.The sensitivity, specificity and cutoff of each variable for diagnosing IR were calculated.

Results: The most promising anthropometric parameters for indicating IR in non-diabetic obese individuals were waist-to-height ratio (WHtR), waist circumference (WC) and BMI. WHtR proved to be an independent predictor of IR, with risk increased by 0.53% in HOMA-IR, 5.3% in HOMA-β and 1.14% in insulin. For HOMA-IR, WHtR had the highest AUC value (0.98), followed by WC (0.93) and BMI (0.81). For HOMA-β, WHtR also had the highest AUC value (0.83), followed by WC (0.75) and BMI (0.73).The optimal WHtR cutoff was 0.65 for HOMA-IR and 0.67 for HOMA-β.

Conclusion: Among anthropometric obesity indicators, WHtR was most closely associated with occurrences of IR and predicted the onset of diabetes in obese individuals.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Body Height
  • Body Mass Index
  • Cardiovascular Diseases / etiology*
  • Cardiovascular Diseases / physiopathology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Insulin Resistance / physiology*
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / physiopathology
  • Predictive Value of Tests
  • ROC Curve
  • Risk Factors
  • Waist Circumference
  • Waist-Hip Ratio