Predicting cardiometabolic disturbances from waist-to-height ratio: findings from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline

Public Health Nutr. 2018 Apr;21(6):1028-1035. doi: 10.1017/S136898001700338X. Epub 2018 Jan 9.


Objective: To evaluate the performance of waist-to-height ratio (WHtR) in predicting cardiometabolic outcomes and compare cut-off points for Brazilian adults.

Design: Cross-sectional study. WHtR areas under the curve (AUC) were compared with those for BMI, waist circumference (WC) and waist-to-hip ratio (WHR). The outcomes of interest were hypertension, diabetes, hypertriacylglycerolaemia and presence of at least two components of metabolic syndrome (≥2 MetS). Cut-offs for WHtR were compared and validity measures were estimated for each point.

Setting: Teaching and research institutions in six Brazilian state capitals, 2008-2010.

Subjects: Women (n 5026) and men (n 4238) aged 35-54 years who participated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) at baseline.

Results: WHtR age-adjusted AUC ranged from 0·68 to 0·72 in men and 0·69 to 0·75 in women, with smaller AUC for hypertriacylglycerolaemia and the largest for ≥2 MetS. WHtR performed better than BMI for practically all outcomes; better than WHR for hypertension in both sexes; and displayed larger AUC than WC in predicting diabetes mellitus. It also offered better discriminatory power for ≥2 MetS in men; and was better than WC, but not WHR, in women. Optimal cut-off points of WHtR were 0·55 (women) and 0·54 (men), but they presented high false-negative rate compared with 0·50.

Conclusions: We recommend using WHtR (which performed similarly to, or better than, other available indices of adiposity) as an anthropometric index with good discriminatory power for cardiometabolic outcomes in Brazilian adults, indicating the already referenced limit of WHtR≥0·50.

Keywords: Abdominal obesity; Anthropometric indices; Cardiometabolic outcomes; Cross-sectional studies; Waist-to-height ratio.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anthropometry*
  • Area Under Curve
  • Brazil
  • Cross-Sectional Studies
  • Diabetes Mellitus
  • Female
  • Humans
  • Hypertension
  • Male
  • Metabolic Syndrome / diagnosis
  • Metabolic Syndrome / epidemiology*
  • Middle Aged
  • Obesity, Abdominal
  • Reference Values
  • Waist-Height Ratio*