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UTILITY OF WAIST-TO-HEIGHT RATIO AS AN INDICATOR OF CARDIO-METABOLIC RISK COMPARED WITH ROUTINELY USED ADIPOSITY INDICES

Objective: The tools used to identify obesity, a common risk factor for hypertension and other cardio-metabolic abnormalities, are not always optimal in all populations; therefore, the utility of other instruments are constantly being assessed. This study aims to compare the utility of waist-to-height ratio (WHtR) with commonly used adiposity indices of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) to identify cardio-metabolic diseases including hypertension in 25–74-year-old black residents in Cape Town. Design and method: This cross-sectional study, stratified for age and gender, determined cardio-metabolic abnormalities by administered questionnaires, clinical measurements and biochemical analyses, including oral glucose tolerance tests. Correlations between BMI, WC, WHR and WHtR with cardio-metabolic components were examined. Age- and gender-adjusted logistic regression analyses determined the associations of obesity by these adiposity indices with cardio-metabolic abnormalities. Results: The study comprised 392 men and 707 women. Age-standardised prevalence (95% confidence interval (CI)) for men and women, respectively, were: hypertension: 39.3% (95% CI: 33.4–45.2) and 39.4% (95% CI: 35.5–43.4), diabetes: 11.3% (95% CI: 8.0–14.6) and 14.7% (95% CI: 12.1–17.3). Compared with other adiposity indices, WHtR in men correlated most closely with fasting (0.360) and 2-hour (0.388) glucose levels, total cholesterol (0.267), low-density lipoprotein cholesterol (LDL-C) (0.351) and triglycerides (0.400). WHR and WC, respectively, correlated the best with systolic BP (0.310) and diastolic BP (0.287) in men. In women, WHtR correlated the best with systolic BP (0.254) and diastolic BP (0.287). Of the adiposity indices, raised WHtR was most closely related to hypertension (OR 1.61, 95% CI: 1.07–2.42), hypercholesterolaemia (OR 1.72, 95%CI: 1.04–2.83) and raised LDL-C (OR 2.46, 95%CI: 1.70–3.55), while raised WC was most strongly associated with diabetes (OR 4.27, 95%CI: 2.39–7.62), low high-density lipoprotein cholesterol (OR 2.84, 95%CI: 1.90–4.26) and hypertriglyceridaemia (OR 3.60, 95%CI: 2.03–6.40). Conclusions: Compared with other adiposity indices, the better correlation of WHtR with many cardio-metabolic components, particularly in men, and the stronger association of raised WHtR with hypertension, hypercholesterolaemia and raised LDL-C supports the utility of WHtR in routine assessments of adiposity in this population, which may improve the identification of cardio-metabolic risk in black South Africans.