Key result
Waist-to-height ratio outperforms BMI and body fat percentage for identifying cardiometabolic risk.
Why the study?
Obesity is a major risk factor for cardiometabolic disease, but the best adiposity indicator to identify elevated cardiometabolic risk remains uncertain.
Which adiposity indicator (BMI, PBF, WC, or WHtR) has the best discriminatory ability for cardiometabolic risk in middle-aged Korean adults?
Cross-Sectional (n=2,412)
Which adiposity indicator (BMI, PBF, WC, or WHtR) has the best discriminatory ability for cardiometabolic risk in middle-aged Korean adults?
Waist-to-height ratio and waist circumference provide better discriminatory ability for cardiometabolic risk than BMI and percent body fat among middle-aged Korean adults.
Obesity is a major risk factor for cardiometabolic disease, but which indicator best identifies elevated risk remains uncertain. This cross-sectional study compared the associations and discriminatory ability of body mass index (BMI), percent body fat (PBF), waist circumference (WC), and waist-to-height ratio (WHtR) for cardiometabolic risk among 2412 Korean adults aged 40–64 years, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2024. Cardiometabolic risk (CMR) was defined as ≥ 2 of four factors: elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol. Survey-weighted logistic regression and receiver operating characteristic analyses were adjusted for age and sex. All adiposity indicators were significantly associated with elevated CMR. Adjusted odds ratios per 1-SD increase were 2.40 (95% CI, 2.12–2.72) for BMI, 2.51 (2.19–2.87) for PBF, 2.84 (2.46–3.28) for WC, and 2.64 (2.32–3.00) for WHtR. WHtR had the highest AUC (0.780), statistically comparable to WC (0.776; Holm-adjusted p = .194) but significantly higher than BMI (0.766; p = .003) and PBF (0.752; p < .001). WC also had a higher AUC than PBF ( p = .001), but not BMI ( p = .098). Although differences in discriminatory ability were modest, WHtR may provide a practical, low-cost complementary measure for cardiometabolic risk assessment among Korean adults.
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Eunok Park (2026) conducted a cross-sectional in Cardiometabolic risk (n=2,412). Waist-to-height ratio (WHtR) vs. Body mass index (BMI), percent body fat (PBF), and waist circumference (WC) was evaluated on Elevated cardiometabolic risk (≥ 2 of four factors: elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol) (OR 2.64, 95% CI 2.32-3.00). Waist-to-height ratio had the highest discriminatory ability for cardiometabolic risk (AUC 0.780), which was significantly higher than BMI (p=0.003) and percent body fat (p<0.001).
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