Can Waist-to-Height Ratio Enhance the Assessment of Adiposity and Cardiometabolic Risks in Ecuadorian Adolescents?

Adolescent obesity is increasing worldwide, and resource-limited settings require simple, reliable tools for assessing adiposity and identifying cardiometabolic abnormalities. This study evaluated whether waist-to-height ratio (WHtR), body mass index (BMI), and waist circumference (WC) can identify excess adiposity and cardiometabolic risk factors in Ecuadorian adolescents. A cross-sectional study was conducted in 798 students aged 10–18 years from two schools in Quito, Ecuador. Measurements included anthropometry, body fat percentage bioelectrical impedance), blood pressure, and fasting lipid and glucose levels. WHtR and the reference adiposity measure each classified 38.7% of participants as having excess adiposity, compared with BMI (8.1%) and WC (17.9%). Girls had higher WHtR and body fat, whereas boys showed higher height, weight, systolic blood pressure, and glucose levels. BMI, WC, and WHtR were significantly associated with cardiometabolic abnormalities, and ROC analyses demonstrated discriminatory ability for selected metabolic outcomes. WHtR showed the strongest association with body fat percentage, whereas BMI demonstrated comparable or slightly superior performance for certain outcomes, indicating that the relative utility of anthropometric indicators depends on the outcome evaluated. These findings support the use of simple, scalable anthropometric indicators for identifying existing cardiometabolic abnormalities in settings where direct assessment of body composition is not feasible. Future research supported by high-quality longitudinal anthropometric monitoring will be essential to evaluate their prognostic value, improve risk prediction, and inform emerging and AI-based applications and data-driven approaches in adolescent health.