Main Article Content

Yong Hwan Kim
Wi-Young So


Body mass index, metabolic syndrome, waist circumference, waist-to-height ratio


Background and Objective
Of anthropometric measurements, body-mass index (BMI) and waist circumference (WC) have been used as determinants of obesity. The waist-to-height (WtHR) is simple, easy to calculate, and easy to apply to various age groups, but its wide use is limited because of a lack of studies. This 7-year longitudinal study was performed to identify the usefulness of WtHR compared with BMI and WC for predicting metabolic syndrome (MetS).

Material and Methods
Of 22,379 people who visited a health screening center over the course of one year, 5,802 men and 3,303 women who consented to the study and had no MetS were followed for 7 years to evaluate the development of MetS. The National Cholesterol Education Program Adult Treatment Panel III criteria were adapted to diagnose MetS. Height, weight, and WC were measured, and traditional reference values for BMI (23 kg/m2 ), WC (men 90 cm, women 80 cm), and WtHR (0.5) were calculated; in addition, other cut-off values were calculated by analyzing receiver operating characteristic (ROC) curves. The relative risk (RR) of developing MetS was calculated by Cox proportional-hazards regression using the cut-off values from traditional obesity references and ROC analysis.

Ultimately, 1,724 (29.7%) men and 627(19.0%) women were diagnosed with MetS. Among men with BMI <23 and >23, 15.1% and 37.0% developed MetS, respectively, resulting in an RR of 0.393 (95% confidence interval [CI] 0.349-0.443, p <0.001). Among men with WC <90 cm and >90 cm, 25.5% and 51.4% developed MetS, respectively, resulting in an RR of 0.442 (95% CI 0.389–0.502, p <0.001). WtHR had the lowest RR at 0.388 (95% CI 0.350–0.430, p <0.001). Among women with BMI<23 and >23, 10.2% and 35.5% developed MetS, respectively, resulting in an RR of 0.290 (95% CI 0.249–0.319, p <0.001). Among women with WC <80 cm and >80 cm, 13.6% and 39.2% developed MetS, respectively, resulting in an RR of 0.346 (95% CI 0.295–0.407, p <0.001). Among women with WtHR <0.5 and > 0.5, 12.7% and 38.2% developed MetS, respectively, resulting in an RR of 0.341 (95% CI 0.290–0.401, p <0.001).


The results of this study on middle-aged men and women show that a WtHR of 0.5, along with BMI and WC, has diagnostic value in predicting Mets. More studies with people of various ethnicities and ages should be conducted, and WtHR should be recognized as a potential health-management tool.


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1. Prange MT, Luck JF, Dibb A, et al. Mechanical properties and anthropometry of the human infant head. Stapp Car Crash J 2004;48:279–99.
2. Flegal KM, Shepherd JA, Looker AC, et al. Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults. Am J Clin Nutr 2008;89(2):500–08.
3. Wohlfahrt-Veje C, Tinggaard J, Winther K, et al. Body fat throughout childhood in 2647 healthy Danish children: agreement of BMI, waist circumference, skinfolds with dual X-ray absorptiometry. Eur J Clin Nutr 2014;68(6):664–70.
4. Henneberg M, Ulijaszek SJ. Body frame dimensions are related to obesity and fatness: Lean trunk size, skinfolds, and body mass index. Am J Hum Biol 2010;22(1):83–91.
5. Wang J, Thornton J, Kolesnik S, et al. Anthropometry in body composition: an overview. Ann N Y Acad Sci 2000;904(1):317–26.
6. Rosales YR. Anthropometry in the diagnosis of obese patients: a review. Nutricion Hospitalaria 2012;27(6):1803–9.
7. Vucenik I, Stains JP. Obesity and cancer risk: evidence, mechanisms and recommendations. Ann N Y Acad Sci 2012;1271:37–43.
8. Lu Y, Hajifathalian K, Ezzati M, et al. Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants. Lancet 2014;15:383(9921):970–83.
9. Johnson KM, Dowe DA. Accuracy of statin assignment using the 2013 AHA/ACC Cholesterol Guideline versus the 2001 NCEP ATP III guideline: correlation with atherosclerotic plaque imaging. Journal of the Am Coll Cardiol 2014;64(9):910–19.
10. Kassi E, Pervanidou P, Kaltsas G, et al. Metabolic syndrome: definitions and controversies. BMC Med 2011;9(1):48–60.
11. Gosse M. How accurate is self‐reported BMI? Nutr Bull 2014;39(1):105–14.
12. Winston GJ, Caesar-Phillips E, Peterson JC, et al. Knowledge of the health consequences of obesity among overweight/obese Black and Hispanic adults. Patient Educ Counsel 2014;94(1):123–7.
13. Camhi SM, Bray GA, Bouchard C, et al. The relationship of waist circumference and BMI to visceral, subcutaneous, and total body fat: sex and race differences. Obesity 2011;19(2):402–8.
14. Lee CMY, Huxley RR, Wildman RP, et al. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 2008;61(7):646–53.
15. McCarthy H, Jarrett K, Crawley H. The development of waist circumference percentiles in British children aged 5.0–16.9y. Eur J Clin Nutrit 2001;55(10):902–7.
16. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev 2010;23(2):247–69.
17. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Internat J Food Sci Nutr 2005;56(5):303–7.
18. Savva S, Tornaritis M, Savva M, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Internat J Obesity 2000;24(11):1453–58.
19. Freedman DS, Kahn HS, Mei Z, et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 2007;86(1):33–40.
20. Lim S, Shin H, Song JH, et al. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998–2007. Diabet Care 2011;34(6):1323–28.
21. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atherosclero Thrombo 2002;9(3):127–32.
22. Sayeed M, Mahtab H, Latif Z, et al. Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia. Bangladesh Med Res Council Bull 2003;29(1):1–10.
23. Lin W, Lee L, Chen C, et al. Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obesity 2002;26(9):1232–38.
24. Brannsether B, Roelants M, Bjerknes R, Júlíusson P. Waist circumference and waist‐to‐height ratio in Norwegian children 4–18 years of age: Reference values and cut‐off levels. Acta Paediatrica 2011;100(12):1576–82.
25. Whitlock EP, Williams SB, Gold R, et al. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 2005;116(1):e125–e144.
26. Hsieh S, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Internat J Obesity 2003;27(5):610–6.
27. Park S-H, Choi S-J, Lee K-S, et al. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circulat J 2009;73(9):1643–50.
28. Sasanow SR, Georgieff MK, Pereira GR. Mid-arm circumference and mid-arm/head circumference ratios: standard curves for anthropometric assessment of neonatal nutritional status. J Pediatr 1986;109(2):311–5.
29. Heitmann BL, Frederiksen P. Thigh circumference and risk of heart disease and premature death: prospective cohort study. BMJ 2009;339:b3292.
30. Roubenoff R. Sarcopenia: effects on body composition and function. J Gerontol Series A: Bio Sci Med Sci 2003;58(11):M1012–M1017.