Study reference |
Outcome |
Results |
Comments |
Studies reporting RR or HR |
Carmienke et al. (2013) |
All-cause mortality |
1BMI: 1.27 (1.21-1.33)
2WC: 1.32 (1.22-1.43)
2WHR: 1.13 (1.11-1.59)
1Obese class II compared to normal weight
2Gender-specific categorical cut-point compared to normal reference |
Meta-regression analysis restricted to nine cohorts that provided RR and 95% CIs and defined category boundaries for adiposity measures
All measures showed similar risk patterns for upper quartiles in comparison to reference quartiles
Patterns of general and abdominal obesity remained significantly associated with mortality when adjusted for the other |
Coutinho et al. (2011) |
CAD mortality |
Overall pooled RR comparing upper to lower obesity tertiles
(gender-specific):
BMI: 0.64 (0.59-0.69)
WC/WHR: 1.70 (1.58-1.83) |
Central obesity was associated with mortality whereas BMI was inversely associated with mortality
Central obesity was also associated with higher mortality in a subset of subjects with normal BMI |
Czernichow et al. (2011) |
All-cause mortality |
Multivariate adjusted HR for 1 SD increase:
BMI: 0.95 (0.91-0.99)
WC: 1.05 (1.00-1.09)
WHR: 1.12 (1.06-1.18) |
Measures of central obesity were more strongly associated with an increased risk of CVD mortality
BMI was related to CVD mortality in age and gender adjusted models only |
CVD mortality |
Multivariate adjusted HR for 1 SD increase:
BMI: 1.05 (0.98-1.14)
WC: 1.15 (1.05-1.25)
WHR: 1.15 (1.04-1.27) |
de Koning et al. (2007) |
Incident CVD events |
Overall risk estimate comparing extreme gender-specific quantiles for each measure:
WC: 1.63 (1.31-2.04)
WHR: 1.95 (1.55-2.44) |
Results suggested that WHR was more strongly associated with CVD events than WC, though differences were not statistically significant
Analysis was not restricted to studies that reported both WC and WHR |
Kodama et al. (2012) |
Incident T2DM |
Pooled RR for a 1 SD increase
(men and women combined):
BMI: 1.55 (1.43-1.69)
WC: 1.63 (1.49-1.79)
WHR: 1.52 (1.40-1.66)
WHtR: 1.62 (1.48-1.78) |
WC and WHtR showed a modest but significantly greater association with T2DM compared to BMI or WHR but measuring height in addition to WC appeared to have no additional benefit |
Vazquez et al. (2007) |
Incident T2DM |
Pooled RR for a 1 SD increase:
BMI: 1.87 (1.67-2.10)
WC: 1.87 (1.58-2.20)
WHR: 1.88 (1.61-2.19) |
Similar associations were noted for all obesity indices with incident T2DM |
Studies reporting ROC values |
Ashwell et al. (2012) |
Incident and prevalent T2DM, Hypertension, Dyslipidaemia, MetS, CVD |
Pooled AUC values for all outcomes:
Men:
BMI: 0.667 (0.650-0.684)
WC: 0.694 (0.678-0.709)
WHtR: 0.704 (0.689-0.718)
Women:
BMI: 0.681 (0.658-0.704)
WC: 0.714 (0.698-0.731)
WHtR: 0.725 (0.709-0.741) |
For all five specific health outcomes, WHtR had a greater discriminatory power compared with BMI
Statistical comparison of AUC values of abdominal obesity with BMI indicated that both WHtR and WC were significantly better at discriminating T2DM risk
Compared with BMI, WC improved discrimination of adverse outcomes by 3% (P <0.05) and WHtR improved discrimination by 4-5% (P <0.01)
Discriminatory ability was greater in women |
Czernichow et al. (2011) |
All-cause mortality |
BMI: 0.847 (0.840-0.855)
WC: 0.847 (0.839-0.855)
WHR: 0.848 (0.840-0.856) |
No clinically relevant difference in discrimination capabilities were observed between the three examined adiposity indices and all cause or CVD related mortality |
CVD mortality |
BMI: 0.868 (0.856-0.880)
WC: 0.868 (0.856-0.880)
WHR: 0.868 (0.856-0.880) |
Lee et al. (2008) |
Incident and prevalent T2DM, Hypertension, Dyslipidaemia |
Pooled AUC values for T2DM:
Men:
BMI: 0.672 (0.646-0.697)
WC: 0.701 (0.670-0.732)
WHR: 0.721 (0.664-0.778)
WHtR: 0.726 (0.698-0.754)
Women:
BMI: 0.693 (0.629-0.757)
WC: 0.744 (0.695-0.794)
WHR: 0.748 (0.687-0.810)
WHtR: 0.756 (0.700-0.811) |
WHtR was the best discriminator for T2DM, hypertension and dyslipidaemia in both genders
Statistical differences between BMI and WHtR were noticed only in men for T2DM and hypertension
Higher pooled AUC values were observed in females compared to males suggesting that discrimination is more precise in women
Statistical evidence supports the superiority of measures of central obesity over BMI for detecting CVD risk factors in men and women |
Mohan (2008) |
Prevalent Hypertension |
Pooled AUC values for Hypertension:
Men:
BMI: 0.63 (0.62-0.66)
WC: 0.66 (0.64-0.67)
WHR: 0.65 (0.63-0.67)
WHtR: 0.67 (0.66-0.69)
Women:
BMI: 0.66 (0.64-0.68)
WC: 0.69 (0.63-0.72)
WHR: 0.68 (0.65-0.70)
WHtR: 0.71 (0.68-0.73) |
Measures of central obesity tended to be better discriminators of hypertension in both gender
Overall – WHtR had the highest discriminatory capability
Heterogeneity in associations and discriminatory capacity were observed between different ethnic populations |
Nyamdorj et al. (2008) |
Prevalent T2DM, Hypertension |
Pooled AUC values for T2DM:
Men:
BMI: 0.725 (0.706-0.743)
WC: 0.729 (0.711-0.747)
WHR: 0.729 (0.711-0.747)
WHtR: 0.735 (0.717-0.753)
Women:
BMI: 0.742 (0.726-0.756)
WC: 0.749 (0.734-0.765)
WHR: 0.742 (0.727-0.758)
WHtR: 0.748 (0.733-0.764) |
AUC values for T2DM were slightly higher for WHtR in both genders and for WC in women only, compared to BMI, but were not statistically different
AUC values for hypertension were greater for BMI in both genders |
Studies reporting OR or other statistic |
Czernichow et al. (2011) |
All-cause mortality |
RIDI statistic:
BMI compared to WC: 0.150 (0.140-0.160)
BMI compared to WHR: 0.335 (0.321-0.348)
WC compared to WHR: 0.184 (0.175-0.193) |
There was a modest (0.1%) enhancement in discriminative capability using WHR compared to BMI
The advantage of using WHR compared to WC was also marginal
Models combining two adiposity indices did not provide improvement in the prediction of mortality |
CVD mortality |
RIDI statistic:
BMI compared to WC: 0.543 (0.524-0.563)
BMI compared to WHR: 0.265 (0.263-0.295)
WC compared to WHR -0.276 (-0.302- to – 0.250) |
Huxley et al. (2008) |
Prevalent T2DM, Hypertension |
0.5 SD increment increase in BMI associated with 20-30% odds for T2DM in Asian subjects
0.5 SD increment increase in WC or WHR associated with 40% increased odds in Asian subjects |
Odds of hypertension were similar for all measures of general and central adiposity
Heterogeneity was observed between obesity/morbidity associations and ethnicity |
Nyamdorj et al. (2008) |
Prevalent T2DM, Hypertension |
Age adjusted OR for 1 SD increase for TDM:
Men:
BMI: 1.52 (1.41-1.64)
WC: 1.54 (1.43-1.67)
WHR: 1.53 (1.41-1.65)
WHtR: 1.62 (1.50-1.75)
Women:
BMI: 1.59 (1.48-1.70)
WC: 1.70 (1.58-1.82)
WHR: 1.50 (1.40-1.60)
WHtR: 1.70 (1.59-1.83) |
WHtR showed a stronger association with T2DM compared to BMI but all indices were equally strongly associated with hypertension |
van Dijk et al. (2012) |
Prevalent FPG, SBP, DBP, HDL-C,
LDL-C, Total-C, TAG |
Mean Pearson Correlation coefficients for FPG
Men:
BMI: 0.188 + 0.019
WC: 0.227 + 0.030
WHR: 0.213 + 0.029
WHtR: 0.136 + 0.013
Women:
BMI: 0.243 + 0.024
WC: 0.289 + 0.038
WHR: 0.261 + 0.035
WHtR: 0.171 + 0.014 |
WC had the strongest correlation with all CVD risk factors in both men and women, except for HDL-C and LDL-C in men
When comparing BMI to WC the latter showed significantly better correlation to CVD risk factors, except for diastolic BP in women and HDL-C and Total-C in men |
