Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis

Crystal Man Ying Lee, Rachel R. Huxley, Rachel P. Wildman, Mark Woodward

Research output: Contribution to journalReview articlepeer-review

696 Scopus citations


Objective: To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors. Study Design and Setting: This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area under the ROC curves (AUC) for overweight and obesity indices with hypertension, type-2 diabetes, and/or dyslipidemia were included. The AUC for each of the four indices, with each risk factor, was pooled using a random-effects model; male and female data were analyzed separately. Results: Ten studies met the inclusion criteria. Body mass index (BMI) was the poorest discriminator for cardiovascular risk factors. Waist-to-height ratio (WHtR) was the best discriminator for hypertension, diabetes, and dyslipidemia in both sexes; its pooled AUC (95% confidence intervals) ranged from 0.67 (0.64, 0.69) to 0.73 (0.70, 0.75) and from 0.68 (0.63, 0.72) to 0.76 (0.70, 0.81) in males and females, respectively. Conclusion: Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women.

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalJournal of Clinical Epidemiology
Issue number7
StatePublished - Jul 2008


  • Body mass index
  • Cardiovascular risk factors
  • Meta-analysis
  • Obesity
  • ROC curve
  • Waist-to-height ratio

ASJC Scopus subject areas

  • Epidemiology


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