What is the optimal anthropometric index/ratio associated with two major measures of cardio-metabolic risk associated with hypertension and diabetes?


Few studies have examined the optimal anthropometric index associated with potential cardiometabolic risk. Using direct measures of standing height, body weight, and waist circumference, we sought to identify the optimal index for detecting cardio-metabolic risk associated with diabetes and hypertension in a nationally representative sample of US adults.


Complete (not missing) cross-sectional data from 8375 US adults aged 18-80 were obtained from the 2015-16 and 2017-March 2020 (pre-pandemic) cycles of the National Health and Nutrition Examination Survey. The cardio-metabolic risk was assessed using blood pressure and glycohemoglobin (A1c). Allometric models were used to identify the optimal anthropometric indices associated with cardio-metabolic risk. Receiver operating characteristics curves were used to verify the discriminative power of the identified index compared to other anthropometric measurements.


The optimal anthropometric index associated with cardio-metabolic risk was waist circumference divided by body weight to the power of 0.333 (WC/M0.333† The ability of this new index to discriminate against people with diabetes (area under the ROC curve: 0.73 [95%CI: 0.71–0.74]) and hypertension (area under the curve: 0.70 [95%CI: 0.69–0.72]) was superior to all other anthropometric measures/indices examined in this study (body mass index, waist circumference, waist-to-height ratio, and waist/height0.5


We have WC/M . identified0.333 as the optimal anthropometric index for identifying US adults with hypertension and diabetes. Instead of body mass index (kg/m2), we recommend using WC/M . at0.333 in clinical and public health practices to better identify U.S. adults with potential cardio-metabolic risk associated with hypertension and diabetes.

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