BMI is dead; long live waist-circumference indices: But which index should we choose to predict cardio-metabolic risk?

Nevill, Alan M., Duncan, Michael J. and Myers, Tony D. (2022) BMI is dead; long live waist-circumference indices: But which index should we choose to predict cardio-metabolic risk? Nutrition, Metabolism and Cardiovascular Diseases. ISSN 09394753

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Background and Aims: There is growing evidence that Body Mass Index (BMI) is unfit for purpose. Waist circumference (WC) indices appear to be the preferred alternative, although it is not clear which WC index is optimal at predicting cardio-metabolic risk (CMR) and associated health outcomes. Methods and Results: We obtained a stratified random probability sample of 53,390 participants from the Health Survey for England (HSE), 2008-2018. The four available CMR factors were; high-density lipoproteins (HDL) cholesterol, glycated haemoglobin (HbA1c), systolic (SBP) and diastolic blood pressure (DBP). Strength of association between the four cardio-metabolic risk factors and competing anthropometric indicators of weight status [BMI, Waist-to-height ratio (WHTR), unadjusted WC, and a new WC index independent of height, WHT∙5R=WC/height0.5] was assessed separately, using simple correlations and ANCOVAs, and together (combined) using MANCOVA, controlling for age, sex and ethnicity. Centile curves for the new index WHT∙5R=WC/height0.5were also provided. Conclusions: Waist-circumference indices were superior to BMI when explaining/predicting our CMR factors, before and after controlling for age, sex and ethnicity. No single WC index was consistently superior. Results suggest that WHTR is the strongest predictor of HbA1c, confirming that shorter individuals are at great risk of diabetes. The most appropriate WC index associated with blood pressure was WHT∙5R for DBP, or unadjusted WC for SBP. Given HDL cholesterol is independent of height, the best predictor of HDL was WHT.5R. Clearly, “no one size fits all!”. MANCOVA identified WHT∙5R to be the best single WC index associated with a composite of all four CMR factors.

Item Type: Article
Divisions: Faculty of of Arts, Society and Professional Studies > Department of Health and Behavioural Sciences
Depositing User: Ms Hazel Barham
Date Deposited: 25 Apr 2022 08:42
Last Modified: 10 Apr 2023 04:00

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