Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults
Nutrition, Metabolism and Cardiovascular Diseases
Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa; Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, United Kingdom; Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, South Africa; Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences, North-West University, South Africa
Background and aims: Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk. Methods and results: Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m2, men 20.9 ± 4.3 kg/m2); median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men. Conclusions: The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa. © 2014 Elsevier B.V.
glucose; high density lipoprotein cholesterol; low density lipoprotein cholesterol; triacylglycerol; cholesterol; glucose blood level; glucosylated hemoglobin A; glycosylated hemoglobin; triacylglycerol; adult; anthropometric parameters; article; blood pressure monitoring; body mass; cardiometabolic risk; cardiovascular risk; clinical evaluation; dyslipidemia; evaluation and follow up; female; human; major clinical study; male; middle aged; priority journal; prospective study; receiver operating characteristic; sensitivity and specificity; waist circumference; waist to height ratio; Africa south of the Sahara; analogs and derivatives; Black person; blood; blood pressure; Cardiovascular Diseases; cross-sectional study; demography; diabetes mellitus; Dyslipidemias; family size; follow up; glucose blood level; hypertension; metabolism; prevalence; risk factor; Adult; Africa South of the Sahara; African Continental Ancestry Group; Blood Glucose; Blood Pressure; Body Mass Index; Cardiovascular Diseases; Cholesterol; Cross-Sectional Studies; Demography; Diabetes Mellitus; Dyslipidemias; Family Characteristics; Female; Follow-Up Studies; Hemoglobin A, Glycosylated; Humans; Hypertension; Male; Middle Aged; Prevalence; Risk Factors; ROC Curve; Triglycerides; Waist Circumference; Waist-Height Ratio