Skip to main content

Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults

  • Ahmet Selçuk Can (a1), Emine Akal Yıldız (a2), Gülhan Samur (a2), Neslişah Rakıcıoğlu (a2), Gülden Pekcan (a2), Sinan Özbayrakçı (a3), K Erhan Palaoğlu (a4), Mithat Gönen (a5) and Thomas P Bersot (a6)...

To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.


Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).


Turkey, 2003.


Adults (1121 women and 571 men) aged 18 years and over were examined.


Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.


We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults
      Available formats
Corresponding author
*Corresponding author: Email
Hide All
1.Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285, 24862497.
2.Malik S, Wong ND, Franklin SS, Kamath TV, L’Italien GJ, Pio JR & Williams GR (2004) Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 110, 12451250.
3.Guize L, Thomas F, Pannier B, Bean K, Jego B & Benetos A (2007) All-cause mortality associated with specific combinations of the metabolic syndrome according to recent definitions. Diabetes Care 30, 23812387.
4.Lorenzo C, Williams K, Hunt KJ & Haffner SM (2007) The National Cholesterol Education Program – Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care 30, 813.
5.Gami AS, Witt BJ, Howard DE, Erwin PJ, Gami LA, Somers VK & Montori VM (2007) Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol 49, 403414.
6.Pischon T, Boeing H, Hoffmann K et al. (2008) General and abdominal adiposity and risk of death in Europe. N Engl J Med 359, 21052120.
7.Schooling CM, Thomas GN, Leung GM, Ho SY, Janus ED & Lam TH (2007) Is height associated with cardiovascular risk in Chinese adults? Epidemiology 18, 274278.
8.McCarron P, Okasha M, McEwen J & Smith GD (2002) Height in young adulthood and risk of death from cardiorespiratory disease: a prospective study of male former students of Glasgow University, Scotland. Am J Epidemiol 155, 683687.
9.Engeland A, Bjorge T, Selmer RM & Tverdal A (2003) Height and body mass index in relation to total mortality. Epidemiology 14, 293299.
10.Lee CM, Huxley RR, Wildman RP & Woodward M (2008) Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 61, 646653.
11.Aekplakorn W, Kosulwat V & Suriyawongpaisal P (2006) Obesity indices and cardiovascular risk factors in Thai adults. Int J Obes (Lond) 30, 17821790.
12.Hsieh SD & Muto T (2005) The superiority of waist-to-height ratio as an anthropometric index to evaluate clustering of coronary risk factors among non-obese men and women. Prev Med 40, 216220.
13.Hsieh SD & Muto T (2006) Metabolic syndrome in Japanese men and women with special reference to the anthropometric criteria for the assessment of obesity: proposal to use the waist-to-height ratio. Prev Med 42, 135139.
14.Schneider HJ, Glaesmer H, Klotsche J, Bohler S, Lehnert H, Zeiher AM, Marz W, Pittrow D, Stalla GK & Wittchen HU (2007) Accuracy of anthropometric indicators of obesity to predict cardiovascular risk. J Clin Endocrinol Metab 92, 589594.
15.Ashwell M & Gibson S (2009) Waist to height ratio is a simple and effective obesity screening tool for cardiovascular risk factors: analysis of data from the British National Diet and Nutrition Survey of adults aged 19–64 years. Obesity Facts 2, 97103.
16.Lin WY, Lee LT, Chen CY, Lo H, Hsia HH, Liu IL, Lin RS, Shau WY & Huang KC (2002) Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes Relat Metab Disord 26, 12321238.
17.Sayeed MA, Mahtab H, Latif ZA, Khanam PA, Ahsan KA, Banu A & Azad Khan AK (2003) Waist-to-height ratio is a better obesity index than body mass index and waist-to-hip ratio for predicting diabetes, hypertension and lipidemia. Bangladesh Med Res Counc Bull 29, 110.
18.Fuchs FD, Gus M, Moreira LB, Moraes RS, Wiehe M, Pereira GM & Fuchs SC (2005) Anthropometric indices and the incidence of hypertension: a comparative analysis. Obes Res 13, 15151517.
19.Can AS, Bersot TP & Gonen M (2009) Anthropometric indices and their relationship with cardiometabolic risk factors in a sample of Turkish adults. Public Health Nutr 12, 538546.
20.Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF & Turner RC (1985) Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28, 412419.
21.Chobanian AV, Bakris GL, Black HR et al. (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289, 25602572.
22.Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26, Suppl. 1, S5S20.
23.Grundy SM, Cleeman JI, Daniels SR et al. (2005) Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 112, 27352752.
24.DeLong ER, DeLong DM & Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44, 837845.
25.Youden WJ (1950) Index for rating diagnostic tests. Cancer 3, 3235.
26.Perkins NJ & Schisterman EF (2006) The inconsistency of ‘optimal’ cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163, 670675.
27.Pepe M (2003) The Statistical Evaluation of Medical Tests for Classification and Prediction. New York: Oxford University Press.
28.Ashwell M & Hsieh SD (2005) Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 56, 303307.
29.Aekplakorn W, Pakpeankitwatana V, Lee CM, Woodward M, Barzi F, Yamwong S, Unkurapinun N & Sritara P (2007) Abdominal obesity and coronary heart disease in Thai men. Obesity (Silver Spring) 15, 10361042.
30.Shimajiri T, Imagawa M, Kokawa M, Konami T, Hara H, Kyoku I, Sone E, Ishigame M & Kikuoka H (2008) Revised optimal cut-off point of waist circumference for the diagnosis of metabolic syndrome in Japanese women and the influence of height. J Atheroscler Thromb 15, 9499.
31.Wu HY, Chen LL, Zheng J, Liao YF & Zhou M (2007) Simple anthropometric indices in relation to cardiovascular risk factors in Chinese type 2 diabetic patients. Chin J Physiol 50, 135142.
32.Mirmiran P, Esmaillzadeh A & Azizi F (2004) Detection of cardiovascular risk factors by anthropometric measures in Tehranian adults: receiver operating characteristic (ROC) curve analysis. Eur J Clin Nutr 58, 11101118.
33.Mansour AA & Al-Jazairi MI (2007) Cut-off values for anthropometric variables that confer increased risk of type 2 diabetes mellitus and hypertension in Iraq. Arch Med Res 38, 253258.
34.Hadaegh F, Zabetian A, Harati H & Azizi F (2006) Waist/height ratio as a better predictor of type 2 diabetes compared to body mass index in Tehranian adult men – a 3·6-year prospective study. Exp Clin Endocrinol Diabetes 114, 310315.
35.Gelber RP, Gaziano JM, Orav EJ, Manson JE, Buring JE & Kurth T (2008) Measures of obesity and cardiovascular risk among men and women. J Am Coll Cardiol 52, 605615.
36.Mansour AA & Al-Jazairi MI (2007) Predictors of incident diabetes mellitus in Basrah, Iraq. Ann Nutr Metab 51, 277280.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 4
Total number of PDF views: 51 *
Loading metrics...

Abstract views

Total abstract views: 130 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 21st November 2017. This data will be updated every 24 hours.