A comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys

OBJECTIVE: To comparatively evaluate cut-off points of waist circumference, body mass index and waist to hip ratio with respect to their ability to predict other individual and multiple cardiovascular disease risk factors. DESIGN: Population-based, cross-sectional surveys. SUBJECTS: A total of 9913 men and women aged 18-74, selected using health insurance registries from five Canadian provinces. MEASUREMENTS: Anthropometric measures, other cardiovascular risk factors, receiver operating characteristic curves, sensitivity, specificity, positive and negative predictive values. RESULTS: Waist circumference may be the best single indicator of other individual and multiple cardiovascular risk factors. Optimal cut-off points of all anthropometric measures are dependent on age, sex and the prevalence of the risk factor(s) being considered. For waist circumference, cut-off points of greater than or equal to 90 cm in men and greater than or equal to 80 cm in women may be most appropriate for prediction of individual and multiple risk factors in Caucasian populations. CONCLUSION: Health professionals should incorporate the use of waist circumference measurements in their routine clinical examination of adult patients.