title: Evaluation of waist-to-height ratio to predict 5 year cardiometabolic risk in sub-Saharan African adults.
abstract: OBJECTIVE
  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.
  
  
  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/m(2), men 20.9 ± 4.3 kg/m(2)); 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.
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: L J
authors.initials: LJ
authors.lastname: Ware
authors.affiliation: Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, United Kingdom.
authors.forename: K L
authors.initials: KL
authors.lastname: Rennie
authors.affiliation: Centre of Excellence for Nutrition (CEN), Faculty of Health Sciences, North-West University, South Africa.
authors.forename: H S
authors.initials: HS
authors.lastname: Kruger
authors.affiliation: Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences, North-West University, South Africa.
authors.forename: I M
authors.initials: IM
authors.lastname: Kruger
authors.affiliation: Africa Unit for Transdisciplinary Health Research (AUTHeR), Faculty of Health Sciences, North-West University, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Greeff
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: C M T
authors.initials: CM
authors.lastname: Fourie
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: H W
authors.initials: HW
authors.lastname: Huisman
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: J D W
authors.initials: JD
authors.lastname: Scheepers
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: A S
authors.initials: AS
authors.lastname: Uys
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Kruger
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: J M
authors.initials: JM
authors.lastname: Van Rooyen
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Schutte
authors.affiliation: Hypertension in Africa Research Team (HART), Faculty of Health Sciences, North-West University, Private Bag X6001, 2520, South Africa. Electronic address: Alta.Schutte@nwu.ac.za.
authors.forename: A E
authors.initials: AE
authors.lastname: Schutte
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003710:Demography; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000031:analogs & derivatives / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012372:ROC Curve; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D065927:Waist-Height Ratio
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D014280:Triglycerides; C025617:glucosylated hemoglobin A
keywords: Cardiovascular disease; Diabetes; Dyslipidaemia; Hypertension; Risk factors; Sub-Saharan Africa; Waist circumference; Waist-to-height ratio