Waist-to-Height Ratio, Waist Circumference, and Body Mass Index in Relation to Full Cardiometabolic Risk in an Adult Population from Medellin, Colombia

<b>Background/Objectives:</b> Few studies have compared the associations of different adiposity markers with cardiometabolic risk factors in individuals without diabetes or cardiovascular disease (CVD), particularly in South America. Moreover, the associations with more severe cardiometabolic risk, defined by the simultaneous presence of altered glycemia, blood pressure, and dyslipidemia, remain unknown. We examined whether the waist-to-height ratio (W-HtR), waist circumference (WC), and BMI were independently associated with cardiometabolic risk in a chronic disease prevention program in Medellín, Colombia. <b>Methods:</b> A cross-sectional study was conducted in 29,236 adults (age: 19-121 years) without diabetes or CVD. Exposures included increased W-HtR (>0.5), increased WC (≥80 cm for women, ≥90 cm for men), and overweight/obesity. The outcomes were dyslipidemia, elevated glycemia, high blood pressure, and full cardiometabolic risk (FCMR), defined as the presence of all three factors. Logistic regressions adjusted for sociodemographic and lifestyle covariates and additional adiposity markers were used. Cubic spline analyses examined the shape of associations. <b>Results:</b> Most individuals were over 40 years old (97.6%), only 40 were ≥100 years, and 16.5% (<i>n</i> = 4821) had FCMR. Increased W-HtR tripled the odds of FCMR compared with normal W-HtR (OR: 3.04, 95%CI: 2.45-3.77, <i>p</i> < 0.001). Increased WC doubled the odds of FCMR (<i>p</i> < 0.001). W-HtR remained the strongest predictor after adjusting for WC (OR: 1.99, 95%CI: 1.59-2.50) and BMI (OR: 2.48, 95%CI: 1.99-3.08). Cubic spline analyses showed a linear association between W-HtR and FCMR, whereas the BMI-FCMR association plateaued at approximately 30 kg/m². <b>Conclusions:</b> In this cross-sectional study of a large middle-to-older-aged cohort, W-HtR was the strongest adiposity marker correlated with cardiometabolic risk.