Comparative Evaluation of Waist- to-Height Ratio, Body Mass Index, and Waist-to-Hip Ratio in an Adult Primary Care Population: A Cross-sectional Study

Abstract Background Body mass index (BMI) does not describe fat distribution. Waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) may provide complementary information about central adiposity in primary care. Objective To compare the distributions and pairwise correlations of BMI, WHtR, and WHR and to describe the prevalence of dyslipidemia and hypertension in an adult primary care cohort. Methods This cross-sectional study enrolled adults from two family medicine clinics affiliated with St. John Hospital and Medical Center in Detroit, Michigan. Standardized anthropometric measurements, blood pressure, and fasting laboratory values were obtained. Analyses used complete cases and included descriptive statistics and Pearson correlations among the three anthropometric indices. Results Of 467 enrolled participants, 406 (86.9%) had complete data. The mean (SD) age was 50.1 (16.0) years; 193 (47.5%) were men and 213 (52.5%) were women. Mean (SD) BMI was 30.1 (6.9) kg/m2, WHtR was 0.61 (0.08), and WHR was 0.95 (0.09). Hypertension was present in 160 participants (39.4%) and dyslipidemia in 177 (43.6%). BMI and WHtR were strongly correlated (r = 0.893, p < 0.001); WHtR and WHR were moderately correlated (r = 0.346, p < 0.001); and BMI and WHR were weakly correlated (r = 0.156, p < 0.05). A WHtR threshold of 0.50 classified 57.6% of participants as having increased cardiometabolic risk, compared with 52.7% classified as obese by BMI. Conclusion The three anthropometric indices were not interchangeable. WHtR tracked closely with BMI but produced a modestly higher screening yield, whereas WHR captured a less closely correlated dimension of body shape. WHtR may be a practical complement to BMI in primary care; outcome-specific regression or discrimination analyses are required before claiming predictive superiority for dyslipidemia or hypertension.