ORIGINAL ARTICLE Waist-to-Height Ratio Compared to Standard Obesity Measures as Predictor of Cardiometabolic Risk Factors in Asian Indians in North India Naval K. Vikram, MD, 1 Ahmad Nawid Latifi, MBBS, 1 Anoop Misra, MD, 2–4 Kalpana Luthra, PhD, 5 Surya Prakash Bhatt, PhD, 1 Randeep Guleria, DM, 6 and Ravindra M. Pandey, PhD 7 Abstract Objective: The aim of this study was to compare the discriminatory ability of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) in identifying the presence of cardiometabolic risk factors in Asian Indians. Methods: This cross-sectional study involved 509 subjects (278 males and 231 females) aged 20–60 years from New Delhi, India. Measurements included complete clinical examination, blood pressure, weight, height, WC, BMI, WHR and WHtR, fasting blood glucose, lipid profile, and fasting insulin levels. Receiver operating characteristic curve analyses were performed to compare predictive validity of various adiposity measures against the cardiometabolic risk factors (dyslipidemia, hyperinsulinemia, impaired fasting glucose, hyperten- sion, and metabolic syndrome). The odds ratio for the presence of individual cardiometabolic risk factors in the presence of overweight, abdominal obesity, and high WHtR were calculated using logistic regression analysis. Results: WC had the highest area under ROC for all other cardiometabolic risk factors except hyperinsulinemia in males and for dyslipidemia, metabolic syndrome and presence of at least one cardiometabolic risk factor in females. For metabolic syndrome, WC, followed by WHtR, was observed to be the better predictor than other measures of adiposity, and WHtR appeared to be the best predictor for hypertension in both genders, partic- ularly in women. Conclusions: In the northern Asian Indian population with high prevalence of cardiometabolic risk factors, a combination of WC and WHtR appeared to be having better clinical utility than BMI and WHR in identifying individuals with cardiometabolic risk factors. Keywords: waist circumference, waist-to-height ratio, metabolic syndrome, cardiometabolic risk, Asian Indians Introduction O verweight and abdominal obesity have become a major public health problem in both developing and developed countries as they are causally related to increased cardiometabolic risk. Developing countries such as India are undergoing a rapid economic development resulting in a simultaneous epidemiological transition to a more sedentary and unhealthy lifestyle leading to an increase in obesity and cardiovascular risk factors. 1,2 Abdominal obesity is associ- ated with insulin resistance, atherogenic dyslipidemia, and altered adipocytokine profile leading to increased cardio- metabolic risk. Asian Indians have been shown to have higher abdominal fat at a similar body mass index (BMI) compared to other ethnic groups. 3 This predisposes them to increased risk of developing insulin resistance, type 2 dia- betes, and cardiovascular disease (CVD). The most widely used parameter to define overweight and obesity across populations is BMI. However, it is not able to distinguish between fat, fat-free mass, and pattern of fat 1 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. 2 Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India. 3 Diabetes Foundation (India) and 4 National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India. Departments of 5 Biochemistry, 6 Pulmonary Medicine and Sleep Disorders, and 7 Biostatistics, All India Institute of Medical Sciences, New Delhi, India. METABOLIC SYNDROME AND RELATED DISORDERS Volume XX, Number XX, 2016 Ó Mary Ann Liebert, Inc. Pp. 1–8 DOI: 10.1089/met.2016.0041 1