Public Health Nutrition

Assessment and methodology

Optimal waist:height ratio cut-off point for cardiometabolic risk factors in Turkish adults

Ahmet Selçuk Cana1 c1, Emine Akal Yıldıza2, Gülhan Samura2, Neslişah Rakıcıoğlua2, Gülden Pekcana2, Sinan Özbayrakçıa3, K Erhan Palaoğlua4, Mithat Gönena5 and Thomas P Bersota6

a1 Division of Endocrinology and Metabolism, Department of Medicine, Private Gayrettepe Florence Nightingale Hospital, Cemil Aslan Güder Sokak No. 8, Gayrettepe, Beşiktaş, 34349, Istanbul, Turkey

a2 Division of Community Nutrition, Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey

a3 Department of Cardiology, Vehbi Koç Foundation American Hospital, Nişantaşı, Istanbul, Turkey

a4 Department of Biochemistry, Vehbi Koç Foundation American Hospital, Nişantaşı, Istanbul, Turkey

a5 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

a6 Gladstone Institute of Cardiovascular Disease and the University of California, San Francisco, CA, USA


Objective To identify the optimal waist:height ratio (WHtR) cut-off point that discriminates cardiometabolic risk factors in Turkish adults.

Design Cross-sectional study. Hypertension, dyslipidaemia, diabetes, metabolic syndrome score ≥2 (presence of two or more metabolic syndrome components except for waist circumference) and at least one risk factor (diabetes, hypertension or dyslipidaemia) were categorical outcome variables. Receiver-operating characteristic (ROC) curves were prepared by plotting 1 − specificity on the x-axis and sensitivity on the y-axis. The WHtR value that had the highest Youden index was selected as the optimal cut-off point for each cardiometabolic risk factor (Youden index = sensitivity + specificity − 1).

Setting Turkey, 2003.

Subjects Adults (1121 women and 571 men) aged 18 years and over were examined.

Results Analysis of ROC coordinate tables showed that the optimal cut-off value ranged between 0·55 and 0·60 and was almost equal between men and women. The sensitivities of the identified cut-offs were between 0·63 and 0·81, the specificities were between 0·42 and 0·71 and the accuracies were between 0·65 and 0·73, for men and women. The cut-off point of 0·59 was the most frequently identified value for discrimination of the studied cardiometabolic risk factors. Subjects classified as having WHtR ≥ 0·59 had significantly higher age and sociodemographic multivariable-adjusted odds ratios for cardiometabolic risk factors than subjects with WHtR < 0·59, except for diabetes in men.

Conclusions We show that the optimal WHtR cut-off point to discriminate cardiometabolic risk factors is 0·59 in Turkish adults.

(Received August 07 2008)

(Accepted August 19 2009)

(Online publication September 28 2009)


c1 Corresponding author: Email