Waist-to-Height Ratio Identifies Cardiometabolic Risk Not Captured by Body Mass Index: The All of Us Research Program

In 308,600 All of Us adults, waist-to-height ratio (WHtR) predicted incident cardiometabolic disease across BMI categories, with diabetes risk rising up to HR 1.31 per 0.05 WHtR.

• Why it matters: BMI can miss central adiposity and may conceal cardiometabolic risk, especially in adults labeled normal weight.
• What they did: Using cause-specific Cox models with exclusions for prevalent disease, the study tested continuous and nonlinear WHtR effects, normal-BMI WHtR thresholds, BMI interaction terms, and incremental discrimination.
• The result: Among 77,684 normal-BMI adults, WHtR ≥0.50 (31.3%) was linked to diabetes (HR 1.74), myocardial infarction (1.49), and ischemic stroke (1.52), and nonlinear WHtR improved diabetes discrimination (C-index=0.0134).

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