Beyond body mass index: The waist-to-height ratio’s significance in predicting diabetes and hypertension in an Indian rural population

Obesity is a pandemic that can be gauged by various anthropometric parameters, with debate on the best measure associated with cardiovascular risk. The waist-to-height ratio (WHtR) has gained attention as a marker of cardiometabolic risk. The primary objective of this study was to evaluate the association of WHtR with diabetes mellitus and hypertension in a rural Indian population. This cross-sectional observational study employed universal screening of all individuals aged ≥45 years in a rural village in western Maharashtra. All participants underwent anthropometric/blood pressure measurements and were sampled for hemoglobin A1c (HbA1c). Data were analyzed using JMP software, version 16.0.0 (SAS Institute Inc., Cary, NC, USA). Associations were tested using one-way analysis of variance, multivariable nominal logistic regression, and receiver operating characteristic curve analysis. The study included 863 participants (median age: 55 years; 56% female). The mean WHtR was 0.54 ± 0.07, with 70% having an increased WHtR (>0.5). WHtR showed the strongest association with diabetes and hypertension categories among all anthropometric indices, followed by body mass index (BMI). WHtR was significantly correlated with HbA1c levels ( P < 0.001), systolic and diastolic blood pressure ( P < 0.001), and Indian Diabetes Risk Score ( P < 0.001). In multivariable logistic regression, WHtR remained an independent predictor of diabetes ( P = 0.028) after adjustment for age, sex, BMI, family history, diet, and physical activity, but did not remain significant for hypertension ( P = 0.113) after adjustment. Our study supports the utility of WHtR as a simple, reliable anthropometric index that is significantly associated with diabetes and hypertension in a rural Indian population aged ≥45 years.