Redefining Obesity in the Indonesian Population: The Critical Role of Waist-to-Height Ratio in Screening for Diabetes Mellitus and Hypertension

Abstract

Objectives: Waist-to-height ratio (WHtR) is an alternative index to evaluate metabolic health and predict the risk of estimating the impact of adiposity on cardiometabolic diseases. Despite the significance, the diagnostic performance of WHtR has not been extensively investigated in large epidemiological studies in Indonesia. Therefore, this study aimed to investigate anthropometric indexes (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR], and WHtR) with the best clinically accurate and diagnostic performance in detecting the prevalence of diabetes mellitus (DM) and hypertension (HTN) in the Indonesian population. Methods: This study used a cross-sectional method to analyze big data of 7699 individuals from the Indonesian Family Life Survey. The diagnostic performance of each anthropometric index was analyzed using the receiver operating characteristics (ROC) curve model in the SPSS and MedCalc applications. Furthermore, the associations of anthropometric indexes with DM and HTN were evaluated using logistic regression adjusted for sociodemographic confounders. Results: WHtR showed the highest area under the curve (AUC) for detecting DM in men (0.731 [0.679–0.784]), as well as HTN in both men (0.650 [0.629–0.671]) and women (0.615 [0.598–0.633]). Although often negligible, the discrepancies had overlapping 95% confidence intervals with other indexes. WHtR also showed the strongest association with both DM (AOR [95% CI]: 3.166 [2.416–4.150]) and HTN (1.938 [1.703–2.206]). Lower cutoffs for BMI (22.72 kg/m2) and WC (83.35 cm) enhanced sensitivity for DM and HTN detection, particularly in men. Discussion: WHtR outperformed BMI, WC, and WHR in detecting DM and HTN in the Indonesian population. Additionally, lower cutoffs for overall (BMI) and abdominal obesity (WC) should be considered to enhance the sensitivity of anthropometric indexes in screening for cardiometabolic diseases in the population.