Systematic Reviews and Meta‐ and Pooled Analyses Comparisons of the Strength of Associations With Future Type 2 Diabetes Risk Among Anthropometric Obesity Indicators, Including Waist-to-Height Ratio: A Meta-Analysis

The aim of this meta-analysis was to compare the association of waist-to-height ratio (WHtR) with risk of incident diabetes with the associations of 3 other conventional obesity indicators (body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)) with risk of incident diabetes. Literature searches in MEDLINE (January 1950 to April 27, 2011) and EMBASE (January 1974 to April 27, 2011) were conducted for prospective studies that made it possible to estimate the relative risk of diabetes per 1-standard deviation increase in WHtR, in addition to the RR of BMI, WC, or WHR. Strength of the estimated pooled relative risk for a 1-standard deviation increase of each indicator (expressed as RRWHtR, RRBMI, RRWC, and RRWHR) was compared with a bivariate random-effects model. Pooled relative risks of the 15 eligible studies with 6,472 diabetes cases were 1.62 (95% CI: 1.48, 1.78) for RRWHtR, 1.55 (95% CI: 1.43, 1.69) for RRBMI, 1.63 (95% CI: 1.49, 1.79) for RRWC, and 1.52 (95% CI: 1.40, 1.66) for RRWHR. WHtR had an association stronger than that of BMI (P<0.001) or WHR (P<0.001). The present meta-analysis showed that WHtR has a modestly but statistically greater importance than BMI and WHR in prediction of diabetes. Nevertheless, measuring height in addition to WC appeared to have no additional benefit.