Volume 36, Issue 256 (4-2026)
J Mazandaran Univ Med Sci 2026, 36(256): 144-159 |
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Soleymani A, Hatami N, Geran M, Zarrinkamar M. Waist-to-Height Ratio Cut offs for Metabolic Syndrome Screening in Adults: A Structured Narrative Review of Population Differences and Predisposing Factors. J Mazandaran Univ Med Sci 2026; 36 (256) :144-159
URL: http://jmums.mazums.ac.ir/article-1-22021-en.html
URL: http://jmums.mazums.ac.ir/article-1-22021-en.html
Abstract: (221 Views)
Background and purpose: Metabolic Syndrome (MetS) is a growing challenge with serious health consequences. The Waist-to-Height Ratio (WHtR) is a simple and cost-effective screening tool for MetS; however, its thresholds vary across different populations. This structured narrative review aimed to synthesize the reported WHtR thresholds, examine differences in their performance for screening MetS among adults, and analyse the potential reasons for these variations.
Materials and methods: In this structured narrative review, an extensive search was conducted of the PubMed and ScienceDirect databases to identify cross-sectional studies related to WHtR thresholds in adults. Study selection and data extraction were performed by two independent researchers. Due to the inherent heterogeneity of the data, the results were categorized and analyzed using a narrative synthesis approach based on influential variables, including sex, age, geographic region/ethnicity, and underlying medical conditions.
Results: Out of 1,003 initial articles, 37 cross-sectional studies were included in the review. The reported WHtR thresholds showed significant variation, ranging from 0.50 to 0.61. The performance of these thresholds (sensitivity and specificity) varied considerably depending on the population and the specific cutoff used. The findings indicated that factors such as sex, age, geographic region/ethnicity, and specific conditions (e.g., diabetes and PCOS) influence both the optimal WHtR threshold and its diagnostic performance. There were conflicting findings regarding the necessity of distinct thresholds for all subgroups.
Conclusion: The findings of this narrative review indicate substantial heterogeneity and variability in the reported WHtR thresholds for diagnosing metabolic syndrome across different populations. It appears that variables such as ethnicity, age, and sex play a role in determining these thresholds. Given these differences, using a single universal value for all populations may be associated with reduced screening accuracy. It is suggested that, in clinical practice, WHtR thresholds should be interpreted with caution, considering the demographic characteristics of each population. Further prospective studies are needed to establish precise cutoff points for specific populations.
Materials and methods: In this structured narrative review, an extensive search was conducted of the PubMed and ScienceDirect databases to identify cross-sectional studies related to WHtR thresholds in adults. Study selection and data extraction were performed by two independent researchers. Due to the inherent heterogeneity of the data, the results were categorized and analyzed using a narrative synthesis approach based on influential variables, including sex, age, geographic region/ethnicity, and underlying medical conditions.
Results: Out of 1,003 initial articles, 37 cross-sectional studies were included in the review. The reported WHtR thresholds showed significant variation, ranging from 0.50 to 0.61. The performance of these thresholds (sensitivity and specificity) varied considerably depending on the population and the specific cutoff used. The findings indicated that factors such as sex, age, geographic region/ethnicity, and specific conditions (e.g., diabetes and PCOS) influence both the optimal WHtR threshold and its diagnostic performance. There were conflicting findings regarding the necessity of distinct thresholds for all subgroups.
Conclusion: The findings of this narrative review indicate substantial heterogeneity and variability in the reported WHtR thresholds for diagnosing metabolic syndrome across different populations. It appears that variables such as ethnicity, age, and sex play a role in determining these thresholds. Given these differences, using a single universal value for all populations may be associated with reduced screening accuracy. It is suggested that, in clinical practice, WHtR thresholds should be interpreted with caution, considering the demographic characteristics of each population. Further prospective studies are needed to establish precise cutoff points for specific populations.
Keywords: Metabolic syndrome (MetS), Waist-to-height ratio (WHtR), Adult populations, MetS screening, Thresholds
Type of Study: Review |
Subject:
Endocrine diseases
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