Abstract

CONTEXT: There is a continuing debate about which adiposity measure is the best risk factor. OBJECTIVES: This study compared the associations of 14 health outcomes with combinations of four adiposity measures: body mass index (BMI), waist to hip ratio (WHR), waist, and waist to height ratio. DESIGN: Data were from the Women's Health Initiative, a prospective study of women enrolled from 1993-1998 with a median follow-up time of 8 yr. Regression models were used to test the association of adiposity measures with outcome after adjusting for a number of variables related to demographic characteristics and health behavior. SETTING: The women were recruited from 40 clinical centers throughout the United States. PARTICIPANTS: The sample analyzed included 141,652 postmenopausal women age 50-79 yr who met the criteria for the Women's Health Initiative randomized control trials. MAIN OUTCOME MEASURES: Outcomes included death and eight medical conditions. RESULTS: Adiposity measures were most strongly associated with diabetes, hypertension, joint replacement, and gallbladder disease; moderately associated with myocardial infarction, endometrial cancer, and death; and least strongly associated with colon cancer, stroke, and breast cancer. Associations were nearly identical for waist and waist to height ratio. For most outcomes, waist was a stronger individual risk factor than BMI or WHR. However, BMI and WHR were the most useful combination of adiposity measures for stratifying participants according to risk of hypertension or diabetes. CONCLUSIONS: The adiposity measure most useful for stratifying persons on the basis of risk depends on the outcome of interest. When the outcome is diabetes or hypertension in postmenopausal women, the best indication of risk is a combination BMI and WHR.