J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://jem.elmerpub.com

Original Article

Volume 15, Number 1, March 2025, pages 24-33

Anthropometric Markers as Cardiovascular Predictors: A Comparison Between Conventional Cut-Off Points and Population Percentiles

↓ **Table 1.** Study Sample Characteristics
Characteristic	N = 10,300
Data were shown in n (%). ^aMean (SD). BMI: body mass index; WC: waist circumference; WHtR: waist-to-height ratio; ATP-III: Adult Treatment Panel III; IDF: International Diabetes Federation; SD: standard deviation.
Sex
Female	1,589 (15.43%)
Male	8,711 (84.57%)
Age^a	37.17 (11.53)
Age group
18 - 59 years	9,847 (95.60%)
60 years or older	453 (4.40%)
Occupation type
Office	3,651 (35.45%)
Physical or manual	5,612 (54.49%)
Customer service or sales	62 (0.60%)
Health professional	243 (2.36%)
Social services	732 (7.11%)
Night shift work
No	9,624 (93.44%)
Yes	676 (6.56%)
Smoking status
No	6,031 (58.55%)
Yes	4,269 (41.45%)
Alcohol consumption
No	5,143 (49.93%)
Yes	5,157 (50.07%)
Body mass index^a	27.18 (4.02)
Abdominal waist^a	91.15 (10.41)
Waist-to-height ratio	0.55 (0.06)
Waist-BMI	25.12 (6.40)
Nutritional status
Normal weight	3,120 (30.29%)
Overweight	4,916 (47.73%)
Obesity	2,264 (21.98%)
Abdominal obesity (percentile)
Normal	7,065 (68.59%)
Elevated	2,553 (24.79%)
Very elevated	682 (6.62%)
WHtR-defined obesity (percentile)
Normal	7,162 (73.31%)
Elevated	2,074 (21.23%)
Very elevated	534 (5.47%)
WC-BMI-defined obesity (percentile)
Normal	7,486 (72.68%)
Elevated	2,271 (22.05%)
Very elevated	543 (5.27%)
Abdominal obesity (ATP-III)
No	8,213 (79.74)
Yes	2,087 (20.26)
Abdominal obesity (IDF)
No	3,958 (38.43)
Yes	6,342 (61.57)
WHtR-defined obesity (≥ 0.5)
No	1,879 (18.24)
Yes	8,421 (81.76)

↓ Table 1. Study Sample Characteristics

Characteristic

N = 10,300

Data were shown in n (%). ^aMean (SD). BMI: body mass index; WC: waist circumference; WHtR: waist-to-height ratio; ATP-III: Adult Treatment Panel III; IDF: International Diabetes Federation; SD: standard deviation.

Sex

Female

1,589 (15.43%)

Male

8,711 (84.57%)

Age^a

37.17 (11.53)

Age group

18 - 59 years

9,847 (95.60%)

60 years or older

453 (4.40%)

Occupation type

Office

3,651 (35.45%)

Physical or manual

5,612 (54.49%)

Customer service or sales

62 (0.60%)

Health professional

243 (2.36%)

Social services

732 (7.11%)

Night shift work

9,624 (93.44%)

Yes

676 (6.56%)

Smoking status

6,031 (58.55%)

Yes

4,269 (41.45%)

Alcohol consumption

5,143 (49.93%)

Yes

5,157 (50.07%)

Body mass index^a

27.18 (4.02)

Abdominal waist^a

91.15 (10.41)

Waist-to-height ratio

0.55 (0.06)

Waist-BMI

25.12 (6.40)

Nutritional status

Normal weight

3,120 (30.29%)

Overweight

4,916 (47.73%)

Obesity

2,264 (21.98%)

Abdominal obesity (percentile)

Normal

7,065 (68.59%)

Elevated

2,553 (24.79%)

Very elevated

682 (6.62%)

WHtR-defined obesity (percentile)

Normal

7,162 (73.31%)

Elevated

2,074 (21.23%)

Very elevated

534 (5.47%)

WC-BMI-defined obesity (percentile)

Normal

7,486 (72.68%)

Elevated

2,271 (22.05%)

Very elevated

543 (5.27%)

Abdominal obesity (ATP-III)

8,213 (79.74)

Yes

2,087 (20.26)

Abdominal obesity (IDF)

3,958 (38.43)

Yes

6,342 (61.57)

WHtR-defined obesity (≥ 0.5)

1,879 (18.24)

Yes

8,421 (81.76)

↓ **Table 2.** Incidence Rates and Development of CVD According to Body Mass Index Categories
	Nutritional status	Incidence rate^a (95% CI)	Number of events	Person-years	cHR	aHR^b
^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.
CVD	Normal weight	1.27 (0.48 - 2.05)	10	7,902.36	Ref.	Ref.
	Overweight	2.52 (1.63 - 3.40)	31	12,317.15	1.91 (0.96, 3.78)	1.23 (0.61, 2.47)
	Obesity	3.54 (1.95 - 5.13)	19	5,371.76	2.99 (1.43, 6.25)	1.87 (0.89, 3.95)
Stroke	Normal weight	0.38 (0.01 - 0.81)	3	7,902.36	Ref.	Ref.
	Overweight	0.73 (0.25 - 1.21)	9	12,317.15	0.67 (0.20, 2.33)	0.46 (0.13, 1.65)
	Obesity	1.68 (0.58 - 2.77)	9	5,371.76	2.13 (0.65, 7.00)	1.44 (0.42, 4.88)
MI	Normal weight	0.63 (0.08 - 1.19)	5	7,902.36	Ref.	Ref.
	Overweight	0.41 (0.05 - 0.76)	5	12,317.15	2.01 (0.54, 7.42)	1.51 (0.40, 5.72)
	Obesity	1.12 (0.22 - 2.01)	6	5,371.76	5.28 (1.43, 19.5)	4.07 (1.08, 15.4)

↓ Table 2. Incidence Rates and Development of CVD According to Body Mass Index Categories

Nutritional status

Incidence rate^a (95% CI)

Number of events

Person-years

cHR

aHR^b

^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.

CVD

Normal weight

1.27 (0.48 - 2.05)

7,902.36

Ref.

Overweight

2.52 (1.63 - 3.40)

12,317.15

1.91 (0.96, 3.78)

1.23 (0.61, 2.47)

Obesity

3.54 (1.95 - 5.13)

5,371.76

2.99 (1.43, 6.25)

1.87 (0.89, 3.95)

Stroke

Normal weight

0.38 (0.01 - 0.81)

7,902.36

Ref.

Overweight

0.73 (0.25 - 1.21)

12,317.15

0.67 (0.20, 2.33)

0.46 (0.13, 1.65)

Obesity

1.68 (0.58 - 2.77)

5,371.76

2.13 (0.65, 7.00)

1.44 (0.42, 4.88)

Normal weight

0.63 (0.08 - 1.19)

7,902.36

Ref.

Overweight

0.41 (0.05 - 0.76)

12,317.15

2.01 (0.54, 7.42)

1.51 (0.40, 5.72)

Obesity

1.12 (0.22 - 2.01)

5,371.76

5.28 (1.43, 19.5)

4.07 (1.08, 15.4)

↓ **Table 3.** Incidence Rates and Development of CVD According to Abdominal Obesity
	Abdominal obesity	Incidence rate^a (95% CI)	Number of events	Person-years	cHR	aHR^b
^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.
CVD	Normal	1.92 (1.28 - 2.57)	34	17,690.21	Ref.	Ref.
	Elevated	2.71 (1.42 - 3.99)	17	6,280.14	1.58 (0.88, 2.84)	1.25 (0.69, 2.26)
	Very elevated	5.55 (1.92 - 9.18)	9	1,620.93	3.54 (1.69, 7.43)	2.40 (1.12, 5.12)
Stroke	Normal	0.68 (0.29 - 1.06)	12	17,690.21	Ref.	Ref.
	Elevated	0.80 (0.10 - 1.49)	5	6,280.14	2.80 (0.93, 8.38)	2.36 (0.78, 7.15)
	Very elevated	2.47 (0.05 - 4.89)	4	1,620.93	5.87 (1.51, 22.9)	4.53 (1.13, 18.1)
MI	Normal	0.40 (0.10 - 0.69)	7	17,690.21	Ref.	Ref.
	Elevated	0.96 (0.19 - 1.72)	6	6,280.14	1.41 (0.49, 4.01)	1.22 (0.42, 3.53)
	Very elevated	1.85 (0.00 - 3.95)	3	1,620.93	4.89 (1.56, 15.3)	3.79 (1.17, 12.2)

↓ Table 3. Incidence Rates and Development of CVD According to Abdominal Obesity

Abdominal obesity

Incidence rate^a (95% CI)

Number of events

Person-years

cHR

aHR^b

CVD

Normal

1.92 (1.28 - 2.57)

17,690.21

Ref.

Elevated

2.71 (1.42 - 3.99)

6,280.14

1.58 (0.88, 2.84)

1.25 (0.69, 2.26)

Very elevated

5.55 (1.92 - 9.18)

1,620.93

3.54 (1.69, 7.43)

2.40 (1.12, 5.12)

Stroke

Normal

0.68 (0.29 - 1.06)

17,690.21

Ref.

Elevated

0.80 (0.10 - 1.49)

6,280.14

2.80 (0.93, 8.38)

2.36 (0.78, 7.15)

Very elevated

2.47 (0.05 - 4.89)

1,620.93

5.87 (1.51, 22.9)

4.53 (1.13, 18.1)

Normal

0.40 (0.10 - 0.69)

17,690.21

Ref.

Elevated

0.96 (0.19 - 1.72)

6,280.14

1.41 (0.49, 4.01)

1.22 (0.42, 3.53)

Very elevated

1.85 (0.00 - 3.95)

1,620.93

4.89 (1.56, 15.3)

3.79 (1.17, 12.2)

↓ **Table 4.** Incidence Rates and Development of CVD According to WHtR-defined Obesity
	WHtR-defined obesity (percentile)	Incidence rate^a (95% CI)	Number of events	Person-years	cHR	aHR^b
^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; WHtR: waist-to-height ratio; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.
CVD	Normal	1.84 (1.21 - 2.47)	33	17,924.96	Ref.	Ref.
	Elevated	2.54 (1.16 - 3.91)	13	5,126.92	1.55 (0.81, 2.96)	1.19 (0.61, 2.30)
	Very elevated	7.14 (2.48 - 11.81)	9	1,260.29	4.76 (2.26, 10.0)	2.57 (1.17, 5.64)
Stroke	Normal	0.67 (0.29 - 1.05)	12	17,924.96	Ref.	Ref.
	Elevated	0.59 (0.00 - 1.25)	3	5,126.92	2.51 (0.81, 7.72)	2.03 (0.64, 6.39)
	Very elevated	3.17 (0.06 - 6.28)	4	1,260.29	6.44 (1.70, 24.4)	4.05 (1.01, 16.3)
MI	Normal	0.45 (0.14 - 0.76)	8	17,924.96	Ref.	Ref.
	Elevated	0.98 (0.12 - 1.83)	5	5,126.92	1.07 (0.30, 3.81)	0.89 (0.25, 3.26)
	Very elevated	2.38 (0.00 - 5.07)	3	1,260.29	6.18 (1.98, 19.3)	4.20 (1.26, 14.0)

↓ Table 4. Incidence Rates and Development of CVD According to WHtR-defined Obesity

WHtR-defined obesity (percentile)

Incidence rate^a (95% CI)

Number of events

Person-years

cHR

aHR^b

^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; WHtR: waist-to-height ratio; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.

CVD

Normal

1.84 (1.21 - 2.47)

17,924.96

Ref.

Elevated

2.54 (1.16 - 3.91)

5,126.92

1.55 (0.81, 2.96)

1.19 (0.61, 2.30)

Very elevated

7.14 (2.48 - 11.81)

1,260.29

4.76 (2.26, 10.0)

2.57 (1.17, 5.64)

Stroke

Normal

0.67 (0.29 - 1.05)

17,924.96

Ref.

Elevated

0.59 (0.00 - 1.25)

5,126.92

2.51 (0.81, 7.72)

2.03 (0.64, 6.39)

Very elevated

3.17 (0.06 - 6.28)

1,260.29

6.44 (1.70, 24.4)

4.05 (1.01, 16.3)

Normal

0.45 (0.14 - 0.76)

17,924.96

Ref.

Elevated

0.98 (0.12 - 1.83)

5,126.92

1.07 (0.30, 3.81)

0.89 (0.25, 3.26)

Very elevated

2.38 (0.00 - 5.07)

1,260.29

6.18 (1.98, 19.3)

4.20 (1.26, 14.0)

↓ **Table 5.** Incidence Rates and Development of CVD According to WC-BMI Index-Defined Obesity
	WC-BMI-defined obesity (percentile)	Incidence rate^a (95% CI)	Number of events	Person-years	cHR	aHR^b
^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; BMI: body mass index; WC: waist circumference; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.
CVD	Normal	1.91 (1.29 - 2.54)	36	18,816.91	Ref.	Ref.
	Elevated	3.98 (2.32 - 5.65)	22	5,525.04	2.36 (1.38, 4.02)	1.81 (1.05, 3.11)
	Very elevated	1.60 (0.01 - 3.82)	2	1,249.33	1.07 (0.26, 4.45)	0.85 (0.20, 3.55)
Stroke	Normal	0.53 (0.20 - 0.86)	10	18,816.91	Ref.	Ref.
	Elevated	1.63 (0.56 - 2.69)	9	5,525.04	2.65 (0.94, 7.47)	2.14 (0.75, 6.13)
	Very elevated	1.60 (0.01 - 3.82)	2	1,249.33	2.34 (0.30, 18.5)	1.98 (0.25, 15.8)
MI	Normal	0.48 (0.17 - 0.79)	9	18,816.91	Ref.	Ref.
	Elevated	1.09 (0.22 - 1.95)	6	5,525.04	3.68 (1.49, 9.11)	3.10 (1.23, 7.76)
	Very elevated	0.80 (0.01 - 2.37)	1	1,249.33	4.37 (0.95, 20.1)	3.84 (0.83, 17.9)

↓ Table 5. Incidence Rates and Development of CVD According to WC-BMI Index-Defined Obesity

WC-BMI-defined obesity (percentile)

Incidence rate^a (95% CI)

Number of events

Person-years

cHR

aHR^b

^aIncidence rate is expressed per 1,000 person-years. ^bAdjusted for sex, age, tobacco use, and alcohol consumption. Categories: normal (< 75th percentile), elevated (75th - 95th percentile), very elevated (> 95th percentile). CVD: cardiovascular events; BMI: body mass index; WC: waist circumference; MI: myocardial infarction; cHR: crude hazard ratio; aHR: adjusted hazard ratio; 95% CI: 95% confidence interval; Ref.: reference category.

CVD

Normal

1.91 (1.29 - 2.54)

18,816.91

Ref.

Elevated

3.98 (2.32 - 5.65)

5,525.04

2.36 (1.38, 4.02)

1.81 (1.05, 3.11)

Very elevated

1.60 (0.01 - 3.82)

1,249.33

1.07 (0.26, 4.45)

0.85 (0.20, 3.55)

Stroke

Normal

0.53 (0.20 - 0.86)

18,816.91

Ref.

Elevated

1.63 (0.56 - 2.69)

5,525.04

2.65 (0.94, 7.47)

2.14 (0.75, 6.13)

Very elevated

1.60 (0.01 - 3.82)

1,249.33

2.34 (0.30, 18.5)

1.98 (0.25, 15.8)

Normal

0.48 (0.17 - 0.79)

18,816.91

Ref.

Elevated

1.09 (0.22 - 1.95)

5,525.04

3.68 (1.49, 9.11)

3.10 (1.23, 7.76)

Very elevated

0.80 (0.01 - 2.37)

1,249.33

4.37 (0.95, 20.1)

3.84 (0.83, 17.9)