Waist-to-Hip Ratio Cut-Off Points

Introduction to Cut-Off Values

The European Society of Cardiology recommends waist-to-hip ratio cut-off points of ≥0.95 for men and ≥0.80 for women to identify high cardiovascular risk 1, 2

For men, a waist-to-hip ratio of ≥0.95 is associated with high cardiovascular risk, as identified by the European Heart Journal 1
For women, a waist-to-hip ratio of ≥0.80 is associated with high cardiovascular risk, as identified by the European Heart Journal 1

The European Society of Cardiology notes that waist circumference alone has been shown to be a superior predictor of cardiovascular risk compared to waist-to-hip ratio, although it may be more prone to measurement error 1, 2

For the European/Caucasian population, the following cut-off points are recommended:
For the Asian population, the following cut-off points are recommended: men ≥90 cm, women ≥80 cm 3, 4

The European Society of Cardiology warns that waist-to-hip ratio cut-off points may require adjustments for different ethnic groups, as populations such as those from South Asia may have a higher percentage of body fat and visceral adipose tissue at lower waist-to-hip ratio and waist circumference values 1, 2, 3
The American Heart Association notes that current waist-to-hip ratio cut-off points may not be appropriate for women, older adults, and certain racial or ethnic groups, as a high number of women may have elevated waist-to-hip ratio without equivalent cardiovascular risk 4

The European Society of Cardiology recommends using waist circumference instead of waist-to-hip ratio as the primary anthropometric measure to evaluate central obesity and cardiovascular risk, as it provides additional information to BMI and is simpler to implement 1, 2, 4

A waist circumference ≥ 90 cm in men and ≥ 80 cm in women signals elevated cardiometabolic risk in Asia‑Pacific populations. [5][6]
These thresholds are lower than Caucasian standards (≥102 cm for men, ≥88 cm for women), reflecting earlier onset of metabolic complications in Asian individuals. 5

Country	Men (cm)	Women (cm)
Japan	≥ 85	≥ 90
China	≥ 85	≥ 80
Indonesia*	Lower cut‑points may be needed for specific ethnic groups	Lower cut‑points may be needed for specific ethnic groups

*All values derived from the same source. 5

Measure waist circumference at the midpoint between the superior iliac crest and the lower margin of the last rib, using a horizontal plane. 5

In patients with BMI < 35 kg/m², routinely measure waist circumference and apply the Asia‑Pacific thresholds (≥90 cm men, ≥80 cm women) to identify elevated risk. [5][6]
When waist circumference is borderline, consider waist‑to‑hip ratio as supplementary information. 6
Evaluate obesity‑related complications (e.g., fasting glucose, lipid profile, blood pressure) in conjunction with anthropometric findings rather than relying on a single measurement. 5

Applying Caucasian/Western waist‑circumference cut‑offs (≥102 cm men, ≥88 cm women) to Asian patients misses a substantial proportion of individuals at high cardiometabolic risk who exceed the Asia‑Pacific thresholds but fall below Western limits. 5

Asian populations develop metabolic syndrome and type 2 diabetes at lower BMI and waist‑circumference values compared with other ethnicities. 5