Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people


Objective: To investigate waist circumference (WC), waist–hip ratio, hip circumference and body mass index (BMI) as risk factors for cardiovascular disease in Aboriginal Australians.

Methods: This cohort study included 836 adults aged 20–74 y in a remote Aboriginal community. WC, waist–hip ratio, hip circumference and BMI were obtained from a screening program. The participants were followed for up to 10 y for cardiovascular events. A Cox regression model was used to calculate the rate ratio (RR) and 95% confidence interval (CI) for the first-ever cardiovascular event (fatal and nonfatal).

Results: RRs for the first-ever cardiovascular event were 1.31 (95% CI: 1.11, 1.54), 1.29 (95% CI: 1.09,1.53), 1.28 (95% CI: 1.08, 1.52) and 1.10 (95% CI: 0.93, 1.30) per standard deviation increase in WC, BMI, hip circumference and waist–hip ratio, respectively, after adjustment for diabetes mellitus, total cholesterol, systolic blood pressure and smoking status. WC, BMI and hip circumference were significantly associated with cardiovascular risk, independent of other cardiovascular risk factors. Dividing each of the four parameters into quartiles, WC had the highest likelihood statistics (12.76) followed by BMI (11.45), hip circumference (10.57) and waist–hip ratio (3.15) for predicting first CV events.

Conclusion: WC, BMI and hip circumference are associated with cardiovascular outcome, independent of traditional risk factors. However, WC appears to be a better predictor for cardiovascular risk than other parameters. Waist–hip ratio is not as useful as other measurements.

Sponsorship: This research was funded by the National Health & Medical Research Council of Australia (193316).

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  • Dey DK, Rothenberg E, Sundh V, Bosaeus I & Steen B (2002): Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds. J. Am. Geriatr Soc 50, 1510–1518.

    Article  Google Scholar 

  • Dunstan DW, Zimmet PZ, Welborn TA, Cameron AJ, Shaw J, de Courten M, Jolley D & McCarty DJ (2002): The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)—methods and response rates. Diabetes Res. Clin. Pract. 57, 119–129.

    Article  Google Scholar 

  • Han TS, van Leer EM, Seidell JC & Lean ME (1995): Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. Br. Med. J. 311, 1401–1405.

    CAS  Article  Google Scholar 

  • Higgins M, Kannel W, Garrison R, Pinsky J & Stokes III J (1988): Hazards of obesity–the Framingham experience. Acta Med. Scand. Suppl. 723, 23–36.

    CAS  PubMed  Google Scholar 

  • Iwao S, Iwao N, Muller DC, Elahi D, Shimokata H & Andres R (2001): Does waist circumference add to the predictive power of the body mass index for coronary risk? Obes. Res. 9, 685–695.

    CAS  Article  Google Scholar 

  • Janssen I, Katzmarzyk PT & Ross R (2002): Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines. Arch. Intern. Med. 162, 2074–2079.

    Article  Google Scholar 

  • Kannel WB, Cupples LA, Ramaswami R, Stokes III J, Kreger BE & Higgins M (1991): Regional obesity and risk of cardiovascular disease; the Framingham Study. J. Clin. Epidemiol. 44, 183–190.

    CAS  Article  Google Scholar 

  • Lean ME, Han TS & Morrison CE (1995): Waist circumference as a measure for indicating need for weight management. Br. Med. J. 311, 158–161.

    CAS  Article  Google Scholar 

  • Lean MJ & Han TS (2002): Waist worries. Am. J. Clin. Nutr. 76, 699–700.

    CAS  Article  Google Scholar 

  • Lemieux S, Prud'homme D, Tremblay A, Bouchard C & Despres JP (1996): Anthropometric correlates to changes in visceral adipose tissue over 7 years in women. Int. J. Obes. Relat. Metab. Disord. 20, 618–624.

    CAS  PubMed  Google Scholar 

  • Lissner L, Bjorkelund C, Heitmann BL, Seidell JC & Bengtsson C (2001): Larger hip circumference independently predicts health and longevity in a Swedish female cohort. Obes. Res. 9, 644–646.

    CAS  Article  Google Scholar 

  • Manson JE, Colditz GA, Stampfer MJ, Willett WC, Rosner B, Monson RR, Speizer FE & Hennekens CH (1990): A prospective study of obesity and risk of coronary heart disease in women. N. Engl. J. Med. 322, 882–889.

    CAS  Article  Google Scholar 

  • Mathur S & Gajanayake I (1998): Surveillance of Cardiovascular Mortality in Australia 1985–1996. Canberra: Australian Institute of Health and Welfare.

    Google Scholar 

  • McDermott R, Rowley KG, Lee AJ, Knight S & O'Dea K (2000): Increase in prevalence of obesity and diabetes and decrease in plasma cholesterol in a central Australian aboriginal community. Med. J. Austr. 172, 480–484.

    CAS  Google Scholar 

  • Norgan NG (1994): Interpretation of low body mass indices: Australian aborigines. Am. J. Phys. Anthropol. 94, 229–237.

    CAS  Article  Google Scholar 

  • Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A & Lupien PJ (1994): Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am. J. Cardiol. 73, 460–468.

    CAS  Article  Google Scholar 

  • Rexrode KM, Carey VJ, Hennekens CH, Walters EE, Colditz GA, Stampfer MJ, Willett WC & Manson JE (1998): Abdominal adiposity and coronary heart disease in women. JAMA 280, 1843–1848.

    CAS  Article  Google Scholar 

  • Rimm EB, Stampfer MJ, Giovannucci E, Ascherio A, Spiegelman D, Colditz GA & Willett WC (1995): Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am. J. Epidemiol. 141, 1117–1127.

    CAS  Article  Google Scholar 

  • Seidell JC, Han TS, Feskens EJ & Lean ME (1997): Narrow hips and broad waist circumferences independently contribute to increased risk of non-insulin-dependent diabetes mellitus. J. Intern. Med. 242, 401–406.

    CAS  Article  Google Scholar 

  • Seidell JC, Perusse L, Despres JP & Bouchard C (2001): Waist and hip circumferences have independent and opposite effects on cardiovascular disease risk factors: the Quebec Family Study. Am. J. Clin. Nutr. 74, 315–321.

    CAS  Article  Google Scholar 

  • Snijder MB, Dekker JM, Visser M, Bouter LM, Stehouwer CD, Kostense PJ, Yudkin JS, Heine RJ, Nijpels G & Seidell JC (2003): Associations of hip and thigh circumferences independent of waist circumference with the incidence of type 2 diabetes: the Hoorn Study. Am. J. Clin. Nutr. 77, 1192–1197.

    CAS  Article  Google Scholar 

  • StataCorp (2003): Stata Statistical Software: Release 8.0. College Station. Texas: Stata Corporation.

  • Vadstrup ES, Petersen L, Sorensen TI & Gronbaek M (2003): Waist circumference in relation to history of amount and type of alcohol: results from the Copenhagen City Heart Study. Int. J. Obes. Relat. Metab. Disord. 27, 238–246.

    CAS  Article  Google Scholar 

  • van der Kooy K & Seidell JC (1993): Techniques for the measurement of visceral fat: a practical guide. Int. J. Obes. Relat. Metab. Disord. 17, 187–196.

    CAS  PubMed  Google Scholar 

  • Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, Horlick M, Kotler D, Laferrere B, Mayer L, Pi-Sunyer FX & Pierson Jr RN (2003): Comparisons of waist circumferences measured at 4 sites. Am. J. Clin. Nutr. 77, 379–384.

    Article  Google Scholar 

  • Wang Z & Hoy W (2003): Hypertension, dyslipidaemia, body mass index, diatetes and smoking status in Aboriginal Australians in a remote community. Ethn. Dis. 13, 324–330.

    PubMed  Google Scholar 

  • Wang Z, Hoy W & McDonald S (2000): Body mass index in Aboriginal Australians in remote communities. Austr. NZ. J. Public Health 24, 570–575.

    CAS  Article  Google Scholar 

Download references


We especially thank the Aboriginal people who participated in this study; the Tiwi Health Board; and Tiwi clinics for their help and support.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Z Wang.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wang, Z., Hoy, W. Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr 58, 888–893 (2004).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • cardiovascular disease
  • waist circumference
  • body mass index
  • hip circumference
  • waist-to-hip ratio

This article is cited by


Quick links