Objective and Method: To analyse data from the nationally representative National Diet and Nutrition Survey (NDNS) collected in 2000/2001 and to investigate how the BMI and two proxy indicators of central fat distribution, namely the waist circumference and the waist to height ratio (WHtR), are associated with each other and with cardiovascular disease (CVD) risk factors. Results: Screening health risk by BMI alone would ‘miss’ 35% of men and 14% of women who are within the normal BMI range (18.5–25 kg/m2) but have central fat distribution, defined by WHtR > 0.5. In the total population this equates to 17% of all men and 6% of all women who would be inadequately screened by BMI alone. Compared to BMI, WHtR was more closely associated with CVD risk factors among both men and women. Furthermore, in a combined analysis of men and women, central fat distribution with a normal BMI was associated with higher levels of CVD risk factors than being overweight without central fat distribution. Conclusion: WHtR is a simple and effective, non-invasive screening tool for CVD risk factors. Our proposed boundary value of 0.5 translates into a simple public health message: ‘Keep your waist circumference to less than half your height’.

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