Comparative Discriminatory Ability of Body Mass Index, Percent Body Fat, Waist Circumference, and Waist-to-Height Ratio for Cardiometabolic Risk Among Korean Adults: A Cross-Sectional Study Using the Korea National Health and Nutrition Examination Survey (KNHANES) 2024.

Obesity is a major risk factor for cardiometabolic disease, but which indicator best identifies elevated risk remains uncertain. This cross-sectional study compared the associations and discriminatory ability of body mass index (BMI), percent body fat (PBF), waist circumference (WC), and waist-to-height ratio (WHtR) for cardiometabolic risk among 2412 Korean adults aged 40-64 years, using data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2024. Cardiometabolic risk (CMR) was defined as ≥ 2 of four factors: elevated blood pressure, hyperglycemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol. Survey-weighted logistic regression and receiver operating characteristic analyses were adjusted for age and sex. All adiposity indicators were significantly associated with elevated CMR. Adjusted odds ratios per 1-SD increase were 2.40 (95% CI, 2.12-2.72) for BMI, 2.51 (2.19-2.87) for PBF, 2.84 (2.46-3.28) for WC, and 2.64 (2.32-3.00) for WHtR. WHtR had the highest AUC (0.780), statistically comparable to WC (0.776; Holm-adjusted p = .194) but significantly higher than BMI (0.766; p = .003) and PBF (0.752; p < .001). WC also had a higher AUC than PBF (p = .001), but not BMI (p = .098). Although differences in discriminatory ability were modest, WHtR may provide a practical, low-cost complementary measure for cardiometabolic risk assessment among Korean adults.