Waist-to-height ratio as a novel marker of metabolic syndrome in patients with type 2 diabetes mellitus

Abstract

Aim: Metabolic syndrome (MetS) is associated with chronic conditions, including type 2 diabetes mellitus (T2DM) and cardiovascular disorders. New markers are needed for the early detection and successful treatment of MetS, especially in patients with T2DM. The serum uric acid-to-creatinine ratio (UCR) and waist-to-height ratio (WHR) are novel markers in various chronic metabolic disorders. We aimed to compare WHR, UCR, and other metabolic and laboratory markers in T2DM patients with and without MetS. Methods: Patients with T2DM who visited the outpatient clinics of our institution were enrolled in the study. Total diabetic subjects were 239 of which 180 were in MetS group while 59 were in without MetS group. Data from both study groups were compared. Results: The serum UCR in the MetS and control groups was 6.3 ± 2.1 and 5.8 ± 1.6, respectively (p = 0.04). The WHR in the MetS and control groups was 0.65 (0.47–0.87) and 0.62 (0.35–0.84), respectively (p ＜ 0.001). Significant positive correlations were observed between UCR and triglycerides (r = 0.17, p = 0.009), waist circumference (r = 0.13, p = 0.046), hip circumference (r = 0.18, p = 0.006), BMI (r = 0.2, p = 0.002), and GFR (r = 0.4, p ＜ 0.001). Similarly, significant positive correlations were noted between WHR and systolic blood pressure (r = 0.12, p = 0.049), weight (r = 0.5, p ＜ 0.001), BMI (r = 0.7, p ＜ 0.001), and UCR (r = 0.12, p = 0.047). In the ROC analysis, the sensitivity and specificity of WHR (when higher than 0.64) in detecting MetS were 72% and 54%, respectively (AUC: 0.69, p ＜ 0.001, 95% CI: 0.61–0.77). Conclusions: We propose that WHR and UCR could be valuable tools for the early detection of MetS in patients with T2DM. The ease and low cost of evaluating WHR and UCR make them practical markers for monitoring and diagnosing MetS.

Keywords

Waist-to-height ratio / uric acid-to-creatinine ratio / type 2 diabetes mellitus / metabolic syndrome

References

[1] Samson SL, Garber AJ. Metabolic syndrome. Endocrinol Metab Clin North Am. 2014; 43: 1-23.

[2] Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, Bechara MD, Sloan KP, Sloan LA. Metabolic syndrome and cardiovascular diseases: Going beyond traditional risk factors. Diabetes Metab Res Rev. 2022; 38: e3502.

[3] Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus. Aging Male. 2020; 23: 1098-102.

[4] Basaran E, Aktas G. The relationship of vitamin D levels with hemogram indices and metabolic parameters in patients with type 2 diabetes mellitus. AIMS Med Sci. 2024; 1: 47-67.

[5] Aktas G, Khalid A, Kurtkulagi O, Duman TT, Bilgin S, Kahveci G, et al. Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: a cross-sectional cohort study. Postgrad Med. 2022; 134: 297-302.

[6] Gonçalves DLN, Moreira TR, da Silva LS. A systematic review and meta-analysis of the association between uric acid levels and chronic kidney disease. Sci Rep. 2022; 12: 6251.

[7] Kosekli MA, Kurtkulagii O, Kahveci G, Duman TT, Tel BMA, Bilgin S, et al. The association between serum uric acid to high density lipoprotein-cholesterol ratio and non-alcoholic fatty liver disease: the abund study. Rev Assoc Med Bras (1992). 2021; 67: 549-54.

[8] Aktas G, Yilmaz S, Kantarci DB, Duman TT, Bilgin S, Balci SB, et al. Is serum uric acid-to-HDL cholesterol ratio elevation associated with diabetic kidney injury? Postgrad Med. 2023; 135: 519-23.

[9] Alqahtani SAM, Awan ZA, Alasmary MY, Al Amoudi SM. Association between serum uric acid with diabetes and other biochemical markers. J Family Med Prim Care. 2022; 11: 1401-9.

[10] Wang A, Tian X, Wu S, Zuo Y, Chen S, Mo D, et al. Metabolic Factors Mediate the Association Between Serum Uric Acid to Serum Creatinine Ratio and Cardiovascular Disease. J Am Heart Assoc. 2021; 10: e023054.

[11] Ding Z, Fan Y, Yao C, Gu L. The association between the serum uric acid to creatinine ratio and all-cause mortality in elderly hemodialysis patients. BMC Nephrol. 2022; 23: 177.

[12] She D, Xu W, Liu J, Zhang Z, Fang P, Li R, et al. Serum Uric Acid to Creatinine Ratio and Risk of Metabolic Syndrome in Patients with Overweight/Obesity. Diabetes Metab Syndr Obes. 2023; 16: 3007-17.

[13] Zhang FL, Ren JX, Zhang P, Jin H, Qu Y, Yu Y, et al. Strong Association of Waist Circumference (WC), Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), and Waist-to-Hip Ratio (WHR) with Diabetes: A Population-Based Cross-Sectional Study in Jilin Province, China. J Diabetes Res. 2021; 2021: 8812431.

[14] Sebai I, Oueslati I, Yazidi M, Chaker F, Abdessalem H, Grira W, et al. Interest of the waist-to-height ratio to predict metabolic syndrome in type 2 diabetic patients. Tunis Med. 2022; 100: 137-42.

[15] Ke JF, Wang JW, Lu JX, Zhang ZH, Liu Y, Li LX. Waist-to-height ratio has a stronger association with cardiovascular risks than waist circumference, waist-hip ratio and body mass index in type 2 diabetes. Diabetes Res Clin Pract. 2022; 183: 109151.

[16] Abdi Dezfouli R, Mohammadian Khonsari N, Hosseinpour A, Asadi S, Ejtahed HS, Qorbani M. Waist to height ratio as a simple tool for predicting mortality: a systematic review and meta-analysis. Int J Obes (Lond). 2023; 47: 1286-301.

[17] Carmen Zaha D, Vesa C, Uivarosan D, Bratu O, Fratila O, Mirela Tit D, et al. Influence of inflammation and adipocyte biochemical markers on the components of metabolic syndrome. Exp Ther Med. 2020; 20: 121-8.

[18] Kimura Y, Tsukui D, Kono H. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. Int J Mol Sci. 2021; 22: 12394.

[19] Zhu HY, Zhao SZ, Zhang ML, Wang Y, Pan ZM, Cheng HR, et al. Elevated Serum Uric Acid Increases the Risk of Ischemic Stroke Recurrence and Its Inflammatory Mechanism in Older Adults. Front Aging Neurosci. 2022; 14: 822350.

[20] Tani S, Matsuo R, Imatake K, Suzuki Y, Takahashi A, Yagi T, et al. The serum uric acid level in females may be a better indicator of metabolic syndrome and its components than in males in a Japanese population. J Cardiol. 2020; 76: 100-8.

[21] Duman TT, Kocak MZ, Atak BM, Erkus E. Serum Uric acid is correlated with HbA1c levels in type 2 diabetes mellitus. Exp Biomed Res. 2018; 1: 6-9.

[22] Rumora L, Hlapčić I, Popović-Grle S, Rako I, Rogić D, Čepelak I. Uric acid and uric acid to creatinine ratio in the assessment of chronic obstructive pulmonary disease: Potential biomarkers in multicomponent models comprising IL-1beta. PLoS One. 2020; 15: e0234363.

[23] Silva NR, Gonçalves CET, Gonçalves DLN, Cotta RMM, da Silva LS. Association of uric acid and uric acid to creatinine ratio with chronic kidney disease in hypertensive patients. BMC Nephrol. 2021; 22: 311.

[24] Louie JCY, Wall-Medrano A. Editorial: Waist-to-height ratio is a simple tool for assessing central obesity and consequent health risk. Front Nutr. 2023; 10: 1277610.

[25] Arnardóttir E, Sigurðardóttir ÁK, Graue M, Kolltveit BH, Skinner T. Can Waist-to-Height Ratio and Health Literacy Be Used in Primary Care for Prioritizing Further Assessment of People at T2DM Risk? Int J Environ Res Public Health. 2023; 20: 6606.

[26] Kuciene R, Dulskiene V. Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study. Sci Rep. 2019; 9: 9493.

[27] Baez-Duarte BG, Zamora-Ginez I, Rodríguez-Ramírez SO, Pesqueda-Cendejas LK, García-Aragón KH. TG/HDL index to identify subjects with metabolic syndrome in the Mexican population. Gac Med Mex. 2022; 158: 259-64.

[28] Santa-Paavola R, Lehtinen-Jacks S, Jääskeläinen T, Männistö S, Lundqvist A. The association of high-sensitivity C-reactive protein with future weight gain in adults. Int J Obes (Lond). 2022; 46: 1234-40.

[29] Adnan E, Rahman IA, Faridin HP. Relationship between insulin resistance, metabolic syndrome components and serum uric acid. Diabetes Metab Syndr. 2019; 13: 2158-62.

[30] Kuwabara M, Borghi C, Cicero AFG, Hisatome I, Niwa K, Ohno M, et al. Elevated serum uric acid increases risks for developing high LDL cholesterol and hypertriglyceridemia: A five-year cohort study in Japan. Int J Cardiol. 2018; 261: 183-8.

[31] Podkowińska A, Formanowicz D. Chronic Kidney Disease as Oxidative Stress- and Inflammatory-Mediated Cardiovascular Disease. Antioxidants (Basel). 2020; 9: 752.