{
  "abstract": "Background: Body mass index (BMI) does not characterize central adiposity and may obscure cardiometabolic risk among adults classified as normal weight. We evaluated associations between waist-to-height ratio (WHtR) and incident disease across the BMI spectrum and among adults with normal BMI. Methods: We studied 308,600 adults in the All of Us Research Program. Participants with the corresponding prevalent disease were excluded separately for eight cardiometabolic outcomes. Cause-specific Cox models adjusted for demographic, socioeconomic, smoking, and BMI-related factors. We evaluated continuous and nonlinear WHtR associations, elevated WHtR among normal-BMI adults, and incremental discrimination. Additional analyses tested WHtR-by-BMI-category interactions. Results: Among 77,684 adults with normal BMI, 24,301 (31.3%) had WHtR 0.50. In whole-cohort analyses, adjusted hazard ratios (HRs) per 0.05 higher WHtR ranged from 1.07 to 1.31 across the eight outcomes. In BMI-stratified interaction models, corresponding diabetes HRs were 1.52 (95% CI, 1.43-1.61) in normal BMI, 1.42 (1.36-1.49) in overweight, and 1.22 (1.20-1.25) in obesity (P for interaction <0.001). Hypertension associations also differed across BMI groups (P for interaction <0.001). Among normal-BMI adults, WHtR 0.50 versus <0.50 was associated with diabetes (HR, 1.74), myocardial infarction (1.49), and ischemic stroke (1.52). Associations with all eight outcomes persisted in normal-BMI landmark analyses excluding the first year. Flexible age adjustment preserved the principal findings. Adding nonlinear WHtR improved cross-validated discrimination, most notably for diabetes (C-index=0.0134). Conclusions: WHtR identified cardiometabolic risk beyond BMI classification. Associations with diabetes and hypertension were particularly pronounced among normal-BMI adults, supporting assessment of central adiposity alongside BMI.",
  "abstract_shown": true,
  "affiliations": [
    "Rutgers School of Health Professions Department of Health Informatics"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "A. W. Potter"
    },
    {
      "name": "C. E. Murphy"
    },
    {
      "name": "J. H. Wasfy"
    },
    {
      "name": "K. E. Friedl"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/040tr60h88b23.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.11.04.26367325",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367325v1.full",
  "id": "040tr60h88b23",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367325v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367325v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/040tr60h88b23.ris",
  "sources": [
    {
      "first_seen": "2026-11-06T00:21:06Z",
      "native_id": "10.64898/2026.11.04.26367325",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.11.04.26367325v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Waist-to-Height Ratio Identifies Cardiometabolic Risk Not Captured by Body Mass Index: The All of Us Research Program",
  "title_text": "Waist-to-Height Ratio Identifies Cardiometabolic Risk Not Captured by Body Mass Index: The All of Us Research Program",
  "type": "preprint",
  "updated_at": "2026-11-07T00:20:53Z",
  "url": "https://research.draconitic.com/paper/040tr60h88b23",
  "venue": "medRxiv",
  "versions": []
}