Waist-to-BMI index outperforms BMI and waist circumference in predicting elevated pulse pressure: a population-based analysis in Peru

Objective: To compare body mass index (BMI), waist circumference (WC) and WC-BMI in predicting elevated pulse pressure and to examine how these associations vary by age and sex. Method: A cross-sectional analysis used data from the Peru Demographic and Health Survey (2018-2023). Poisson regression models with robust variance were employed to evaluate the association between anthropometric measures and elevated pulse pressure (>= 50 mmHg), adjusting for sociodemographic and lifestyle factors. Results: WC-BMI showed the most consistent and robust association with elevated pulse pressure compared to BMI and WC. The strength of the association was more significant in adults under 60 years and women. An attenuation of the effect was observed in individuals over 60 years for all anthropometric measures. WC-BMI presented a more linear and stable relationship across different population subgroups. Conclussions: WC-BMI predicts elevated pulse pressure more precisely than BMI or WC alone. The attenuation of the effect in older adults and the differences by sex highlights the importance of considering demographic factors in evaluating cardiovascular risk.