Aim. The aim was to compare body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), and waist height ratio (WHtR) to identify the best predictor of metabolic syndrome (MetS) among Qatari adult population. Methods. A cross-sectional survey from April 2011 to December 2012. Data was collected from 1552 participants followed by blood sampling. MetS was defined according to Third Adult Treatment Panel (ATPIII) and International Diabetes Federation (IDF). Receiver operating characteristics (ROC) curve analysis was performed. Results. Among men, WC followed by WHR and WHtR yielded the highest area under the curve (AUC) (0.78; 95% CI 0.74–0.82 and 0.75; 95% CI 0.71–0.79, resp.). Among women, WC followed by WHtR yielded the highest AUC (0.81; 95% CI 0.78–0.85 & 0.79; 95% CI 0.76–0.83, resp.). Among men, WC at a cut-off 99.5？cm resulted in the highest Youden index with sensitivity 81.6% and 63.9% specificity. Among women, WC at a cut-off 91？cm resulted in the highest Youden index with the corresponding sensitivity and specificity of 86.5% and 64.7%, respectively. BMI had the lowest sensitivity and specificity in both genders. Conclusion. WC at cut-off 99.5？cm in men and 91？cm in women was the best predictor of MetS in Qatar. 1. Introduction Metabolic syndrome (MetS) is known to be a cluster of interrelated risk factors of metabolic origin such as elevated blood pressures, glucose metabolism disturbances, dyslipidemia, and obesity [1], which are linked to the development of atherosclerotic cardiovascular diseases and type 2 diabetes mellitus (T2DM) [1–4]. Out of all these risk factors, obesity or body fat seems to be the predominant underlying risk factor not only in the development of MetS but also other cardiovascular risk factors [5, 6]. It has been widely considered that central obesity as a marker of body fat can be conveniently and cost effectively estimated by measuring body mass index (BMI) and waist circumference (WC) that in turn might effectively predict the risk of MetS [7, 8]. Recently some other indices of abdominal obesity such as waist hip ratio (WHR) and waist height ratio (WHtR) have also been reported to be better discriminators of cardiovascular and metabolic risk factors than BMI and/or WC. However, studies from different countries and ethnicities have different conclusions regarding the superiority of one or the other obesity index and related cut-off points to diagnose obesity and hence MetS [9–11]. Researchers believe that ethnic and racial variation among population from different regions might need different cut-off
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