{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:07:33Z","timestamp":1790168853656,"version":"4.1.0"},"reference-count":65,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: We evaluated the discriminatory performance of traditional anthropometric parameters and novel body-shape indices for identifying hypertension among adults with type 2 diabetes mellitus (T2DM) in Malawi. Methods: This was a multicenter cross-sectional study of 1356 adults with T2DM attending outpatient diabetes clinics at three tertiary referral hospitals. Traditional anthropometric parameters were body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Novel body-shape indices were the weight-adjusted waist index (WWI), a body shape index (ABSI), the conicity index, and body roundness index (BRI). Hypertension was defined as systolic blood pressure \u2265 140 mmHg and\/or diastolic blood pressure \u2265 90 mmHg, or current antihypertensive medication use. Multivariable logistic regressions and receiver operating characteristic (ROC) analyses were performed overall and, as secondary subgroup analyses, stratified by sex; effect modification by sex was tested formally using interaction terms. Results: Overall, 68.3% had hypertension. All anthropometric measures were positively associated with hypertension in adjusted models. The strongest associations were observed for WHtR and its monotonic transformation, the BRI (aOR, 1.79; 95% CI 1.55\u20132.07 and aOR, 1.80; 95% CI 1.55\u20132.09, respectively), followed by WC (aOR, 1.70; 95% CI 1.48\u20131.95). The ranking of measures was similar in men and women, and no measure showed a statistically significant sex interaction. WHtR and BRI had the highest overall AUCs (0.69; 95% CI 0.66\u20130.72), followed by WC (0.68; 95% CI 0.65\u20130.71), indicating modest discrimination. Youden-derived WHtR cut-offs were 0.53 in men and 0.61 in women. Conclusions: All anthropometric measures were independently associated with hypertension, but discrimination was modest and none are adequate as a stand-alone screening test. WHtR is the simplest of the best-performing measures and may help prioritize patients for repeat blood pressure assessment in resource-limited diabetes clinics. The sex-stratified estimates and the internally derived cut-offs are exploratory and require external validation.<\/jats:p>","DOI":"10.3390\/diagnostics16193083","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T12:36:07Z","timestamp":1790166967000},"page":"3083","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations and Discriminatory Performance of Anthropometric and Body-Shape Indices for Identifying Hypertension in Adults with Type 2 Diabetes in Malawi: A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7694-7418","authenticated-orcid":false,"given":"Alexander Thomas","family":"Mboma","sequence":"first","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Department of Research and Development, Sub-Sahara Health and Research Institute, Lilongwe P.O. Box 40371, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-7275","authenticated-orcid":false,"given":"Saulos Kondwani","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Department of Medicine, Zomba Central Hospital, Zomba P.O. Box 21, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Kondwani Joseph","family":"Banda","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Sub-Sahara Health and Research Institute, Lilongwe P.O. Box 40371, Malawi"},{"name":"School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9771-5093","authenticated-orcid":false,"given":"Alexander Archippus","family":"Kalimbira","sequence":"additional","affiliation":[{"name":"Department of Human Nutrition and Health Sciences, Bunda College, Lilongwe University of Agriculture & Natural Resources, Lilongwe P.O. Box 219, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Rong-Hong","family":"Hsieh","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2287-0723","authenticated-orcid":false,"given":"Tuyen Van","family":"Duong","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18892","DOI":"10.1038\/s41598-024-69062-7","article-title":"Hypertension among persons with type 2 diabetes and its related demographic, socioeconomic and lifestyle factors in the Fasa cohort study","volume":"14","author":"Taheri","year":"2024","journal-title":"Sci. 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