{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:47:32Z","timestamp":1790207252049,"version":"4.1.0"},"reference-count":66,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:00:00Z","timestamp":1789257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Body mass index (BMI) does not capture abdominal fat distribution and may classify adiposity differently from central-obesity indicators. We quantified discordance between BMI-defined overweight\/obesity and waist-to-height ratio (WHtR)-defined central obesity among adults with type 2 diabetes mellitus (T2DM) in Malawi. Methods: This multicenter cross-sectional study included 1356 adults attending diabetes clinics at three tertiary hospitals. Overweight\/obesity was BMI \u2265 25 kg\/m2. Central obesity was defined by waist circumference (WC \u2265 94\/80 cm, men\/women), waist-to-hip ratio (WHR \u2265 0.90\/0.85), and WHtR \u2265 0.50. BMI and WHtR were cross-classified into four phenotypes, and agreement between the two classifications was summarized using observed agreement and Cohen\u2019s kappa. Logistic and multinomial logistic regression models estimated (adjusted) odds ratios with 95% CIs; sensitivity analyses added study site as a fixed effect and modified Poisson models with robust variance provided adjusted prevalence ratios for the common binary outcomes. Results: Prevalence of BMI-defined overweight\/obesity was 60.8%; central obesity was 67.5% (WC), 65.3% (WHR), and 80.1% (WHtR). Cross-classification showed 23.7% had central obesity only and 56.3% had combined overweight\/obesity and central obesity; observed agreement between the two classifications was 71.8% and Cohen\u2019s kappa was 0.35 (95% CI 0.30\u20130.40). Overweight\/obesity was associated with older age (aOR 2.95), female sex (aOR 2.19), and physical inactivity (aOR 1.93). WC-defined central obesity was strongly associated with female sex (aOR 10.16), although the corresponding adjusted prevalence ratio was considerably smaller (aPR 2.25). WHR-defined central obesity was associated with older age, and anxiety. WHtR-defined central obesity was associated with older age, female sex, ever-married status, and late-evening eating behavior (aOR 1.36), although the association did not persist when study site was added. The combined phenotype was associated with age, sex, marital status, meal frequency, and physical inactivity. Conclusions: Overweight\/obesity and central obesity were highly prevalent, with WHtR identifying the greatest burden and a substantial central-obesity-only phenotype that BMI alone would not detect. Incorporating WHtR alongside BMI may improve anthropometric assessment of adiposity in diabetes care, particularly among older and female patients.<\/jats:p>","DOI":"10.3390\/diseases14090334","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Discordance Between BMI-Defined Overweight\/Obesity and Waist-to-Height Ratio-Defined Central Obesity Among Adults with Type 2 Diabetes in Malawi: A Multicenter Cross-Sectional Study"],"prefix":"10.3390","volume":"14","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":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6127-1611","authenticated-orcid":false,"given":"Elias Peter","family":"Mwakilama","sequence":"additional","affiliation":[{"name":"Department of Research and Development, Sub-Sahara Health and Research Institute, Lilongwe P.O. Box 40371, Malawi"},{"name":"Department of Mathematical Sciences, University of Malawi, Zomba P.O. Box 280, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-review-editing","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":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Duc Minh","family":"Cap","sequence":"additional","affiliation":[{"name":"School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Faculty of Public Health, Haiphong University of Medicine and Pharmacy, Haiphong 180000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","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"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","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":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/S2213-8587(23)00315-7","article-title":"Tackling the diabetes surge in sub-Saharan Africa through novel youth-centric strategies","volume":"11","author":"Chilunga","year":"2023","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","first-page":"23","article-title":"Prevalence and Epidemiology of Diabetes in West Africa: Trends and Challenges","volume":"4","author":"Ntakirutimana","year":"2024","journal-title":"Res. 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