Medicine:Waist-to-height ratio

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A person's waist-to-height ratio (WHtR), occasionally written WtHR or called waist-to-stature ratio (WSR), is defined as their waist circumference divided by their height, both measured in the same units. It is used as a predictor of obesity-related cardiovascular disease. The WHtR is a measure of the distribution of body fat. Higher values of WHtR indicate higher risk of obesity-related cardiovascular diseases; it is correlated with abdominal obesity.[1]

More than twenty-five years ago, waist-to-height ratio (WHtR) was first suggested as a simple health risk assessment tool because it is a proxy for harmful central adiposity[2] and a boundary value of 0.5 was proposed to indicate increased risk.[3][4] A WHtR of over 0.5 is critical and signifies an increased risk; a 2010 systematic review of published studies concluded that "WHtR may be advantageous because it avoids the need for age-, sex- and ethnic-specific boundary values".[5] In April 2022, the UK's National Institute for Health and Care Excellence (a government body) proposed new guidelines which suggested that all adults "ensure their waist size is less than half their height in order to help stave off serious health problems".[6] In September 2022, NICE formally adopted this guideline.[7]

According to World Health Organization guidance, the waist circumference is usually measured midway between the lower rib and the iliac crest.[8]

Guidelines

United Kingdom

In April 2022, the UK's National Institute for Health and Care Excellence (a government body) proposed new guidelines which suggested that all adults "ensure their waist size is less than half their height in order to help stave off serious health problems".[9] In September 2022, NICE formally adopted this guideline.[10]

Suggested boundary values

The October 2022 NICE guidelines have suggested boundary values for WHtR (defining the degree of central adiposity) as follows:

  • healthy central adiposity: waist-to-height ratio 0.4 to 0.49, indicating no increased health risks
  • increased central adiposity: waist-to-height ratio 0.5 to 0.59, indicating increased health risks
  • high central adiposity: waist-to-height ratio 0.6 or more, indicating further increased health risks.

NICE say that these classifications can be used for people with a body mass index (BMI) of under 35, for both sexes and all ethnicities, including adults with high muscle mass. The health risks associated with higher levels of central adiposity include type 2 diabetes, hypertension and cardiovascular disease. NICE have proposed the same boundary values for children of 5 years and over.[11]

Boundary values were first suggested for WHtR in 1996 to reflect health implications and were portrayed on a simple chart of waist circumference against height. The boundary value of WHtR = 0.4 was suggested to indicate the start of the 'OK' range. The 0.5 boundary value was suggested to indicate the start of the 'Take Care' range, with the 0.6 boundary value indicated the start of the 'Take Action' range.[12]

Simplified guidelines

The first boundary value for increased risk of WHtR 0.5 translates into the simple message "Keep your waist to less than half your height".[13][14] The updated NICE guideline says "When talking to a person about their waist-to-height ratio, explain that they should try and keep their waist to half their height (so a waist-to height ratio of under 0.5)".[10]

Public health tool

WHtR is a proxy for central (visceral or abdominal) adiposity: values of WHtR are significantly correlated with direct measures of central (visceral or abdominal) adiposity using techniques such as CT, MRI or DEXA.[4][15][16][17]

WHtR is an indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages,[18][19][20][21] as well as in children and adolescents,[22][23] have supported the superiority of WHtR over the use of BMI and waist circumference in predicting early health risk.

Cross-sectional studies in many different global populations have supported the premise that WHtR is a simple and effective anthropometric index to identify health risks in adults of all ages[19][20][24][25][26][27][28][29][30][31][32][33][34][35] and in children and adolescents.[36][37][38][39][40][41]

In a comprehensive narrative review, Yoo concluded that "additional use of WHtR with BMI or WC may be helpful because WHtR considers both height and central obesity. WHtR may be preferred because of its simplicity and because it does not require sex- and age-dependent cut-offs".[42]

As an indicator of mortality

Not only does WHtR have a close relationship with morbidity, it also has a clearer relationship with mortality than BMI.[43][44][45]

As an indicator of central adiposity

Many cross- sectional studies have shown that, even within the normal BMI range, many adults have WHtR which is above 0.5.[46][47][35] Many children show the same phenomenon.[48][49] Risk factors for metabolic diseases[47][50] and mortality are raised in these subjects.[51][52][53]

See also

  • Allometry – Study of the relationship of body size to shape, anatomy, physiology, and behaviour
  • Body fat percentage – Total mass of fat divided by total body mass, multiplied by 100
  • Body mass index - Total mass divided by the square of height
  • Waist–hip ratio– Dimensionless ratio of circumference
  • Body shape index - Waist circumference compared to its allometric average
  • Body shape – General shape of a human body
  • Body water – Water content of an animal's body

References

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  2. "The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease". The American Journal of Clinical Nutrition 4 (1): 20–34. 1956. doi:10.1093/ajcn/4.1.20. PMID 13282851. 
  3. "Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women". Internal Medicine 34 (12): 1147–1152. December 1995. doi:10.2169/internalmedicine.34.1147. PMID 8929639. 
  4. 4.0 4.1 "Ratio of waist circumference to height may be better indicator of need for weight management". BMJ 312 (7027): 377. February 1996. doi:10.1136/bmj.312.7027.377. PMID 8611847. 
  5. "A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value". Nutrition Research Reviews 23 (2): 247–269. December 2010. doi:10.1017/S0954422410000144. PMID 20819243. 
  6. "Ensure waist size is less than half your height, health watchdog says". The Guardian. 8 April 2022. https://www.theguardian.com/society/2022/apr/08/ensure-waist-size-is-less-than-half-your-height-health-watchdog-says. 
  7. "Obesity: identification, assessment and management | Clinical guideline [CG189"]. National Institute for Health and Care Excellence. 8 September 2022. https://www.nice.org.uk/guidance/cg189.  Recommendations 1.2.11 and 1.2.12
  8. Waist circumference and waist-hip ratio: report of a WHO expert consultation 2008 (Report). Geneva: World Health Organization. 2011. 
  9. "Obesity: identification and classification of overweight and obesity (update)". National Institute for Health and Care Excellence (NICE). 2022. https://www.nice.org.uk/guidance/GID-NG10284/documents/draft-guideline. 
  10. 10.0 10.1 "Obesity: identification and classification of overweight and obesity (update) | Recommendations 1.2.11 and 1.2.12.". National Institute for Health and Care Excellence (NICE). 2022. https://www.nice.org.uk/guidance/cg189. 
  11. "Obesity: identification and classification of overweight and obesity (update) Recommendations 1.2.25 and 1.2.26.". National Institute for Health and Care Excellence (NICE). 2022. https://www.nice.org.uk/guidance/cg189. 
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  14. "A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message--'keep your waist circumference to less than half your height'". International Journal of Obesity 30 (6): 988–992. June 2006. doi:10.1038/sj.ijo.0803226. PMID 16432546. 
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  19. 19.0 19.1 "Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis". Obesity Reviews 13 (3): 275–86. March 2012. doi:10.1111/j.1467-789X.2011.00952.x. PMID 22106927. 
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  21. "Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: A systematic literature review". Archives of Gerontology and Geriatrics 65: 174–82. 2016. doi:10.1016/j.archger.2016.03.021. PMID 27061665. 
  22. "Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis". Obesity Reviews 17 (12): 1258–1275. December 2016. doi:10.1111/obr.12456. PMID 27452904. 
  23. "Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis". Pediatric Obesity 13 (7): 421–432. July 2018. doi:10.1111/ijpo.12285. PMID 29700992. 
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  28. "Waist-to-height ratio as a screening measure for identifying adolescents with hypertriglyceridemic waist phenotype". Journal of Pediatric Endocrinology & Metabolism 28 (9–10): 1079–1083. September 2015. doi:10.1515/jpem-2015-0043. PMID 25901712. 
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Further reading

  • "Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis". Obesity Reviews 13 (3): 275–286. March 2012. doi:10.1111/j.1467-789X.2011.00952.x. PMID 22106927.