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

  1. ↑ "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". Journal of Clinical Epidemiology 61 (7): 646–653. July 2008. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190. 
  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. 
  12. ↑ "The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: A systematic review". JBI Library of Systematic Reviews 10 (42 Suppl): 1–14. 2012. doi:10.11124/jbisrir-2012-248. PMID 27820152. 
  13. ↑ "Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity". International Journal of Food Sciences and Nutrition 56 (5): 303–307. August 2005. doi:10.1080/09637480500195066. PMID 16236591. 
  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. 
  15. ↑ "Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly". PLOS ONE 9 (7): e103499. 2014. doi:10.1371/journal.pone.0103499. PMID 25078454. Bibcode: 2014PLoSO...9j3499R. 
  16. ↑ "Association between Body Mass Index, Waist-to-Height Ratio and Adiposity in Children: A Systematic Review and Meta-Analysis". Nutrients 8 (8): E512. August 2016. doi:10.3390/nu8080512. PMID 27556485. 
  17. ↑ "Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables". PLOS ONE 12 (5): e0177175. 2017. doi:10.1371/journal.pone.0177175. PMID 28493988. Bibcode: 2017PLoSO..1277175S. 
  18. ↑ "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". Journal of Clinical Epidemiology 61 (7): 646–653. July 2008. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190. 
  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. 
  20. ↑ 20.0 20.1 "Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis". Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 6: 403–19. October 2013. doi:10.2147/DMSO.S34220. PMID 24179379. 
  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. 
  24. ↑ "Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults". Circulation Journal 73 (9): 1643–1650. September 2009. doi:10.1253/circj.cj-09-0161. PMID 19638708. 
  25. ↑ "Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index". Journal of the American College of Cardiology 62 (8): 742–751. August 2013. doi:10.1016/j.jacc.2013.01.026. PMID 23500256. 
  26. ↑ "Waist to height ratio: a better anthropometric marker of diabetes and cardio-metabolic risks in South Asian adults". Diabetes Research and Clinical Practice 99 (3): 292–299. March 2013. doi:10.1016/j.diabres.2012.12.013. PMID 23298662. 
  27. ↑ "Waist-to-Height Ratio Is a Better Anthropometric Index than Waist Circumference and BMI in Predicting Metabolic Syndrome among Obese Mexican Adolescents". International Journal of Endocrinology 2014: 195407. 2014. doi:10.1155/2014/195407. PMID 25574166. 
  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. 
  29. ↑ "Race/ethnic comparisons of waist-to-height ratio for cardiometabolic screening: The study of women's health across the nation". American Journal of Human Biology 29 (1): e22909. January 2017. doi:10.1002/ajhb.22909. PMID 27801534. 
  30. ↑ "Use of the waist-to-height ratio to predict cardiovascular risk in patients with diabetes: Results from the ADVANCE-ON study". Diabetes, Obesity & Metabolism 20 (8): 1903–1910. August 2018. doi:10.1111/dom.13311. PMID 29603537. https://ora.ox.ac.uk/objects/uuid:7fdc4785-aa8b-4d0e-bbbd-3ae1c940cc64. 
  31. ↑ "Temporal trends in normal weight central obesity and its associations with cardiometabolic risk among Chinese adults". Scientific Reports 9 (1): 5411. April 2019. doi:10.1038/s41598-019-41986-5. PMID 30931996. Bibcode: 2019NatSR...9.5411S. 
  32. ↑ "Stronger associations of waist circumference and waist-to-height ratio with diabetes than BMI in Chinese adults". Diabetes Research and Clinical Practice 147: 9–18. January 2019. doi:10.1016/j.diabres.2018.07.029. PMID 30144478. 
  33. ↑ "Optimal Cut-off Point of Waist to Height Ratio in Beijing and Its Association with Clusters of Metabolic Risk Factors". Current Medical Science 39 (2): 330–336. April 2019. doi:10.1007/s11596-019-2039-x. PMID 31016530. 
  34. ↑ "Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals". PLOS ONE 14 (4): e0216069. 2019. doi:10.1371/journal.pone.0216069. PMID 31034487. Bibcode: 2019PLoSO..1416069K. 
  35. ↑ 35.0 35.1 "A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England". The British Journal of Nutrition 123 (6): 681–690. March 2020. doi:10.1017/S0007114519003301. PMID 31840619. 
  36. ↑ "Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity and Metabolic Syndrome among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2010-2014". Nutrients 9 (3): 256. March 2017. doi:10.3390/nu9030256. PMID 28287410. 
  37. ↑ "Waist-to-height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents". Acta Paediatrica 107 (9): 1629–1634. March 2018. doi:10.1111/apa.14323. PMID 29569350. 
  38. ↑ "Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance". Jornal de Pediatria 95 (4): 428–434. 2019. doi:10.1016/j.jped.2018.04.004. PMID 29746812. 
  39. ↑ "Utility of waist circumference-to-height ratio as a screening tool for generalized and central obesity among Iranian children and adolescents: The CASPIAN-V study". Pediatric Diabetes 20 (5): 530–537. August 2019. doi:10.1111/pedi.12855. PMID 30968521. 
  40. ↑ "Discriminative ability of adiposity measures for elevated blood pressure among adolescents in a resource-constrained setting in northeast Nigeria: a cross-sectional analysis". BMC Obesity 5: 35. 2018. doi:10.1186/s40608-018-0211-7. PMID 30524740. 
  41. ↑ "Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: a cross-sectional study". BMJ Open 10 (1): e032874. January 2020. doi:10.1136/bmjopen-2019-032874. PMID 31932391. 
  42. ↑ "Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk". Korean Journal of Pediatrics 59 (11): 425–431. November 2016. doi:10.3345/kjp.2016.59.11.425. PMID 27895689. 
  43. ↑ "The predictive value of different measures of obesity for incident cardiovascular events and mortality". The Journal of Clinical Endocrinology and Metabolism 95 (4): 1777–1785. April 2010. doi:10.1210/jc.2009-1584. PMID 20130075. 
  44. ↑ "Waist-to-height ratio is more predictive of years of life lost than body mass index". PLOS ONE 9 (9): e103483. 2014. doi:10.1371/journal.pone.0103483. PMID 25198730. Bibcode: 2014PLoSO...9j3483A. 
  45. ↑ "Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies". BMJ (Clinical Research Ed.) 370: m3324. September 2020. doi:10.1136/bmj.m3324. PMID 32967840. 
  46. ↑ "Gender Differences in Cardiometabolic Risk Factors in Metabolically Healthy Normal Weight Adults with Central Obesity". Experimental and Clinical Endocrinology & Diabetes 126 (5): 309–315. May 2018. doi:10.1055/s-0043-119877. PMID 29117621. 
  47. ↑ 47.0 47.1 "Normal weight central obesity: the value of waist-to-height ratio in its identification. In response to Waist measurement, not BMI, is stronger predictor of death risk, study finds.". BMJ 357: j2033. 2017. doi:10.1136/bmj.j2033. 
  48. ↑ "Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study". BMC Pediatrics 10: 73. October 2010. doi:10.1186/1471-2431-10-73. PMID 20937123. 
  49. ↑ "Utility of waist-to-height ratio in detecting central obesity and related adverse cardiovascular risk profile among normal weight younger adults (from the Bogalusa Heart Study)". The American Journal of Cardiology 104 (5): 721–4. September 2009. doi:10.1016/j.amjcard.2009.04.037. PMID 19699351. 
  50. ↑ "Comparison of the ability to identify cardiometabolic risk factors between two new body indices and waist-to-height ratio among Chinese adults with normal BMI and waist circumference". Public Health Nutrition 20 (6): 984–991. April 2017. doi:10.1017/S1368980016003281. PMID 27989263. 
  51. ↑ "Normal-Weight Central Obesity and Mortality Risk". Annals of Internal Medicine 165 (4): 298. August 2016. doi:10.7326/L16-0074. PMID 27538167. 
  52. ↑ "Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease". Mayo Clinic Proceedings 91 (3): 343–351. March 2016. doi:10.1016/j.mayocp.2015.12.007. PMID 26860580. 
  53. ↑ "Normal-Weight Central Obesity and Mortality Risk". Annals of Internal Medicine 165 (4): 298–299. August 2016. doi:10.7326/L16-0073. PMID 27538166. 

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. 



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