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Waist-to-height ratio

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A person's waist-to-height ratio – occasionally written WHtR[a] – or called waist-to-stature ratio (WSR), is defined as their waist circumference divided by their height, both measured in the same units. This dimensionless quantity is used as a predictor of obesity-related cardiovascular disease and 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, 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

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Calculation

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e.g. 1: ⁠72 cm/160 cm ⁠ = 0.45

e.g. 2: ⁠36 in/72 in ⁠ = 0.50 (72" = 6'0")

Any unit will do, as long as waist and height share the same unit.

United Kingdom

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The UK's National Institute for Health and Care Excellence (NICE): All adults "ensure their waist size is less than half their height in order to help stave off serious health problems".[9] [10]

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vertical axis: height
horizontal axis: waist circumference
colours: NICE risk level
lines: Waist-to-height-ratio

The October 2022 NICE guidelines recommend boundary values for WHtR (defining the degree of "central adiposity" (abdominal obesity)) as follows:

WHtR central adiposity health risks action?
0.6 or more high further increased Take Action
0.5 to 0.59 increased increased Take Care
0.4 to 0.49 healthy not increased no, OK

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

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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]

Age-adjusted boundary values

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A 2013 study identified critical threshold values according to age, with consequent significant reduction in life expectancy if exceeded. These are: WHtR greater than 0.5 for people under 40 years of age, 0.5 to 0.6 for people aged 40–50, and greater than 0.6 for people over 50 years of age.[15]

Public health tool

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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][16][17][18]

WHtR is an indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages,[19][20][21][22] as well as in children and adolescents,[23][24] 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,[20][21][25][26] and in children and adolescents.[27][28][29]

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".[30]

As an indicator of mortality

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Not only does WHtR have a close relationship with morbidity, it also has a clearer relationship with mortality than BMI.[31][32][33]

As an indicator of central adiposity

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Many cross- sectional studies have shown that, even within the normal BMI range, many adults have WHtR which is above 0.5.[34][35][26] Many children show the same phenomenon.[36][37] Risk factors for metabolic diseases[35][38] and mortality are raised in these subjects.[39][40][41]

See also

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  • Allometry – Study of the relationship of body size to shape, anatomy, physiology, and behavior
  • Body fat percentage – Total mass of fat divided by total body mass, multiplied by 100
  • Body mass index – Relative weight based on mass and height (Total mass divided by the square of height)
  • Body roundness index – Body scale based on waist circumference and height
  • Body shape – General shape of a human body
  • Body shape index – Human health index (Waist circumference compared to its allometric average)
  • Body water – Water content of an animal's body
  • Normal weight obesity – Metabolically obese normal weight
  • Waist–hip ratio – Waist measurement divided by hip measurement

Notes

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  1. ^ As distinct from the better-known WHR or WHpR, Waist–hip ratio

References

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  1. ^ Lee CM, Huxley RR, Wildman RP, Woodward M (July 2008). "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". Journal of Clinical Epidemiology. 61 (7): 646–653. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190.
  2. ^ Vague J (1956). "The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease". primary. The American Journal of Clinical Nutrition. 4 (1): 20–34. doi:10.1093/ajcn/4.1.20. PMID 13282851.
  3. ^ Hsieh SD, Yoshinaga H (December 1995). "Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women". primary. Internal Medicine. 34 (12): 1147–1152. doi:10.2169/internalmedicine.34.1147. PMID 8929639.
  4. ^ a b Ashwell M, Lejeune S, McPherson K (February 1996). "Ratio of waist circumference to height may be better indicator of need for weight management". primary. BMJ. 312 (7027): 377. doi:10.1136/bmj.312.7027.377. PMC 2350287. PMID 8611847.
  5. ^ Browning LM, Hsieh SD, Ashwell M (December 2010). "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. doi:10.1017/S0954422410000144. PMID 20819243.
  6. ^ Gregory A (8 April 2022). "Ensure waist size is less than half your height, health watchdog says". The Guardian. Retrieved 8 April 2022.
  7. ^ "Obesity: identification, assessment and management | Clinical guideline [CG189]". National Institute for Health and Care Excellence. 8 September 2022. 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.
  10. ^ a b "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.
  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.
  12. ^ Antwi F, Fazylova N, Garcon MC, Lopez L, Rubiano R, Slyer JT (2012). "The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: A systematic review". secondary. JBI Library of Systematic Reviews. 10 (42 Suppl): 1–14. doi:10.11124/jbisrir-2012-248. PMID 27820152.
  13. ^ Ashwell M, Hsieh SD (August 2005). "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". primary. International Journal of Food Sciences and Nutrition. 56 (5): 303–307. doi:10.1080/09637480500195066. PMID 16236591. S2CID 24420745.
  14. ^ McCarthy HD, Ashwell M (June 2006). "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'". primary. International Journal of Obesity. 30 (6): 988–992. doi:10.1038/sj.ijo.0803226. PMID 16432546. S2CID 26576960.
  15. ^ HospiMedica International staff writers (18 Jun 2013). "Waist-Height Ratio Better Than BMI for Gauging Mortality". Archived from the original on 17 April 2016. Retrieved 7 April 2016.
  16. ^ Roriz AK, Passos LC, de Oliveira CC, Eickemberg M, Moreira P, Sampaio LR (2014). "Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly". primary. PLOS ONE. 9 (7): e103499. Bibcode:2014PLoSO...9j3499R. doi:10.1371/journal.pone.0103499. PMC 4117503. PMID 25078454.
  17. ^ Martin-Calvo N, Moreno-Galarraga L, Martinez-Gonzalez MA (August 2016). "Association between Body Mass Index, Waist-to-Height Ratio and Adiposity in Children: A Systematic Review and Meta-Analysis". secondary. Nutrients. 8 (8): E512. doi:10.3390/nu8080512. PMC 4997425. PMID 27556485.
  18. ^ Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K (2017). "Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables". primary. PLOS ONE. 12 (5): e0177175. Bibcode:2017PLoSO..1277175S. doi:10.1371/journal.pone.0177175. PMC 5426673. PMID 28493988.
  19. ^ Lee CM, Huxley RR, Wildman RP, Woodward M (July 2008). "Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis". secondary. Journal of Clinical Epidemiology. 61 (7): 646–653. doi:10.1016/j.jclinepi.2007.08.012. PMID 18359190.
  20. ^ a b Ashwell M, Gunn P, Gibson S (March 2012). "Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis". secondary. Obesity Reviews. 13 (3): 275–86. doi:10.1111/j.1467-789X.2011.00952.x. PMID 22106927. S2CID 7290185.
  21. ^ a b Savva SC, Lamnisos D, Kafatos AG (October 2013). "Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis". secondary. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 6: 403–19. doi:10.2147/DMSO.S34220. PMC 3810792. PMID 24179379.
  22. ^ Corrêa MM, Thumé E, De Oliveira ER, Tomasi E (2016). "Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: A systematic literature review". secondary. Archives of Gerontology and Geriatrics. 65: 174–82. doi:10.1016/j.archger.2016.03.021. PMID 27061665.
  23. ^ Lo K, Wong M, Khalechelvam P, Tam W (December 2016). "Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis". secondary. Obesity Reviews. 17 (12): 1258–1275. doi:10.1111/obr.12456. PMID 27452904. S2CID 3597681.
  24. ^ Ochoa Sangrador C, Ochoa-Brezmes J (July 2018). "Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis". secondary. Pediatric Obesity. 13 (7): 421–432. doi:10.1111/ijpo.12285. PMID 29700992. S2CID 13795818.
  25. ^ Kawamoto R, Kikuchi A, Akase T, Ninomiya D, Kumagi T (2019). "Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals". primary. PLOS ONE. 14 (4): e0216069. Bibcode:2019PLoSO..1416069K. doi:10.1371/journal.pone.0216069. PMC 6488078. PMID 31034487.
  26. ^ a b Gibson S, Ashwell M (March 2020). "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". primary. The British Journal of Nutrition. 123 (6): 681–690. doi:10.1017/S0007114519003301. PMID 31840619. S2CID 209386183.
  27. ^ Choi DH, Hur YI, Kang JH, Kim K, Cho YG, Hong SM, Cho EB (March 2017). "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". primary. Nutrients. 9 (3): 256. doi:10.3390/nu9030256. PMC 5372919. PMID 28287410.
  28. ^ Jiang Y, Dou YL, Xiong F, Zhang L, Zhu GH, Wu T, et al. (March 2018). "Waist-to-height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents". primary. Acta Paediatrica. 107 (9): 1629–1634. doi:10.1111/apa.14323. PMID 29569350. S2CID 4206581.
  29. ^ Tee JY, Gan WY, Lim PY (January 2020). "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". primary. BMJ Open. 10 (1): e032874. doi:10.1136/bmjopen-2019-032874. PMC 7044891. PMID 31932391.
  30. ^ Yoo EG (November 2016). "Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk". secondary. Korean Journal of Pediatrics. 59 (11): 425–431. doi:10.3345/kjp.2016.59.11.425. PMC 5118501. PMID 27895689.
  31. ^ Schneider HJ, Friedrich N, Klotsche J, Pieper L, Nauck M, John U, et al. (April 2010). "The predictive value of different measures of obesity for incident cardiovascular events and mortality". primary. The Journal of Clinical Endocrinology and Metabolism. 95 (4): 1777–1785. doi:10.1210/jc.2009-1584. PMID 20130075.
  32. ^ Ashwell M, Mayhew L, Richardson J, Rickayzen B (2014). "Waist-to-height ratio is more predictive of years of life lost than body mass index". primary. PLOS ONE. 9 (9): e103483. Bibcode:2014PLoSO...9j3483A. doi:10.1371/journal.pone.0103483. PMC 4157748. PMID 25198730.
  33. ^ Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S (September 2020). "Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies". secondary. BMJ (Clinical Research Ed.). 370: m3324. doi:10.1136/bmj.m3324. PMC 7509947. PMID 32967840.
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  35. ^ a b Ashwell M, Gibson S (2017). "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". secondary. BMJ. 357: j2033. doi:10.1136/bmj.j2033. S2CID 32653852.
  36. ^ Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS (October 2010). "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". primary. BMC Pediatrics. 10: 73. doi:10.1186/1471-2431-10-73. PMC 2964659. PMID 20937123.
  37. ^ Srinivasan SR, Wang R, Chen W, Wei CY, Xu J, Berenson GS (September 2009). "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)". primary. The American Journal of Cardiology. 104 (5): 721–4. doi:10.1016/j.amjcard.2009.04.037. PMID 19699351.
  38. ^ Liu PJ, Ma F, Lou HP, Zhu YN (April 2017). "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". primary. Public Health Nutrition. 20 (6): 984–991. doi:10.1017/S1368980016003281. PMC 10261557. PMID 27989263. S2CID 3574565.
  39. ^ Yu Y (August 2016). "Normal-Weight Central Obesity and Mortality Risk". Annals of Internal Medicine. 165 (4): 298. doi:10.7326/L16-0074. PMID 27538167. S2CID 26722676.
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  41. ^ Carter RE, Hodge DO, Lopez-Jimenez F (August 2016). "Normal-Weight Central Obesity and Mortality Risk". Annals of Internal Medicine. 165 (4): 298–299. doi:10.7326/L16-0073. PMID 27538166. S2CID 6941690.

Further reading

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  • Ashwell M, Gunn P, Gibson S (March 2012). "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. doi:10.1111/j.1467-789X.2011.00952.x. PMID 22106927. S2CID 7290185.
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