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Waist-to-height ratio

April 10, 2024

Not to be confused with Waist–hip ratio.

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 edit

United Kingdom edit

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 edit

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 edit

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 edit

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 edit

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][27][28][29][30][31][32][33][34][35][36] and in children and adolescents.[37][38][39][40][41][42]

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".[43]

As an indicator of mortality edit

Not only does WHtR have a close relationship with morbidity, it also has a clearer relationship with mortality than BMI.[44][45][46]

As an indicator of central adiposity edit

Many cross- sectional studies have shown that, even within the normal BMI range, many adults have WHtR which is above 0.5.[47][48][36] Many children show the same phenomenon.[49][50] Risk factors for metabolic diseases[48][51] and mortality are raised in these subjects.[52][53][54]

See also edit

References edit

  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.
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Further reading edit

  • 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.

April 10, 2024
waist, height, ratio, confused, with, waist, ratio, person, waist, height, ratio, whtr, occasionally, written, wthr, called, waist, stature, ratio, defined, their, waist, circumference, divided, their, height, both, measured, same, units, used, predictor, obes. Not to be confused with Waist hip ratio 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 Contents 1 Guidelines 1 1 United Kingdom 1 1 1 Suggested boundary values 1 1 2 Simplified guidelines 1 1 3 Age adjusted boundary values 2 Public health tool 2 1 As an indicator of mortality 2 2 As an indicator of central adiposity 3 See also 4 References 5 Further readingGuidelines editUnited Kingdom edit 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 edit 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 edit 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 edit 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 editWHtR 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 27 28 29 30 31 32 33 34 35 36 and in children and adolescents 37 38 39 40 41 42 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 43 As an indicator of mortality edit Not only does WHtR have a close relationship with morbidity it also has a clearer relationship with mortality than BMI 44 45 46 As an indicator of central adiposity edit Many cross sectional studies have shown that even within the normal BMI range many adults have WHtR which is above 0 5 47 48 36 Many children show the same phenomenon 49 50 Risk factors for metabolic diseases 48 51 and mortality are raised in these subjects 52 53 54 See also editAllometry 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 bodyReferences edit 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 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 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 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 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 Gregory A 8 April 2022 Ensure waist size is less than half your height health watchdog says The Guardian Retrieved 8 April 2022 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 Waist circumference and waist hip ratio report of a WHO expert consultation 2008 Report Geneva World Health Organization 2011 Obesity identification and classification of overweight and obesity update National Institute for Health and Care Excellence NICE 2022 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 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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 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 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 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 Swainson MG Batterham AM Tsakirides C Rutherford ZH Hind K 2017 Prediction of whole body fat percentage and 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9 1643 1650 doi 10 1253 circj cj 09 0161 PMID 19638708 S2CID 23639450 Khoury M Manlhiot C McCrindle BW August 2013 Role of the waist height ratio in the cardiometabolic risk assessment of children classified by body mass index primary Journal of the American College of Cardiology 62 8 742 751 doi 10 1016 j jacc 2013 01 026 PMID 23500256 S2CID 25857523 Jayawardana R Ranasinghe P Sheriff MH Matthews DR Katulanda P March 2013 Waist to height ratio a better anthropometric marker of diabetes and cardio metabolic risks in South Asian adults primary Diabetes Research and Clinical Practice 99 3 292 299 doi 10 1016 j diabres 2012 12 013 PMID 23298662 Rodea Montero ER Evia Viscarra ML Apolinar Jimenez E 2014 Waist to Height Ratio Is a Better Anthropometric Index than Waist Circumference and BMI in Predicting Metabolic Syndrome among Obese Mexican Adolescents primary International Journal of Endocrinology 2014 195407 doi 10 1155 2014 195407 PMC 4276350 PMID 25574166 Liu XL Yin FZ Ma CP Gao GQ Ma 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weight central obesity and its associations with cardiometabolic risk among Chinese adults primary Scientific Reports 9 1 5411 Bibcode 2019NatSR 9 5411S doi 10 1038 s41598 019 41986 5 PMC 6443661 PMID 30931996 Hou X Chen S Hu G Chen P Wu J Ma X et al January 2019 Stronger associations of waist circumference and waist to height ratio with diabetes than BMI in Chinese adults primary Diabetes Research and Clinical Practice 147 9 18 doi 10 1016 j diabres 2018 07 029 PMID 30144478 S2CID 207117199 Dong J Wang SS Chu X Zhao J Liang YZ Yang YB Yan YX April 2019 Optimal Cut off Point of Waist to Height Ratio in Beijing and Its Association with Clusters of Metabolic Risk Factors primary Current Medical Science 39 2 330 336 doi 10 1007 s11596 019 2039 x PMID 31016530 S2CID 128359229 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 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 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 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 Alvim RO Zaniqueli D Neves FS Pani VO Martins CR Pecanha MA et al 2019 Waist to height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance primary Jornal de Pediatria 95 4 428 434 doi 10 1016 j jped 2018 04 004 PMID 29746812 S2CID 13682700 Ejtahed HS Kelishadi R Qorbani M Motlagh ME Hasani Ranjbar S Angoorani P et al August 2019 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 primary Pediatric Diabetes 20 5 530 537 doi 10 1111 pedi 12855 PMID 30968521 S2CID 106410872 Wariri O Jalo I Bode Thomas F 2018 Discriminative ability of adiposity measures for elevated blood pressure among adolescents in a resource constrained setting in northeast Nigeria a cross sectional analysis primary BMC Obesity 5 35 doi 10 1186 s40608 018 0211 7 PMC 6276203 PMID 30524740 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 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 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 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 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 Sebekova K Csongova M Gurecka R Krivosikova Z Sebek J May 2018 Gender Differences in Cardiometabolic Risk Factors in Metabolically Healthy Normal Weight Adults with Central Obesity primary Experimental and Clinical Endocrinology amp Diabetes 126 5 309 315 doi 10 1055 s 0043 119877 PMID 29117621 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 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 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 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 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 Sharma S Batsis JA Coutinho T Somers VK Hodge DO Carter RE et al March 2016 Normal Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease primary Mayo Clinic Proceedings 91 3 343 351 doi 10 1016 j mayocp 2015 12 007 PMID 26860580 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 editAshwell 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 Retrieved from https en wikipedia org w index php title Waist to height ratio amp oldid 1214387822, wikipedia, wiki, book, books, library,

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