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)

Tulane Center for Cardiovascular Health, Tulane University Health Sciences Center, New Orleans, Louisiana, USA.
The American journal of cardiology (Impact Factor: 3.28). 09/2009; 104(5):721-4. DOI: 10.1016/j.amjcard.2009.04.037
Source: PubMed


Data on the utility of the waist-to-height ratio in detecting central obesity and related cardiovascular risk among normal weight younger adults are scant. This aspect was examined in 639 normal weight (body mass index 18.5 to 24.9 kg/m(2)) black and white adults (75% white and 36% men) 20 to 44 years old. The subjects with a waist-to-height ratio > or =0.5 were grouped as having central obesity normal weight, with the rest considered the control group. The subjects with central obesity, compared to the controls, after adjusting for age, race, and gender, had significantly greater diastolic blood pressure, mean arterial pressure, low-density lipoprotein cholesterol level, triglycerides, triglycerides/high-density lipoprotein cholesterol ratio, insulin, homeostasis model assessment of insulin resistance, uric acid, C-reactive protein, and liver function enzymes (alanine aminotransferase and gamma-glutamyl transferase). On multivariate analysis, the central obesity group compared to the control group was 1.9, 2.2, 2.9, and 2.5 times more likely to have significantly adverse levels (top tertile vs the rest) of mean arterial pressure, triglycerides/high-density lipoprotein cholesterol ratio, homeostasis model assessment of insulin resistance, and C-reactive protein, respectively. The central obesity group also had a greater prevalence of dyslipidemia, hypertension, insulin resistance, hyperuricemia, and elevated C-reactive protein. The age-, race-, and gender-adjusted mean value of the common carotid intima-media thickness, a measure of subclinical atherosclerosis, was greater in the central obesity group compared to the control group (0.76 vs 0.71 mm, p = 0.009). In conclusion, these findings underscore the utility of the waist-to-height ratio in detecting central obesity and related adverse cardiovascular risk among normal weight younger adults.

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    • "As a result, the measurement of waist circumference (WC) has been adopted as criterion for diagnosing MetS by different organizations such as the International Diabetes Federation (IDF) [4] and the National Cholesterol Education Program-Adult Treatment Program (NCEP-ATP III) [5]. The waist-to-height ratio (WHtR) has been proposed as an alternative to waist circumference for the assessment of central obesity when defining the metabolic syndrome (MetS) [6], [7]. The suggestion that WHtR cut-off may be similar in men and women makes it attractive for the quantification of central obesity in children which otherwise, could be very complex when using age-sex-race specific charts. "
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    ABSTRACT: The proposed waist-to-height ratio (WHtR) cut-off of 0.5 is less optimal for cardiometabolic risk screening in children in many settings. The purpose of this study was to determine the optimal WHtR for children from South Africa, and investigate variations by gender, ethnicity and residence in the achieved value. Metabolic syndrome (MetS) components were measured in 1272 randomly selected learners, aged 10-16 years, comprising of 446 black Africans, 696 mixed-ancestry and 130 Caucasians. The Youden's index and the closest-top-left (CTL) point approaches were used to derive WHtR cut-offs for diagnosing any two MetS components, excluding the waist circumference. The two approaches yielded similar cut-off in girls, 0.465 (sensitivity 50.0, specificity 69.5), but two different values in boys, 0.455 (42.9, 88.4) and 0.425 (60.3, 67.7) based on the Youden's index and the CTL point, respectively. Furthermore, WHtR cut-off values derived differed substantially amongst the regions and ethnic groups investigated, whereby the highest cut-off was observed in semi-rural and white children, respectively, Youden's index0.505 (31.6, 87.1) and CTL point 0.475 (44.4, 75.9). The WHtR cut-off of 0.5 is less accurate for screening cardiovascular risk in South African children. The optimal value in this setting is likely gender and ethnicity-specific and sensitive to urbanization.
    PLoS ONE 08/2013; 8(8):e71133. DOI:10.1371/journal.pone.0071133 · 3.23 Impact Factor
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    • "Hsieh et al. pointed out that the relative amount of central fat may be more closely associated with metabolic risks than the absolute amount of central fat among a population with moderate BMI, and WC adjusted by height may better reflect the combined metabolic risks (Hsieh et al. 2010). Srinivasan et al. (2009) "
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    ABSTRACT: There is little consensus on the best obesity index associated with metabolic risk factors among the population with normal both body mass index (BMI) and waist circumference (WC). We therefore evaluated the association between anthropometric indices and metabolic risk factors in a Korean population with normal BMI and WC. This cross-sectional study involved 2,952 participants aged 20-79 years who had normal BMI and WC, based on the Fourth Korea National Health and Nutrition Examination Surveys conducted in 2008. The receiver operating characteristic (ROC) curves were generated to identify the optimal measurement of obesity for the prediction of metabolic risk factors in this population. The area under the ROC curve value for waist-to-height ratio (WHtR) in prediction of metabolic syndrome (MetS) and its components was higher than that for BMI and WC. Among individuals with normal BMI and WC, prevalence of all metabolic risk factors and MetS significantly increased across the quartiles of WHtR in both men and women. After adjustment for potential confounders, the Odds Ratios (95% confidence intervals) for MetS in the second, third, and fourth quartiles of WHtR compared to the first quartile of WHtR were 3.53 (2.12-5.89), 6.06 (3.52-10.43), and 7.11 (4.08-12.38) in men, and 1.66 (1.01-2.72), 2.79 (1.81-4.30), and 2.82 (1.76-4.52) in women, respectively. In conclusion, WHtR has the best predictive value for evaluating the metabolic risk factors compared to BMI or WC alone among subjects with normal BMI and WC.
    The Tohoku Journal of Experimental Medicine 09/2012; 228(1):1-8. DOI:10.1620/tjem.228.1 · 1.35 Impact Factor
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    • "Thus, for optimal assessment of a patient’s cardiometabolic risk, it may be ideal to use BMI in concert with a measure of central adiposity such as WC and WHtR, as has been previously suggested in clinical guidelines [13]. In prior studies, WHtR has also been shown to denote cardiometabolic risk among individuals who are not obese according to other anthropometric indices [23–25]. In agreement with these prior observations, the current study found that an elevated WHtR was able to predict elevated cardiometabolic risk in both men and women who had a normal BMI or WC level. "
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    ABSTRACT: Purpose We aimed to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cardiometabolic risk. Methods In this cross-sectional study, 21,038 men and 15,604 women who participated in a health check-up were included. Results In both men and women, the area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of diabetes, hypertension, high total cholesterol, high triglycerides, and low HDL-cholesterol (P < 0.05 for all). The AUC for WHtR in the prediction of metabolic syndrome (MS) was also highest in the women (P < 0.05). After adjustment for potential confounders, the odds ratios and 95% confidence intervals for MS for each standard deviation increase in BMI, WHtR, and WC were 1.47 (1.46–1.49), 1.32 (1.31–1.33), and 1.19 (1.18–1.19), respectively. Finally, patients of either sex with a normal BMI or WC level, but with an elevated WHtR, had higher levels of various cardiometabolic risk factors in comparison with their normal BMI or WC, but low WHtR, counterparts (P < 0.05 for all). Conclusion Among Taiwanese adults, a WHtR greater than 0.5 is a simple, yet effective indicator of centralized obesity and associated cardiometabolic risk, even among individuals deemed ‘healthy’ according to BMI and WC.
    European Journal of Nutrition 12/2011; 52(1). DOI:10.1007/s00394-011-0286-0 · 3.47 Impact Factor
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