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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".<ref>{{cite journal | vauthors = Browning LM, Hsieh SD, Ashwell M | title = 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 | journal = Nutrition Research Reviews | volume = 23 | issue = 2 | pages = 247–269 | date = December 2010 | pmid = 20819243 | doi = 10.1017/S0954422410000144 | doi-access = free }}</ref> In April 2022, the UK's ] (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".<ref>{{cite news |title=Ensure waist size is less than half your height, health watchdog says |work=] | url=https://www.theguardian.com/society/2022/apr/08/ensure-waist-size-is-less-than-half-your-height-health-watchdog-says | date=8 April 2022 | access-date=8 April 2022 | vauthors = Gregory A }}</ref> In September 2022, NICE formally adopted this guideline.<ref>{{cite web |title= Obesity: identification, assessment and management {{!}} Clinical guideline | date=8 September 2022 |publisher=National Institute for Health and Care Excellence | url=https://www.nice.org.uk/guidance/cg189 }} Recommendations 1.2.11 and 1.2.12</ref> 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".<ref>{{cite journal | vauthors = Browning LM, Hsieh SD, Ashwell M | title = 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 | journal = Nutrition Research Reviews | volume = 23 | issue = 2 | pages = 247–269 | date = December 2010 | pmid = 20819243 | doi = 10.1017/S0954422410000144 | doi-access = free }}</ref> In April 2022, the UK's ] (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".<ref>{{cite news |title=Ensure waist size is less than half your height, health watchdog says |work=] | url=https://www.theguardian.com/society/2022/apr/08/ensure-waist-size-is-less-than-half-your-height-health-watchdog-says | date=8 April 2022 | access-date=8 April 2022 | vauthors = Gregory A }}</ref> In September 2022, NICE formally adopted this guideline.<ref>{{cite web |title= Obesity: identification, assessment and management {{!}} Clinical guideline | date=8 September 2022 |publisher=National Institute for Health and Care Excellence | url=https://www.nice.org.uk/guidance/cg189 }} Recommendations 1.2.11 and 1.2.12</ref>


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 obsity related cardiovascular diease.
== See also ==

* {{annotated link|Allometry}}
According to ] guidance, Waist is usually measured midway between the lower rib and the ].<ref name=":6" />
* {{annotated link|Body fat percentage}}

* {{annotated link|Body proportions}}
== Guidelines ==
** {{annotated link|Artistic canons of body proportions}}

* {{annotated link|Body shape}}
=== United Kingdom ===
* {{annotated link|Body water}}

* ]{{snd}}ratio between leg length and whole body.
In April 2022, the UK's ] (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".<ref name=":1" /> In September 2022, NICE formally adopted this guideline.<ref name=":2" />
* {{annotated link|Corpulence index}}

* {{annotated link|Waist–hip ratio}}
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 ]<ref name=":3" /> and a boundary value of 0.5 proposed to indicate increased risk.<ref name=":4" /><ref name=":5" />

==== 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 BMI under 35 kg/m<sup>2</sup> of both sexes and all ethnicities, including adults with high muscle mass. The health risks associated with higher levels of central adiposity include ], ] and ]. NICE have proposed the same boundary values for children of 5 years and over.<ref name=":59" />

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.<ref name=":60" />

==== 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".<ref name=":61" /><ref name=":62" /> 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)".<ref name=":2" />

Another great advantage of using WHtR as a primary screening tool is that a simple piece of string can be used to indicate early risk.<ref name=":20" /><ref name=":63" /> A person's height can be measured with string ; the string is then cut or folded in half. If this does not fit around the person’s waist, then that person has WHtR of more than 0.5. Further screening would be indicated.
<!-- === United States === -->

== Public health tool ==

WHtR is a proxy for central (visceral or abdominal) ]: values of WHtR are significantly correlated with direct measures of central (visceral or abdominal) adiposity using techniques such as ], ] or ].<ref name=":5" /><ref name=":7" /><ref name=":8" /><ref name=":9" />

WHtR is an indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages,<ref name=":10" /><ref name=":11" /><ref name=":12" /><ref name=":13" /> as well as in children and adolescents,<ref name=":14" /><ref name=":15" /> 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 ] index to identify health risks in adults of all ages<ref name=":11" /><ref name=":12" /><ref name=":16" /><ref name=":17" /><ref name=":18" /><ref name=":19" /><ref name=":20" /><ref name=":21" /><ref name=":22" /><ref name=":23" /><ref name=":24" /><ref name=":25" /><ref name=":26" /><ref name=":27" /><ref name=":28" /> and in children and adolescents.<ref name=":29" /><ref name=":30" /><ref name=":31" /><ref name=":32" /><ref name=":33" /><ref name=":34" />

<s>Prospective studies in many adult populations have also lent further support to the premise that WHtR is a simple and effective anthropometric index to predict health risks in adults of all ages (35) (36) (37) (38; 39) (40) (40). (41) (42) (43) (44) (45) (46). Further, prospective data from the ALSPAC study in UK has shown that WHtR in children aged 7-9y predicts adolescent cardiometabolic risk better than BMI (47). </s> {{!xt|WP doesn't cite preprints or prospective studies}}

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".<ref name=":48" />

=== As an indicator of mortality ===

Not only does WHtR have a close relationship with ], it also has a clearer relationship with ] than BMI.<ref name=":43" /><ref name=":49" /><ref name=":50" />

=== 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.<ref name=":51" /><ref name=":52" /><ref name=":28" /> Many children show the same phenomenon.<ref name=":53" /><ref name=":54" /> Risk factors for metabolic diseases<ref name=":52" /><ref name=":55" /> and mortality are raised in these subjects.<ref name=":56" /><ref name=":57" /><ref name=":58" />

==See also==
* ] – Study of the relationship of body size to shape, anatomy, physiology, and behaviour
* ] – Total mass of fat divided by total body mass, multiplied by 100
* ] - Total mass divided by the square of height
* ] – General shape of a human body
* ] – Water content of an animal's body
* ]– Dimensionless ratio of circumference

== References ==
{{Reflist|refs=
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}}

== Further reading ==
{{refbegin}}
* {{cite journal |last=Ashwell |first=M |year=2017 |title=How long is A Piece of String? Less than Half your Height. {{!}} Five Steps from Science to Screening: A Mini Review. |journal=Advances in Obesity, Weight Management & Control |volume=7 |number=191|doi= 10.15406/aowmc.2017.07.00191 }} ''Link to medcraveonline removed, predatory "journal"''
{{refend}}


== References == == References ==

Revision as of 16:04, 13 October 2022

Numerical index of body proportion Not to be confused with Waist–hip ratio.
Part of a series on
Human body weight
General concepts
Medical concepts
Measurements
Related conditions
Obesity-associated morbidity
Management of obesity
Social aspects

A person's waist-to-height ratio (WHtR), also called waist-to-stature ratio (WSR), is defined as their waist circumference divided by their height, both measured in the same units. 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.

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". 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". In September 2022, NICE formally adopted this guideline.

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 obsity related cardiovascular diease.

According to World Health Organisation guidance, Waist is usually measured midway between the lower rib and the iliac crest.

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". In September 2022, NICE formally adopted this guideline.

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 and a boundary value of 0.5 proposed to indicate increased risk.

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 BMI under 35 kg/m of 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.

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.

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". 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)".

Another great advantage of using WHtR as a primary screening tool is that a simple piece of string can be used to indicate early risk. A person's height can be measured with string ; the string is then cut or folded in half. If this does not fit around the person’s waist, then that person has WHtR of more than 0.5. Further screening would be indicated.

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.

WHtR is an indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages, as well as in children and adolescents, have supported the superiority of WHtR over the use of Body Mass Index (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 and in children and adolescents.

Prospective studies in many adult populations have also lent further support to the premise that WHtR is a simple and effective anthropometric index to predict health risks in adults of all ages (35) (36) (37) (38; 39) (40) (40). (41) (42) (43) (44) (45) (46). Further, prospective data from the ALSPAC study in UK has shown that WHtR in children aged 7-9y predicts adolescent cardiometabolic risk better than BMI (47). Template:!xt is only for examples of style and formatting. Do not use it in actual articles.

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".

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.

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. Many children show the same phenomenon. Risk factors for metabolic diseases and mortality are raised in these subjects.

See also

References

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Further reading

  • Ashwell, M (2017). "How long is A Piece of String? Less than Half your Height. | Five Steps from Science to Screening: A Mini Review". Advances in Obesity, Weight Management & Control. 7 (191). doi:10.15406/aowmc.2017.07.00191. Link to medcraveonline removed, predatory "journal"

References

Further reading

  • 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.</ref>
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