Waist-to-height ratio surpasses conventional metrics in predicting cardiovascular disease risk

In a recent study published in The American Journal of Clinical Nutrition, researchers investigated the independent associations of body fat percentage (BF%) and waist-to-height ratio (WHtR) and the risk of future ischemic cardiovascular disease (CVD), including its main subtypes (ischemic stroke [IS] and myocardial infarction [MI]). While previous work has compared the accuracy of a combination of both metrics with body mass index [BMI], the current most frequently used obesity estimate, their independent predictive power remained hitherto unknown.

This study used a UK Biobank-derived sample cohort comprising 468,333 individuals followed over 12 years for their study. Study findings reveal that WHtR is linearly associated with CVD risk. Notably, the metric significantly outperforms currently existing central obesity measures such as waist-to-hip ratio [WHR] and waist circumference [WC]) in predicting subsequent ischemic CVD risk. Contrasting previous hypotheses, BF% displayed poor predictive power, suggesting that its assumed predictive power was due to its correlation with WHtR and not its independent association with CVD. These findings suggest that WHtR may replace WHR and WC in population-wide obesity censuses and highlight visceral fat as a primary target in weight management interventions.

Cardiovascular diseases (CVDs) are the foremost cause of human mortality globally, claiming an estimated 17.9 million lives annually. Obesity, commonly defined as a body mass index (BMI measured in kg/m2)>30, is a well-established predictor of CVD. Alarmingly, the prevalence of obesity has more than tripled in the past four decades, with an estimated 2.3 billion individuals presently suffering from the condition. Obesity-attributable premature deaths have correspondingly doubled in just the last 20 years, making it a public health issue requiring urgent, population-wide interventions.

While the association between BMI and CVD risk is well established, a growing body of literature criticized the former's use, particularly when making etiological interferences pertaining to CVD risk, because it is a general measure of obesity incapable of considering differences in body fat distribution or composition. Body fat percentage (BF%) has been suggested as an improvement over BMI due to its relatively accurate measure of body composition.

Recently, central measures of obesity (such as waist-to-hip ratio [WHR] and waist circumference [WC]) are increasingly being investigated as CVD risk predictors due to their additional benefit of measuring body fat distribution. Encouragingly, clinical trials are increasingly reporting central obesity measures as more accurate CVD risk predictors than their general obesity predecessors. Waist-to-height ratio (WHtR) is one such metric computed by dividing WC by height. The most recent United Kingdom (UK) obesity guidelines recommend its use as a population-wide obesity metric due to a large number of studies reporting its association with subsequent CVD risk.

Unfortunately, these studies almost exclusively compare a combination of WC or WHR with BMI, with only a handful of studies evaluating the associations of BF% or WHtR with ischemic CVD. The few studies that have compared the latter conduct these comparisons in unison, with no evidence for the independent effects of either BF% or WHtR. Notably, these studies have reported confounding outcomes.

The current study addresses this knowledge gap by investigating the independent associations of WHtR and BF% with ischemic CVD. The study sample cohort was derived from the UK Biobank, a large-scale, long-term prospective cohort comprising more than 500,000 individuals between the ages of 40 and 69 years from Wales, Scotland, and England. Study inclusion criteria comprised the lack of CVD events at baseline, completed anthropometric data, and ongoing pregnancy during the study period.

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