A proposal for a primary screening tool: ‘Keep your waist circumference to less than half your height’

BMC Medicine

Sigrid Gibson²  Margaret Ashwell¹ 

[1] Oxford Brookes University, Oxford OX3 0BP, UK;Sig-Nurture Ltd, Guildford GU1 2TF, Surrey, UK

关键词: Mortality;    Morbidity;    Waist-to-height ratio;    Obesity;   

Others  :  1118252
DOI  :  10.1186/s12916-014-0207-1

 received in 2014-08-18, accepted in 2014-10-07,  发布年份 2014

【 摘 要 】

Background

There is now overwhelming scientific evidence that central obesity, as opposed to total obesity assessed by body mass index (BMI), is associated with the most health risks and that the waist-to-height ratio (WHtR) is a simple proxy for this central fat distribution. This Opinion reviews the evidence for the use of WHtR to predict mortality and for its association with morbidity. A boundary value of WHtR of 0.5 has been proposed and become widely used. This translates into the simple screening message ‘Keep your waist to less than half your height’. Not only does this message appear to be suitable for all ethnic groups, it also works well with children.

Discussion

Ignoring this simple message and continuing to use BMI as a sole indicator of risk would mean that 10% of the whole UK population, and more than 25% of the UK population who are judged to be normal weight using BMI, are misclassified and might not be alerted to the need to take care or to take action.

Summary

Accepting that a boundary value whereby WHtR should be less than 0.5 not only lends itself to the simple message ‘Keep your waist to less than half your height’ but it also provides a very cheap primary screening method for increased health risks: A piece of string, measuring exactly half a person’s height should fit around that person’s waist.

【 授权许可】

   
2014 Ashwell and Gibson; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Garrow J: Treat Obesity Seriously - a Clinical Manual. Churchill Livingstone, Edinburgh; 1981.
• [2]Obesity. Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, Geneva 3–5 June 1997. World Health Organisation, Geneva; 2000.
• [3]Vague J: The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout and uric calculous disease. Am J Clin Nutr 1956, 4:20-34.
• [4]Obesity. Preventing and Managing the Global Epidemic. Report of a WHO Consultation on Obesity, Geneva 3–5 June 1997. World Health Organisation, Geneva; 1998.
• [5]Ashwell M, Cole TJ, Dixon AK: Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography. Br Med J (Clin Res Ed) 1985, 290:1692-1694.
• [6]Seidell JC, Cigolini M, Charzewska J, Ellsinger BM, di Biase G: Fat distribution in European women: a comparison of anthropometric measurements in relation to cardiovascular risk factors. Int J Epidemiol 1990, 19:303-308.
• [7]Kahn HS, Simoes EJ, Koponen M, Hanzlick R: The abdominal diameter index and sudden coronary death in men. Am J Cardiol 1996, 78:961-964.
• [8]Zamboni M, Turcato E, Armellini F, Kahn HS, Zivelonghi A, Santana H, Bergamo-Andreis IA, Bosello O: Sagittal abdominal diameter as a practical predictor of visceral fat. Int J Obes Relat Metab Disord 1998, 22:655-660.
• [9]Krakauer NY, Krakauer JC: A new body shape index predicts mortality hazard independently of body mass index. PLoS One 2012, 7:e39504.
• [10]Hsieh SD, Yoshinaga H: Abdominal fat distribution and coronary heart disease risk factors in men-waist/height ratio as a simple and useful predictor. Int J Obes Relat Metab Disord 1995, 19:585-589.
• [11]Ashwell M: A new shape chart for assessing the risks of obesity. Proc Nutr Soc 1995, 54:86A.
• [12]Ashwell M, Cole TJ, Dixon AK: Ratio of waist circumference to height is strong predictor of intra-abdominal fat. BMJ 1996, 313:559-560.
• [13]Cox BD, Whichelow M: Ratio of waist circumference to height is better predictor of death than body mass index. BMJ 1996, 313:1487.
• [14]Alberti KG, Zimmet P, Shaw J: International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med 2007, 24:451-463.
• [15]Browning LM, Hsieh SD, Ashwell M: 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. Nutr Res Rev 2010, 23:247-269.
• [16]Parikh RM: Limit your waist size to half of your height. Indian J Endocrinol Metab 2011, 15:228-229.
• [17]Parikh R, Mohan V, Joshi S: Should waist circumference be replaced by index of central obesity (ICO) in definition of metabolic syndrome? Diabetes Metab Res Rev 2012, 28:3-5.
• [18]Park YS, Kim JS: Association between waist-to-height ratio and metabolic risk factors in Korean adults with normal body mass index and waist circumference. Tohoku J Exp Med 2012, 228:1-8.
• [19]Cai L, Liu A, Zhang Y, Wang P: Waist-to-height ratio and cardiovascular risk factors among Chinese adults in Beijing. PLoS One 2013, 8:e69298.
• [20]Jayawardana R, Ranasinghe P, Sheriff MH, Matthews DR, Katulanda P: Waist to height ratio: a better anthropometric marker of diabetes and cardio-metabolic risks in South Asian adults. Diabetes Res Clin Pract 2013, 99:292-299.
• [21]Guasch-Ferre M, Bullo M, Martinez-Gonzalez MA, Corella D, Estruch R, Covas MI, Aros F, Warnberg J, Fiol M, Lapetra J, Muñoz MÁ, Serra-Majem L, Pintó X, Babio N, Díaz-López A, Salas-Salvadó J: Waist-to-height ratio and cardiovascular risk factors in elderly individuals at high cardiovascular risk. PLoS One 2012, 7:e43275.
• [22]Koch E, Bogado M, Araya F, Romero T, Diaz C, Manriquez L, Paredes M, Roman C, Taylor A, Kirschbaum A: Impact of parity on anthropometric measures of obesity controlling by multiple confounders: a cross-sectional study in Chilean women. J Epidemiol Community Health 2008, 62:461-470.
• [23]McCarthy HD, Ashwell M: 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’. Int J Obes (Lond) 2006, 30:988-992.
• [24]Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS: 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. BMC Pediatr 2010, 10:73.
• [25]Khoury M, Manlhiot C, McCrindle BW: Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol 2013, 62:742-751.
• [26]Song X, Jousilahti P, Stehouwer CD, Soderberg S, Onat A, Laatikainen T, Yudkin JS, Dankner R, Morris R, Tuomilehto J, Qiao Q: Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. Eur J Clin Nutr 2013, 67:1298-1302.
• [27]Graves L, Garnett SP, Cowell CT, Baur LA, Ness A, Sattar N, Lawlor DA: Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort. Pediatr Obes 2014, 9:327-338.
• [28]Cox BD: Health and Lifestyle Survey, 1984–1985 (HALS1). UK Data Archive, Colchester, Essex; 1988.
• [29]Ashwell M, Mayhew L, Richardson J, Rickayzen B: Waist-to-height ratio is more accurate than body mass index to quantify reduced life expectancy. Obes Facts 2013, 6:145.
• [30]Ashwell M: The Ashwell shape chart- a new millennium approach to communicate the metabolic risks of obesity. Obes Res 1997, 5:45S.
• [31]Ashwell M, Mayhew L, Richardson J, Rickayzen B: Waist-to-height ratio is more predictive of years of life lost than body mass index. PLoS One 2014, 9:e103483.
• [32]Rey-Lopez JP, de Rezende LF, Pastor-Valero M, Tess BH: The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used. Obes Rev 2014, 15:781-790.
• [33]Ashwell M: Plea for simplicity: use of waist-to-height ratio as a primary screening tool to assess cardiometabolic risk. Clin Obesity 2012, 2:3-5.
• [34]Ntuk UE, Gill JM, Mackay DF, Sattar N, Pell JP: Ethnic-specific obesity cutoffs for diabetes risk: cross-sectional study of 490,288 UK biobank participants. Diabetes Care 2014, 37:2500-2507.
• [35]Ashwell M, Gunn P, Gibson S: Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev 2012, 13:275-286.