Article Text

Download PDFPDF
Effects of waist to height ratio, waist circumference, body mass index on the risk of chronic diseases, all-cause, cardiovascular and cancer mortality
  1. Kenneth Lo1,2,
  2. Yu-Qing Huang1,
  3. Geng Shen1,
  4. Jia-Yi Huang1,
  5. Lin Liu1,
  6. Yu-Ling Yu1,
  7. Chao-Lei Chen1,
  8. Ying Qing Feng1
  1. 1 Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou, China
  2. 2 Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Kenneth Lo, Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, RI 02912, USA; kenneth_lo{at}


Background Given the fat redistribution in later stages of life, how the associations between abdominal obesity and the risk of morbidity and mortality have changed with age have not been elucidated, especially for waist to height ratio (WHtR).

Objective To compare the strength of association between obesity indices and chronic diseases at baseline, and the subsequent mortality risk among US adults.

Methods We included 21 109 participants from National Health and Nutrition Examination Survey 1999–2014. We performed logistic regression and receiver operating curve analysis to examine the discriminatory power of obesity indicators on cardiometabolic diseases and cancer at baseline. Sex-stratified and age-stratified Cox models were constructed to explore the prospective association between obesity indices and all-cause, cardiovascular and cancer mortality.

Results Elevated WHtR, elevated waist circumference (WC) and body mass index (BMI)-classified obesity are associated with higher odds of hypertension (OR: 1.37-2.13), dyslipidemia (OR: 1.06 to 1.75, all p<0.05) and diabetes (OR: 1.40-3.16, all p<0.05). WHtR had significantly better discriminatory power to predict cardiometabolic health than BMI, especially for diabetes (area under the curve: 0.709 vs 0.654). After multivariable adjustment, all obesity indicators are associated with lower risk of all-cause mortality among females aged ≥65 years (HR: 0.64 to 0.85), but the association was only significant for BMI when obesity indicators were mutually adjusted (HR: 0.79).

Conclusions WHtR and WC appeared to be the better indicators for cardiometabolic health than BMI. However, BMI had a stronger and inverse association with a greater risk of all-cause mortality among older females.

  • epidemiology

Data availability statement

Data are available in a public, open access repository.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available in a public, open access repository.

View Full Text


  • Contributors KL, Y-QH, GS searched the literature, analysed and interpreted the data, and wrote the manuscript. J-YH, LL, Y-LY, C-LC, Y-QF participated in the study design; collected, analysed and interpreted the data; and wrote the manuscript.

  • Funding This work was supported by the Natural Science Foundation of Guangdong Province (No 2015A030313660), the Science and Technology Plan Project of Guangdong Province (No 2014B020212008), the Science and Technology Program of Guangzhou (No 201604020143, No 201604020018, No 201604020186, No 201510010254 and No 201803040012), and the National Key Research and Development Program of China (No 2017FYC1307603, No 2016YFC1301305 and No 2017YFC0909303).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.