Effects of waist to height ratio, waist circumference, body mass index on the risk of chronic diseases, all-cause, cardiovascular and cancer mortality

Kenneth Lo (Corresponding Author), Yu Qing Huang, Geng Shen, Jia Yi Huang, Lin Liu, Yu Ling Yu, Chao Lei Chen, Ying Qing Feng

Research output: Journal article publicationJournal articleAcademic researchpeer-review

3 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)306-311
Number of pages6
JournalPostgraduate Medical Journal
Issue number1147
Publication statusPublished - 1 May 2021
Externally publishedYes


  • epidemiology

ASJC Scopus subject areas

  • Medicine(all)

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