View source for Waist-to-height ratio

{{Short description|Waist circumference divided by height}}
{{Human body weight}}
The '''waist-to-height ratio''' (WHtR,{{efn|The abbreviation WHR is more commonly used for [[Waist–hip ratio]], although WHpR is preferred.}} or WSR: waist-to-stature ratio) is the waist [[circumference]] divided by body height, both measured in the same units. 

WHtR is a measure of the distribution of [[body fat]]. Higher values of WHtR indicate higher risk of obesity-related [[cardiovascular disease]]s, which are correlated with [[abdominal obesity]].<ref>{{cite journal | vauthors = Lee CM, Huxley RR, Wildman RP, Woodward M | title = Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis | journal = Journal of Clinical Epidemiology | volume = 61 | issue = 7 | pages = 646–653 | date = July 2008 | pmid = 18359190 | doi = 10.1016/j.jclinepi.2007.08.012 | doi-access = free }}</ref> A waist size less than half the height helps to stave off serious health problems.<ref>{{cite news |title=Ensure waist size is less than half your height, health watchdog says |work=[[The Guardian]] | 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>

== History ==
More than twenty-five years ago, WHtR was first suggested as a simple health risk assessment tool because "it is a proxy for harmful [[central adiposity]]";<ref name="Vague-1956" /> it predicts obesity-related cardiovascular disease. A boundary value of 0.5 was proposed to indicate increased risk.<ref name="Hsieh-1995" /><ref name="Ashwell-1996" /> 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> 

According to [[World Health Organization]] guidance, the waist circumference is usually measured midway between the lower rib and the [[iliac crest]].<ref name="WHO-2011" />

== Guidelines ==

=== Calculation ===
{{Body roundness index}}
<math display="block">\text{WHtR}=\frac{\text{waist circumference}}{\text{height}}</math>
e.g. 1: {{sfrac
|{{calculator|id=waistFormula1|formula=waistcm|default=72|type=plain}} cm
|{{calculator|id=heightFormula1|formula=heightcm|default=160|type=plain}} cm
}} {{=}} {{calculator|id=whtrFormula1|decimals=2|formula=waistcm/heightcm|default=0.45|type=plain}}

e.g. 2: {{sfrac
|{{calculator|id=waistFormula2a|formula=waistinch|default=28|type=plain}} in
|{{calculator|id=heightFormula2a|formula=heightfeet|default=5|type=plain}} ft {{calculator|id=heightFormula|formula=heightinches|default=3|type=plain}} in
}} 
{{=}}
{{sfrac
|{{calculator|id=waistFormula2b|formula=waistinch|default=28|type=plain}} in
|{{calculator|id=heightInches2b|formula=heightfeet*12+heightinches|default=63|type=plain}} in
}} 
{{=}} {{calculator|id=whtrFormula2c|decimals=2|formula=waistFormula2b/heightInches2b|default=0.44 |type=plain}} 

Any unit will do, as long as waist and height share the same unit.

=== United Kingdom ===
The UK's [[National Institute for Health and Care Excellence]] (NICE):
All adults "ensure their waist size is less than half their height in order to help stave off serious health problems".<ref name="NICE-2022-2" /><ref name="NICE-2022-1" />

In September 2022, NICE formally adopted this guideline.<ref>{{cite web |title= Obesity: identification, assessment and management {{!}} Clinical guideline [CG189] | 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>
==== Recommended boundary values <span class="anchor" id="Suggested boundary values"></span>====
[[File:Waist_to_height_ratio_graph.svg|thumb|upright=1.5|
vertical axis: height
<br>horizontal axis: [[waist]] [[circumference]]
<br>colours: NICE risk level
<br>lines: Waist-to-height-ratio
]]
The October 2022 NICE guidelines recommend boundary values for WHtR (defining the degree of "[[wikt:central adiposity|central adiposity]]" ([[abdominal obesity]])) as follows:
{| class="wikitable"
|-
! WHtR
! central adiposity
! health risks
! action?
|- bgcolor="#ffCCCC"
| 0.6 or more
| high
| id="furtherIncreasedHealthRisks"| further increased
| Take Action
|- bgcolor="#ffff99"
| 0.5 to 0.59
| increased
| id="increasedHealthRisks"| increased
| Take Care
|- bgcolor="#99ffcc"
| 0.4 to 0.49
| healthy
| id="noIncreasedHealthRisks"| not increased
| no, OK
|}
NICE say that these classifications can be used for people with a [[body mass index]] (BMI) of under 35, for both sexes and all [[ethnicity|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.<ref name="NICE-2022-3" />

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{{nbsp}}={{nbsp}}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="Antwi-2012" />

==== 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="Ashwell-2005" /><ref name="McCarthy-2006" /> 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="NICE-2022-1" />

====Age-adjusted boundary values====

A 2013 study identified critical threshold values according to age, with consequent significant reduction in life expectancy if exceeded. These are: WHtR greater than 0.5 for people under 40 years of age, 0.5 to 0.6 for people aged 40–50, and greater than 0.6 for people over 50 years of age.<ref>{{cite web | author = HospiMedica International staff writers |url=http://www.hospimedica.com/critical-care/articles/294746805/waist-height-ratio-better-than-bmi-for-gauging-mortality.html |title=Waist-Height Ratio Better Than BMI for Gauging Mortality |date=18 Jun 2013 |access-date=7 April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160417064352/http://www.hospimedica.com/critical-care/articles/294746805/waist-height-ratio-better-than-bmi-for-gauging-mortality.html |archive-date=17 April 2016 }}</ref>

== 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 [[computed tomography|CT]], [[Magnetic resonance imaging|MRI]] or [[Dual-energy X-ray absorptiometry|DEXA]].<ref name="Ashwell-1996" /><ref name="Roriz-2014" /><ref name="Martin-Calvo-2016" /><ref name="Swainson-2017" />

WHtR  is an  indicator of 'early health risk': several systematic reviews and meta-analyses of data in adults of all ages,<ref name="Lee-2008" /><ref name="Ashwell-2012" /><ref name="Savva-2013" /><ref name="Corrêa-2016" /> as well as in children and adolescents,<ref name="Lo-2016" /><ref name="Ochoa Sangrador-2018" /> 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 [[anthropometry|anthropometric]] index to identify health risks in adults of all ages,<ref name="Ashwell-2012" /><ref name="Savva-2013" /><ref name="Kawamoto-2019" /><ref name="Gibson-2020" /> and in children and adolescents.<ref name="Choi-2017" /><ref name="Jiang-2018" /><ref name="Tee-2020" />

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="Yoo-2016" />

=== As an  indicator of mortality ===

Not only does WHtR have a close relationship with [[morbidity]], it also has a clearer relationship with [[Mortality rate|mortality]] than BMI.<ref name="Schneider-2010" /><ref name="Ashwell-2014" /><ref name="Jayedi-2020" />

=== 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="Šebeková-2018" /><ref name="Ashwell-2017" /><ref name="Gibson-2020" />  Many children show the same phenomenon.<ref name="Mokha-2010" /><ref name="Srinivasan-2009" /> Risk factors for metabolic diseases<ref name="Ashwell-2017" /><ref name="Liu-2017" /> and mortality are raised in these subjects.<ref name="Yu-2016" /><ref name="Sharma-2016" /><ref name="Carter-2016" />

==See also==
* {{anli|Allometry}}
* {{anli|Body fat percentage}}
* {{anli|Body mass index}} (Total mass divided by the square of height)
* {{anli|Body roundness index}}
* {{anli|Body shape}}
* {{anli|Body shape index}} (Waist circumference compared to its allometric average)
* {{anli|Body water}}
* {{anli|Normal weight obesity}}
* {{anli|Waist–hip ratio}}

==Notes==
{{notelist}}

== References ==
{{Reflist|refs=
<ref name="NICE-2022-2">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022|title=Obesity: identification and classification of overweight and obesity (update) |url=https://www.nice.org.uk/guidance/GID-NG10284/documents/draft-guideline}}</ref>
<ref name="NICE-2022-1">{{cite web |publisher=National Institute for Health and Care Excellence (NICE) |year=2022 |title=Obesity: identification and classification of overweight and obesity (update) {{!}} Recommendations 1.2.11 and 1.2.12. |url= https://www.nice.org.uk/guidance/cg189 }}</ref>
<ref name="Vague-1956">{{cite journal | vauthors = Vague J | title = The degree of masculine differentiation of obesities: a factor determining predisposition to diabetes, atherosclerosis, gout, and uric calculous disease | journal = The American Journal of Clinical Nutrition | volume = 4 | issue = 1 | pages = 20–34 | year = 1956 | pmid = 13282851 | doi = 10.1093/ajcn/4.1.20 | department = primary | doi-access = free }}</ref>
<ref name="Hsieh-1995">{{cite journal | vauthors = Hsieh SD, Yoshinaga H | title = Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women | journal = Internal Medicine | volume = 34 | issue = 12 | pages = 1147–1152 | date = December 1995 | pmid = 8929639 | doi = 10.2169/internalmedicine.34.1147 | department = primary | doi-access = free }}</ref>
<ref name="Ashwell-1996">{{cite journal | vauthors = Ashwell M, Lejeune S, McPherson K | title = Ratio of waist circumference to height may be better indicator of need for weight management | journal = BMJ | volume = 312 | issue = 7027 | pages = 377 | date = February 1996 | pmid = 8611847 | doi = 10.1136/bmj.312.7027.377 | pmc = 2350287 | department = primary }}</ref>
<ref name="WHO-2011">{{cite report|publisher=World Health Organization |year=2011 |title=Waist circumference and waist-hip ratio: report of a WHO expert consultation 2008 |location=Geneva}}</ref>
<ref name="Roriz-2014">{{cite journal | vauthors = Roriz AK, Passos LC, de Oliveira CC, Eickemberg M, Moreira P, Sampaio LR | title = Evaluation of the accuracy of anthropometric clinical indicators of visceral fat in adults and elderly | journal = PLOS ONE | volume = 9 | issue = 7 | pages = e103499 | date = 2014 | pmid = 25078454 | doi = 10.1371/journal.pone.0103499 | pmc = 4117503 | bibcode = 2014PLoSO...9j3499R | doi-access = free | department = primary }}</ref>
<ref name="Martin-Calvo-2016">{{cite journal | vauthors = Martin-Calvo N, Moreno-Galarraga L, Martinez-Gonzalez MA | title = Association between Body Mass Index, Waist-to-Height Ratio and Adiposity in Children: A Systematic Review and Meta-Analysis | journal = Nutrients | volume = 8 | issue = 8 | page = E512 | date = August 2016 | pmid = 27556485 | doi = 10.3390/nu8080512 | pmc = 4997425 | doi-access = free | department = secondary }}</ref>
<ref name="Swainson-2017">{{cite journal | vauthors = Swainson MG, Batterham AM, Tsakirides C, Rutherford ZH, Hind K | title = Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables | journal = PLOS ONE | volume = 12 | issue = 5 | pages = e0177175 | year = 2017 | pmid = 28493988 | doi = 10.1371/journal.pone.0177175 | pmc = 5426673 | bibcode = 2017PLoSO..1277175S | doi-access = free | department = primary }}</ref>
<ref name="Lee-2008">{{cite journal | vauthors = Lee CM, Huxley RR, Wildman RP, Woodward M | title = Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis | journal = Journal of Clinical Epidemiology | volume = 61 | issue = 7 | pages = 646–653 | date = July 2008 | pmid = 18359190 | doi = 10.1016/j.jclinepi.2007.08.012 | department = secondary | doi-access = free }}</ref>
<ref name="Ashwell-2012">{{cite journal | vauthors = Ashwell M, Gunn P, Gibson S | title = Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis | journal = Obesity Reviews | volume = 13 | issue = 3 | pages = 275–86 | date = March 2012 | pmid = 22106927 | doi = 10.1111/j.1467-789X.2011.00952.x | s2cid = 7290185 | department = secondary }}</ref>
<ref name="Savva-2013">{{cite journal | vauthors = Savva SC, Lamnisos D, Kafatos AG | title = Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis | journal = Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | volume = 6 | issue = | pages = 403–19 | date = October 2013 | pmid = 24179379 | pmc = 3810792 | doi = 10.2147/DMSO.S34220 | department = secondary | doi-access = free }}</ref>
<ref name="Corrêa-2016">{{cite journal | vauthors = Corrêa MM, Thumé E, De Oliveira ER, Tomasi E | title = Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: A systematic literature review | journal = Archives of Gerontology and Geriatrics | volume = 65 | issue = | pages = 174–82 | date = 2016 | pmid = 27061665 | doi = 10.1016/j.archger.2016.03.021 | department = secondary }}</ref>
<ref name="Lo-2016">{{cite journal | vauthors = Lo K, Wong M, Khalechelvam P, Tam W | title = Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis | journal = Obesity Reviews | volume = 17 | issue = 12 | pages = 1258–1275 | date = December 2016 | pmid = 27452904 | doi = 10.1111/obr.12456 | s2cid = 3597681 | department = secondary }}</ref>
<ref name="Ochoa Sangrador-2018">{{cite journal | vauthors = Ochoa Sangrador C, Ochoa-Brezmes J | title = Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis | journal = Pediatric Obesity | volume = 13 | issue = 7 | pages = 421–432 | date = July 2018 | pmid = 29700992 | doi = 10.1111/ijpo.12285 | s2cid = 13795818 | department = secondary }}</ref>
<ref name="Kawamoto-2019">{{cite journal | vauthors = Kawamoto R, Kikuchi A, Akase T, Ninomiya D, Kumagi T | title = Usefulness of waist-to-height ratio in screening incident metabolic syndrome among Japanese community-dwelling elderly individuals | journal = PLOS ONE | year = 2019 | volume = 14 | issue = 4 | pages = e0216069 | pmid = 31034487 | doi = 10.1371/journal.pone.0216069 | pmc = 6488078 | bibcode = 2019PLoSO..1416069K | doi-access = free | department = primary }}</ref>
<ref name="Gibson-2020">{{cite journal | vauthors = Gibson S, Ashwell M | title = A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England | journal = The British Journal of Nutrition | volume = 123 | issue = 6 | pages = 681–690 | date = March 2020 | pmid = 31840619 | doi = 10.1017/S0007114519003301 | s2cid = 209386183 | department = primary }}</ref>
<ref name="Choi-2017">{{cite journal | vauthors = Choi DH, Hur YI, Kang JH, Kim K, Cho YG, Hong SM, Cho EB | title = Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity and Metabolic Syndrome among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2010-2014 | journal = Nutrients | volume = 9 | issue = 3 | date = March 2017 | page = 256 | pmid = 28287410 | doi = 10.3390/nu9030256 | pmc = 5372919 | doi-access = free | department = primary }}</ref>
<ref name="Jiang-2018">{{cite journal | vauthors = Jiang Y, Dou YL, Xiong F, Zhang L, Zhu GH, Wu T, Zhang Y, Yan WL | display-authors = 6 | title = Waist-to-height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents | journal = Acta Paediatrica | date = March 2018 | volume = 107 | issue = 9 | pages = 1629–1634 | pmid = 29569350 | doi = 10.1111/apa.14323 | s2cid = 4206581| department = primary }}</ref>
<ref name="Tee-2020">{{cite journal | vauthors = Tee JY, Gan WY, Lim PY | title = Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: a cross-sectional study | journal = BMJ Open | volume = 10 | issue = 1 | pages = e032874 | date = January 2020 | pmid = 31932391 | doi = 10.1136/bmjopen-2019-032874 | pmc = 7044891 | department = primary }}</ref>
<!-- <ref name=":35">{{cite journal | vauthors = Zafari N, Lotfaliany M, Mansournia MA, Khalili D, Azizi F, Hadaegh F | title = Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes: results of a cohort study | journal = BMC Public Health | volume = 18 | issue = 1 | pages = 691 | date = June 2018 | pmid = 29866083 | doi = 10.1186/s12889-018-5611-6 | pmc = 5987476 }}</ref>
<ref name=":36">{{cite journal | vauthors = Wang Q, Wang Z, Yao W, Wu X, Huang J, Huang L, Sun Y | title = Anthropometric Indices Predict the Development of Hypertension in Normotensive and Pre-Hypertensive Middle-Aged Women in Tianjin, China: A Prospective Cohort Study | journal = Medical Science Monitor | volume = 24 | pages = 1871–1879 | date = March 2018 | pmid = 29601569 | doi = 10.12659/msm.908257 | pmc = 5892460 }}</ref>
<ref name=":37">{{cite journal | vauthors = Choi JR, Koh SB, Choi E | title = Waist-to-height ratio index for predicting incidences of hypertension: the ARIRANG study | journal = BMC Public Health | volume = 18 | issue = 1 | pages = 767 | date = June 2018 | pmid = 29921256 | doi = 10.1186/s12889-018-5662-8 | pmc = 6008942 }}</ref>
<ref name=":38">{{cite journal | vauthors = Chen X, Liu Y, Sun X, Yin Z, Li H, Deng K, Cheng C, Liu L, Luo X, Zhang R, Liu F, Zhou Q, Wang C, Li L, Zhang L, Wang B, Zhao Y, Zhou J, Han C, Zhang H, Yang X, Pang C, Yin L, Feng T, Zhao J, Zhang M, Hu D | display-authors = 6 | title = Comparison of body mass index, waist circumference, conicity index, and waist-to-height ratio for predicting incidence of hypertension: the rural Chinese cohort study | journal = Journal of Human Hypertension | volume = 32 | issue = 3 | pages = 228–235 | date = March 2018 | pmid = 29416119 | doi = 10.1038/s41371-018-0033-6 | s2cid = 3938438 }}</ref>
<ref name=":39">{{cite journal | vauthors = Lee DH, Keum N, Hu FB, Orav EJ, Rimm EB, Willett WC, Giovannucci EL | title = Comparison of the association of predicted fat mass, body mass index, and other obesity indicators with type 2 diabetes risk: two large prospective studies in US men and women | journal = European Journal of Epidemiology | volume = 33 | issue = 11 | pages = 1113–1123 | date = November 2018 | pmid = 30117031 | doi = 10.1007/s10654-018-0433-5 | s2cid = 52019913 }}</ref>
<ref name=":40">{{cite journal | vauthors = Son YJ, Kim J, Park HJ, Park SE, Park CY, Lee WY, Oh KW, Park SW, Rhee EJ | display-authors = 6 | title = Association of Waist-Height Ratio with Diabetes Risk: A 4-Year Longitudinal Retrospective Study | journal = Endocrinology and Metabolism | volume = 31 | issue = 1 | pages = 127–133 | date = March 2016 | pmid = 26754587 | doi = 10.3803/EnM.2016.31.1.127 | pmc = 4803548 }}</ref>
<ref name=":41">{{cite journal | vauthors = Lee JW, Lim NK, Baek TH, Park SH, Park HY | title = Anthropometric indices as predictors of hypertension among men and women aged 40-69 years in the Korean population: the Korean Genome and Epidemiology Study | journal = BMC Public Health | volume = 15 | pages = 140 | date = February 2015 | pmid = 25886025 | doi = 10.1186/s12889-015-1471-5 | pmc = 4332746 }}</ref>
<ref name=":42">{{cite journal | vauthors = Xu J, Xu T, Bu X, Peng H, Li H, Zhang M, Zhang Y | title = The predictive value of waist-to-height ratio for ischemic stroke in a population-based prospective cohort study among Mongolian men in China | journal = PLOS ONE | year = 2014 | volume = 9 | issue = 10 | pages = e110245 | pmid = 25353632 | doi = 10.1371/journal.pone.0110245 | pmc = 4212917 | bibcode = 2014PLoSO...9k0245X | doi-access = free }}</ref>
<ref name=":44">{{cite journal | vauthors = Hadaegh F, Shafiee G, Azizi F | title = Anthropometric predictors of incident type 2 diabetes mellitus in Iranian women | journal = Annals of Saudi Medicine | year = 2009 | volume = 29 | issue = 3 | pages = 194–200 | pmid = 19448363 | doi = 10.4103/0256-4947.51788 | doi-broken-date = 2022-10-11 | pmc = 2813660 }}</ref>
<ref name=":45">{{cite journal | vauthors = Aekplakorn W, Pakpeankitwatana V, Lee CM, Woodward M, Barzi F, Yamwong S, Unkurapinun N, Sritara P | display-authors = 6 | title = Abdominal obesity and coronary heart disease in Thai men | journal = Obesity | volume = 15 | issue = 4 | pages = 1036–1042 | date = April 2007 | pmid = 17426340 | doi = 10.1038/oby.2007.604 | s2cid = 34220799 }}</ref>
<ref name=":46">{{cite journal | vauthors = Hadaegh F, Zabetian A, Harati H, Azizi F | title = Waist/height ratio as a better predictor of type 2 diabetes compared to body mass index in Tehranian adult men--a 3.6-year prospective study | journal = Experimental and Clinical Endocrinology & Diabetes | volume = 114 | issue = 6 | pages = 310–315 | date = June 2006 | pmid = 16868890 | doi = 10.1055/s-2006-924123 }}</ref>
 -->
<ref name="Schneider-2010">{{cite journal | vauthors = Schneider HJ, Friedrich N, Klotsche J, Pieper L, Nauck M, John U, Dörr M, Felix S, Lehnert H, Pittrow D, Silber S, Völzke H, Stalla GK, Wallaschofski H, Wittchen HU | display-authors = 6 | title = The predictive value of different measures of obesity for incident cardiovascular events and mortality | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 95 | issue = 4 | pages = 1777–1785 | date = April 2010 | pmid = 20130075 | doi = 10.1210/jc.2009-1584 | department = primary | doi-access = free }}</ref>
<!-- <ref name=":47">{{cite journal | vauthors = Graves L, Garnett SP, Cowell CT, Baur LA, Ness A, Sattar N, Lawlor DA | title = Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort | journal = Pediatric Obesity | volume = 9 | issue = 5 | pages = 327–338 | date = October 2014 | pmid = 23894119 | doi = 10.1111/j.2047-6310.2013.00192.x | pmc = 4238826 | department = primary }}</ref>
 --><ref name="Yoo-2016">{{cite journal | vauthors = Yoo EG | title = Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk | journal = Korean Journal of Pediatrics | volume = 59 | issue = 11 | pages = 425–431 | date = November 2016 | pmid = 27895689 | doi = 10.3345/kjp.2016.59.11.425 | pmc = 5118501 | department = secondary }}</ref>
<ref name="Ashwell-2014">{{cite journal | vauthors = Ashwell M, Mayhew L, Richardson J, Rickayzen B | title = Waist-to-height ratio is more predictive of years of life lost than body mass index | journal = PLOS ONE | year = 2014 | volume = 9 | issue = 9 | pages = e103483 | pmid = 25198730 | doi = 10.1371/journal.pone.0103483 | pmc = 4157748 | bibcode = 2014PLoSO...9j3483A | doi-access = free | department = primary }}</ref>
<ref name="Jayedi-2020">{{cite journal | vauthors = Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S | title = Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies | journal = BMJ (Clinical Research Ed.) | volume = 370 | issue = | pages = m3324 | date = September 2020 | pmid = 32967840 | pmc = 7509947 | doi = 10.1136/bmj.m3324 | department = secondary }}</ref>
<ref name="Šebeková-2018">{{cite journal | vauthors = Šebeková K, Csongová M, Gurecká R, Krivošíková Z, Šebek J | title = Gender Differences in Cardiometabolic Risk Factors in Metabolically Healthy Normal Weight Adults with Central Obesity | journal = Experimental and Clinical Endocrinology & Diabetes | volume = 126 | issue = 5 | pages = 309–315 | date = May 2018 | pmid = 29117621| doi = 10.1055/s-0043-119877 | department = primary }}</ref>
<ref name="Ashwell-2017">{{cite journal | vauthors = Ashwell M, Gibson S | date = 2017 | title = Normal weight central obesity: the value of waist-to-height ratio in its identification. In response to Waist measurement, not BMI, is stronger predictor of death risk, study finds. | journal = BMJ | volume = 357 | page = j2033 | doi = 10.1136/bmj.j2033  | s2cid = 32653852 | department = secondary }}</ref>
<ref name="Mokha-2010">{{cite journal | vauthors = Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, Berenson GS | title = 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 | journal = BMC Pediatrics | volume = 10 | issue = | pages = 73 | date = October 2010 | pmid = 20937123 | pmc = 2964659 | doi = 10.1186/1471-2431-10-73 | department = primary | doi-access = free }}</ref>
<ref name="Srinivasan-2009">{{cite journal | vauthors = Srinivasan SR, Wang R, Chen W, Wei CY, Xu J, Berenson GS | title = Utility of waist-to-height ratio in detecting central obesity and related adverse cardiovascular risk profile among normal weight younger adults (from the Bogalusa Heart Study) | journal = The American Journal of Cardiology | volume = 104 | issue = 5 | pages = 721–4 | date = September 2009 | pmid = 19699351 | doi = 10.1016/j.amjcard.2009.04.037| department = primary }}</ref>
<ref name="Liu-2017">{{cite journal | vauthors = Liu PJ, Ma F, Lou HP, Zhu YN | title = Comparison of the ability to identify cardiometabolic risk factors between two new body indices and waist-to-height ratio among Chinese adults with normal BMI and waist circumference | journal = Public Health Nutrition | volume = 20 | issue = 6 | pages = 984–991 | date = April 2017 | pmid = 27989263 | doi = 10.1017/S1368980016003281 | pmc = 10261557 | s2cid = 3574565 | department = primary | doi-access = free }}</ref>
<ref name="Yu-2016">{{cite journal | vauthors = Yu Y | title = Normal-Weight Central Obesity and Mortality Risk | journal = Annals of Internal Medicine | volume = 165 | issue = 4 | pages = 298 | date = August 2016 | pmid = 27538167 | doi = 10.7326/L16-0074 | s2cid = 26722676 }}</ref>
<ref name="Sharma-2016">{{cite journal | vauthors = Sharma S, Batsis JA, Coutinho T, Somers VK, Hodge DO, Carter RE, Sochor O, Kragelund C, Kanaya AM, Zeller M, Park JS, Køber L, Torp-Pedersen C, Lopez-Jimenez F | display-authors = 6 | title = Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease | journal = Mayo Clinic Proceedings | volume = 91 | issue = 3 | pages = 343–351 | date = March 2016 | pmid = 26860580 | doi = 10.1016/j.mayocp.2015.12.007 | department = primary }}</ref>
<ref name="Carter-2016">{{cite journal | vauthors = Carter RE, Hodge DO, Lopez-Jimenez F | title = Normal-Weight Central Obesity and Mortality Risk | journal = Annals of Internal Medicine | volume = 165 | issue = 4 | pages = 298–299 | date = August 2016 | pmid = 27538166 | doi = 10.7326/L16-0073 | s2cid = 6941690 }}</ref>
<ref name="NICE-2022-3">{{cite web | work = National Institute for Health and Care Excellence (NICE) | date = 2022 | title = Obesity: identification and classification of overweight and obesity (update) Recommendations 1.2.25 and 1.2.26. | url = https://www.nice.org.uk/guidance/cg189  }}</ref>
<ref name="Antwi-2012">{{cite journal | vauthors = Antwi F, Fazylova N, Garcon MC, Lopez L, Rubiano R, Slyer JT | title = The effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: A systematic review | journal = JBI Library of Systematic Reviews | volume = 10 | issue = 42 Suppl | pages = 1–14 | date = 2012 | pmid = 27820152 | doi = 10.11124/jbisrir-2012-248 | department = secondary }}</ref>
<ref name="Ashwell-2005">{{cite journal | vauthors = Ashwell M, Hsieh SD | title = Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity | journal = International Journal of Food Sciences and Nutrition | volume = 56 | issue = 5 | pages = 303–307 | date = August 2005 | pmid = 16236591 | doi = 10.1080/09637480500195066 | s2cid = 24420745 | department = primary }}</ref>
<ref name="McCarthy-2006">{{cite journal | vauthors = McCarthy HD, Ashwell M | title = 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' | journal = International Journal of Obesity | volume = 30 | issue = 6 | pages = 988–992 | date = June 2006 | pmid = 16432546 | doi = 10.1038/sj.ijo.0803226 | s2cid = 26576960 | department = primary }}</ref>
}}

[[Category:Body shape]]
[[Category:Classification of obesity]]
[[Category:Medical signs]]
[[Category:Anthropometry]]
[[Category:Waist]]