High and excess pediatric WHtR cutoffs were associated with 79% and 88% higher odds of elevated BP and hypertension in adulthood, respectively.
Does a high or excess fat waist-to-height ratio predict elevated blood pressure and hypertension?
A novel waist-to-height ratio cutoff for adiposity demonstrates a graded positive association with elevated blood pressure and hypertension, supporting its utility as an accessible screening tool for cardiovascular risk.
Abstract Background Waist-to-height ratio (WHtR) has emerged as a superior adiposity marker than body mass index (BMI) for assessing both total body and central fat mass when compared to dual-energy X-ray absorptiometry direct measures of fat mass. Recent evidence indicates that WHtR is a stronger predictor of obesity-driven conditions—including heart failure, liver steatosis disease, and type 2 diabetes mellitus—than BMI. Excess adiposity or obesity is a preventable risk factor for hypertension and subsequent cardiovascular complications, but a universally accessible, cheap and more accurate adiposity estimation tool is needed for early detection and prevention of cardiovascular risks. A novel WHtR-based estimated fat mass cutpoints (Agbaje cutoff) for pediatric populations has recently been developed, along with an online WHtR calculator (https://urfit-child.com/waist-height-calculator/), but the external validity of these cutoffs in predicting adult hypertension remains uncharacterized. Methods We analyzed data from 7,243 participants in the National Health and Nutrition Examination Survey (2021–2023 cycle). Participants were categorized according to WHtR-estimated adiposity levels: normal fat (0.40–0.50), high fat (0.50–0.53), and excess fat (0.53). Elevated blood pressure (BP) was defined as ≥120/70 mmHg and hypertension as ≥140/90 mmHg. Multivariable models were adjusted for age, sex, educational status, smoking status, race, physical activity, total cholesterol, and high-sensitivity C-reactive protein. Results Mean (SD) age was 44.8±22.6 years. Both mean (SD) systolic BP (normal fat 110.5±14.4; high fat 118.0±17.5; and excess fat 122.3±18.3 mmHg, p0.001), and diastolic BP (65.7±9.7; 71.7±10.9; and 74.8±11.1 mmHg, p0.001) increased progressively across WHtR categories. Altogether 4597 (63.5%) participants had elevated BP and 1046 (14.4%) participants had hypertension. In relation to the reference normal fat WHtR category, high fat WHtR was associated with 79% higher odds of elevated BP (Odds ratio 1.79 95% CI 1.49–2.15, p0.001) and hypertension (1.47 1.13–1.91, p=0.03). Excess fat WHtR predicted higher odds of elevated BP (2.43 2.09–2.82, p0.001) and hypertension (1.88 1.43–2.47, p0.001). Conclusions WHtR is an inexpensive and universally accessible adiposity marker that had graded positive associations with systolic and diastolic BP. Both high and excess fat WHtR categories were significantly associated with increased odds of elevated BP and hypertension. These findings support WHtR as a valuable excess adiposity (obesity) early screening tool for cardiovascular risk assessment in pediatric population. The new WHtR adiposity pediatric cutoff may be clinically useful in the diagnosis, management, and prognostic evaluation of obesity complications, such as elevated BP and hypertension, in low resource settings.
Corsi et al. (2025) studied this question. High and excess pediatric WHtR cutoffs were associated with 79% and 88% higher odds of elevated BP and hypertension in adulthood, respectively.