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Advisor(s)
Abstract(s)
Background: Adiposity can be measured using BMI (which is based on weight and height) and indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions. We quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR, and hypertension in people aged 20-64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both about BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in South Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, the Middle East, and North Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of South Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31-3·28) lower for women and 1·28 kg/m2 (1·02-1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in South Asia, Latin America, the Caribbean, and the region of central Asia, the Middle East, and North Africa have higher WHtR than in the other regions.
Description
This study was funded by the UK Medical Research Council (grant number MR/V034057/1) and UK Research and Innovation (Innovate UK grant number 10103595, for participation in the OBCT consortium funded by the EU grant agreement 101080250).
Keywords
Hypertension Epidemiology Obesity Abdominal adiposity Global health Waist-height ratio North Africa Asia Caribbean Latin America Middle East Oceania
Citation
NCD Risk Factor Collaboration (NCD-RisC) [Brito M]. General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants. Lancet. 2024;404(10455):851-63.
Publisher
Elsevier