Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women

OBJECTIVE: The normal body mass index (BMI) range, as defined by the World Health Organization (WHO), is quite wide, and some people within this range may have excessive central fat accumulation and elevated metabolic risks. We hypothesize that the waist-to-height ratio (W/Ht), an effective index for assessing central fat distribution among Japanese people, can be used to identify subjects who are at higher metabolic risk within the normal as well as the overweight range. METHODS: We investigated: (1) the values of BMI, waist circumference, and W/Ht in 6141 men and 2137 women at various age intervals and calculated gender (female to male) ratios for all these anthropometric indices; (2) the relation between age and each anthropometric index, between age and morbidity index for coronary risk factors (sum of the scores for hyperglycemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and low HDL cholesterol; one point for each condition if present), and between morbidity index for coronary risk factors and each anthropometric index; (3) the distributions of the subjects, using various proposed indices of waist circumference (those suggested by WHO, the Japan Society for the Study of Obesity, and the Asia-Pacific perspective), and our proposed boundary value, W/Ht 0.5, among the WHO categories based on BMI; (4) the metabolic risks (coronary risk factors, hyperuricemia, high γ-glutamyltransferase, and fatty liver diagnosed by ultrasonography), and exercise habits among normal-weight subjects with W/Ht<0.5 or >=0.5. RESULTS: (1) For the various anthropometric indices in all age groups, the gender ratio for W/Ht was closest to 1, indicating that a single set of values for W/Ht can be used for men and women. (2) Height correlated negatively with age. Among the anthropometric indices, only W/Ht correlated positively with age for both men and women, while age and all anthropometric indices, except height, correlated positively with the morbidity index for coronary risk factors. For both men and women, the highest correlation coefficient was between W/Ht and the morbidity index for coronary risk factors. (3) Nearly all overweight men and women (BMI>=25) had W/Ht>=0.5 (98.5% of men and 97.5% of women). None of the underweight subjects had W/Ht>=0.5. However, 45.5% of men and 28.3% of women of normal weight (BMI 18.5-<25) had W/Ht>=0.5. W/Ht, of all the indices investigated, was the best index for signaling metabolic risk in the normal-weight subjects as well as the overweight subjects. (4) Age- and BMI-adjusted odds ratios for multiple metabolic risks, and history of no habitual exercise were significantly higher in normal-weight men and women with W/Ht>=0.5 than in others of normal weight. CONCLUSIONS: Waist circumference is improved by relating it to height to categorized fat distribution of different genders and ages. W/Ht is a simple and practical anthropometric index to identify higher metabolic risks in normal and overweight Japanese men and women.