Waist-to-Height Ratio - Reference Values and Associations with Cardiovascular Risk Factors in a Russian Adult...

Waist-to-height ratio (WHtR) is an anthropometric index with limited data on its population distribution. The aim was to establish WHtR reference values and investigate WHtR associations with socio-demographic, lifestyle and clinical characteristics in Russian adults.

We used data from the population-based cross-sectional Know Your Heart study (2015-2018, Arkhangelsk and Novosibirsk, N = 4495, 58.1% of women, 35-69 years, mean age 54.0). Age-adjusted WHtR reference values for the total study population and by sex were modeled as marginal 5th-95th percentiles (P5-P95) through quantile regressions. WHtR associations with cardiovascular biomarkers were assessed using linear regressions.

The conventional WHtR threshold of 0.5 for abdominal obesity was the value of P25, while P50 and P75 values were 0.54 and 0.60. In ages 35-49 years, P5-P50 values were higher in men. In the age group 60-69 years, P25-P95 values were higher in women. In both sexes, WHtR was associated with age, city of residence, not having university education and low physical activity; in women - with poor financial situation, in men - with being married, non-smoking and hazardous drinking. Among clinical parameters, C-reactive protein had the strongest positive association with WHtR in both sexes, while HDL cholesterol had the strongest negative association. Each standard deviation (SD) change in ln-transformed C-reactive protein was associated with 0.435 and 0.321 SD increase in WHtR in women and men, respectively. One SD increase in HDL cholesterol was associated with -0.334 SD change in WHtR in women and with corresponding change of -0.297 SD in men. In women, WHtR had stronger associations with age, university education, poor financial situation, blood pressure, HDL cholesterol, and ln-transformed C-reactive protein, in men - with being married, current smoking, LDL and non-HDL cholesterol, and HbA1c.

Three-quarters of the study population had WHtR values exceeding the conventional threshold for abdominal obesity. Men and women differed in the WHtR associations with socio-demographic and lifestyle risk factors, biomarkers of inflammation, hypertension, dyslipidemia, and diabetes. WHtR is a useful cardiovascular risk indicator in a Russian adult population.