B4297 - Is waist circumference to height ratio an alternative tool for predicting metabolic risk above that achieved with BMI - 24/04/2023

B number: 
B4297
Principal applicant name: 
Sumona Mandal | University of Bristol (United Kingdom)
Co-applicants: 
Professor Julian Hamilton-Shield, Dr Sam Leary, Professor Nicholas Timpson, Dr Kushala Abeysekera
Title of project: 
Is waist circumference to height ratio an alternative tool for predicting metabolic risk above that achieved with BMI?
Proposal summary: 

Studies have suggested that waist (cm)/height (cm) ratio (WC/H) is a useful alternative measure of central adiposity and obesity related metabolic risk in adults and children than body mass index (BMI) (1-3). In practice, BMI has shown poor performance in certain cohorts and does not indicate an individual’s distribution of fat. WC/H focuses on central adiposity, a known cardiometabolic risk factor for adults and children. Furthermore, calculating BMI requires weighing equipment, a calculator and potentially software/charts. WC/H only needs a tape measure, uses a simple calculation and has a pre-defined ratio to define risk across participant types (cited as >0.5).

NICE have recently recommended the use of WC/H alongside BMI to assess and predict weight-related conditions. There is currently a paucity of research describing the life course patterns of WC/H or demonstrating that it provides equal or improved prediction in metabolic health from childhood to adult life compared to BMI. There is also little evidence relating WC/H to outcomes or intermediates related to central adiposity in particular – e.g., hypertension and non-alcoholic fatty liver disease.

This study aims to 1) chart the trajectory of WC/H compared to BMI through ages 7, 11, 15 and 24, 2) examine associations of WC/H or BMI, and blood pressure and liver health at these ages and 3) compare these associations to explore if WC/H is more discriminatory in defining risk. This will provide additional evidence for the recommendation of an easier measure to assess clinical need for weight management interventions across childhood and adolescence.

References
1. Ashwell M, Gibson S. Waist-to-height ratio as an indicator of 'early health risk': simpler and more predictive than using a 'matrix' based on BMI and waist circumference. BMJ Open. 2016 Mar 14;6(3):e010159.
2. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, Georgiou C, Kafatos A. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord. 2000 Nov;24(11):1453-8.
3. Khoury M, Manlhiot C, McCrindle BW. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol. 2013 Aug 20;62(8):742-51.

Impact of research: 
The findings would provide additional evidence for the NICE recommendation of an easier measure to assess clinical need for weight management interventions across childhood and adolescence. This may contribute to the early detection of overweight and obese children, allowing earlier intervention to reduce obesity in adulthood. If WC/H is found to have equal or better prediction than BMI, this would be particularly useful in community settings and countries with poorer access to resources.
Date proposal received: 
Thursday, 30 March, 2023
Date proposal approved: 
Monday, 24 April, 2023
Keywords: 
Clinical research/clinical practice, Hypertension, Obesity, Liver disease, Statistical methods, Blood pressure, BMI, Liver function, Statistical methods