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Epidemiology and Population Health

Waist to height ratio as a simple tool for predicting mortality: a systematic review and meta-analysis

International Journal of Obesity volume 47, pages 1286–1301 (2023)Cite this article

Subjects

Abstract

Background

The association of central obesity with higher rates of mortality is not well studied. This study evaluates the association between waist-to-height ratio (WHtR), as a measure of central obesity, with mortality.

Methods

Documents were retrieved from PubMed, Web of Science, Scopus, and Google Scholar databases until May 2022. Data were extracted from cohort studies reporting effect size (hazard ratio (HR)) regarding the association between WHtR as a continuous (per 1 SD increment) or categorical (highest/lowest) measure and all-cause and cause-specific mortality. Screening of included studies was performed independently by two authors. Moreover, the quality assessment of included studies was performed based on the Newcastle-Ottawa assessment scale. Finally, random effect meta-analysis was performed to pool the data, and the outcomes’ certainty level was assess based on the GRADE criteria.

Results

Of the 815 initial studies, 20 were included in the meta-analysis. Random effect meta-analysis showed that in the general population, the all-cause mortality HRs for categorical and continuous measurements of WHtR increased significantly by 23% (HR:1.23; 95% CI: 1.04–1.41) and 16% (HR:1.16; 95% CI: 1.07–1.25), respectively. Moreover, the hazard of cardiovascular (CVD) mortality increased significantly for categorical and continuous measurements of WHtR by 39% (HR:1.39; 95% CI: 1.18–1.59) and 19% (HR:1.19; 95% CI: 1.07–1.31). The quality assessment score of all included studies was high.

Conclusions

Higher levels of WHtR, indicating central obesity, were associated with an increased hazard of CVD and all-cause mortality. This measure can be used in the clinical setting as a simple tool for predicting mortality.

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Fig. 1: The PRISMA flowchart.
Fig. 2: Meta-analysis results.
Fig. 3: Meta-analysis results.
Fig. 4: Meta-analysis results.
Fig. 5: Meta-analysis results.
Fig. 6: Meta-analysis results.
Fig. 7: Meta-analysis results.
Fig. 8: Meta-analysis results.
Fig. 9: Meta-analysis results.

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Data availability

All data generated or analyzed during this study are included in this published article [and its Supplementary Information files].

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Funding

This study was funded by Alborz University of Medical Sciences.

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Author notes

  1. These authors contributed equally: Hanieh-Sadat Ejtahed, Mostafa Qorbani.

Authors and Affiliations

  1. Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ramin Abdi Dezfouli & Mostafa Qorbani

  2. Non-communicable Diseases Research Center, Alborz University of Medicl Sciences, Karaj, Iran

    Nami Mohammadian Khonsari, Ali Hosseinpour & Mostafa Qorbani

  3. Social Determinants of Health Research Center, Alborz University of Medicl Sciences, Karaj, Iran

    Sasan Asadi

  4. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hanieh-Sadat Ejtahed

  5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hanieh-Sadat Ejtahed

Authors
  1. Ramin Abdi Dezfouli
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  2. Nami Mohammadian Khonsari
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  3. Ali Hosseinpour
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  4. Sasan Asadi
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  5. Hanieh-Sadat Ejtahed
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  6. Mostafa Qorbani
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Contributions

RA & AH conducted the primary search and the screening stages and wrote the manuscript. SA created tables. NMK performed the analytical procedures. Finally, HE and MQ checked the data and monitored the correctness of the work process.

Corresponding authors

Correspondence to Hanieh-Sadat Ejtahed or Mostafa Qorbani.

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Competing interests

The authors declare no competing interests.

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This study was approved by the Ethics Committee of Alborz University of Medical Sciences.

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Supplementary information

41366_2023_1388_MOESM1_ESM.docx

Supplementary table 1 (S1). The score of Newcastle-Ottawa assessment scale for the retrieved studies. Supplementary table 2. GRADE evidence profile: The association between central obesity and mo

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Abdi Dezfouli, R., Mohammadian Khonsari, N., Hosseinpour, A. et al. Waist to height ratio as a simple tool for predicting mortality: a systematic review and meta-analysis. Int J Obes 47, 1286–1301 (2023). https://doi.org/10.1038/s41366-023-01388-0

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  • DOI: https://doi.org/10.1038/s41366-023-01388-0

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