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Novel Waist-to-Height Ratio Estimated Fat Mass Pediatric Cut-offs Predict Hypertension Better than Body Mass Index in Multiracial United States Youths and Adults: The National Health and Nutrition Examination Survey 2015-2023 Cycle
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DOI：10.1016/j.tjnut.2026.101426.png)
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Abstract
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Background Emerging frameworks and clinical consensus statements have strongly recommended that diagnosing obesity with body mass index [BMI (in kg/m(2))] should be confirmed with surrogate markers, such as the waist circumference-to-height ratio (WHtR). Recent studies have reported that new pediatric WHtR adiposity cutpoints predicted the risk of type 2 diabetes, fatty liver disease, and bone fracture in adults more accurately than BMI, but its role in predicting hypertension remains unclear. Objectives To examine the associations of WHtR cutpoints with elevated blood pressure (BP) and hypertension among multiracial United States participants. Methods Altogether 19,124 participants were studied from the United States National Health and Nutrition Examination Survey (NHANES) 2015-2023 cycle. WHtR cutoffs were defined as normal fat (0.40 to <0.50), high fat (0.50 to <0.53), and excess fat (>= 0.53). Elevated BP was defined as >= 120/70 mm Hg, and hypertension as >= 140/90 mm Hg. Results In the 2021-2023 NHANES cycle, participants' mean age was 44.8 +/- 22.6 y, elevated BP and hypertension prevalence were 63.5% and 14.4%, respectively. WHtR-high fat was associated with elevated BP [odds ratio (OR): 1.49; 95% confidence interval (CI): 1.04, 2.12, P < 0.001] and hypertension (OR: 1.82; 95% CI: 1.49, 2.22, P < 0.001), and WHtR-excess fat predicted higher odds of elevated BP (OR: 1.91; 95% CI: 1.40, 2.49, P < 0.001) and hypertension (OR: 2.61; 95% CI: 2.21, 3.08, P < 0.001). BMI-overweight (OR: 1.11; 95% CI: 0.90, 1.36, P = 0.321) and BMI-obesity (OR: 1.25; 95% CI: 1.00, 1.56, P = 0.058) were not associated with hypertension. In youth <25 y (mean age 14.7 y), both WHtR-high fat (OR: 1.70; 95% CI: 1.11, 2.61, P = 0.015) and WHtR-excess fat (OR: 2.16; 95% CI: 1.59, 2.92, P < 0.001) were associated with elevated BP, but not hypertension. WHtR-excess fat predicted elevated BP in non-Hispanic White, Blacks, and Asians. The results were consistent with 2015-2016, 2017-2018, and combined 2015-2023 NHANES cycles. Conclusions The new pediatric WHtR-estimated adiposity cutpoints predicted the risk of elevated BP and hypertension across the lifecourse in a multiracial adult and youth population. WHtR is a universally accessible cardiovascular disease risk assessment tool for early screening, detection, prevention, and management of obesity and can be assessed at https://urfit-child.com/waist-height-calculator/.
Keywords:
obesity
cardiovascular diseases
children
preventive cardiology
metabolism
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