Biomarkers · Anthropometric

Waist-to-Height Ratio (WHtR)

Lower values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 9% higher risk of death. We found the same pattern in NHANES

WHtR and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)1.09×95% CI 1.06–1.12 · 48,666 adults, 6,727 deaths

Published risk of death1.16×continuous WHtR, per 1 SD increment (95% CI 1.07–1.25) · Random-effects meta-analysis of 20 cohort studies, general population

Value of the measurement+0.012gain in concordance within age bands; rank 29 of 56 · all tests

Across studies, risk per SD1.09×NHANES 1.09 [1.06–1.12] · HRS 1.18 [1.14–1.22]

WHtR across cohorts

11.11.25HR per SD (95% CI)

NHANES · United States, 20–8448,666 people · 6,727 deaths1.09 1.06–1.12

HRS · United States, 50+*23,786 people · 8,247 deaths1.18 1.14–1.22

Risk-of-death ratio per standard deviation, adjusted for age and sex, within each cohort. Cohorts differ in age range, assay, measurement protocol and follow-up, and one SD is a different amount in each, so the comparison is of direction and rough size per SD, not per unit. Vertical line: no association.

* Measured differently from NHANES (see the note on the row); compare direction more than size.

WHtR by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (ratio), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	0.43	0.49	0.56	0.64	0.77	1,465	NHANES 2017-2018
All	40-59	0.47	0.54	0.59	0.66	0.80	1,577	NHANES 2017-2018
All	60+	0.49	0.57	0.62	0.68	0.78	1,845	NHANES 2017-2018
All	all	0.45	0.53	0.59	0.66	0.79	4,887	NHANES 2017-2018
Men	20-39	0.42	0.49	0.55	0.62	0.72	709	NHANES 2017-2018
Men	40-59	0.47	0.55	0.59	0.65	0.77	745	NHANES 2017-2018
Men	60+	0.49	0.56	0.62	0.67	0.75	950	NHANES 2017-2018
Men	all	0.44	0.53	0.59	0.65	0.75	2,404	NHANES 2017-2018
Women	20-39	0.43	0.49	0.56	0.67	0.81	756	NHANES 2017-2018
Women	40-59	0.45	0.52	0.60	0.69	0.82	832	NHANES 2017-2018
Women	60+	0.49	0.57	0.63	0.69	0.80	895	NHANES 2017-2018
Women	all	0.45	0.53	0.60	0.68	0.81	2,483	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in WHtR, study by study

1 effect with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
pharmacologic	Subcutaneous semaglutide 2.4 mg once weekly for up to 4 years in adults with overweight/obesity and cardiovascular disease without diabetes	Waist-to-height ratio -6.9% with semaglutide vs -1.0% with placebo at 208 weeks	RCT	Ryan DH, Lingvay I, Deanfield J, et al. Nat Med. 2024.

Sources

Risk curve: Abdi Dezfouli R 2023 (PMID 37770574): all-cause HR 1.16 (1.07-1.25) continuous WHtR, per 1 SD increment. Scaled to US values (NHANES).
Abdi Dezfouli R, Mohammadian Khonsari N, Hosseinpour A, Sheidaei A, Baygi F, Djalalinia S, et al. Waist to height ratio as a simple tool for predicting mortality: a systematic review and meta-analysis. Int J Obes (Lond). 2023;47(12):1286-1293.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map Waist-to-Height Ratio (WHtR) against another biomarker.

Map WHtR against another marker