NCD Risk Factor Collaboration (NCD-RisC) and Di Cesare, Mariachiara and Benzeval, Michaela and Kumari, Meena and et al. (2024) General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7.5 million participants. The Lancet, 404 (10455). pp. 851-863. DOI https://doi.org/10.1016/S0140-6736(24)01405-3
NCD Risk Factor Collaboration (NCD-RisC) and Di Cesare, Mariachiara and Benzeval, Michaela and Kumari, Meena and et al. (2024) General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7.5 million participants. The Lancet, 404 (10455). pp. 851-863. DOI https://doi.org/10.1016/S0140-6736(24)01405-3
NCD Risk Factor Collaboration (NCD-RisC) and Di Cesare, Mariachiara and Benzeval, Michaela and Kumari, Meena and et al. (2024) General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7.5 million participants. The Lancet, 404 (10455). pp. 851-863. DOI https://doi.org/10.1016/S0140-6736(24)01405-3
Abstract
Background: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m<sup>2</sup> (95% CI 2·31–3·28) lower for women and 1·28 kg/m<sup>2</sup> (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding: UK Medical Research Council and UK Research and Innovation (Innovate UK).
Item Type: | Article |
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Uncontrolled Keywords: | NCD Risk Factor Collaboration (NCD-RisC); Humans; Hypertension; Body Mass Index; Prevalence; Adult; Middle Aged; Africa, Northern; Caribbean Region; Latin America; Asia; Middle East; Oceania; Female; Male; Adiposity; Young Adult; Obesity, Abdominal; Global Health; Waist-Height Ratio |
Divisions: | Faculty of Science and Health Faculty of Social Sciences Faculty of Science and Health > Health and Social Care, School of Faculty of Social Sciences > Institute for Social and Economic Research |
SWORD Depositor: | Unnamed user with email elements@essex.ac.uk |
Depositing User: | Unnamed user with email elements@essex.ac.uk |
Date Deposited: | 04 Jul 2025 13:14 |
Last Modified: | 04 Jul 2025 13:14 |
URI: | http://repository.essex.ac.uk/id/eprint/38871 |
Available files
Filename: PIIS0140673624014053.pdf
Licence: Creative Commons: Attribution 4.0