Waist-to-Height Ratio - Reference Values and Associations with Cardiovascular Risk Factors in a Russian Adult Population.

Purpose: Waist-to-height ratio (WHtR) is an anthropometric index with limited data on its population distribution. The aim was to establish WHtR reference values and investigate WHtR associations with socio-demographic, lifestyle and clinical characteristics in Russian adults.

Methods: We used data from the population-based cross-sectional Know Your Heart study (2015-2018, Arkhangelsk and Novosibirsk, N = 4495, 58.1% of women, 35-69 years, mean age 54.0). Age-adjusted WHtR reference values for the total study population and by sex were modeled as marginal 5th-95th percentiles (P5-P95) through quantile regressions. WHtR associations with cardiovascular biomarkers were assessed using linear regressions.

Results: The conventional WHtR threshold of 0.5 for abdominal obesity was the value of P25, while P50 and P75 values were 0.54 and 0.60. In ages 35-49 years, P5-P50 values were higher in men. In the age group 60-69 years, P25-P95 values were higher in women. In both sexes, WHtR was associated with age, city of residence, not having university education and low physical activity; in women - with poor financial situation, in men - with being married, non-smoking and hazardous drinking. Among clinical parameters, C-reactive protein had the strongest positive association with WHtR in both sexes, while HDL cholesterol had the strongest negative association. Each standard deviation (SD) change in ln-transformed C-reactive protein was associated with 0.435 and 0.321 SD increase in WHtR in women and men, respectively. One SD increase in HDL cholesterol was associated with -0.334 SD change in WHtR in women and with corresponding change of -0.297 SD in men. In women, WHtR had stronger associations with age, university education, poor financial situation, blood pressure, HDL cholesterol, and ln-transformed C-reactive protein, in men - with being married, current smoking, LDL and non-HDL cholesterol, and HbA1c.

Conclusion: Three-quarters of the study population had WHtR values exceeding the conventional threshold for abdominal obesity. Men and women differed in the WHtR associations with socio-demographic and lifestyle risk factors, biomarkers of inflammation, hypertension, dyslipidemia, and diabetes. WHtR is a useful cardiovascular risk indicator in a Russian adult population.