Agbaje Andrew O
Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, 70211 Kuopio, Finland.
Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter EX1 2LU, UK.
J Endocr Soc. 2025 May 3;9(7):bvaf079. doi: 10.1210/jendso/bvaf079. eCollection 2025 Jul.
Recent clinical consensus statements have emphasized a shift from diagnosing obesity with body mass index (BMI) requiring confirmation with surrogate markers such as waist circumference-to-height ratio (WHtR). WHtR is a highly sensitive and specific predictor of dual-energy X-ray absorptiometry-measured total body fat mass and abdominal fat mass but not lean mass. However, newly developed WHtR adiposity cut points warrant external validation before clinical application.
To examine whether new WHtR cut points predict liver steatosis and fibrosis in a multiracial population.
Data from 6464 (54% female) multiracial US participants from the National Health and Nutrition Examination Survey conducted between 2021 and 2023 were analyzed. Liver fibrosis was assessed with transient elastography and staged as fibrosis stage F0 to F4 and liver steatosis graded S0 to S3.
Participants' mean (SD) age was 47.3 (20.9) years. The prevalence of WHtR cut points of 0.40 to <0.50 (normal fat mass), 0.5 to <0.53 (high fat mass), and ≥0.53 (excess fat mass) was 20.3%, 13.6%, and 64.5%. Multivariable-adjusted WHtR high fat mass predicted liver steatosis (odds ratio 1.63 [95% confidence interval 1.16-2.29] = .005) and fibrosis (1.31 [1.01-1.70] = .043). Excess WHtR fat mass was associated with liver steatosis (4.02 [2.87-5.64] < .001) and fibrosis (1.61 [1.03-2.54] = .038). Normal WHtR fat mass predicted lower odds of liver steatosis (0.52 [0.37-0.73] < .001) and fibrosis/cirrhosis (0.48 [0.30-0.76] < .001). WHtR high fat mass and excess fat mass separately predicted higher odds of liver steatosis 1.6-fold and 6-fold, respectively, better than BMI-overweight and BMI-obesity.
The simple and universally accessible WHtR cut points may be useful in clinical and public health practice for obesity screening, diagnosis, and management.
最近的临床共识声明强调，从使用体重指数（BMI）诊断肥胖转变为需要用腰围身高比（WHtR）等替代指标进行确认。WHtR是双能X线吸收法测量的全身脂肪量和腹部脂肪量的高度敏感和特异的预测指标，但不是瘦体重的预测指标。然而，新制定的WHtR肥胖切点在临床应用前需要进行外部验证。
研究新的WHtR切点是否能预测多民族人群的肝脂肪变性和肝纤维化。
分析了2021年至2023年期间美国国家健康和营养检查调查中6464名（54%为女性）多民族参与者的数据。用瞬时弹性成像评估肝纤维化，并分为F0至F4期，肝脂肪变性分为S0至S3级。
参与者的平均（标准差）年龄为47.3（20.9）岁。WHtR切点为0.40至<0.50（正常脂肪量）、0.5至<0.53（高脂肪量）和≥0.53（过多脂肪量）的患病率分别为20.3%、13.6%和64.5%。多变量调整后的WHtR高脂肪量可预测肝脂肪变性（比值比1.63[95%置信区间1.16 - 2.29]=.005）和肝纤维化（1.31[1.01 - 1.70]=.043）。过多的WHtR脂肪量与肝脂肪变性（4.02[2.87 - 5.64]<0.001）和肝纤维化（1.61[1.03 - 2.54]=.038）相关。正常的WHtR脂肪量预测肝脂肪变性（0.52[0.37 - 0.73]<0.001）和肝纤维化/肝硬化（0.48[0.30 - 0.76]<0.001）的几率较低。WHtR高脂肪量和过多脂肪量分别预测肝脂肪变性的几率高出1.6倍和6倍，优于BMI超重和BMI肥胖。
简单且普遍适用的WHtR切点可能在肥胖筛查、诊断和管理的临床及公共卫生实践中有用。
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