Comparison of Waist to Hip Ratio Sites and Heart Disease Risk Factors in Healthy Premenopausal Women

Abstract

LEARNING OUTCOME: To identify the recommended waist to hip ratio measurement method for determination of upper body fat distribution. Upper body fat distribution (UBFD) is associated with an increased risk for cardiovascular disease (CVD). Women with UBFD often have low HDL-cholesterol levels, hypertriglyceridemia, and hypertension. The waist to hip ratio (WHR) is a useful screening tool to determine UBFD and potential CVD risk. A WHR in women of >0.8 is indicative of UBFD. Currently, there is no agreement regarding which anatomical sites most effectively identify UBFD. The purpose of this study was to determine which of four commonly used WHR waist sites correlated best with CVD risk factors in premenopausal women. Forty healthy females (aged 34.3±10.7 yrs.) volunteered for this study. Diastolic blood pressure (DBP), fasting lipids [HDL-cholesterol (HDL) and triglycerides (TG)], and percent body fat (%BF) were determined. Four waist sites were measured: WHR 1 - smallest waist; WHR 2 - midway between the lowest rib and anterior superior iliac spine: WHR 3 - umbilicus; and WHR 4 –1/3 the distance between the xiphoid process and the umbilicus. Maximum extension of the buttocks was used for the hip site. The group mean for %BF was 29.5±7%, DBP was 73.7±8.1 mmHg, HDL was 70.2±17.7 mg/dl, and TG was 106.9±56.1 mg/dl. The average WHRs varied with each site used; WHR 1,2,3, and 4 averaged 0.77, 0.82, 0.88, and 0.80, respectively. Pearson product moment correlation coefficients determined that WHR 2 correlated (p<0.05) with DBP (r=0.36) and HDL (r=−0.36) but not with TG. WHR 3 correlated with DBP (r=0.45) and TG (r=0.42) but not with HDL. In identifying the sensitivity of a specific WHR measure as an acceptable screening tool for CVD risk, we examined whether the individuals identified by a given WHR as having UBFD also had either high TGs, low HDLs. or high DBP. We called this a true positive (TP) finding; false positive (FP) findings meant subjects had WHR >0.8 but no CVD risks. We accepted WHR2 as being the best measure because it had a high TP rate (86%) and a low FP rate (45%). We recommend WHR2 as the best site to identify UBFD and potential risk for CVD.