Although increasing attention is being given to the problem, the prevalence of overweight and obesity has doubled since 1980 around the world and has shown a continuous increase in most countries ( 3). It is responsible for 40% of cases of cardiovascular disease, most cases of type 2 diabetes, and more than 10% of gastrointestinal as well as urogenital cancer ( 2). Obesity has been recognized as one of the three gravest threats to human health and survival ( 1). ROC curve analysis suggested that Waist-BMI Ratio was a better discriminator of mortality (AUC 0.637 for overall and 0.639 for cardiovascular mortality) than BMI, WC, and waist-to-height ratio (Delong’s test all P <0.001).Ĭonclusions: Waist-BMI Ratio was independently associated with overall and cardiovascular mortality in a J-shaped pattern, offering an immense potential risk marker for obesity in the clinical setting. The mortality risk rises dramatically above the cut-off point of the Waist-BMI Ratio (HR, 3.22 95% CI, 2.43-4.26 for overall mortality and HR, 3.07 95% CI, 1.71-5.52 for cardiovascular mortality). Spline analyses revealed that dose-response relationships existed between Waist-BMI Ratio and death. In fully adjusted models, Waist-BMI Ratio was independently associated with overall (hazard ratio, 1.78 95% confidence interval, 1.48-2.13) and cardiovascular (HR, 1.77 95% CI, 1.25-2.52) mortality. During an average follow-up of 101.8 months, 3680 participants died, including 807 of cardiovascular causes. Results: This study is based on data from 35557 adults (51.1% female, mean age 44.9 years). The discriminative abilities of different anthropometric measures were compared using receiver operating characteristic curves (ROC). Restricted cubic spline and two-piecewise linear regression models were used to identify non-linear relationships. The associations between Waist-BMI Ratio and mortality were estimated using Cox regression models. The Waist-BMI Ratio was defined as WC divided by BMI. Methods: Data for analysis were derived from the National Health and Nutrition Examination Survey (NHANES 1999-2014). This study aimed to investigate whether the quotient of WC and BMI can be used as a proxy of the high-risk phenotype of obesity. Objective: Measuring the body mass index (BMI) or waist circumference (WC) alone is insufficient for assessing possible health risks due to obesity. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. Xiao-cong Liu, Yu Huang, Kenneth Lo, Yu-qing Huang, Ji-yan Chen and Ying-qing Feng *
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