The Increasing Importance of Waist-to-Height Ratio to Assess Cardiometabolic Risk: A Plea for Consistent Terminology

Margaret Ashwell*, 1, 2, Lucy M. Browning1
1 Ashwell Associates (Europe) Ltd, Ashwell Street, Ashwell, Herts, SG7 5PZ, UK
2 Oxford Brookes University, Oxford OX3 0BP, UK

© 2011 Ashwell and Browning.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Ashwell Associates (Europe) Ltd, Ashwell Street, Ashwell, Herts, SG7 5PZ, UK; Tel: +44(0)1462742166; E-mail:


We have recently performed a systematic review which collated seventy eight cross-sectional and prospective studies exploring waist-to-height ratio and waist circumference or body mass index as predictors of diabetes and cardiovascular disease published in English between 1950 and 2008. This review, which also employed specificity and sensitivity comparisons, indicated that waist-to-height ratio could be a useful global clinical screening tool, with a weighted mean boundary value of 0.5, supporting the simple public health message “keep your waist circumference to less than half your height”. During the collation of evidence, we noticed inconsistency in the site of measurement of waist circumference and also the terminology and abbreviations used to describe ‘waist-to-height ratio’. We encourage others to routinely use the waist circumference measurement used most often (that recommended by World Health Organization – mid way between the lower rib and the iliac crest) and the terminology ‘waist-to-height ratio’ abbreviated to WHtR to avoid confusion about this anthropometric index which is growing in popularity for screening for cardiometabolic risk.

Keywords: Waist-to-height ratio, waist circumference, abdominal obesity, terminology, body weights and measures.