Novel Waist-to-Height Ratio Estimated Fat Mass Pediatric Cut-offs Predict Hypertension Better than Body Mass Index in Multiracial United States Youths and Adults: The National Health and Nutrition Examination Survey 2015–2023 Cycle

BACKGROUND: )] should be confirmed with surrogate markers, such as the waist circumference-to-height ratio (WHtR). Recent studies have reported that new pediatric WHtR adiposity cutpoints predicted the risk of type 2 diabetes, fatty liver disease, and bone fracture in adults more accurately than BMI, but its role in predicting hypertension remains unclear. OBJECTIVES: To examine the associations of WHtR cutpoints with elevated blood pressure (BP) and hypertension among multiracial United States participants. METHODS: Altogether 19,124 participants were studied from the United States National Health and Nutrition Examination Survey (NHANES) 2015-2023 cycle. WHtR cutoffs were defined as normal fat (0.40 to <0.50), high fat (0.50 to <0.53), and excess fat (≥0.53). Elevated BP was defined as ≥120/70 mm Hg, and hypertension as ≥140/90 mm Hg. RESULTS: In the 2021-2023 NHANES cycle, participants' mean age was 44.8 ± 22.6 y, elevated BP and hypertension prevalence were 63.5% and 14.4%, respectively. WHtR-high fat was associated with elevated BP [odds ratio (OR): 1.49; 95% confidence interval (CI): 1.04, 2.12, P < 0.001] and hypertension (OR: 1.82; 95% CI: 1.49, 2.22, P < 0.001), and WHtR-excess fat predicted higher odds of elevated BP (OR: 1.91; 95% CI: 1.40, 2.49, P < 0.001) and hypertension (OR: 2.61; 95% CI: 2.21, 3.08, P < 0.001). BMI-overweight (OR: 1.11; 95% CI: 0.90, 1.36, P = 0.321) and BMI-obesity (OR: 1.25; 95% CI: 1.00, 1.56, P = 0.058) were not associated with hypertension. In youth <25 y (mean age 14.7 y), both WHtR-high fat (OR: 1.70; 95% CI: 1.11, 2.61, P = 0.015) and WHtR-excess fat (OR: 2.16; 95% CI: 1.59, 2.92, P < 0.001) were associated with elevated BP, but not hypertension. WHtR-excess fat predicted elevated BP in non-Hispanic White, Blacks, and Asians. The results were consistent with 2015-2016, 2017-2018, and combined 2015-2023 NHANES cycles. CONCLUSIONS: The new pediatric WHtR-estimated adiposity cutpoints predicted the risk of elevated BP and hypertension across the lifecourse in a multiracial adult and youth population. WHtR is a universally accessible cardiovascular disease risk assessment tool for early screening, detection, prevention, and management of obesity and can be assessed at https://urfit-child.com/waist-height-calculator/.