Novel Waist-to-Height Ratio Estimated Fat Mass Pediatric Cut-offs Predict Hypertension Better than Body Mass Index in Multiracial US Youths and Adults: The NHANES 2015 – 2023 Cycle

FIGURE 1. Age-stratified effects of waist circumference-to-height ratio (WHtR) on systolic blood pressure (BP). Age-stratified analysis of the differential effects of WHtR adiposity categories on systolic BP across the lifespan in 7243 adults from the NHANES 2021‒2023 cohort. The figure displays adjusted mean differences in systolic BP (mm Hg) with 95% confidence intervals (shaded areas) compared with the normal fat mass reference category (WHtR 0.40 to <0.50) across 4 age groups: 12‒24 y, 25‒45 y, 46‒65 y, and >65 y. Results are from linear regression models adjusted for age, sex, and race/ethnicity. The red line represents excess fat mass (WHtR ≥0.53) and the blue line represents high fat mass (WHtR 0.50 to <0.53). Filled circles indicate statistically significant associations (P < 0.05), whereas open circles represent non-significant findings. The analysis reveals a pronounced age-dependent pattern with peak cardiovascular impact occurring in middle-aged adults (46‒65 y), where excess fat mass was associated with a 4.82 mm Hg increase in systolic BP (P < 0.001). The effect diminishes in older adults (>65 y), suggesting age-related arterial changes may overshadow adiposity effects. No…

FIGURE 2. Forest plot of the relationship of blood pressure (BP) outcomes by waist circumference-to-height ratio (WHtR) categories. Forest plot of the association between WHtR adiposity categories and BP outcomes in 7243 adults from the NHANES 2021‒2023 cohort. The plot displays odds ratios (OR) with 95% confidence intervals (CI) for elevated BP (≥120/70 mm Hg) and hypertension (≥140/90 mm Hg) across WHtR categories. Results are from fully adjusted logistic regression models controlling for age, sex, heart rate, educational status, smoking status, race/ethnicity, sedentary time, moderate physical activity, fasting total cholesterol, and high-sensitivity C-reactive protein. The normal fat mass category (WHtR 0.40 to <0.50) serves as the reference group (OR = 1.0, indicated by gray circles). Red circles represent point estimates with horizontal lines indicating 95% CIs. The vertical dashed line at OR = 1.0 represents no association. For elevated BP, high fat mass (WHtR 0.50 to <0.53) was associated with (OR: 1.82; 95% CI: 1.49, 2.22, P < 0.001), and excess fat mass (WHtR ≥ 0.53) with (OR: 2.61; 95% CI: 2.21, 3.08, P < 0.001). For hypertension, high fat mass demonstrated (OR: 1.49; 95% CI:…

FIGURE 3. Comparative predictive performance of waist circumference-to-height ratio (WHtR) compared with BMI for blood pressure (BP) outcomes. Comparative analysis of the differential predictive performance of WHtR compared with BMI for BP outcomes in 7243 adults from the NHANES 2021‒2023 cohort. The figure displays odds ratios (OR) with 95% confidence intervals (CIs) (error bars) from fully adjusted logistic regression models for elevated BP (≥120/70 mm Hg, left panel) and hypertension (≥140/90 mm Hg, right panel). Dark blue bars represent BMI categories (normal weight, overweight, and obesity), whereas red bars represent WHtR categories (normal fat, high fat, and excess fat). All models were adjusted for age, sex, heart rate, educational status, smoking status, race/ethnicity, sedentary time, moderate physical activity, fasting total cholesterol, and high-sensitivity C-reactive protein. Asterisks (∗) indicate statistical significance (P < 0.05). For elevated BP, both WHtR and BMI demonstrated comparable predictive performance, with WHtR excess fat (OR: 1.91; 95% CI: 1.40, 2.59) and BMI obesity (OR: 2.48; 95% CI: 2.11, 2.91) showing strong associations. However, for hypertension…