title: Central adiposity and mortality after first-ever acute ischemic stroke.
abstract: BACKGROUND
  The waist-to-height ratio (WHtR) may be a better adiposity measure than the body mass index (BMI). We evaluated the prognostic performance of WHtR in patients with acute ischemic stroke (AIS).
  
  
  METHODS
  First, we compared WHtR and BMI as adiposity measures in 712 healthy adults by tetrapolar bioimpedance analysis. Thereafter, baseline WHtR was analyzed as predictor of 12-month all-cause mortality in 821 Mexican mestizo adults with first-ever AIS by a Cox proportional hazards model adjusted for baseline predictors.
  
  
  RESULTS
  In healthy individuals, WHtR correlated higher than BMI with total fat mass and showed a higher accuracy in identifying a high percentage of body fat (p < 0.01). In AIS patients a U-shaped relationship was observed between baseline WHtR and mortality (fatality rate 29.1%). On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently predicted 12-month all-cause mortality (hazard ratio 1.91, 95% confidence interval 1.04-3.51). BMI was not associated with mortality, tested either as continuous, binomial or stratified variable.
  
  
  CONCLUSIONS
  WHtR is a modifiable risk factor that accurately demonstrates body fat excess. Extreme WHtR values were associated with increased 12-month all-cause mortality in Mexican mestizo patients with AIS. No survival advantage was found with high WHtR as the pragmatic indicator of obesity in this population.
authors.affiliation: Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Sanofi-Aventis, Mexico City, Mexico.
authors.forename: Erwin
authors.initials: E
authors.lastname: Chiquete
authors.forename: José L
authors.initials: JL
authors.lastname: Ruiz-Sandoval
authors.forename: Luis
authors.initials: L
authors.lastname: Murillo-Bonilla
authors.forename: Carolina
authors.initials: C
authors.lastname: León-Jiménez
authors.forename: Bertha
authors.initials: B
authors.lastname: Ruiz-Madrigal
authors.forename: Erika
authors.initials: E
authors.lastname: Martínez-López
authors.forename: Sonia
authors.initials: S
authors.lastname: Román
authors.forename: Arturo
authors.initials: A
authors.lastname: Panduro
authors.forename: Alma
authors.initials: A
authors.lastname: Ramos
authors.forename: Carlos
authors.initials: C
authors.lastname: Cantú-Brito
mesh_terms: D050154:Adiposity; D000328:Adult; D001827:Body Height; D015992:Body Mass Index; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality*; D055105:Waist Circumference