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Association between waist-to-height ratio and anxiety in middle-aged women: a secondary analysis of a cross-sectional multicenter Latin American study

Arroyo, Karen J., MD1; Ramos-Torres, Gabriela, MD1; Mezones-Holguin, Edward, MD, MSc1,2,3; Blümel, Juan E., MD, PhD3,4; Barón, Germán, MD3; Bencosme, Ascanio, MD3; Benítez, Zully, MD3; Bravo, Luz M., MD3; Calle, Andrés, MD3; Flores, Daniel, MD3; Espinoza, María T., MD3; Gómez, Gustavo, MD3; Hernández-Bueno, José A., MD3; Martino, Mabel, MD3; Lima, Selva, MD3; Monterrosa, Alvaro, MD3; Mostajo, Desiree, MD3; Ojeda, Eliana, MD3; Onatra, William, MD3,*; Sánchez, Hugo, MD3; Tserotas, Konstantinos, MD3; Vallejo, María S., MD3; Witis, Silvina, MD3; Zúñiga, María C., MD3; Chedraui, Peter, MD, MSc, PhD3,5

doi: 10.1097/GME.0000000000001089
Original Articles

Objective: The aim of the study was to evaluate the association between waist-to-height ratio (WHtR) and anxiety in middle-aged women.

Methods: We carried out a secondary analysis of data from a multicenter study of women between 40 and 59 years old from 11 Latin America countries. Anxiety was assessed using the Goldberg Anxiety and Depression Scale. WHtR was calculated according to World Health Organization standards and categorized in tertiles: upper, middle, and lower using 0.45 and 0.6 as cutoff values. Prevalence ratios (PRs) and 95% CIs were calculated by generalized linear models of Poisson family with robust standard errors, both crude and adjusted models based on statistical and epidemiological criteria.

Results: Data of a total of 5,580 women were analyzed. Mean age was 49.7 ± 5.5 years, and 57.9% were postmenopausal. The 61.3% of women had anxiety and mean WHtR was 0.54 ± 0.1. In the crude model, compared with women in lower tertile, those in the middle (PR: 1.07; 95% CI, 1.01-1.13) and upper (PR: 1.23 95% CI, 1.07-1.29) WHtR tertile were significantly more likely to have anxiety. In the adjusted models, only women in upper tertile were, however, more likely of displaying anxiety than those in lower tertile (PR: 1.13; 95% CI, 1.08-1.18).

Conclusions: In this series, WHtR was associated with anxiety in middle-aged women. It is advisable to further study this anthropometric measure in order for it to be incorporated in the routine clinical practice and evaluation of middle-aged women.

1School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú

2Faculty of Health Sciences, Universidad Nacional de Piura (UNP), Piura, Perú

3Collaborative Group for Climacteric Research in Latin America (REDLINC)

4Department of Medicine, Faculty of Medicine, Universidad de Chile, Santiago de Chile, Chile

5Institute of Biomedicine, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.

Address correspondence to: Edward Mezones-Holguin, MD, MSc, Prolongación Primavera 2390, Monterrico, Santiago de Surco, Lima, Perú. E-mail:,

Received 2 July, 2017

Revised 23 January, 2018

Accepted 23 January, 2018

Funding/support: None.

Financial disclosure/conflicts of interest: None reported.

© 2018 by The North American Menopause Society.