A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth

Kahn, Henry S.; Imperatore, Giuseppina; Cheng, Yiling J.

doi:10.1016/j.jpeds.2004.12.028

Cited by 263 publications

(250 citation statements)

References 39 publications

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“…It is important, however, to examine the WHtR, as this index takes height into account. ) 5th 10th 15th 25th 50th 75th 85th 90th 95th Boys 7 51·2 52·3 53·1 54·4 57·3 60·8 63·1 64·9 68·0 8 52·2 53·5 54·4 56·0 59·4 63·8 66·8 69·2 73·4 9 53·4 54·8 55·8 57·5 61·2 66·0 69·3 71·9 76·8 10 54·9 56·3 57·3 59·0 62·8 67·7 71·2 74·0 79·1 Girls 7 50·5 51·5 52·3 53·5 56·2 59·8 62·1 64·0 67·3 8 49·9 51·2 52·1 53·7 57·0 61·4 64·3 66·6 70·7 9 51·3 52·8 53·8 55·5 59·2 63·9 67·0 69·5 73·8 10 52·4 53·8 54·9 56·6 60·3 65·0 68·1 70·5 The WHtR has recently been proposed as an index to assess central adiposity in children and adolescents, based on evidence that it is a better predictor of CVD risk factors than the BMI (Savva et al 2000;Kahn et al 2005;McCarthy & Ashwell, 2006). Although WC measurement cannot differentiate between visceral and subcutaneous adiposity stores, it has been shown that WC is a good predictor of visceral fat, linked to increased risk of metabolic diseases in children and adolescents (Hirschler et al 2005;Lee et al 2006).…”

Section: Discussionmentioning

confidence: 99%

Central adiposity in Brazilian schoolchildren aged 7–10 years

et al. 2007

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Waist circumference (WC) is a measure of central adiposity related to elevated risk factor levels in children and adolescents. The aim of the present study was to describe WC percentiles in 7-to 10-year-old Brazilian children and to compare frequencies of obesity and overweight as defined by BMI and frequencies of excess and at risk of abdominal adiposity as defined by WC to the corresponding age and sex data from British references. A representative sample of 2919 schoolchildren of the city of Florianopolis (southern Brazil) was examined. Smoothed WC percentiles were derived using the least mean square method. Frequencies of overweight and obesity and of excess and at risk of abdominal adiposity were assessed using the 91st and 98th centiles of the British references as cut-off points. WC increased with age in both boys and girls, with higher values for boys at every age and percentile level. Nutritional status categories of children assessed by the 91st and 98th British BMI and WC centiles showed moderate agreement (weighted k ¼ 0·58). Overweight was more frequent in Brazilian than British children: 15·1 % of girls and 20·1 % of boys were above the 91st percentile of the 1990 BMI for age British references. About one-quarter (22·0 % of girls and 26·9 % of boys) exceeded the 91st percentile of WC British references. The present data could be used to compare WC in children in other populations and may serve as a baseline for future studies of temporal trends in WC in Brazil.Central adiposity: Waist circumference percentiles: Childhood: Obesity prevalence: Brazil Recent studies have shown that waist circumference (WC) increased much faster than BMI in children and adolescents over the past 10 -20 years (McCarthy et al. 2003(McCarthy et al. , 2005Moreno et al. 2005).While the BMI is generally accepted and used to classify children as overweight or obese in population studies, it is recognised that the BMI cannot distinguish between muscle and fat masses and gives no indication about body adiposity distribution (Reilly et al. 2000). The BMI therefore seems a poor proxy for central adiposity. The WC is a highly sensitive and specific measure of trunk adiposity (Taylor et al. 2000) and a strong predictor of visceral adiposity in the paediatric population (Brambilla et al. 2006;Lee et al. 2006). Further, WC is related to metabolic complications of obesity, including poor lipid profile, increased blood pressure and insulin resistance in children and adolescents (Freedman et al. 1999;Savva et al. 2000;Maffeis et al. 2001;Moreno et al. 2002).It has therefore been recommended that WC should be used to identify young individuals at risk of morbidity associated with central body adiposity and could be adopted as an alternative or additional measurement to BMI (McCarthy et al. 2003). However, there are no commonly accepted WC cut-offs for classifying children with high central adiposity.The prevalence of overweight based on BMI has tripled in Brazilian children and adolescents over the past two decades (Wang et al. 2002); ho...

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Section: Discussionmentioning

confidence: 99%

Central adiposity in Brazilian schoolchildren aged 7–10 years

et al. 2007

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“…[31][32][33][34][35] The waist:height ratio also shows some promise as useful measure of size-adjusted central adiposity. [36][37][38] The addition of circumferential measures may help to address the major weakness of BMI: its inability to distinguish between elevated adiposity and elevated lean mass. From a public health perspective, the observation that BMI in children and adolescents A Must and SE Anderson from 1987 to B1997 waist circumferences of British children increased more than BMI 33 suggests that surveillance by BMI alone may obscure important changes in body composition 39 at the population level.…”

Section: Looking To the Futurementioning

confidence: 99%

Body mass index in children and adolescents: considerations for population-based applications

2006

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After several years of experience with body mass index (BMI)-for-age reference standards in the US, the UK, and elsewhere, reflection on 'how things are going' seems timely. In this issue, Reilly 1 offers a summary of the evidence base for the diagnostic accuracy of BMI in youth and his perspective on what is achieved by a definition of overweight and obesity based on high BMI. To complement this, in our short review, we describe the BMI measure itself, the utility of a BMI z-score (s.d. score), their utility in cross-sectional and longitudinal applications in public health/surveillance, clinical and population-based research settings. Body mass index definedBody mass index is a measure of weight adjusted for height. It is calculated as weight in kilograms divided by the square of height in meters. Although BMI is an imperfect tool -it does not distinguish overweight due to excess fat mass from overweight due to excess lean mass -it is the most commonly used measure for assessing obesity in adults. Other methods of determining adiposity are more accurate, 2 but have limited applicability to screening or studying large populations. The BMI is well correlated with these more direct fatness measures, 3,4 and weight and height are simple, inexpensive, non-invasive measurements that are recorded routinely in clinical and research settings.Others have discussed the limitations of clinical screening for high adiposity by comparing weight centiles to height centiles, 5 and the inaccuracy of assessing overweight by observation or 'eye-balling' has been established. 6,7 Therefore, for screening or for epidemiologic research, using a weight/height index to define obesity has advantages that outweigh its limitations. Despite the likelihood of misclassification of the small percentage of individuals whose high BMI is due to lean muscle mass (e.g. some professional athletes), the great majority of individuals with high BMI have excess body fat. Use of body mass index in children and adolescentsThe BMI is used to assess weight status in children and adolescents as well as adults, but whereas in adults the BMI cut points that define obesity and overweight are not linked to age and do not differ for males and females, in growing children BMI varies with age and sex. Thus, a 5-year-old boy with a BMI of 20 kg/m 2 is likely to be overfat, but a 15-yearold boy with a BMI of 20 kg/m 2 is likely to be lean. As a result, for BMI to be meaningful in children it must be compared to a reference-standard that accounts for child age and sex.

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“…In 2006, McCarthy and Ashwell 2 suggested the waist-to-height ratio (WHtR) as a measure of excess central adiposity. WHtR has been shown to more readily identify adolescents with adverse cardiovascular risk factors compared to waist circumference and body mass index (BMI) 3 and a WHtR cutpoint of 0.5 has been proposed as a simple means of indicating whether the amount of central adiposity is excessive and a health risk in children. 2 However, the validity of these cut-points has not been examined in relation to metabolic outcomes in adolescents.…”

Section: Introductionmentioning

confidence: 99%

Waist-to-height ratio: a simple option for determining excess central adiposity in young people

2008

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Waist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. In this study we examined the relation between sex-and age-specific waist circumference cut-points, the waist-to-height ratio (WHtR) cut-point of o0.5 and cardiovascular disease (CVD) risk clustering in 164 young people, mean age 14.9±0.2 years (mean ± s.d.). In total 19 (11.6%) of the sample were identified as having CVD risk clustering. These young people were significantly (Po0.001) heavier and had higher body mass index (BMI) and waist circumference z-scores compared to those without CVD risk clustering. The WHtR cut-point of 0.5 estimated CVD risk clustering to a similar extent to sex-and age-adjusted cut-points for waist circumference and BMI. Young people with excess central adiposity (WHtRX0.5) were 11 times (OR 11.4, Po0.001), more likely to have CVD risk clustering compared to those who did not have excess central adiposity. The WHtR has several advantages; it is easy to calculate, does not require sex-and age-specific centiles and as has been previously suggested, it is a simple message, easily understood by clinicians and families, to 'keep your waist circumference to less than half your height'. IntroductionWaist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. Recently there have been two studies that have presented cut-points for use in young people. 1,2 Jolliffe and Janssen 1 suggest sex-and age-specific waist circumference cut-points based on the National Cholesterol Education Program Adult Treatment Panel (ATP) and International Diabetes Federation (IDF) adult criteria. The ATP and IDF adult criteria for waist circumference are 102 cm for male patients and 88 cm for female patients and 94 cm for male patients and 80 cm for female patients, respectively. In 2006, McCarthy and Ashwell 2 suggested the waist-to-height ratio (WHtR) as a measure of excess central adiposity. WHtR has been shown to more readily identify adolescents with adverse cardiovascular risk factors compared to waist circumference and body mass index (BMI) 3 and a WHtR cutpoint of 0.5 has been proposed as a simple means of indicating whether the amount of central adiposity is excessive and a health risk in children. 2 However, the validity of these cut-points has not been examined in relation to metabolic outcomes in adolescents.The aim of this study was to examine the relation between age-and sex-specific waist circumference cut-points based on ATP and IDF adult criteria, the WHtR cut-point of 0.5 and cardiovascular disease (CVD) risk clustering in young people. ParticipantsThe young people involved in this study are participants in the longitudinal 'Nepean Study' that was designed to investigate the effect...

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A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth

Cited by 263 publications

References 39 publications

Central adiposity in Brazilian schoolchildren aged 7–10 years

Central adiposity in Brazilian schoolchildren aged 7–10 years

Body mass index in children and adolescents: considerations for population-based applications

Waist-to-height ratio: a simple option for determining excess central adiposity in young people

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