A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message – ‘keep your waist circumference to less than half your height’

McCarthy, H. D.; Ashwell, Margaret

doi:10.1038/sj.ijo.0803226

Cited by 515 publications

(522 citation statements)

References 20 publications

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“…Previous literature has found that the WHtR, rather than BMI and WC, was more strongly correlated with cardiovascular comorbidities and was better at predicting the metabolic syndrome in adults and cardiovascular health risks, such as high BP and high blood lipids, in adults and children (18,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) .…”

Section: Discussionmentioning

confidence: 99%

Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents

Nambiar

Hughes

Davies

2010

Public Health Nutr.

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Objective: The waist-to-height ratio (WHtR) assesses abdominal adiposity and has been proposed to be of greater value in predicting obesity-related cardiovascular health risks in children than BMI. The present study aims to develop WHtR cutoffs for overweight and obesity based on the 85th and 95th percentiles for the percentage body fat (%BF) in a cohort of children and adolescents. Design: Waist circumference (WC), height, triceps and subscapular skinfolds were used to calculate WHtR and %BF. Correlations between WHtR and %BF and WHtR/mid-abdominal skinfold were made. Receiver-operating characteristic (ROC) curve analysis was used to select WHtR cut-offs to define overweight and obesity. Subjects were grouped by WHtR cut-offs, and mean values for anthropometry, blood lipids and blood pressure (BP) variables were compared. Setting: Australian primary and secondary schools. When comparing the highest WHtR group to the lowest, both sexes had significantly higher means for weight, WC, %BF, TG (male subjects only), systolic BP (female subjects only) and lower means for HDL cholesterol (P , 0?05). Conclusions: WHtR is useful in clinical and population health as it identifies children with higher %BF at greater risk of developing weight-related CVD at an earlier age.

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Section: Discussionmentioning

confidence: 99%

Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents

Nambiar

Hughes

Davies

2010

Public Health Nutr.

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“…The WHtR cut-point of 0.5 has several advantages over the other measures and cut-points; it is easy to calculate, does not require sex-and age-specific centiles (which are often not readily available to clinicians) and as previously suggested, 2 it is a simple message, easily understood by clinicians and families, to 'keep your waist circumference to less than half your height'.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…[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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A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message – ‘keep your waist circumference to less than half your height’

Cited by 515 publications

References 20 publications

Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents

Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents

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

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

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