Combined Influence of Body Mass Index and Waist Circumference on Coronary Artery Disease Risk Factors Among Children and Adolescents

Janssen, Ian; Katzmarzyk, Peter T.; Srinivasan, Sathanur R.; Chen, Wei; Malina, Robert M.; Bouchard, Claude; Berenson, Gerald S.

doi:10.1542/peds.2004-2588

Cited by 248 publications

(211 citation statements)

References 31 publications

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“…In particular the representative 50th percentile for WC (which reflects waist size in the population) was higher in the USA national data collected from 1988 to 1994 29 than in these ethnic Chinese children in Hong Kong (Figure 3). Data relating WC to CV risk factors in different child populations are scant 15,34,38,39,47,48 and valid comparisons are limited by differences in methodology (non-random population sampling, different sites of WC measurement, selection and number of CV risk factors) and/ or failure to include more than one of the inter-related variables (WC percentiles, WC risk threshold percentiles and cutoff values) in the same study. The only methodologically comparable study to derive WC risk thresholds percentiles and gender-and age-related cutoff values is the Bogalusa study of 2597 Black and White American children, 34 in which three-or-more of the same six CV risk factors as in the present study were used.…”

Section: Discussionmentioning

confidence: 99%

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

et al. 2006

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Background: Body mass index (BMI) and waist circumference (WC) correlate with cardiovascular (CV) risk factors in childhood which track into adulthood. WC provides a measure of central obesity, which has been specifically associated with CV risk factors. Reference standards for WC, and for WC and BMI risk threshold values are not established in Chinese children. Objectives: To construct reference percentile charts of WC, establish relationships between WC, BMI and other risk factors, and propose WC and BMI threshold values predictive of CV risk factors in Hong Kong ethnic Chinese children. Methods: Weight, height, waist and hip circumference were measured in 2593 (52% boys, 47% girls) randomly sampled Hong Kong school children aged 6-12 years. In 958 of these and 97 additional overweight children (n ¼ 1055), the relationships between WC, BMI, waist/hip and waist/height ratio and six age-adjusted CV risk factors (485% percentile levels of blood pressure (BP), fasting triglycerides, low-density lipoprotein (LDL) cholesterol, glucose and insulin levels, and o15% percentile levels of high-density lipoprotein (HDL) cholesterol) were studied. Receiver-operating characteristic analysis was employed to derive optimal age-adjusted sex-specific WC and BMI thresholds for predicting these measures of risk. Results: WC percentiles were constructed. WC correlated slightly more than BMI with CV risk factors and most strongly with insulin and systolic BP, but poorly or not with LDL and glucose. Optimal WC and BMI risk thresholds for predicting four of these six CV risk factors were ca. the 85th percentiles (sensitivities B0.8, specificities B0.87) with age-specific cutoff values in girls/ boys from B57/58 to B71/76 cm and 17/18 to 22/23 kg/m 2 . Conclusion: These are the first set of WC reference data for Chinese children. WC risk cutoff values are proposed which, despite a smaller waist in Chinese children, are similar to those reported for American children. WC percentiles may reflect population risk.

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Section: Discussionmentioning

confidence: 99%

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

et al. 2006

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“…In Table 1 we present 15 papers, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] all of which used different sets of variables, number of criteria and cutoff points to define the risk-factors associated with the MS. [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The main differences concern the techniques used to estimate adiposity (body mass index (BMI) and/or waist circumference (WC)), and the variable(s) chosen to evaluate glucose metabolism (fasting glucose, …”

Section: Actual Featuresmentioning

confidence: 99%

“…12 Nonetheless, the three proposed definitions have been used in several studies carried out in pediatric populations, which reported high-prevalence of the MS in obese children and adolescents. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The results of these studies varied according to the selected diagnostic criteria used, as established by a recent comparison study. 34 Moreover, in an evaluation of the different prevalence yields using different definition, Goodman et al 35 found that ATP III definition identified half as many children and adolescents as having MS as did WHO definition in the same population.…”

Section: Introductionmentioning

confidence: 99%

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

et al. 2007

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Background: The diagnostic criteria of the metabolic syndrome (MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis; the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.

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“…Waist circumference has been shown to provide information on coronary artery risk factors in children and adolescents beyond that provided by BMI alone. 16,17 We found no effects of school activity on BMI or BMI s.d. scores, nor any significant differences in the development of obesity as indexed by the IOTF criteria.…”

Section: Discussionmentioning

confidence: 58%

“…Eleven of the schools admitted boys and girls and the others were single sex, which is characteristic of the British school system. Data collection started in 1999 with 4320 students in year 7 (age [11][12] and continued annually to year 11 (age [15][16]. Two schools withdrew after year 10 because of staff changes at the school.…”

Section: Setting and Participantsmentioning

confidence: 99%

School-based physical activity and changes in adiposity

2007

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Objective: School-based physical education (PE) is often proposed as a strategy for obesity prevention, but many trials have found non-significant effects on body mass index (BMI). We examined the impact of school PE on adiposity in adolescents, using an ecological analysis to relate the number of PE sessions to changes in BMI and waist circumference. Research methods and procedures: Five-year, longitudinal, school-based study involving 34 secondary schools in London, England. Students were aged 11-12 years at baseline. Twenty-five schools reported one weekly session of PE, seven schools reported two sessions and two boys' schools reported three sessions. Weights, heights and waist circumferences were measured annually, and complete data from the first and fifth years of the study were available on 2727 students. Analyses compared anthropometric changes between students in schools with higher or lower amounts of PE time. In boys, the comparisons were between those receiving 1, 2 or 3 weekly sessions. In girls, comparisons were between those receiving one and two sessions. Results: There were no differences in BMI changes or the percentage of students classified as obese between schools of higher and lower frequency of PE. However, using unadjusted data, there were lower gains in waist circumference in boys and girls from the higher PE schools. Controlling for baseline demographic and anthropometric characteristics, boys in schools providing 3 weekly PE sessions gained on average approximately 3 cm less than boys in schools providing one or two sessions (Po0.001). Differences in girls were in the same direction but not significant. Discussion: Higher levels of school PE were associated with lower gains in adiposity in boys. This strengthens the case for including recommendations on school PE time as part of population strategies to control adolescent obesity.

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Combined Influence of Body Mass Index and Waist Circumference on Coronary Artery Disease Risk Factors Among Children and Adolescents

Abstract: These findings provide some evidence that a combination of BMI and WC should be used in clinical settings to evaluate the presence of elevated health risk among children and adolescents.

Cited by 248 publications

References 31 publications

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors

Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome

School-based physical activity and changes in adiposity

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