Comparison of BMI, waist circumference, and waist‐to‐height ratio for identification of subclinical cardiovascular risk in pediatric kidney transplant recipients

Abstract

Background: Kidney transplant recipients are at high risk for CV morbidity. However, the measure of obesity that best predicts CV risk has not been established.Objective: A prospective, controlled study was conducted to compare the ability of BMI, WC, and WHr to identify CV risk in pediatric kidney transplant recipients. Methods: Transplant recipients, aged 3-20 years, had echocardiogram, CIMT, BMI, WC, WHr, blood pressure, lipids, and leptin measured. Receiver operating characteristic analysis was used to compare the ability of BMI, WC, and WHr to detect a composite adverse CV outcome. Presence of the composite outcome was defined by ≥3 of the following five criteria: (a) LVH, (b) high CIMT, (c) impaired myocardial strain, (d) dyslipidemia, and/or (e) hypertension. Multivariate analysis was conducted by generalized estimating equation regression. Results:We analyzed 108 visits of 42 transplant recipients. Prevalence of obesity by WHr (43.5%) was higher than BMI (24.1%) and WC (12.0%). Proportion of WHrobese who met criteria for the adverse CV outcome was higher (62.2%) than BMI (34.6%) and WC-obese (33.3%). Leptin levels were higher in children with obesity.Area under the ROC curve for WHr-obese (0.77) was higher compared to BMI (0.47) and WC (0.48) to detect the CV outcome, P = 0.0006. WHr-obesity was associated with 5.72 increased odds of having the adverse CV outcome, P = 0.0001, while BMI and WC were not significant. Conclusion:WHr is more sensitive than BMI or WC to detect subclinical CV risk and should be included in screening of pediatric kidney transplant recipients. K E Y W O R D Scarotid intima-media thickness, dyslipidemia, hypertension, leptin, myocardial strain, obesity

Assessment of nutritional status in children with kidney diseases—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

“…However, additional screening measurements may aid in targeting specific potential deficiencies and facilitate a more comprehensive assessment. There is evidence in the pediatric literature that grip strength [48] and waist-to-height ratio [49,50] are measures to consider. However, additional experience with these measures in clinical practice settings is necessary before their routine use can be recommended.…”

Impact of changes in waist-to-hip ratio after kidney transplantation on cardiovascular outcomes

“…In the study, normal BMI but higher WHR posed the highest risk of CAC, which suggests that patients who had normal BMI with less muscle mass or less subcutaneous fat but had high WHR with more visceral fat showed the highest risk for CAC. A recent study on transplant patients also found that WHR is a more sensitive predictor of clinical CVD risk than BMI 21 . However, the study was conducted in a relatively small number of pediatric transplant patients with a low CVD risk, and hyperlipidemia and even hypertension were included as CVD outcomes.…”

Body Fat Distribution, Adipocytokines Levels and Variability in Associated Genes and Kidney Transplant Outcomes

“…18 Waist-to-height ratio has also been shown to have an optimal discriminatory capacity to predict metabolic syndrome and insulin resistance in women with kidney transplant. 19 Furthermore, Sgambat et al 20 demonstrated that WHr was superior to BMI and WC as an indicator of subclinical cardiovascular risk in pediatric RTR, and the authors suggested that WHr could be a really useful measurement for adults undergoing renal transplantation. 20 All these indications prompted us to evaluate whether WHr could also be related to other complications in renal transplantation.…”