The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children

Abstract

BMI, waist circumference (WC) and waist-to-height ratio (WHtR) can be used for discriminating children and adolescents at risk of CVD. However, consensus on how to use these anthropometric indicators is lacking for children and adolescents in Asia. Discrete criteria are promoted internationally, but continuous variables could be used. Data from a survey of 10 949 Vietnamese school-aged children (6–18 years) were used to evaluate the performance of anthropometric indicators to identify elevated blood pressure (BP), dyslipidaemia or at least three cardiovascular risk factors (CVRF). Weight, height, WC and BP were measured using standardised protocols; 1009 participants who had blood lipids were analysed. AUC was used to assess the performance, and the Youden index to identify optimal cut-offs. The prevalence of elevated BP, dyslipidaemia and CVRF was 26·5, 49·3 and 12·2 %, respectively. BMI, WC and WHtR had low capacity to identify elevated BP and dyslipidaemia (AUC range 0·61–0·66) but moderate capacity to identify CVRF (0·72–0·74). Optimal BMIZ cut-offs to identify elevated BP, dyslipidaemia and CVRF were 0·40, 1·01 and 1·1 sd; for WC z-score, they were 0·06, 0·49 and 0·62 sd; for WHtR, optimal cut-offs were close to 0·5. A BMIZ cut-off of 1·0 sd and a WHtR cut-off of 0·5 would, therefore, be useful criteria to identify Vietnamese children who are likely to have CVRF. However, further validation of these criteria in other studies of Asian children and adolescents is needed.

Accuracy of different cutoffs of the waist‐to‐height ratio as a screening tool for cardiometabolic risk in children and adolescents: A systematic review and meta‐analysis of diagnostic test accuracy studies

“…Sample sizes ranged from 152 35 to 32,036 49 participants. WHtR cutoffs ranged between 0.41 20 and 0.59 35 as follows: 10 studies reported cutoffs of 0.41 to 0.45 20,22,24–26,32,42,48,58,60 ; 23 studies reported cutoffs of 0.46 to 0.50 23–30,32–34,36,43–47,51,53–55,57,59 ; and 12 studies reported cutoffs ≥0.51 21,30,31,33,35,37–39,48,52,54,55 . The general characteristics of the studies are depicted in Table S1.…”

“…Second, several studies estimated the optimal cutoff using a balance between sensitivity and specificity, while others used the Youden Index. [21][22][23]27,29,33,38,39,41,42,44,45,[47][48][49][50][51]54,57,59 Because the Youden Index maximizes correct classification rates and minimizes incorrect ones, the cutoff produced by this method generates a low frequency of false positives and false negatives. 70 Third, the different WC measurement techniques may cause bias and variability among the included studies, which may be related to the heterogeneity in our pooled analyses.…”

“…Forty-one cross-sectional studies were included in the present study, including 138,561 children and adolescents (50% girls) aged between 3 and 19 years. The studies were conducted in the following countries: 11 studies were conducted in countries from the European region (Denmark, Estonia, Portugal, Spain, Scotland, Wales, Finland, Sweden, UK, Greece, Italy, Hungary, Belgium, France, Germany, and Austria) [20][21][22][23][24][25][26][27][28][29][30] ; 10 studies were conducted in countries from the Latin American region (Chile, Brazil, Mexico, and Venezuela) [31][32][33][34][35][36][37][38][39][40] ; 11 studies were conducted in East and Southeast Asian countries (Malaysia, South Korea, China, Taiwan, and Vietnam) [41][42][43][44][45][46][47][48][49][50][51] ; 3 studies were conducted in the USA [52][53][54] ; 1 study was conducted in Algeria 55 ; 1 study was conducted in India 56 ; 1 study was conducted in Iran 57 ; and 3 studies were conducted in South Africa. [58][59][60] Sample sizes ranged from 152 35 to 32,036 49 participants.…”

“…[58][59][60] Sample sizes ranged from 152 35 to 32,036 49 participants. WHtR cutoffs ranged between 0.41 20 and 0.59 35 as follows: 10 studies reported cutoffs of 0.41 to 0.45 20,22,[24][25][26]32,42,48,58,60 ; 23 studies reported cutoffs of 0.46 to 0.50 [23][24][25][26][27][28][29][30][32][33][34]36,[43][44][45][46][47]51,[53][54][55]57,59 ; and 12 studies reported cutoffs ≥0.51. 21,30,31,33,35,[37][38][39]48,52,54,...…”

Utility of Three Adiposity Indices for Identifying Left Ventricular Hypertrophy and Geometric Remodeling in Chinese Children

“…Previous studies have compared the predictive utility of BMI, WC and WHtR for common CV risk factors in children and adolescents (25)(26)(27)(28)(29)(30)(54)(55)(56) with most reporting similar performance among these three adiposity indices (25)(26)(27)(28)(29)(30). However, few studies have assessed the performance for identifying LVH and LVG remodeling among children.…”