Waist Circumference and Cardiovascular Risk Factors in Prepubertal Children

Abstract

MAFFEIS, CLAUDIO, ANGELO PIETROBELLI, ALESSANDRA GREZZANI, SILVIA PROVERA, AND LUCIANO TATÒ . Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res. 2001;9: 179 -187. Objective: Intra-abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body-fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body-fat distribution and cardiovascular risk factors are available in children, especially before puberty. Research Methods and Procedures:This cross-sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. Results: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p Ͻ 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p Ͻ 0.001 and p Ͻ 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r ϭ 0.40 and 0.29, respectively; p Ͻ 0.001) than triceps (r ϭ 0.35 and 0.21, respectively; p Ͻ 0.001) and subscapular (r ϭ 0.28 and 0.16, respectively; p Ͻ 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p Ͻ 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. Discussion: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood-lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.

Associations between adiposity, family history of CHD and blood pressure in 3–8 year-old children

“…Nonetheless, the results of the present study are consistent with previous investigations of adiposity and BP in young children. [28][29][30][31][32][33] The results also provide further evidence that simple anthropometric indices such as the BMI, skinfolds, and WC are important and feasible measures to identify young children who may be at risk of subsequent obesity, hypertension, and CVD. To support the use of simple anthropometric indices in clinical settings, we have previously shown that the BMI and skinfold thickness are highly correlated with DXA measures of %BF, FFM, and FM in this sample.…”

Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls

“…This finding is not surprising because all but five of the girls had a waist circumference above the 90th centile of the reference for age and sex. Previous studies in prepubertal children have shown that subjects with a waist circumference above the cut-off value of the 90th centile for age and sex have a high risk of obesity-related morbidity (Maffeis et al, 2001). In addition, in our sample, more than 20% of girls had three or more metabolic or cardiovascular risk factors.…”

“…Recently, studies on children seem to confirm the usefulness of waist circumference as an appropriate index of metabolic and cardiovascular risk also in the pre-puberty years (Freedman et al, 1999;Maffeis et al, 2001). However, few data are available for the period during puberty.…”

The risk factors for elevated blood pressure and how to address cardiovascular risk factors: a review in paediatric populations

“…Generally, logistic regression was used to calculate the age-adjusted odds ratio for hypertension and the 95% confidence interval (CI). [21][22][23][24][26][27][28] Maffeis et al 29 performed a multivariate logistic regression analysis with backward stepping of variables and an evaluation of the model using three goodness of fit X 2 statistics, whereas Addo et al 13 used both univariate and multivariate regression models to calculate the odds ratio for hypertension. Barger and Muldoon 25 used the ordinal regression model, the cumulative odds model to evaluate differences in self-rated health as a function of hypertension status, labelling which further provides an extension of logistic regression for determining the odds ratios.…”