Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index

Abstract

BACKGROUND: Visceral adipose tissue is associated with increased risk for cardiovascular disease risk factors and morbidity from cardiovascular diseases. Waist measurement and waist-to-height ratio (WHtR) have been used as proxy measures of visceral adipose tissue, mainly in adults. OBJECTIVE: To validate body mass index (BMI), waist circumference and WHtR as predictors for the presence of cardiovascular disease risk factors in children of Greek-Cypriot origin. SUBJECTS AND METHODS: A total of 1037 boys and 950 girls with mean age 11.4 AE 0.4 y were evaluated. Dependent variables for the study were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholestrol (HDL-C), lowdensity lipoprotein cholesterol (LDL-C), and systolic (SBP) and diastolic (DBP) blood pressure. RESULTS: When children were divided into two groups according to the 75th percentile for BMI, waist circumference and WHtR, all dependent variables had higher mean values in the highest percentile groups in WHtR groups and almost all variables in BMI and waist circumference groups. Adjusted odds ratios for predicting pathological values of cardiovascular disease risk factors were slightly higher for the highest WHtR group for predicting lipid and lipoprotein pathological values and for the highest BMI groups in predicting high blood pressure measurement. Using stepwise multiple regression analysis to explain the variance of the dependent variables, waist circumference was the most signi®cant predictor for all variables both for boys and girls, whereas BMI had the lowest predictive value for the detection of cardiovascular disease risk factors. CONCLUSION: Waist circumference and WHtR are better predictors of cardiovascular disease risk factors in children than BMI. Further studies are necessary to determine the cutoff points for these indices for an accurate prediction of risk factors.

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

“…[5][6][7][8][9] CV disease appears to be related specifically to intraabdominal fat (visceral adipose tissue) 10,11 of which waist circumference (WC) provides a good and clinically useful measure, [12][13][14][15][16][17] supporting the growing view that WC is a better measure of CV risk than body mass index (BMI) in both children and adults. [18][19][20][21] Ethnic differences of WC have been described in adults 22,23 but have not been studied in children, although reference data for WC are available from a number of different countries. [24][25][26][27][28][29][30][31] Data for ethnic Chinese children have not previously been reported.…”

Central adiposity in Brazilian schoolchildren aged 7–10 years

“…The WC is a highly sensitive and specific measure of trunk adiposity (Taylor et al 2000) and a strong predictor of visceral adiposity in the paediatric population (Brambilla et al 2006;Lee et al 2006). Further, WC is related to metabolic complications of obesity, including poor lipid profile, increased blood pressure and insulin resistance in children and adolescents (Freedman et al 1999;Savva et al 2000;Maffeis et al 2001;Moreno et al 2002).It has therefore been recommended that WC should be used to identify young individuals at risk of morbidity associated with central body adiposity and could be adopted as an alternative or additional measurement to BMI (McCarthy et al 2003). However, there are no commonly accepted WC cut-offs for classifying children with high central adiposity.…”

Growth curves of anthropometric indices in a general population of French children and comparison with reference data

“…Furthermore, distribution of adiposity has been correlated to cardiovascular risk factors during childhood and adolescence (Freedman et al, 1989;Sangi et al, 1992;Asayama et al, 1995;Savva et al, 2000). Persistence of obesity and of truncal distribution of fat mass may herald, in adulthood, an increase in some diseases such as diabetes mellitus or the metabolic syndrome in men, but also in women, although they are generally considered as protected from them before menopause (Price and Fowkes, 1997;Bertrais et al, 1999).…”

“…Both the amount and distribution of fat mass can be evaluated by anthropometric measurements. The anatomic distribution of body fat is of particular interest because of the close relationship between truncal adiposity and cardiovascular events or risk factors (Asayama et al, 1995;Goran and Gower, 1999;Gower et al, 1999;Savva et al, 2000). Abdominal circumference and skinfold thicknesses provide a useful measure of regional fat distribution in that context (Savva et al, 2000;Kahn et al, 2005).…”

“…The anatomic distribution of body fat is of particular interest because of the close relationship between truncal adiposity and cardiovascular events or risk factors (Asayama et al, 1995;Goran and Gower, 1999;Gower et al, 1999;Savva et al, 2000). Abdominal circumference and skinfold thicknesses provide a useful measure of regional fat distribution in that context (Savva et al, 2000;Kahn et al, 2005). For instance, some studies showed that truncal subcutaneous adiposity was more associated than peripheral subcutaneous adiposity with adverse metabolic or cardiovascular outcomes in children and adolescents (Freedman et al, 1987;Freedman et al, 1989).…”