Waist‐to‐height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents

Jiang, Yuan; Dou, Yalan; Xiong, Feng; Zhang, Lan; Zhu, Gaohui; Wu, Ting; Zhang, Yi; Yan, Weili

doi:10.1111/apa.14323

Cited by 25 publications

(44 citation statements)

References 21 publications

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“…Along those lines, it is suggested that researchers adhere to the Consensus on Exercise Reporting Template when designing their study and reporting exercise programme information from their clinical trials 104. Sixth, while none of the studies included waist-to-height ratio as an outcome and it was not part of our a priori protocol, future original studies may want to consider the inclusion of such given that it has been shown to be an accurate predictor105 and correlate106 of cardiometabolic risk in children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

Kelley

Pate

2019

BMJ Open

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ObjectivesDetermine both the effects and hierarchy of effectiveness for exercise interventions (aerobic, strength training or both) on selected measures of adiposity (body mass index (BMI) in kg/m2, fat mass and per cent body fat) in overweight and obese children and adolescents.DesignNetwork meta-analysis of randomised exercise intervention trials.SettingAny setting where a randomised trial could be conducted.ParticipantsOverweight and obese male and/or female children and adolescents 2–18 years of age.InterventionsRandomised exercise intervention trials>4 weeks, published between 1 January 1973 and 22 August 2018, and which included direct and/or indirect evidence for aerobic, strength training or combined aerobic and strength training.Primary outcomesChanges in BMI in kg/m2, fat mass and per cent body fat.ResultsFifty-seven studies representing 127 groups (73 exercise, 54 control) and 2792 participants (1667 exercise, 1125 control) met the criteria for inclusion. Length of training (trueX- ± SD) averaged 14.1±6.2 weeks, frequency, 3.3±1.1 days per week and duration 42.0±21.0 min per session. Significant and clinically important reductions in BMI, fat mass and per cent body fat were observed in aerobic versus control comparisons (BMI, mean, 95% CI -1.0, 1.4 to −0.6; fat mass -2.1, –3.3 to −1.0 kg; per cent fat -1.5, –2.2 to −0.9%) and combined aerobic and strength versus control comparisons (BMI -0.7, –1.4 to −0.1; fat mass -2.5, –4.1 to −1.0 kg; per cent fat, -2.2, –3.2 to −1.2%). A significant reduction in per cent fat was also found for strength vs control comparisons (-1.3,–2.5 to −0.1%). Combined aerobic and strength training was ranked first for improving both fat mass (kg) and per cent body fat while aerobic exercise was ranked first for improving BMI.ConclusionsAerobic and combined aerobic and strength training are associated with improvements in adiposity outcomes in overweight and obese children and adolescents.PROSPERO registration numberCRD42017073103.

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Section: Discussionmentioning

confidence: 99%

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

Kelley

Pate

2019

BMJ Open

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“…The physical examination was carried out by two trained investigators who measured weight and height for calculating BMI and BMI z-score [4,29], and the waist circumference (after gently exhaling, at the narrowest part between the lower rib and the iliac crest using a non-elastic flexible tape, recorded to the nearest 0.1 cm) and the waist to height ratio (WtHR) [30] were also calculated. Systolic and diastolic blood pressure (BP) was recorded before blood sampling with the subject in a sitting position and after a minimum of 5 min of acclimation.…”

Section: Study Procedures and Assaysmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Children and Adolescents with Metabolically Healthy Obesity: Role of Insulin Sensitivity

Vinciguerra

Tumminia

Baratta

et al. 2020

Life

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Obesity represents a major risk factor for metabolic disorders, but some individuals, “metabolically healthy” (MHO), show less clinical evidence of these complications, in contrast to “metabolically unhealthy” (MUO) individuals. The aim of this cross-sectional study is to assess the prevalence of the MHO phenotype in a cohort of 246 overweight/obese Italian children and adolescents, and to evaluate their characteristics and the role of insulin resistance. Homeostasis model assessment–insulin resistance (HOMA-IR), insulin sensitivity index (ISI), insulinogenic index (IGI) and disposition index (DI) were all calculated from the Oral Glucose Tolerance Test (OGTT). MHO was defined by either: (1) HOMA-IR < 2.5 (MHO-IRes), or (2) absence of the criteria for metabolic syndrome (MHO-MetS). The MHO prevalence, according to MHO-MetS or MHO-IRes criteria, was 37.4% and 15.8%, respectively. ISI was the strongest predictor of the MHO phenotype, independently associated with both MHO-IRes and MHO-MetS. The MHO-MetS group was further subdivided into insulin sensitive or insulin resistant on the basis of HOMA-IR (either < or ≥ 2.5). Insulin sensitive MHO-MetS patients had a better metabolic profile compared to both insulin resistant MHO-MetS and MUO-MetS individuals. These data underscore the relevance of insulin sensitivity to identifying, among young individuals with overweight/obesity, the ones who have a more favorable metabolic phenotype.

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“…Although many authors have produced specific WHtR boundary values for populations (24,27,61,62) , many suggest that the simple boundary value of 0•5 can be used to indicate increased risk and used universally for primary screening (29) . Since it was first advocated in 2006 (63) , the simple message 'Keep your waist to less than half your height' has been recommended often (20,34,(64)(65)(66) .…”

Section: Very Simple Screening Based On Waist-to-height Ratio 0•5: Thmentioning

confidence: 99%

“…More than 20 years ago, a boundary value of WHtR 0•5 was first suggested as a risk assessment tool and this translates into the simple message 'keep your waist to less than half your height' (1,(11)(12)(13) . Studies in many populations have supported the premise that WHtR is a simple and effective anthropometric index to identify health risks in adults of all ages (6,7,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) and in children and adolescents (26)(27)(28)(29) . Not only does WHtR have a close relationship with morbidity, but also it has a clearer relationship with mortality compared with BMI (13,30) .…”

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confidence: 99%

A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England

Gibson

Ashwell

2019

Br J Nutr

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The National Institute for Health and Care Excellence (NICE) has acknowledged the value of waist-to-height ratio (WHtR) as an indicator for ‘early health risk’. We used recent UK data to explore whether classification based on WHtR identifies more adults at cardiometabolic risk than the ‘matrix’ based on BMI and waist circumference, currently used for screening. Data from the Health Survey for England (4112 adults aged 18+ years) were used to identify cardiometabolic risk, indicated by raised glycated Hb, dyslipidaemia and hypertension. HbA1c, total/HDL-cholesterol and systolic blood pressure (BP) were more strongly associated with WHtR than the ‘matrix’. In logistic regression models for HbA1c ≥ 48 mmol/mol, total/HDL-cholesterol > 4 and hypertension (BP > 140/90 mmHg or on medication), WHtR had a higher predictive value than the ‘matrix’. AUC was significantly greater for WHtR than the ‘matrix’ for raised HbA1c and hypertension. Of adults with raised HbA1c, 15 % would be judged as ‘no increased risk’ using the ‘matrix’ in contrast to 3 % using WHtR < 0·5. For hypertension, comparative values were 23 and 9 %, and for total/HDL-cholesterol > 4, 26 and 13 %. Nearly one-third of the ‘no increased risk’ group in the ‘matrix’ had WHtR ≥ 0·5 and hence could be underdiagnosed for cardiometabolic risk. WHtR has the potential to be a better indicator of cardiometabolic risks associated with central obesity than the current NICE ‘matrix’. The cut-off WHtR 0·5 in early screening translates to a simple message, ‘your waist should be less than half your height’, that allows individuals to be aware of their health risks.

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Waist‐to‐height ratio remains an accurate and practical way of identifying cardiometabolic risks in children and adolescents

Abstract: The WHtR was a superior and practical screening tool for detecting CMR in this paediatric population, as it provided comparable accuracy to other methods and just required a simple calculation.

Cited by 25 publications

References 21 publications

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

Exercise and adiposity in overweight and obese children and adolescents: a systematic review with network meta-analysis of randomised trials

Prevalence and Clinical Characteristics of Children and Adolescents with Metabolically Healthy Obesity: Role of Insulin Sensitivity

A simple cut-off for waist-to-height ratio (0·5) can act as an indicator for cardiometabolic risk: recent data from adults in the Health Survey for England

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