Elsevier

The Journal of Pediatrics

Volume 152, Issue 2, February 2008, Pages 207-213.e2
The Journal of Pediatrics

Original article
Waist-to-Height Ratio, a Useful Index to Identify High Metabolic Risk in Overweight Children

https://doi.org/10.1016/j.jpeds.2007.09.021Get rights and content

Objective

To determine whether using a combination of body mass index (BMI) and waist circumference (WC) or waist-to-height ratio (W/Hr) is clinically helpful in identifying children with high metabolic and cardiovascular risks.

Study design

Caucasian children (M/F: 740/739; n = 1479; ages 5 to 15 years) were studied. Anthropometry, blood pressure, and venous fasting blood samples tested for triacylglycerol, HDL cholesterol, and glucose were measured.

Results

Overweight children with a large waist (>90th percentile) or high W/Hr (>0.5) but not obese or normal-weight children had significantly greater chances of being at high metabolic and cardiovascular risk than normal-weight children (OR: 7; 95% CI: 3.63-13.48; P < .001, OR: 8.16; 95% CI: 3.87-17.23; P < .001, respectively) with a low waist measurement (≤90th percentile) or W/Hr (≤0.5). Interestingly, waist and W/Hr cutoffs (90th percentile and 0.5, respectively) were both able to identify children with the highest metabolic and cardiovascular risks among those who were overweight. However, contrary to waist circumference, W/Hr has the advantage of not requiring population specific reference tables as well as age and sex specific cutoffs.

Conclusions

Waist circumference and W/Hr are helpful in detecting, among overweight children, those with a higher likelihood of having metabolic and cardiovascular risks.

Section snippets

Methods

Italian children (740 boys and 739 girls, n = 1479), ranging from 5 to 15 years of age, participated in the study. The children and adolescents were recruited from 15 national clinical centres for the care of childhood obesity equally distributed in the north, centre and south of Italy, between the autumn of 2003 and spring 2004. At their physical examination, the children were found to be healthy and not in treatment for any disease. A group of 974 healthy normal-weight children who came to

Results

The physical characteristics of the children, divided into 3 groups based on their BMI, are shown in Table I. In both sexes, all physical and biochemical variables were significantly higher (except for HDL cholesterol, which was lower) in subjects with a larger waist or W/Hr than in those with a smaller waist or W/Hr (data not shown).

The proportions of boys and girls with biochemical or physical measures higher than the predefined cutoffs are shown in Table II (available at www.jpeds.com). As

Discussion

The results of this study show that waist circumference and W/Hr are useful to identify overweight children at higher metabolic and cardiovascular risk. The considerable association between excess adiposity and morbidity justifies looking for MCVRF markers in all obese individuals.4 However, MCVRFs are also often found in subjects who, on the basis of their BMI, have been defined as overweight.10, 34 Freedman et al35 recently reported that 70% of overweight children have at least one MCVRF; 52%

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