Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence

Garnett, Sarah P.; Baur, Louise A.; Srinivasan, Shubha; Lee, Jenny W.; Cowell, Chris

doi:10.1093/ajcn/86.3.549

Cited by 115 publications

(108 citation statements)

References 36 publications

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“…Thus far, population-based studies focused on the associations of different detailed total body and abdominal fat mass measures with cardiovascular risk factors in children show inconsistent results. Abdominal fat mass in children has been identified as a stronger predictor of cardiovascular risk factors, as compared to BMI, though results are not consistent (2,3,9). These inconsistent findings may be explained by different measures of fat mass and variation of children's age included in these studies.…”

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confidence: 75%

BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children

Gishti

Gaillard

Durmuş³

et al. 2015

Pediatr Res

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Background: More specific total body and abdominal fat mass measures might be stronger associated with cardiovascular risk factors in childhood, than BMI. We examined the independent associations of total and abdominal fat measures with cardiovascular risk factors in school age children. Methods:We performed a population-based cohort study among 6,523 children. At the age of 6 y, we measured childhood BMI, and general and abdominal fat mass, using dual-energy X-ray absorptiometry, and ultrasound and cardiovascular risk factors. results: Conditional on BMI, higher fat mass percentage and abdominal fat mass were associated with higher blood pressure, total-and low-density lipoprotein (LDL)-cholesterol, insulin and c-peptide levels, but with lower left ventricular mass and high-density lipoprotein (HDL)-cholesterol (P values < 0.05). These associations differed between underweight, normal weight, overweight, and obese children. Higher childhood adiposity measures were associated with increased odds of cardiovascular risk factors clustering, with the strongest effect for fat mass percentage (odds ratios: 3.01 (95% confidence interval: 2.67, 3.9). conclusion: Our results suggest that general and abdominal fat measures are associated with cardiovascular risk factors in childhood, independent from BMI. These measures may provide additional information for identification of children with an adverse cardiovascular profile.c hildhood obesity is a major public health problem (1). It seems that not only overweight and obesity, but also higher body mass across the full range is associated with risk factors for cardiovascular and metabolic diseases in childhood and adulthood (2-5). BMI does not distinguish lean mass from fat mass (6). Among adults and children, total body fat mass assessed by dual-energy X-ray absorptiometry (DXA) seems to be, independent from BMI, associated with cardiovascular risk factors (3,7). Also, waist circumference, as proxy for abdominal fat mass, was independent of BMI related to the risk of mortality in adults, suggesting that central or abdominal adiposity is more strongly associated with adverse health outcomes (4,8). Abdominal fat mass is an accumulation of both subcutaneous and visceral adipose tissues. In adults, visceral adipose tissue accumulation is stronger related with an adverse glucose and lipid profile than subcutaneous adipose tissue accumulation (8). Thus far, population-based studies focused on the associations of different detailed total body and abdominal fat mass measures with cardiovascular risk factors in children show inconsistent results. Abdominal fat mass in children has been identified as a stronger predictor of cardiovascular risk factors, as compared to BMI, though results are not consistent (2,3,9). These inconsistent findings may be explained by different measures of fat mass and variation of children's age included in these studies.Therefore, we examined in a population-based cohort study among 6,523 school-age children, the independent associations of BMI and total ...

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confidence: 75%

BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children

Gishti

Gaillard

Durmuş³

et al. 2015

Pediatr Res

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“…All were born at term at Nepean Hospital, in western Sydney, between August 1989 and April 1990 and were part of a birth cohort whose details and selection criteria have been previously published. 4,5 Between July 2004 and March 2005, 290 young people aged 14.9 ± 0.2 years (mean ± s.d.) were recruited, of which 164 (86 boys) had a blood sample taken and blood pressure measured.…”

Section: Participantsmentioning

confidence: 99%

“…Cardiovascular disease risk clustering CVD risk clustering was based on a previous definition used in paediatric populations 5,10 and defined as three or more of the following fasting glucose X6.1 mmol/l, triglycerides X80th centile, HDL-Cp20th centile, insulinX80th centile, systolic blood pressure (SBP)X90th centile for age, sex and height centile and overweight or obese. Cut-points for triglycerides, HDL-C, insulin were estimated from our study population.…”

Section: Blood Pressurementioning

confidence: 99%

Waist-to-height ratio: a simple option for determining excess central adiposity in young people

2008

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Waist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. In this study we examined the relation between sex-and age-specific waist circumference cut-points, the waist-to-height ratio (WHtR) cut-point of o0.5 and cardiovascular disease (CVD) risk clustering in 164 young people, mean age 14.9±0.2 years (mean ± s.d.). In total 19 (11.6%) of the sample were identified as having CVD risk clustering. These young people were significantly (Po0.001) heavier and had higher body mass index (BMI) and waist circumference z-scores compared to those without CVD risk clustering. The WHtR cut-point of 0.5 estimated CVD risk clustering to a similar extent to sex-and age-adjusted cut-points for waist circumference and BMI. Young people with excess central adiposity (WHtRX0.5) were 11 times (OR 11.4, Po0.001), more likely to have CVD risk clustering compared to those who did not have excess central adiposity. The WHtR has several advantages; it is easy to calculate, does not require sex-and age-specific centiles and as has been previously suggested, it is a simple message, easily understood by clinicians and families, to 'keep your waist circumference to less than half your height'. IntroductionWaist circumference is recommended as a means of identifying people at risk of morbidity associated with central adiposity. Yet, there are no universally agreed cut-points to determine when a waist circumference is too large in young people. Recently there have been two studies that have presented cut-points for use in young people. 1,2 Jolliffe and Janssen 1 suggest sex-and age-specific waist circumference cut-points based on the National Cholesterol Education Program Adult Treatment Panel (ATP) and International Diabetes Federation (IDF) adult criteria. The ATP and IDF adult criteria for waist circumference are 102 cm for male patients and 88 cm for female patients and 94 cm for male patients and 80 cm for female patients, respectively. In 2006, McCarthy and Ashwell 2 suggested the waist-to-height ratio (WHtR) as a measure of excess central adiposity. WHtR has been shown to more readily identify adolescents with adverse cardiovascular risk factors compared to waist circumference and body mass index (BMI) 3 and a WHtR cutpoint of 0.5 has been proposed as a simple means of indicating whether the amount of central adiposity is excessive and a health risk in children. 2 However, the validity of these cut-points has not been examined in relation to metabolic outcomes in adolescents.The aim of this study was to examine the relation between age-and sex-specific waist circumference cut-points based on ATP and IDF adult criteria, the WHtR cut-point of 0.5 and cardiovascular disease (CVD) risk clustering in young people. ParticipantsThe young people involved in this study are participants in the longitudinal 'Nepean Study' that was designed to investigate the effect...

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“…In younger subjects, waist circumference (WC) has also been shown to be at least as strong a predictor as BMI for metabolic complications (4,5). Although several groups have applied the LMS model to create smoothed centile charts for waist-circumference in North American children and adolescents (6)(7)(8), none published tables of LMS parameters needed to calculate Z-score or exact centiles in subsequent studies.…”

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confidence: 99%

LMS tables for waist-circumference and waist-height ratio Z-scores in children aged 5–19 y in NHANES III: association with cardio-metabolic risks

et al. 2015

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Background:In adults, anthropometric measures of central adiposity, such as waist-height ratio (WHtR) and waist circumference (WC), are more strongly associated with cardiometabolic risks than BMI. Methods: To provide similar quantitative tools for North American children, we created smoothed centile charts and LMS tables for WHtR and WC based on data from the US National Health and Nutrition Survey, cycle III (NHANES III, N = 11,930 aged 2-24 y 1988-1994. results: Applying these reference charts to subsequent NHANES survey cycles, 1999-2012) demonstrated a significant mean increase in both Z-scores of approximately 0.30 SD. In measuring the strength of the association between anthropometric measures and cardio-metabolic risk factors, a unit change in Z-scores for WHtR, WC, and BMI significantly increased the odds of an adverse outcome in all cases (1.18-2.03, P < 0.0001). Z-scores for both measures of central adiposity were significantly more strongly associated with cardio-metabolic comorbidities than BMI-Z. conclusion: Since Z-scores permit standardized comparisons across ages and genders, they are useful measures of central adiposity in both clinical or research settings. By providing LMS tables for children and adolescents based on North American reference data, we hope to provide quantitative tools for the study of obesity and its complications.W ith increasing prevalence of obesity at younger ages, anthropometric measures other than BMI have been proposed as predictors for the development of cardio-metabolic risks, such as diabetes and hyperlipidemia. In particular, a waist-height ratio (WHtR) > 0.5 has been shown to be a stronger predictor than BMI at all ages, presumably because the former is a better direct measure of central adiposity (1-3). Nevertheless, this "one-size-fits all" approach to WHtR ignores the natural variation of this measure with age and gender in children and adolescents.In younger subjects, waist circumference (WC) has also been shown to be at least as strong a predictor as BMI for metabolic complications (4,5). Although several groups have applied the LMS model to create smoothed centile charts for waist-circumference in North American children and adolescents (6-8), none published tables of LMS parameters needed to calculate Z-score or exact centiles in subsequent studies. In addition to dissimilarities between populations, there were also differences in measurement techniques: Although both Statistics Canada and NHANES recommend a validated protocol for measuring WC at the level of the iliac crest in the mid-axillary line (9), reference data from outside North America are often based on different choices for the physical landmarks used to measure WC (see Discussion for details).Our primary objective was to apply the LMS method to create gender-specific reference growth charts for both WHtR and WC in children aged 5-19 y of age in the North American NHANES III cohort (1988)(1989)(1990)(1991)(1992)(1993)(1994), a North American reference population that predates much of the recent...

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Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence

Cited by 115 publications

References 36 publications

BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children

BMI, total and abdominal fat distribution, and cardiovascular risk factors in school-age children

Waist-to-height ratio: a simple option for determining excess central adiposity in young people

LMS tables for waist-circumference and waist-height ratio Z-scores in children aged 5–19 y in NHANES III: association with cardio-metabolic risks

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