Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity and Metabolic Syndrome among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2010–2014

Abstract

The aims of this study were to assess the diagnostic value of the weight-to-height ratio (WHtR) for the detection of obesity and metabolic syndrome (MS) in Korean children and adolescents, and to determine the advantages of WHtR as a population-based screening tool in comparison with other obesity indicators, such as body mass index (BMI) and waist circumference (WC). We performed a cross-sectional analysis of data from 3057 children and adolescents (1625 boys, 1332 girls) aged 10–19 years who were included in the fifth Korean National Health and Nutrition Examination Survey (KNHANES, 2010–2012) up to the second year of the sixth KNHANES (2013–2014). Receiver operation characteristic (ROC) curves were generated to determine the optimal cutoff value and accuracy of WHtR for predicting individual obesity indicators or more than two non-WC components of MS. The area under the ROC curve (AUC) is a measure of the diagnostic power of a test. A perfect test will have an AUC of 1.0, and an AUC equal to 0.5 means that the test performs no better than chance. The optimal WHtR cutoff for the evaluation of general obesity and central obesity was 0.50 in boys and 0.47–0.48 in girls, and the AUC was 0.9. Regarding the assessment of each MS risk factor, the optimal WHtR cutoff was 0.43–0.50 in boys and 0.43–0.49 in girls, and these cutoffs were statistically significant only for the detection of high triglyceride and low High-density lipoprotein (HDL) cholesterol levels. When a pairwise comparison of the AUCs was conducted between WHtR and BMI/WC percentiles to quantify the differences in power for MS screening, the WHtR AUC values (boys, 0.691; girls, 0.684) were higher than those of other indices; however, these differences were not statistically significant (boys, p = 0.467; girls, p = 0.51). The WHtR cutoff value was 0.44 (sensitivity, 67.7%; specificity, 64.6%) for boys and 0.43 (sensitivity, 66.4%; specificity, 66.9%) for girls. There was no significant difference between the diagnostic power of WHtR and that of BMI/WC when screening for MS. Although the use of WHtR was not superior, WHtR is still useful as a screening tool for metabolic problems related to obesity because of its convenience.

The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children

“…For the identification of dyslipidaemia and combined CVRF, our results indicated that although BMIZ and WHtR had higher capacity than WCZ to detect dyslipidaemia, all anthropometric indicators had a comparable capacity to identify combined CVRF. This is in agreement with the finding from Lo and colleagues' meta-analysis (10) , with a recent study of Korean adolescents (10-19 years old) (AUC for BMI percentile, WC percentile, WHtR 0•68-0•69) (41) , and with a cohort study of Chilean children (42) . Therefore, it is highly likely that all three anthropometric indicators are useful for the identification of Vietnamese children and adolescents with dyslipidaemia and combined CVRF.…”

“…Sensitivity for the WHtR optimal cut-offs was low but acceptable (>50•0 %) but lower for the 0•5 cut-off. A study in Korean children also reported a very low sensitivity (27•8 %) for the WHtR 0•5 cut-off in the identification of at least two cardiometabolic risk factors (41) . The evidence thus suggests that the use of WHtR 0•44 for boys and WHtR 0•43 for girls, instead of the universal 0•5 cut-off, would be optimal for screening of CVD risk factors in Korean children (41) .…”

Identification of metabolic syndrome using phenotypes consisting of triglyceride levels with anthropometric indices in Korean adults

“…Additionally, Bener and colleagues [9] reported that compared with BMI, WHR, and WHtR, WaistC with cut-off values of 91 cm in women and 99.5 cm in men was the best indicator of MetS in a Qatari adult population. Choi and colleagues [43] documented that WaistC, BMI, and WHtR had similar predictive power for MetS in a Korean population.…”

“…Many studies to date have examined the association of MetS with several anthropometric indices such as BMI, WaistC, WHtR, and WHR to determine the best indicator of MetS in different countries [7][8][9][10][11][12][13][42][43][44][45]. However, the best anthropometric indicator of MetS remains controversial, even though WaistC is one of the five components used to diagnose MetS and is a strong predictor of MetS.…”

Predictores de riesgo cardiometabólico en adolescentes de Quito

“…Los estudios de mayor relevancia sobre el r-CT han sido efectuados prioritariamente en personas norteamericanas, europeas o asiáticas, que tienen características étnicas diferentes a las de los latinoamericanos [32][33][34][35][36][37]. En América Latina, donde la presencia de obesidad y riesgos cardiometabólicos están en incremento, poco se ha investigado sobre la utilidad del r-CT para el diagnóstico de obesidad y riesgos cardiometabólicos, con respecto a otros índices como CC e IMC, y los resultados son heterogéneos [28,[38][39][40].…”