Usefulness of the waist-to-height ratio for predicting cardiometabolic risk in children and its suggested boundary values

Abstract

Background & aims: Only limited information is available on the usefulness of the waist-to-height ratio (WHtR) as an abdominal obesity marker in children. Our aim was to compare the ability of a WHtR >90th percentile, a WHtR !0.50, a WHtR !0.55 and a BMI z-score !2 SD to predict cardiometabolic risk in children followed-up at different ages. Methods: We evaluated data from 660 children at 5, 8 and 11 years of age who participated in the Childhood Obesity Project trial in 5 European countries. We classified children with or without cardiometabolic (CMet) risk (yes vs. no) according to the presence of ≥2 parameters (blood pressure, HOMA-IR, triglyceride levels and high-density lipoprotein (HDL) cholesterol levels) !90th percentile. Results: The odds ratio for CMet risk in children at all followed-up ages was statistically significant for all measures. The OR for the WHtR!0.55 cut-off was 29.1 (5.6, 151.7) at 5 years of age, 11.8 (4.1, 33.8) at 8 year of age and 3.6 (1.7, 7.7) at 11 years of age, compared to the WHtR<0.55 cut-off. The WHtR!0.55 cutoff showed a higher OR at younger ages than the BMI z-score !2SD, WHtR !90th percentile and WHtR!0.50 cut-offs and a higher positive predictive value (82% at 5 years of age compared to 55%, 36% and 41%, respectively). Conclusion: A WHtR!0.55 is a suitable cut-off for screening children at high cardiometabolic risk in the general young European population.

Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

“…A cross-sectional study evaluated the usefulness of the WHtR in predicting cardiometabolic risks in children in five European countries. They suggested WHtR > 0.55 as an appropriate boundary value for screening young European population at high cardiometabolic risk ( 43 ). The higher WHtR value in children and adolescents could predict high cardiometabolic risks in future life ( 44 – 46 ).…”

Population-based references for waist and hip circumferences, waist-to-hip and waist-to-height ratios for children and adolescents, and evaluation of their predictive ability

“…While WC and WHtR optimal cut-offs are available for the detection of MHO & MUO phenotypes in adults [49,50], according to the best authors' knowledge, such uniform cut-offs have not been established, so far, for children and adolescents. To predict increased cardiometabolic risk in children and adolescents, WC-SDS in the range of 0.5 − 1.28 and WHtR ratio in the range of 0.41 − 0.60 is proposed [31,42,[51][52][53][54]. Some authors proposed a xed and equal value of WHtR ratio = 0.5 as a criterion for abdominal obesity in children and adolescents, regardless of age.…”

Tri-ponderal Mass Index and Left Ventricular Hypertrophy in a Cohort of Obese Caucasian Children and Adolescents

“…WHR predicts abdominal fat mass and takes body size into account [20] and a value ≥ 0.55 is a proper cut-off for screening European children at high cardiometabolic risk [21,22]. WHR has certain advantages over WC alone, since having a universal cut-off would help standardize practice, which may be independent of age, sex, height and race [21].…”

“…WHR predicts abdominal fat mass and takes body size into account [20] and a value ≥ 0.55 is a proper cut-off for screening European children at high cardiometabolic risk [21,22]. WHR has certain advantages over WC alone, since having a universal cut-off would help standardize practice, which may be independent of age, sex, height and race [21]. Moreover its utility in discriminating children with cardiac structural damage, mainly left ventricular hypertrophy (LVH) and left ventricular geometry (LVG), has been reported [23,24].…”