Waist to height ratio: a simple screening tool for nonalcoholic fatty liver disease in obese children

Abstract

Simple predictors are needed for the screening of nonalcoholic fatty liver disease (NAFLD) in obese children. We aimed to assess the role of anthropometric parameters in the prediction of NAFLD. Three hundred and thirty two obese children (152 male, 180 female) aged 4.6-17.0 years were included in this study. Weight, height, waist (WC), and hip circumference were measured. Body mass index (BMI), waist-hip-ratio (WHR), and waist-height-ratio (WHtR) were calculated. Obesity was defined as BMI for age and sex ≥ 95th percentile. NAFLD was diagnosed using ultrasonography (US). NAFLD was present in 60.8% of obese children. Fatty liver prevalence differed significantly by gender and puberty (55.0% of girls vs 67.7% of boys, and 28.7% in prepubertal vs 71.3% in pubertal children; p < 0.05). Significantly higher BMI, BMI standard deviation score (SDS), WC, and WHtR were found in obese children with NAFLD compared to obese children without NAFLD (p < 0.05). Only WHtR was found to be an independent predictor for NAFLD in a logistic regression analysis (p < 0.001, B:1.096, 95% CI 1.047-1.148). Fatty liver is common among obese children, particularly in obese boys. WHtR is a simple and easy index for predicting of NAFLD in obese children and can be used for mass screening in public health.

Reducing NAFLD‐screening time: A comparative study of eight diagnostic methods offering an alternative to ultrasound scans

“…The values of the eight formulas analysed (FLI, HIS, BMI, WC, AVI, WHtR, WHt_5R and BRI) also resulted significantly higher in the NAFLD vs NOT NAFLD group in both sexes confirming the possibility of using these formulas for identifying the NAFLD risk. [17][18][19][20][21][22][23]26 Our findings confirm a good predictive power of all the formulas analysed, compared using AUROC. The widest AUROC, in both sexes, was for FLI, which confirms the indications in the EASL-EASD-EASO guidelines.…”

“…The values of the eight formulas analysed (FLI, HIS, BMI, WC, AVI, WHtR, WHt_5R and BRI) also resulted significantly higher in the NAFLD vs NOT NAFLD group in both sexes confirming the possibility of using these formulas for identifying the NAFLD risk …”

“…Some studies suggest that other scores or anthropometric measures (anthro‐m) work as the FLI in predicting the NAFLD risk . Aim of this study was firstly to analyse the performance of eight different scores and anthro‐m (formulas) in identifying people with NAFLD, then to evaluate which factors most strongly affect the performance, in order to find the best cut‐offs and to assess the optimal cut‐offs of each factor in our population, taking care to include any critical discriminant factors.…”

“…18 Some studies suggest that other scores or anthropometric measures (anthro-m) work as the FLI in predicting the NAFLD risk. [19][20][21][22][23] Aims of this study were first to analyze the performance of 8 different scores and anthro-m (formulas) in identifying people with NAFLD; second to evaluate which factors most strongly affect the performance of each formula; third to find the best cut-offs and to assess the optimal cut-offs of each factor in our population, taking care to include any critical discriminant factors. Finally, to compare the performance of 8 alternative hybrid in a large population by using the predictive formulas as first filter strategy, and then performing US in subjects predicted as at risk.…”

Anthropometric indicators of visceral adiposity as predictors of non-alcoholic fatty liver disease: A review

“…The cutoff point of WHtR to predict NAFLD in the study population was 0.499 (sens: 70.1%, spec: 76.9%). Özhan et al[ 18 ], evaluated 332 obese children with and without NAFLD, and the WHtR presented an optimal cutoff point for the prediction of NAFLD of 0.62, but with low sensitivity (48.5%) and high specificity (73.8%). In all this study WC was measured according to WHO[ 26 ].…”