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

Abstract

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...

Ability of Measures of Adiposity in Identifying Adverse Levels of Inflammatory and Metabolic Markers in Adolescents

“…Besides, the WC cut-off values for pediatric ages have to be age and sex specific, so, a fixed cut-off point for WC not taking account of height might underestimate the relative amount of abdominal fat in short subjects and overestimate it in tall subjects. Likewise, some authors [43][44][45] adjusted the WC to the person's height, proposing the WHtR as a way of assessing shape and monitoring risk reduction, first in adults, suggesting that values greater than 0.5 were indicative of increased health risks for both sexes, and showing then to be also valid to screen youth as young as five years old, [46][47][48] making it interestingly age and sex independent. Systematic reviews and meta-analysis [49][50][51] have been suggesting some superiority of WHtR over WC and BMI for detecting cardiometabolic risk factors in adults and children of both sexes, of various nationalities and ethnic groups.…”

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