Waist-to-height ratio as a screening tool for cardiometabolic risk in children and adolescents: a nationwide cross-sectional study in China

Abstract

ObjectivesTo demonstrate the accuracy and flexibility of using waist-to-height ratio (WHtR) as a screening tool for identifying children and adolescents with cardiometabolic risk (CMR) across a wide range of prevalence levels among general paediatric populations.DesignA nationwide population-based cross-sectional study with all data collected at school settings in six cities of China.ParticipantsA total of 8130 children and adolescents aged 7–18 years with complete anthropometric and CMR measurements based on blood tests were recruited.Outcome measuresElevated blood pressure, dyslipidaemia, elevated fasting blood glucose and central obesity were measured. The primary outcome, CMRs, was defined as meeting three or more of the above risk factors. The accuracy of WHtR for identifying CMRs was evaluated using areas under the curves (AUCs) with 95% CI of the receiver operating characteristic curve. The predictability of WHtR at given CMRs prevalence levels was estimated by positive predictive value (PPV) and negative predictive value.ResultsOverall, 6.1% of study participants were presented with CMRs. WHtR had high AUCs ranging from 0.84 (95% CI 0.81 to 0.88) to 0.88 (95% CI 0.86 to 0.90) in the total population and age-subgroup and gender-subgroup. The overall optimal WHtR cut-off value was 0.467, with boys having a higher cut-off than girls (0.481 vs 0.456). WHtR achieved an overall sensitivity of 0.89 and PPV of 18.8% at a specificity of 0.75. The screening performance of WHtR remained satisfactory across a wide range of given CMRs prevalence levels (5%, 10% and 20%).ConclusionWHtR as a screening tool could accurately and flexibly identify children affected with the clusters of three or more of CMR factors from the general paediatric population with various CMR prevalence levels. Our findings provide support for policy-making on early CMR identification and management in the high-risk group of children.

Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis

“…An Algerian study showed that the optimal cutoff value of 0.55 achieved a specificity of 0.89 in identifying girls with MetS, while this number was only 0.75 using the well-reported cutoff of 0.5 [ 38 ]. Our previous study also suggested that the critical value of WHtR of 0.467 is more accurate than 0.50 in Chinese children [ 20 ]. We used the AUSROC to minimise the influence of the threshold effects [ 17 , 30 ].…”

“…Moreover, the excellent performance of WHtR with the summarised area under the receiver operating characteristic (ROC) curve (AUC) in discriminating MetS exceeded 0.8 [ 13 ]. Since that, a range of new original studies have been published, presenting good but diverse discriminating performances of WHtR in screening various CMRs and MetS based on different population and methodologies [ 8 , 20 – 24 ].…”

Waist-to-height ratio as a clinical predictor for cardiovascular risks and insulin resistance in children and adolescents with exogenous obesity

“…Several studies have been recently conducted to demonstrate the accuracy of WHtR in identifying the risks for CVD in obese children and adolescents from healthy youth population; defining cut-offs and centiles for this easily calculated parameter [36][37][38]. It is also ideal and non-invasive tool in terms of interpretation and measurement to be used in clinical practice.…”

Utility of Three Adiposity Indices for Identifying Left Ventricular Hypertrophy and Geometric Remodeling in Chinese Children

“…It has been generally accepted that a WHtR cut-off of 0.5 might be useful in predicting CV risk in youth, independent of sex, age or ethnicity ( 44 , 60 ), whereas a study including children and adolescents aged 7-19 years from Europe (13,172; boys: 49.7%) and southern China (14,566; boys: 50.3%) reported that a WHtR cut-off of 0.5 was not suitable for diverse ethnic groups, with a lower threshold of WHtR proposed, especially for girls from southern China ( 61 ). Another multicenter study involving 8,130 children and adolescents aged 7-18 years (boys: 53.2%) from China suggested that the optimal WHtR cut-off of 0.467 would be more accurate to identify the clustering of CV risk factors in the pediatric population, and that the optimal cut-offs varied across sex and age with lower cut-offs for girls and those aged 12 years or older ( 62 ). In our study, the optimal cut-offs of WHtR were ~0.5 for boys and <0.5 for girls, which may support the sex dependent cut-offs of WHtR.…”