Waist‐to‐height ratio, body mass index and waist circumference for screening paediatric cardio‐metabolic risk factors: a meta‐analysis

Lo, K.W.; Wong, Michael; Khalechelvam, Parames; Tam, Wilson W.S.

doi:10.1111/obr.12456

Cited by 208 publications

(206 citation statements)

References 62 publications

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“…For assessment of obesity, only SDS-BMI was available and WC was not measured. In adults, WC has been suggested as a better predictor of cardiovascular disease and type 2 diabetes than BMI [48, 49], while in children the results comparing WC and BMI in regard to cardiometabolic risk are less clear [50, 51], and a recent meta-analysis of 30 studies found no significant advantage of WC over BMI in the prediction of cardiometabolic risk in children and adolescents [52]. …”

Section: Discussionmentioning

confidence: 99%

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

Hampe

Shaffer²,

Roth

2017

Horm Res Paediatr

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Background: Obesity is strongly associated with insulin resistance, hypertension, dyslipidemia, and therefore risk for metabolic syndrome (MetS), which is an increasing problem in youth. The potential role of elevated liver enzyme levels in this context needs to be further investigated. Methods: This paper provides a post hoc analysis of a cross-sectional study of 77 obese nondiabetic children (51% female; median age 11.7 years; BMI >97th percentile) enrolled at the University of Bonn, Bonn, Germany. Anthropometric parameters, lipid profiles, glycemic control, and liver enzyme levels were evaluated. Glucose and insulin levels were determined during an oral glucose tolerance test (OGTT). Gender- and age-specific cutoff values were used to assess MetS. Results: A high prevalence of hypertension (51%), dyslipidemia (52%), elevated liver enzyme levels (51%), and hyperglycemia (24%) was found. There was considerable overlap between the presence of different MetS risk factors in individuals, and 40% of the participants had ≥3 of a maximum of 5 MetS risk factors. Elevated liver enzyme levels were significantly associated with reduced insulin sensitivity, as the OGTT-insulin response was significantly higher in participants with elevated transaminases (p = 0.01). This association was independent of hyperglycemia and dyslipidemia (p = 0.03). Conclusions: We conclude that liver enzyme levels are related to insulin sensitivity in obese children and could therefore be an indirect indicator for MetS. Testing for disturbed glucose metabolism should be considered for obese children with elevated liver enzymes.

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Section: Discussionmentioning

confidence: 99%

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

Hampe

Shaffer²,

Roth

2017

Horm Res Paediatr

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“…A good screening test should be not only highly predictive but also easy to perform and interpret [12]. BMI and WC have been the most commonly used predictors of obesity and cardiovascular disease to date.…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, WHtR can be applied to a single reference point regardless of race, sex, or age. Consequently, it has been proposed as a population-based screening tool for cardiometabolic risk prediction in large-scale epidemiological studies and during medical examinations [12,15,16]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…The first systematic review to show that WHtR performed better than BMI in predicting cardiometabolic risk was published in 2008 [26]. Since then, other systematic reviews and meta-analyses have compared several anthropometric indices including WHtR with BMI and always found that WHtR was the best predictor of cardiometabolic risk in adults [27][28][29] and in children [30].…”

Section: Step1: Central Obesity Is Harmfulmentioning

confidence: 99%

How long is A Piece of String? Less than Half your Height. Five Steps from Science to Screening: A Mini Review

Ashwell¹

2017

AOWMC

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Central obesity is harmful in terms of cardiometabolic risk, but it can only be measured accurately with expensive equipment. The aim of this review is to summarise how the scientific evidence has accumulated to the extent that waist-to-height ratio (WHtR), which has been shown to be a simple proxy for central obesity, is starting to be adopted into public health policy and can now be used as a simple, early screening tool. A boundary value of WHtR 0.5 has been suggested as the first level of risk. This translates into the simple message "Keep your waist to less than half your height". However, to check if WHtR is less than 0.5 does not even need a tape measure. A piece of string will suffice. The string is used to measure the person's height and then it is folded in half to see whether it fits easily around the person's waist. If it does not, early health risk is indicated and further screening is indicated. Thus the string acts as a simple, cheap, signposting tool for early health risk. At long last we have the answer to that age old question: "How long is piece of string?" The answer is "Less than half a person's height if we want to improve public health through opportunistic screening."

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Waist‐to‐height ratio, body mass index and waist circumference for screening paediatric cardio‐metabolic risk factors: a meta‐analysis

Cited by 208 publications

References 62 publications

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

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

How long is A Piece of String? Less than Half your Height. Five Steps from Science to Screening: A Mini Review

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