Korean J Pediatr Gastroenterol Nutr.  2011 Dec;14(4):385-392. 10.5223/kjpgn.2011.14.4.385.

Waist-to-height Ratio, a Simple and Practical Index for Screening of Adolescent Metabolic Syndrome Aged 17~19 Years

• Kim AR
• Hong CH

• KMID: 2277710
• DOI: http://doi.org/10.5223/kjpgn.2011.14.4.385

Abstract

PURPOSE
To evaluate the validity and usefulness of the waist circumference-to-height ratio (WHtR) in screening for metabolic syndrome in Korean adolescents aged 17~19 years.
METHODS
Data (body mass index, waist circumference, and height) and blood samples were obtained from adolescents in A University Hospital in 2011. This study included 554 adolescents (176 boys and 378 girls) aged 17~19 years. Dependent variables were systolic and diastolic blood pressure, fasting blood glucose (FBS), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Using the Pearson's correlation analysis and logistic regression analysis, we measured the WHtR against Body mass index (BMI).
RESULTS
An assessment was carried out of the ability of the 2 indexes to 1) account for the variability in each metabolic risk factor and 2) correctly identify adolescents with metabolic risk factors. The results revealed that the predictive abilities of the waist-to-height ratio index were better values. The waist-to-height ratio showed superior values in predicting concentrations of DBP, FBS, TC, TG and LDL-C. However, BMI showed better values in identifying adolescents with high systolic blood pressure and HDL-C. 3) Normal weight adolescents (BMI: 5th< or =BMI<85th percentiles) were divided by WHtR (obesity cutoff value: > or =0.51 in male, > or =0.49 in female). WHtR was better than the BMI index for signaling metabolic risk in the normal-weight adolescents.
CONCLUSION
The WHtR is a better predictor for finding metabolic risk factors in adolescents aged 17~19 years with normal BMI. The WHtR is proposed as an alternative, convenient measure of screening metabolic syndrome for adolescents aged 17~19 years independent of age and sex.

Keyword

Metabolic syndrome; Adolescents; Waist circumference to height ratio; Body mass index

MeSH Terms

Adolescent
Aged
Blood Glucose
Blood Pressure
Body Mass Index
Cholesterol
Fasting
Humans
Logistic Models
Male
Mass Screening
Risk Factors
Waist Circumference
Blood Glucose
Cholesterol

Reference

1. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, et al. Obesity and metabolic syndrome in children and adolescents. N Engl J Med. 2004. 350:2362–2374.

2. Oh KW, Jang MJ, Lee NY, Moon JS, Lee CG, Yoo MH, et al. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr. 2008. 51:950–955.

3. Berenson GS, Srinivasan SR, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. The Bogalusa Heart Study. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998. 338:1650–1656.

4. Alberti KGMM, Zimmet PZ, Shaw JE. The metabolic syndrome-a new world-wide definition from the International Diabetes Federation Consensus. Lancet. 2005. 366:1059–1062.

5. Bao W, Srinivasan SR, Wattigney WA, Berenson GS. Persistence of multiple cardiovascular risk clustering related to syndrome X from childhood to young adulthood. Arch Intern Med. 1994. 154:1842–1847.

6. Wilson PW, D'Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005. 112:3066–3072.

7. Després JP, Prud homme D, Pouliot MC, Tremblay A, Bouchard C. Estimation of deep abdominal adipose-tissue accumulation from simple anthropometric measurements in men. Am J Clin Nutr. 1991. 54:471–477.

8. Lee S, Bacha F, Gungor N, Arslanian SA. Waist circumference is an independent predictor of insulin resistance in black and white youths. J Pediatr. 2006. 148:188–194.

9. Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumferenceaction levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995. 311:1401–1405.

10. Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circ J. 2009. 73:1643–1650.

11. Sung RY, Yu CC, Choi KC, McManus A, Li AM, Xu SL, et al. Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors. Int J Obes (Lond). 2007. 31:550–558.

12. Weili Y, He B, Yao H, Dai J, Cui J, Ge D, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity (Silver Spring). 2007. 15:748–752.

13. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese school children. J Atheroscler Thromb. 2002. 9:127–132.

14. Ashwell M. Waist to height ratio and the Ashwell R shape chart could predict the health risks of obesity in adults and children in all ethnic groups. Nutrition Food Science. 2005. 35:359–364.

15. 2007 Korean Children and Adolescent national growth chart: Commentary. Korea Centers for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents. 2007. cited 2009 Feb 20. Seoul: Korea Centers for Disease Control and Prevention;Available from: http://www.cdc.go.kr/KcdcHome.portal.

16. Lee CG, Moon JS, Choi JM, Nam CM, Lee SY, Oh K, et al. Normative blood pressure references for Korean children and adolescents. Korean J Pediatr. 2008. 51:33–41.

17. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988-1994. Arch Pediatr Adolesc Med. 2003. 157:821–827.

18. Gil JH, Lee MN, Lee HA, Park HS, Seo JW. Usefulness of the waist circumference-to-height ratio in screening for obesity in Korean children and adolescents. Korean J Pediatr Gastroenterol Nutr. 2010. 13:180–192.

19. Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinic Follow up Study. Pediatrics. 2007. 120:340–345.

20. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr. 2002. 91:1307–1312.

21. McCarthy HD, Ellis SM, Cole TJ. Central overweight and obesity in British youth aged 11-16 years: cross-sectional surveys of waist circumference. BMJ. 2003. 326:624.

22. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK Children and adolescents over two decades supports the simple message. Int J Obes (Lond). 2006. 30:988–992.

23. Moreno LA, Sarria A, Fleta J, Marcos A, Bueno M. Secular trends in waist Circumference In Spanish adolescents, 1995 to 2000-02. Arch Dis Child. 2005. 90:818–819.

24. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tatò L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res. 2001. 9:179–187.

25. Revenga-Frauca J, González-Gil EM, Bueno-Lozano G, De Miguel-Etayo P, Velasco-Martínez P, Rey-López JP, et al. Abdominal fat and metabolic risk in obese children and adolescents. J Physiol Biochem. 2009. 65:415–420.

26. Hsieh SD, Yoshinaga H. Do people with similar waist circumference share similar health risks irrespective of height? Tohoku J Exp Med. 1999. 188:55–60.

27. Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Kim YS, et al. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. The International Diabetes Institute. 2000. Available from: URL//http://www.diabets.com.au/pdf/obesity_report.pdf.

28. Chang CJ, Wu CH, Chang CS, Yao WJ, Yang YC, Wu JS, et al. Low body mass index but high percent body fat in Taiwanese subjects: Implications of obesity cutoffs. Int J Obes Relat Metab Disord. 2003. 27:253–259.

29. Ashwell M, Hsieh SD. Six reasons why the waist to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005. 56:303–307.

30. Ashwell M. The Ashwell Shape Chart-a public health approach to the metabolic risks of obesity. Int J Obes Relat Metab Disord. 1998. 22:3 Suppl. S213.

31. Ashwell M, Lejeune S, McPherson K. Ratio of waist circumference to height may be better indicator of need for weight management. BMJ. 1996. 312:377.

32. Hsieh SD, Yoshinaga H, Muto T, Sakurai Y, Kosaka K. Health risks among Japanese men with moderate body mass index. Int J Obes Relat Metab Disord. 2000. 24:358–362.

33. Kahn HS, Imperatore G, Cheng JY. A population based comparison of BMI percentiles and waist-to height ratio for identifying cardiovascular risk in youth. J Pediatr. 2005. 146:482–488.

34. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord. 2000. 24:1453–1458.