Utility of waist-to-height ratio, waist circumference and body mass index in predicting clustered cardiometabolic risk factors and subclinical vascular phenotypes in children and adolescents: A pooled analysis of individual data from 14 countries

Xin'nan Zong, Roya Kelishadi, Hae Soon Kim, Peter Schwandt, Tandi E. Matsha, Jose G. Mill, Peter H. Whincup, Lucia Pacifico, Abel López-Bermejo, Carmelo Antonio Caserta, Carla Campos Muniz Medeiros, Wei Li Yan, Anastasios Kollias, Paula Skidmore, Liane Correia-Costa, A. Khadilkar, Fariborz Sharifian Jazi, Zhuo Gong, Cheng Zhang, Costan G. MagnussenMin Zhao, Bo Xi

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV). Methods: We analyzed data from 34,224 youths (51.0 % boys, aged 6–18 years) with CMRFs, 5004 (49.5 % boys, aged 6–18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6–17 years) with PWV measurement from 20 pediatric samples across 14 countries. Results: WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75–0.78) to 0.78 (0.76–0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74–0.79) to 0.77 (0.74–0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64–0.71) to 0.70 (0.66–0.73) for high cIMT (≥P95 values) and from 0.60 (0.58–0.66) to 0.62 (0.58–0.66) for high PWV (≥P95 values). Conclusions: Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings.

Original languageEnglish
Article number103042
JournalDiabetes and Metabolic Syndrome: Clinical Research and Reviews
Volume18
Issue number5
DOIs
StatePublished - May 2024

Bibliographical note

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© 2024

Keywords

  • Adolescent
  • Body mass index
  • Cardiometabolic risk factors
  • Carotid intima-media thickness
  • Child
  • Obesity
  • Pulse wave velocity
  • Waist circumference
  • Waist-to-height ratio

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