Combined Influence of Body Mass Index and Waist Circumference on Coronary Artery Disease Risk Factors Among Children and Adolescents
ABSTRACT In adult populations, it is recognized widely that waist circumference (WC) predicts health risk beyond that predicted by BMI alone; current recommendations for adults are that a combination of BMI and WC be used to classify obesity-related health risk. For children and adolescents, however, little is known about the combined influence of BMI and WC on health outcomes. The objectives of this study were to determine whether BMI and WC predict coronary artery disease (CAD) risk factors independently for children and adolescents and to assess the clinical utility of using WC in combination with BMI to identify CAD risk.
Subjects included 2597 black and white, 5- to 18-year-old, male and female youths. Outcome measures included 7 CAD risk factors. In the first analysis step, BMI and WC were used as continuous variables to predict CAD risk factors. In the second analysis step, participants were placed into normal-weight, overweight, and obese BMI categories and, within each BMI category, CAD risk factors were compared for groups with low and high WC values.
When BMI and WC were included in the same regression model to predict CAD risk factors, the added variance above that predicted by BMI or WC alone was minimal, which indicated that BMI and WC did not have independent effects on the risk factors. For example, for systolic blood pressure, BMI alone explained 7.3% of the variance, WC alone explained 7.7% of the variance, and the combination of BMI and WC explained 8.1% of the variance. When BMI and WC values were categorized with a threshold approach, WC provided information on CAD risk beyond that provided by BMI alone, particularly when the categories were used to predict elevated CAD risk factor levels. For instance, in the overweight BMI category, the high-WC group was approximately 2 times more likely to have high triglyceride levels, high insulin levels, and the metabolic syndrome, compared with the low-WC group.
These findings provide some evidence that a combination of BMI and WC should be used in clinical settings to evaluate the presence of elevated health risk among children and adolescents.
- SourceAvailable from: Heather E Dillaway
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- " specifically regarding BMI . In particular , the findings closely match the landmark Bogalusa Heart Study , in which African American female adolescents possessed the highest BMI compared with other groups ( Bhuiyan et al . , 2003 ; Brambilla , Bedogni , Heo , & Pietrobelli , 2013 ; Hirschler , Aranda , Calcagno , Maccalini , & Jadzinsky , 2005 ; Janssen et al . , 2005 ) ."
ABSTRACT: African American adolescents experience higher rates of obesity and have an increased risk of obesity-related diseases than do White American adolescents. Despite culturally sensitive obesity preventive interventions, obesity rates are increasing within the African American adolescent population. Current obesity interventions do not usually address the heterogeneity (e.g., socioeconomic status [SES], gender, and residential status differences) within the African American adolescent community that can affect the efficacy of these interventions.Journal of Pediatric Health Care 01/2015; 29(3). DOI:10.1016/j.pedhc.2014.11.005 · 1.97 Impact Factor
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- "Otherwise, the relationship of blood pressure with BMI was more important than with WC. These findings differ in some respects from those of a previous studies suggesting that WC identifies a greater number of children with elevated blood pressure than BMI  . However, they agree with those reported in recent study in which BMI was found to be better measurement than WC in predicting cardiovascular risks in adolescents . "
ABSTRACT: This study aimed to estimate the prevalence of hypertension among a group of adolescents and to assess the relationship of systolic and diastolic blood pressure (SBP, DBP) with body fat mass (BFM), body mass index (BMI) and waist circumference (WC). A total of 167 subjects aged 11â17 years were recruited, 29.3% and 12.6% were overweight and obese respectively. BMI, WC, SBP and DBP were determined using standardized equipment. BFM was estimated by the deuterium oxide dilution. Hypertension (HT) and prehypertension (pre-HT) were observed in 17.4% and 9.6%, of the study population, respectively. The prevalence of HT and pre-HT was significantly higher in boys and in overweight-obese groups (p = 0.044; p = 0.003 respectively). Both SBP and DBP were significantly higher in overweight-obese compared to healthy-weight groups (p < 0.001; p = 0.002 respectively). SBP was significantly higher in boys than girls (p = 0.013). With some exceptions, SBP and DBP were significantly correlated with BMI, WC and BFM in the study population and different weight-status groups of both genders. The relationship of blood pressure with BMI appeared to be more significant than with WC and BFM. The prevalence of hypertension was higher in boys than girls and in overweight-obese than healthy-weight adolescents. Overall SBP and DBP were associated with BFM, BMI and WC. However, the strong association between these variables was seen in girls, and the greater risk of developing hypertension could be associated with increasing BMI.:Obesity Research & Clinical Practice 07/2013; 7(4):e235-320. DOI:10.1016/j.orcp.2012.02.006 · 1.18 Impact Factor
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- "Currently, there is no consensus on a specific insulin resistance cut-off in screening and testing for the onset of type II diabetes in US children and adolescents (Nsiah- Kumi et al., 2010). Similar to previous studies involving US adolescents (Janssen et al., 2005; Katzmarzyk et al., 2004) ; the top quintile was selected in our study to indicate elevated IR. The top quintile of the current HOMA distribution although arbitrary, represents the youth who are most likely to be at risk for diagnostic follow-up tests (potentially expensive) and candidates for intervention. "
ABSTRACT: We compared adiposity from triceps and subscapular skinfold thickness (SF) with total body fat from dual energy X-ray absorptiometry (DXA) in their associations with HOMA insulin resistance for a large sample of US adolescents. We analyzed cross-sectional data from 1496 adolescents, ages 12.0-17.99 year examined as part of the US national health and nutrition examination survey (NHANES) cycles 2001-04. Data collected included skinfold thicknesses, DXA-based total body fat (DXF), serum insulin and fasting glucose for homeostasis model assessment of insulin resistance (HOMA-IR). Regression models adjusting for complex survey design effects and correspondence analyses were used to study associations with HOMA-IR and concordance between the two measures of adiposity. SF and DXA models had identical precisions for estimating continuous HOMA-IR, based on bootstrap estimations. For boys, RMSEs = 0.53 (95% CI: 0.49-0.58) and 0.53 (95% CI: 0.48-0.57) for SF and DXA models respectively; and for girls RMSEs were SF = 0.45 (95% CI: 0.41-0.48) and DXA = 0.46 (95% CI: 0.42-0.48). Both adiposity models identified high proportions of the same individuals (positive percent agreement: 80-81%) with exact agreements exceeding 92% for identifying adolescents at elevated risk of IR in both sexes. Triceps and subscapular skinfold thicknesses estimate HOMA-IR and identify those at highest risk for insulin resistance as well as total body fat from DXA. Skinfold thickness provides an inexpensive and widely applicable measure of fatness that is appropriate for studies of insulin resistance and perhaps other metabolic variables in adolescents. Am. J. Hum. Biol. 2012. © 2012Wiley Periodicals, Inc.American Journal of Human Biology 11/2012; 24(6):806-11. DOI:10.1002/ajhb.22321 · 1.93 Impact Factor