Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study

Abstract

Dietetics, Universidad Central de Venezuela,
Email gbauce@hotmail.com
Received: December 05, 2017 | Published: August 20, 2018
Abstract
Is a review of indicators to measure obesity in children and adolescents, such as the index
of body mass (BMI), waist circumference (CC) and index weight - waist circumference (P/
CC), and compare the results. Sample: of 304 children between 6 and 18years of age, 128 of
Caracas, 139 of Mérida and 37 of Valencia, of fourth educational institutions, Objective: to
compare three indicators that measure overweight and obesity. Method: it is a descriptive,
transversal study correlational; applied descriptive measures of association and correlation,
the variables age, weight, height, waist circumference (WC), hip (C DAC) circumference,
measured and calculated indicators: body mass mass index (BMI), waist to hip rate (ICC)
and index Peso-circumference waist (P/CC). Results: According to CDC for BMI, 9.87% at
risk of overweight, and 5.26% overweight; average of 65 CC, 92±7, 78cm, and percentile
increases with age; average P/DC 0, 67±0, 11, higher in males and evidence sexual
dimorphism from the age of 15. (R>0.70) correlations were obtained between weight-ccin.;
weight c cad. BMI-weight; P/CC-age, height, weight and c cad. Conclusions: BMI remains
a good indicator to assess overweight and obesity, DC complements the evaluation, but
there is still no matching criteria for reference values; index P/CC, can be useful, since it
discriminates by gender and correlated with age, weight, height, BMI, C hip.
Keywords: children, teens, BMI, waist circumference, index weight-waist circumference.
MOJ Biology and Medicine
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Introduction
As already mentioned, in many studies before, the problem of
obesity in children and adolescents has been a concern for national
and international organizations, due to the fact that it has increased
considerably in recentyears, so much so that has called “public health
problem”, both in developed countries, and in underdeveloped countries.
The WHO, in its technical report 894, states that individuals who
have excess abdominal fat, have a risk to health, as a result of obesity;
also refers that there are additional tools to assess obesity, such as
underwater weight, magnetic resonance imaging, double watermark;
which have practical difculties for their use, coupled with high costs.1
In the same report, he reports that comorbidities of obesity include
coronary heart disease, high blood pressure and stroke, certain
types of cancer, non-insulin-dependent diabetes, diabetes mellitus,
gallbladder disease, dyslipidemia, osteoarthritis and gout, and lung
diseases, including sleep apnea.1
It must be taken into account that the body mass index (BMI),
which has been useful for the evaluation in adults, has recently been
recommended for the evaluation of children and adolescents. In the
same way, different groups of experts and international organizations
have set themselves the task of proposing reference standards of
the IMC for international use; among them the Centers for Disease
Control and Prevention (CDC) of the United States of America and the
Working Group on Obesity (IOTF) of the World Health Organization.2
With regard to waist circumference, the results obtained in
the studies that have been carried out in countries such as Brazil,
Spain, the United States, England and Italy show that, in children
and adolescents, waist circumference is a good indicator of central
obesity, with clinical and epidemiological utility.3 A cardiological
study conducted in Bogalusa, shows that in the case of children,
from 5 to 17years, the distribution of abdominal fat, measured by
waist circumference, is associated with abnormal concentrations of
triglycerides, low and high density lipoproteins and insulin.4 Likewise,
in a study conducted by Barreira et al, they found an association
between waist circumference and fat mass, as well as between waist
circumference and abdominal subcutaneous area and visceral adipose
tissue.5
In Venezuela, there is talk of children between 7 and 14years
old, with an incidence of 19.31% with overweight (above the 90th
percentile), and particularly in the Capital District, the gure is 23.26%.6
In a study of overweight and obesity in Venezuela, conducted by the
INN, they say that for the population of 7 to 12years, there are 17.57%
overweight and 9.87% of obesity nationwide; and for the group of 13
to 17years, they report a 12.03% of overweight and a 9.33% of obesity;
They also report that when the sample is discriminated in the group
of 7 to 17years, a higher prevalence of overweight and obesity was
observed in males, with gures of 15.32% and 10.63%, respectively.7
This increase in malnutrition has its possible causes in the so-called
demographic and nutritional transition, reected in changes in the diet
(high consumption of carbohydrates) and a decrease in individual
physical activity, which has been very accelerated in recentyears,
and It is also typical of developing regions, which has resulted in the
presence of malnutrition, obesity and overweight, a situation that also
leads to an increase in deaths from CVD, cancer, hypertension and
cerebrovascular diseases.7,8
Considerando que se ha incrementado la incidencia de sobrepeso
y obesidad en la población infantil de Venezuela en los últimos diez
años, se ha planteado la posibilidad de realizar un estudio en el cual
se incluyan otros índices, con el n de disponer de otros indicadores
para evaluar a esta población, en cuanto a sobrepeso y obesidad,
particularmente, si son indicadores mucho más fácil de calcular, y
conables.
MOJ Biol Med. 2018;3(3):120‒125. 120
©2018 Bauce. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits
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Three indicators for overweight and obesity: BMI,
CC and P/CC-index in children and adolescents:
Pilot study
Volume 3 Issue 3 - 2018
Gerardo Bauce
School of Nutrition and Dietetics, Universidad Central de
Venezuela, Venezuela
Correspondence: Gerardo Bauce, School of Nutrition and
Dietetics, Universidad Central de Venezuela,
Email gbauce@hotmail.com
Received: December 05, 2017 | Published: August 20, 2018
Abstract
Is a review of indicators to measure obesity in children and adolescents, such as the index
of body mass (BMI), waist circumference (CC) and index weight - waist circumference (P/
CC), and compare the results. Sample: of 304 children between 6 and 18years of age, 128 of
Caracas, 139 of Mérida and 37 of Valencia, of fourth educational institutions, Objective: to
compare three indicators that measure overweight and obesity. Method: it is a descriptive,
transversal study correlational; applied descriptive measures of association and correlation,
the variables age, weight, height, waist circumference (WC), hip (C DAC) circumference,
measured and calculated indicators: body mass mass index (BMI), waist to hip rate (ICC)
and index Peso-circumference waist (P/CC). Results: According to CDC for BMI, 9.87% at
risk of overweight, and 5.26% overweight; average of 65 CC, 92±7, 78cm, and percentile
increases with age; average P/DC 0, 67±0, 11, higher in males and evidence sexual
dimorphism from the age of 15. (R>0.70) correlations were obtained between weight-ccin.;
weight c cad. BMI-weight; P/CC-age, height, weight and c cad. Conclusions: BMI remains
a good indicator to assess overweight and obesity, DC complements the evaluation, but
there is still no matching criteria for reference values; index P/CC, can be useful, since it
discriminates by gender and correlated with age, weight, height, BMI, C hip.
Keywords: children, teens, BMI, waist circumference, index weight-waist circumference.
MOJ Biology and Medicine
Research Article Open Access

Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot
study 121
Copyright:
©2018 Bauce
Citation: Bauce G. Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study. MOJ Biol Med.
2018;3(3):120‒125. DOI: 10.15406/mojbm.2018.03.00086
Materials and methods
A descriptive, cross-sectional and correlational study was carried
out, in which a group of schoolchildren selected by a randomized
procedure was used as a sample, from three cities: Caracas, Mérida
and Valencia, where schoolchildren from educational institutions of
each school were chosen. the cities, El Libertador de Caracas, 128
schoolchildren, Father Madariaga and Los Próceres in Mérida, 139
schoolchildren, and Los Maitines in Valencia, 37 schoolchildren,
who made up a sample of 304 children and adolescents, between
6 and 18years old, with the same number of them of each sex. The
variables age, weight, height, waist circumference, hip circumference
were measured, and the indicators were calculated: Body Mass Index
(BMI), Waist-Hip Index (BCI) and Weight-Circumference Waist
Index (IPCC). For the evaluation, the criterion suggested by the
WHO for the BMI9 was considered, based on the mean and deviation,
with the categories: overweight+1SD<BMI≤+2 SD, obesity
BMI>2DE; the CDC criteria for CC,10 based on the percentiles, with
categories cc<5% (Decit); 5%≤P/CC<85% (Normal); 85%≤P/
CC<95% (Overweight risk) and P/CC≥95% (Overweight), and
for the hip weight-waist index (P/CC), there are no references, as
it is a new index that is experiment in this pilot study. However,
the criterion suggested by the CDC for waist circumference was
used to classify this index, because it is based on the percentiles.
Descriptive and correlation statistics were determined, according to
the variables that were related.
Results
In Table 1 & Table 2, the averages of the anthropometric variables
of the students are presented, it can be seen that the averages are
higher for the male sex; Likewise, it can be observed that, very
interestingly, the averages decrease at 12years in males and at 17years
in females. In addition, all the variables behave in a similar way, since
they increase as the age advances. These differences become visible
when the graphic representation is observed, and it can be seen in
Figure 1, how the waist and hip circumferences behave, by sex, being
very similar during the rstyears and differentiating from the age of
18. In the same way, it is necessary to visualize the Figure 2, it is
observed that the waist/hip index, behaves in a similar way during
the rstyears, but then accentuates at 17years, evidencing the sexual
dimorphism. In the classication, according to the WHO criteria, of
the BMI, by sex, and there is a very high percentage (74.79%) of
schoolchildren classied as normal weight; 8.88% overweight and
4.14% with Obesity.
Table 1 Average of the variables size, weight, waist circumference, hip circumference. Schoolchildren from three cities of Venezuela
Sex nAge Size Weight Waist circumference Hip circumference
3 9 139,47±5,03 36,67±15,09 64,67±15,89 75,33±13,47
M 14 10 139,58±3,55 38,14±13,05 66,97±14,93 76,52±14,15
A 38 11 144,34±10,16 38,18±14,07 63,49±13,99 74,86±12,10
S 28 12 148,35±7,67 38,52±8,95 62,10±6,17 73,95±7,14
C 16 13 153,36±4,71 47,38±8,60 69,75±8,06 83,48±8,78
U 18 14 161,38±8,51 52,85±8,15 71,27±6,45 83,58±5,71
L 11 15 164,53±5,69 52,56±7,86 68,40±5,03 83,02±5,44
I 12 16 169,21±7,83 63,92±11,78 76,22±6,63 91,74±8,12
N 11 17 169,85±7,06 63,94±12,08 73,54±7,32 88,2±6,07
O 1 18 187,00±0,00 76,00±0,00 77,90±0,00 99,80±0,00
Total 153,36±12,31 46,25±13,47 67,63±8,66 80,01±9,67
3 9 135,10±6,43 31,50±12,29 60,37±10,23 72,47±12,70
28 10 140,19±8,46 37,73±9,61 62,10±6,85 76,84±9,22
F 33 11 147,27±7,15 38,44±7,16 61,75±5,85 78,74±6,45
E 38 12 150,25±5,84 42,29±7,35 63,28±5,39 81,15±7,08
M 14 13 152,93±2,67 46,87±6,59 65,53±7,39 85,90±5,22
E 9 14 154,00±4,99 45,11±5,93 64,63±4,48 82,12±5,91
N 11 15 156,87±4,96 52,45±9,23 69,34±7,28 90,46±7,48
I 9 16 155,56±6,17 55,33±5,76 71,11±3,92 91,79±4,42
N 4 17 152,80±3,84 50,50±7,22 69,95±8,35 87,05±5,65
O 1 18 161,20±0,00 58,50±0,00 70,60±0,00 95,00±0,00
Total 148,36±9,21 42,55±9,81 64,12±6,69 81,36±8,86

Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot
study 122
Copyright:
©2018 Bauce
Citation: Bauce G. Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study. MOJ Biol Med.
2018;3(3):120‒125. DOI: 10.15406/mojbm.2018.03.00086
Table 2 Promedio de las variables índice cintura/cadera, IMC e índice peso/circunferencia de cintura. Escolares de tres ciudades de Venezuela
Sex nAge Waist / hip index IMC Weight / waist circumference
3 9 0,85±0,07 18,54±6,16 0,55±0,09
M 14 10 0,87±0,04 19,49±6,88 0,56±0,07
A 38 11 0,85±0,05 18,14±5,40 0,59±0,08
S 28 12 0,84±0,04 17,31± 2,46 0,61±0,09
C 16 13 0,84±0,03 20,14±3,61 0,68±0,07
U 18 14 0,85±0,05 20,24±2,35 0,74±0,08
L 11 15 0,82±0,03 19,32 ±1,87 0,77±0,07
I 12 16 0,83±0,03 22,29± 3,65 0,83±0,10
N 11 17 0,83±0,05 22,07± 3,41 0,86±0,10
O 1 18 0,78±0,00 21,73±0,00 0,98±0,00
Total 0,85±0,04 19,29±3,50 0,67±0,13
3 9 0,83±0,3 16,95±4,96 0,51± 0,11
28 10 0,81±0,04 18,99±3,42 0,60±0,09
F 33 11 0,78±0,05 17,62±2,38 0,63±0,09
E 38 12 0,78±0,03 18,66±2,56 0,66± 0,07
M 14 13 0,76±0,05 20,01±2,47 0,71±0,04
E 9 14 0,79±0,03 19,04±2,45 0,70±0,05
N 11 15 0,77±0,04 21,21±2,79 0,75±0,06
I 9 16 0,78±0,04 22,88±2,25 0,78±0,06
N 4 17 0,80±0,6 21,70±3,70 0,72±0,02
O 1 18 0,74±0,00 22,51±0,00 0,83±0,00
Total 0,79±0,04 19,13±3,14 0,66±0,10
Figure 1 Cirncunferencias de Cintura y Cadera, según sexo. Escolares de tres ciudades, Venezuela.
The school children were classied according to the BMI value,
according to the WHO, and the averages of the waist and hip
circumferences are considerably higher (81.78±5.69cm, 96.19±4,
98cm, respectively) for school children who are in the obesity category;
while the averages of the CC and Weight/CC index are slightly higher in
the obese group (0.85±0.06 and 0.79±0.11, respectively). In addition,
we have that the averages are statistically signicant (p<0.001), for
waist circumference, hip circumference and weight/C waist index.
With regard to waist circumference, the average is 65.92±7.89cm, for
the total sample, being 67.63±8.66 in males, higher than the average
of females (64, 12±6.69), which is statistically signicant (p<0.001).
When the waist circumference is evaluated, by means of the

Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot
study 123
Copyright:
©2018 Bauce
Citation: Bauce G. Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study. MOJ Biol Med.
2018;3(3):120‒125. DOI: 10.15406/mojbm.2018.03.00086
percentiles suggested by the CDC, the value increases as the age
advances, in addition, the Differences are more accentuated in
the percentile values at 10, 12 and 17years, in the case of males
(Figure 3). Regarding the behavior of the percentiles, in the case
of females, the behavior is similar to that of males, with the
difference that the values are more distant at 17years (Figure 4).
We proceeded to classify the P/CC index, according to the criterion
suggested by the CDc for the CC, since it is the one that ts most
for this index, because it is based on the percentiles, and we have
that with the risk of overweight. 9.87% and overweight there are
5.26% of school children. The P/CC index resulted in an average
of 0.67±0.11, with average values of 0.6733±0.1275 for males and
0.6569±0.0989 for females, which are not statistically signicant
It was also observed that when the P/CC index is discriminated by sex,
it increases as age progresses, and evidences more notable differences
after 15years, in the male sex. As for the female sex, it increases as
the age increases, and the differences are evident up to 16years, and
at 17years, tend to approach. Very good correlations (r≥0.70) were
obtained between waist circumference with weight and with hip
circumference; hip circumference with weight, body mass index with
weight, waist circumference and hip circumference; the P/C Waist
and Age Index, the Size, the Weight and the C Hip. In addition to
the P/C Waist index, the distribution behaves approximately normal
(p<0.001); and the behavior of this index, is similar to the behavior of
the waist circumference and the hip circumference, as well as the hip
waist index. When considering the classication of BMI, according to
the WHO, and classifying schoolchildren according to the P/C Waist
index is ≥0.78, based on the 85th percentile, to consider that they are
at risk, and<0.78 to consider that it is not At risk, it was obtained
that 259 schoolchildren, who represent 85.20% have no risk, and 45
schoolchildren, who represent 14.80% are at risk.
Figure 2 Índices Cintura/Cadera y Peso/C Cintura, según sexo. Escolares de tres ciudades, Venezuela.
Figure 3 Percentiles de Circunferencia de Cintura por edad, sexo masculino. Escolares de tres ciudades de Venezuela.
Figure 4 Percentiles de Circunferencia de Cintura por edad, sexo femenino. Escolares de tres ciudades de Venezuela.

Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot
study 124
Copyright:
©2018 Bauce
Citation: Bauce G. Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study. MOJ Biol Med.
2018;3(3):120‒125. DOI: 10.15406/mojbm.2018.03.00086
Discussion
It is known that today, overweight and obesity, has become a public
health problem in underdeveloped and developing countries,2 therefore;
Likewise, it is known that obesity in childhood and adolescence has
reached epidemic proportions in the Americas región.11 On the other
hand, it is necessary to agree with the results of the ENCA 2012,
cited by López-Blanco et al (2014), the Venezuelan diet is of low
quality, safety and innocuousness, which consolidates a known diet
pattern as obesogenic, which contributes to overweight and obesity.12
In view of the above, to evaluate both overweight and obesity in
children and adolescents, the present study was carried out, where the
BMI indicators, Circumference of the Waist, Hip Circumference, and
a new index that was obtained as the relationship between the Weight
and the Circumference of Waist, in order to compare them, and to
have reliable indicators to evaluate the obesity. First, we obtained,
for the aforementioned indicators, averages differentiated by sex, with
higher results in men, with the exception of the hip circumference,
these results; however, they are not signicant, except for the waist
circumference that is signicantly higher in children (p<0.0001), a
result that agrees with that obtained by Mederico et al. As for the
averages of the height by age, both in the case of males and females,
they are slightly lower than those obtained by Mederico et al, likewise
with weight averages, although these are slightly higher than 16,
17 and 18years, in this study.13 The average BMI of the sample is
19.23±3.29 (kg/m2) is, and for males it is 19.29±3.50 (kg/m2), while
for females it is 19 , 13±3.14 (kg/m2), which are not statistically
signicant, and in both sexes, are lower than those reported by
Cordero et al.,14 but the average in males is higher and in females less,
as reported by Cossio-Bolaños et al.15 The averages are considered
by age groups, according to sex, and only weight (p<0.01) and height
(p<0.001) for the group of 13 to 16years and waist circumference are
statistically signicant. (p<0.001) for the group of 10 to 12years; in
addition, the averages of the four variables, both in males and females,
are greater than those obtained by Benjumea et al.16 Additionally,
there is a 5.26% is classied as obese, a percentage lower than that
reported by NHANES, which for the period 2007-2008 is 16.9%, for
children and young people from 2 to 19years, who they are above the
95th percentile.17
Regarding the waist circumference, it is noteworthy that the
reference values differ according to the authors, so for example
Hirschler et al.,18 refers that the CC can be useful to predict metabolic
syndrome in children, considering a value>75th percentile ; in
which case, for the group studied there is a value of CC>70.65cm
and>72.38cm in males and females respectively, it would suggest
that 70 students are candidates to suffer from metabolic syndrome.
The average waist circumference by sex is 67.63±8.66 (cm) and
64.21±6.65 (cm) in males and females, respectively, lower than
those obtained by Mederico, and those reported by Cordero et al.,14
likewise, the average of the cc for the whole group is of 65.92±7.89
(cm), which is lower than that obtained by Hidalgo et al.,19 and also
when comparing the percentile values, the 25th and 50th percentiles are
similar, and the 75th percentile is slightly lower. On the other hand,
it was obtained that the averages of the cc by sex are statistically
signicant (p<0,001). When considering percentiles by age for waist
circumference, these increase with age in both sexes, coinciding
with the results obtained by Esquivel Lauzurique et al.,20 although
slightly higher in men, and differ signicantly (p<0.001) in the 85th,
90th and 95th percentiles. When considering by age groups with the
results obtained by Benjumea et al.,16 it is possible that the averages
of waist circumference obtained in this study are greater in both
sexes, although they are not statistically signicant among them. In
relation to the Weight/CC index, it has been classied based on the
average and the standard deviation established the catagories: Severe
decit (<0.44), Moderate decit (0.44≤p/CC<0.55), Normal (0.55≤P/
CC<0.78), overweight (0.78≤P/CC<0.90) and Obesity (≥0.90), with
the following percentages by category: 1.32%, 16.45%, 68.09%,
11.51% and 2.63%, respectively, corresponding to an approximately
normal distribution. When classifying the values of the P/CC index
by percentiles, we have that the 75th percentile is 0.74, if we take into
account the suggested by Hirscler et al (3) for the waist circumference,
and according to this criterion , schoolchildren are classied, in no
risk and risk, in such a way that those who have an index of 0.74 or
more are at risk; and there are only 32 esolares, who represent 10,
.53%, classied as risk, a percentage higher than that obtained by
applying the above criterion.
Conclusion
It has been shown that physical activity plays an important role in
the prevention of obesity and exercise levels high enough to counteract
excessive caloric intake are needed.10 The BMI is still a good indicator
to assess overweight and obesity in children and adolescents;
however, there is a tendency to use other indicators such as waist
circumference, which has allowed for a new element to evaluate the
school population and prevent metabolic syndrome;18 but nevertheless
there is no agreement as to the criterion to be used to classify in no
risk and risk; since there are several criteria, such as suggesting the
percentiles by age and sex.13 The P/C Waist index can be a useful
indicator to detect obesity, particularly due to its easy calculation and
behavior, since it has been proven that sexual dimorphism can be
veried when discriminating by age (Figure 2). In addition, for this
particular group, it was found to behave approximately as a normal
distribution (p<0.001), in addition it is highly correlated with weight,
height and hip circumference (r>0.80) and moderately with age and
BMI (p>0.69).
Acknowledgements
None.
Conict of interest
The author declares no conict of interest.
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Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot
study 125
Copyright:
©2018 Bauce
Citation: Bauce G. Three indicators for overweight and obesity: BMI, CC and P/CC-index in children and adolescents: Pilot study. MOJ Biol Med.
2018;3(3):120‒125. DOI: 10.15406/mojbm.2018.03.00086
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