Relation of Body Mass Index and Waist-to-Height Ratio to Cardiovascular Disease Risk Factors in Children and Adolescents: The Bogalusa Heart Study

Divisions of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 08/2007; 86(1):33-40.
Source: PubMed


Several investigators have concluded that the waist-to-height ratio is more strongly associated with cardiovascular disease risk factors than is the body mass index (BMI; in kg/m(2)).
We examined the relation of the BMI-for-age z score and waist-to-height ratio to risk factors (lipids, fasting insulin, and blood pressures). We also compared the abilities of these 2 indexes to identify children with adverse risk factors.
Children aged 5-17 y (n=2498) in the Bogalusa Heart Study were evaluated.
As assessed by the ability of the 2 indexes to 1) account for the variability in each risk factor and 2) correctly identify children with adverse values, the predictive abilities of the BMI-for-age z score and waist-to-height ratio were similar. Waist-to-height ratio was slightly better (0.01-0.02 higher R(2) values, P<0.05) in predicting concentrations of total-to-HDL cholesterol ratio and LDL cholesterol, but BMI was slightly better in identifying children with high systolic blood pressure (0.03 higher R(2), P<0.05) in predicting measures of fasting insulin and systolic and diastolic blood pressures. On the basis of an overall index of the 6 risk factors, no difference was observed in the predictive abilities of BMI-for-age and waist-to-height ratio, with areas under the curves of 0.85 and 0.86 (P=0.30) and multiple R(2) values of 0.320 and 0.318 (P=0.79). This similarity likely results from the high intercorrelation (R(2)=0.78) between the 2 indexes.
BMI-for-age and waist-to-height ratio do not differ in their abilities to identify children with adverse risk factors. Although waist-to-height ratio may be preferred because of its simplicity, additional longitudinal data are needed to examine its relation to disease.

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    • "Like most of the work on which current knowledge is based[3,4,14,15,20,21], our study is cross-sectional, prohibiting us from making causal inferences. Indeed, a large FFM and a high stature could be secondary to a high blood pressure, or they could be separate effects of an underlying unmeasured factor. "
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    ABSTRACT: Background To improve understanding of the pathophysiology of hypertension in adolescents and pave the way for risk stratification, studies have sought to determine the correlates of blood pressure (BP). Inconsistencies in dependent and independent variables have resulted in an elusive consensus. The aim of this report is to examine an inclusive array of correlates of BP, as a continuous (systolic and diastolic BP) and a dichotomous variable. Methods Subjects were a school-based sample of 730 urban, mostly African American, non-referred 6th and 7th grade girls. To find independent correlates of SBP/DBP, we used a stepwise model selection method based on the Schwarz Bayesian Information Criterion, enabling selection of a parsimonious model among highly correlated covariates. Candidate variables were: age, stature, heart rate, pubertal development, BMI, BMI z-score, waist circumference, waist-to-height ratio (WHtR), body surface area, fat mass (by bioelectrical impedance analysis), fat-free mass (FFM), percentage of body fat, and presence of overweight/obesity. Results The best-fitting models for DBP and SBP (considered separately) included fat-free mass, heart rate and, in the case of SBP, stature. The best-fitting model for high-normal/elevated blood pressure (H-N/EBP) included WHtR with no independent relation of any other variable. The prevalence of H-N/EBP tripled between a WHtR of 0.5 and 0.7. Conclusions The easily obtained and calculated WHtR is the strongest correlate of elevated blood pressure among available variables and is a prime candidate for longitudinal studies of predictors of the development of hypertension. Trial registration Identifier, NCT00746083
    Full-text · Article · Dec 2015 · BMC Public Health
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    • "Participants of these studies had diabetes of unknown duration [18]. This makes it difficult to distinguish between the role of weight loss as an innocent bystander reflecting poorly controlled diabetes or as a mediator effectuating the impact of diabetes on death or as an independent risk factor [19]. To deal with this limitation, Carnethon et al. have conducted a study on a sample of participant with newly diagnosed diabetes to examine all-cause, cardiovascular, and noncardiovascular mortality. "
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    ABSTRACT: Background. To reconcile "the obesity paradox," we tested if (1) the contribution of anthropometric measures to mortality was nonlinear and (2) the confounding of hip circumference contributed to the obesity paradox recently observed among diabetic patients. Methods. We analyzed data of diabetic patients attending a community-based prospective, "Tehran lipid and glucose study." In the mortality analysis, anthropometric measures-body mass index (BMI), waist, and hip circumference-were assessed using Cox models incorporating cubic spline functions. Results. During 12 990 person-years follow-up, BMI levels below 27 and those above 40 kg·m(-2) were associated with increased mortality. When we added waist circumference to the BMI in the multivariate-adjusted model, the steepness of BMI-mortality association curve slope for values below 27 kg·m(-2) increased, whereas the steepness of BMI-mortality association curve slope for values above this threshold decreased. Further adjusting the model for hip circumference, the steepness of the slopes of the association curve moved towards null on both extremes and no associations between BMI and all-cause mortality remained. Conclusion. BMI harbors intermixed positive and negative confounding effects on mortality of waist and hip circumference. Failing to control for the confounding effect of hip circumference may stymie unbiased hazard estimation and render conclusions paradoxical.
    Full-text · Article · Aug 2014 · International Journal of Endocrinology
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    • "The suggestion that WHtR cut-off may be similar in men and women makes it attractive for the quantification of central obesity in children which otherwise, could be very complex when using age-sex-race specific charts. A WHtR cut-off of 0.5 has been proposed for predicting cardiovascular risk [8], and its accuracy has been reported in several studies [9], [10], [11]. Despite its reported advantages and the ease of computing the WHtR, a suitable WHtR cut-off for populations from Africa has yet to be determined. "
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    ABSTRACT: The proposed waist-to-height ratio (WHtR) cut-off of 0.5 is less optimal for cardiometabolic risk screening in children in many settings. The purpose of this study was to determine the optimal WHtR for children from South Africa, and investigate variations by gender, ethnicity and residence in the achieved value. Metabolic syndrome (MetS) components were measured in 1272 randomly selected learners, aged 10-16 years, comprising of 446 black Africans, 696 mixed-ancestry and 130 Caucasians. The Youden's index and the closest-top-left (CTL) point approaches were used to derive WHtR cut-offs for diagnosing any two MetS components, excluding the waist circumference. The two approaches yielded similar cut-off in girls, 0.465 (sensitivity 50.0, specificity 69.5), but two different values in boys, 0.455 (42.9, 88.4) and 0.425 (60.3, 67.7) based on the Youden's index and the CTL point, respectively. Furthermore, WHtR cut-off values derived differed substantially amongst the regions and ethnic groups investigated, whereby the highest cut-off was observed in semi-rural and white children, respectively, Youden's index0.505 (31.6, 87.1) and CTL point 0.475 (44.4, 75.9). The WHtR cut-off of 0.5 is less accurate for screening cardiovascular risk in South African children. The optimal value in this setting is likely gender and ethnicity-specific and sensitive to urbanization.
    Full-text · Article · Aug 2013 · PLoS ONE
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