Predictive ability of waist-to-hip-ratio and waist-to-height-ratio in relation to overweight/obesity in adolescents from Vojvodina (the Republic of Serbia) predictive ability of waist-to-hip-ratio and waist-to-height-ratio Predictive Ability of Waist-to-Hip-Ratio and Waist-to-Height-Ratio
Main Article Content
Keywords
waist-to-height ratio, waist-to-hip ratio, body mass index, adolescents, Serbia
Abstract
Introduction/Aim Overweight in childhood is a risk factor for later diseases in adulthood. It is necessary to identify thresholds for anthropometric indexes for assessing obesity. The aim of our study was to explore the accuracy of waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) and for the first time proposes the optimal thresholds of these indices for identifying overweight/obesity in Serbian adolescents aged 11-15 years. Methods The cross-sectional study was conducted with 2391 adolescents. Anthropometric measurements included body height, weight, waist circumference and hip circumferences. The relation between WHR and WHtR and general obesity as defined by the International Obesity Task Force IOTF was investigated with nonparametric receiver operating characteristic (ROC) analysis. Results Both of the indicators of central adiposity showed a higher mean in the group of children with exceeded weight. The correlation of WHtR and body mass index (BMI) was considerably greater than the correlation between WHR and BMI in both sexes. The WHtR was a better predictor of general obesity than the WHR in both boys and girls. The WHtR cut-offs of 0.464 for boys and 0.465 for girls, and 0.510 for boys and 0.504 for girls have been proposed to identify overweight and obesity, respectively, in Serbian adolescents. Conclusion WHtR is an accurate index with high applicability to screening adolescents with excess weight.
References
1. Nathan BM, Moran A. Metabolic complications of obesity in childhood and adolescence: more than just diabetes. Curr Opin Endocrinol Diabetes Obes 2008; 15: 21-9.
2. Kromeyer-Hauschild K, Neuhauser H, Schaffrath Rosario A, Schienkiewitz A. Abdominal Obesity in German Adolescents Defined by Waist-to-Height Ratio and Its Association to Elevated Blood Pressure: The KiGGS Study. Obes Ffacts 2013; 6: 165-75.
3. 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: 303-7.
4. Roswall J, Bergman S, Almqvist-Tangen G, et al. Population-based waist circumference and waist-to-height ratio reference values in preschool children. Acta Paediatr 2009; 98: 1632-6.
5. Goulding A, Taylor RW, Grant AM, Parnell WR, Wilson NC, Williams SM. Waist-to-height ratios in relation to BMI z-scores in three ethnic groups from a representative sample of New Zealand children aged 5-14 years. Int J Obes 2010; 34: 1188-90.
6. Report of a WHO Expert Consultation Geneva 2008, Waist Circumference and Waist- Hip Ratio, 8–11 December 2008. Retrieved 15.06.2017.
http://apps.who.int/iris/bitstream/10665/44583/1/9789241501491_eng.pdf
7. Savva SC, Tornaritis M, Savva ME. 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: 1453-8.
8. Brambilla P, Bedogni G, Heo M, Pietrobelli A. Waist circumference-to-height ratio predicts adiposity better than body mass index in children and adolescents. Int J Obes 2013; 37(7): 943-6.
9. 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: 818-9.
10. Weiner JS, Lourie JA. Human biology; a guide to field methods, International biological programme. Oxford and Edinburg: Blackwell scientific publications. 1969; p. 621.
11. Lohman T, Roche A, Martorell E. Anthropometric standardization reference manual. Champaign: Human Kinetics. 1988. p. 177.
12. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240-3.
13. Zimmet P, Alberti K, George MM, et al. IDF Consensus Group. The metabolic syndrome in children and adolescents - an IDF consensus report. Pediatric Diabetes 2007; 8:299–306.
14. Hajian-Tilaki K. Receiver Operating Characteristic (ROC) Curve Analysis for Medical Diagnostic Test Evaluation. Caspian J Intern Med 2013; 4: 627-35.
15. Batson YA, Teelucksingh S, Maharaj RG, Cockburn BN. A cross-sectional study to determine the prevalence of obesity and other risk factors for type 2 diabetes among school children in Trinidad, West Indies. Paediatr Int Child Health 2014; 34:178-83.
16. Santomauro F, Lorini C, Pieralli F, et al. Waist-to-height ratio and its associations with body mass index in a sample of Tuscan children in primary school. Ital J Pediatr 2017; 43: 53.
17. Staiano AE, Gupta AK, Katzmarzyk PT. Cardiometabolic risk factors and fat distribution in children and adolescents. J Pediatr 2014; 164: 560-5.
18. So HK, Yip GW, Choi KC, et al. Hong Kong ABP Working Group. Association between waist circumference and childhood-masked hypertension: A community-based study. J Paediatr Child Health 2016; 52: 385-90.
19. Vieira SA, Ribeiro AQ, Hermsdorff HHM, Pereira PF, Priore SE, Franceschini SDCC. Waist-to-height ratio index or the prediction of overweight in children. Rev Paul Pediatr 2018; 36: 52-8.
20. Weili Y, He B, Yao H, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity 2007; 15: 748-52.
21. Choi DH, Hur YI, Kang JH, et al. Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity and Metabolic Syndrome among Korean Children and Adolescents: Korea National Health and Nutrition Examination Survey, 2010-2014. Nutrients 2017; 9: 256.
22. Gil JH, Lee MN, Lee HA, Park H, 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: 180-92.
23. Saldivar-Ceron HI, Vazquez-Martinez AL, Barron-Torres MT. Diagnostic accuracy of anthropometric indicators: waist circumference, waistheight index and waist-hip ratio to identify overweight and childhood obesity. Acta Pediatr Mex 2016; 37(2): 79-87.
24. Bacopoulou F, Efthymiou V, Landis G, Rentoumis A, Chrousos GP. Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatr 2015; 15: 50.
25. Motlagh M, Shirvani S, Hassanzadeh-Rostami Z, Taheri M, Ghadimi R. Assessment of overweight and obesity in Iranian adolescents: optimal cut-off values of anthropometric indices. EMHJ 2018; 24(10): 975-87.
26. Marrodan MD, Martinez-Alvarez JR, Gonzalez-Montero De Espinosa M, et al. Diagnostic accuracy of waist to height ratio in screening of overweight and infant obesity. Med Clin (Barc) 2013; 140: 296-301.
27. de Padua Cintra I, Zanetti Passos MA, Dos Santos LC, da Costa Machado H, Fisberg M. Waist-to-Height Ratio Percentiles and Cutoffs for Obesity: A Cross-sectional Study in Brazilian Adolescents. J Health Popul Nutr 2014; 32(3): 411-9.
28. Panjikkaran ST. Waist to Height Ratio for Recording the Risks for Overweight in Schoolchildren in Kerala. Indian Pediatrics 2013; 50: 493-5.
29. Guntsche Z, Guntsche EM, Saravi FD, et al. Umbilical waist-to-height ratio and trunk fat mass index (DXA) as markers of central adiposity and insulin resistance in Argentinean children with a family history of metabolic syndrome. J Pediatr Endocrinol Metab 2010; 23: 245-56.