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Gray LA. Evidence for central obesity risk-related thresholds for adolescents aged 11 to 18 years in England using the LMS method. Obes Res Clin Pract 2024:S1871-403X(24)00083-8. [PMID: 39019689 DOI: 10.1016/j.orcp.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/20/2024] [Accepted: 07/06/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Central obesity has been shown to better indicate health risks compared to general obesity. Measures of central obesity include waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and waist circumference (WC). The National Institute of Health and Care Excellence (NICE) recently recommended the use of WHtR alongside body mass index (BMI) to identify risks in adults and children, whilst recognising the need for more evidence relating to WHtR in children. This study explores risk thresholds for central obesity measures throughout adolescence. It compares these with those currently recommended in England and discusses whether these thresholds are age- and sex-specific. METHODS Data on adolescents aged 11 to 18 years from the Health Survey for England (HSE) during 2005 to 2014 was used to calculate WHtR, WHR and WC percentiles. Next, smoothed lambda-mu-sigma (LMS) curves were created and the percentiles which align with the adult thresholds at age 18 years identified. This allows the most appropriate risk related thresholds for each measure during adolescence to be determined. RESULTS WHtR LMS curves are stable and flat throughout adolescence. WHR decreases in girls and WC increases in both boys and girls, during adolescence. Across all measures, there is slightly more fluctuation in higher percentiles, and in girls' WHR. DISCUSSION In practice, WHtR thresholds are simple to use to identify central obesity related risks. In particular, they are recommended because the same thresholds can be used for males and females and for adolescents and adults. The results support NICE guidance to use WHtR thresholds alongside BMI thresholds to identify individual risk. IMPLICATIONS AND CONTRIBUTION This study uses central obesity measures, including waist-to-height and waist-to-hip ratios, to investigate risk-related thresholds for adolescents. It is the first to do so using English data. It provides support for current NICE recommendations to use adult waist-to-height thresholds in adults and children, alongside BMI measures in clinical and non-clinical settings.
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Affiliation(s)
- Laura A Gray
- Division of Population Health, School of Medicine and Population Health, University of Sheffield, Sheffield S10 2TN, UK; Healthy Lifespan Institution, University of Sheffield, S10 2TN, UK.
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Ramesh N, Kumar P, Sweta S, Prasad A, Tiwari LK. Correlation of anthropometric measurements with body mass index and estimation of the proportion of metabolic syndrome among overweight and obese children: a hospital-based cross-sectional study. BMJ Paediatr Open 2024; 8:e002354. [PMID: 38851220 PMCID: PMC11163612 DOI: 10.1136/bmjpo-2023-002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/14/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Early identification of overweight and obesity with the help of simple anthropometric tests can prevent from development of metabolic complications in these children. Body mass index (BMI) is the most commonly used parameter but, measurements such as waist circumference (WC), waist-to-height ratio (WHtR) and wrist circumference (WrC) have also been studied and found to have a better correlation with visceral fat. OBJECTIVE To correlate WC, WHtR and WrC with BMI among overweight and obese children. The secondary objective was to estimate the proportion of metabolic syndrome among obese and overweight children. METHODS A single-centre, cross-sectional study involving 80 overweight and obese children aged 3-15 years. Anthropometric measures such as WC, WHtR and WrC of the study subjects were correlated with BMI and investigated for metabolic syndrome. RESULTS Statistically significant and moderate positive correlation was found between BMI and WC, r (80)=0.45 and p<0.001 with WC explaining 20% of the variation of BMI. There was a statistically significant, moderate positive correlation between WHtR and BMI r (80)=0.34 and p<0.001 with 11% of the variation in BMI. There was a statistically significant strong positive correlation between WC and WrC (80)=0.61 and p<0.001, and WrC explains 37.2% of the variation in WC. However, there was no statistically significant correlation between BMI and WrC. Metabolic syndrome was found in 13 (16.25%) children. CONCLUSION Alternative anthropometric measurements such as WC and WHtR have a significant correlation with BMI and may be of help in defining overweight and obesity in children. There was a statistically significant strong positive correlation between WC and WrC among obese children. Metabolic syndrome is common in these children.
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Affiliation(s)
- Nithin Ramesh
- Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Pradeep Kumar
- Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sweta Sweta
- Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Arun Prasad
- Paediatrics, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Lokesh Kumar Tiwari
- Paediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Paysal J, Merlin E, Rochette E, Terral D, Nottin S. Left atrial remodeling in adolescents with obesity evaluated by speckle-tracking echocardiography. Int J Obes (Lond) 2024; 48:111-117. [PMID: 37864002 DOI: 10.1038/s41366-023-01397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND AIMS In adolescents with obesity, a left atrial (LA) enlargement has been reported. However, data regarding its function and its stiffness are missing. The aim of this study was to describe LA morphology and function, using speckle-tracking echocardiography (STE) and to explore their potential determinants in adolescents with obesity. METHODS Twenty-eight adolescent women with obesity (13.2 ± 1.4 yr) with an illness duration of 130 ± 27 months and 33 controls (14.1 ± 2.0 yr) underwent a resting echocardiography including an analysis of left ventricular (LV) and LA morphologies and strains. A fasting venous blood sample was performed to biochemical determinations including inflammation markers. RESULTS LA volume and stiffness index were increased in adolescents with obesity compared to controls. LA reservoir, conduit and booster pump functions were not different between groups. By stepwise forward multivariate regression analyses, systolic blood pressures, cardiac output and sedimentation rate were the independent determinants of LA volume (p < 0.0001, β-coefficient = 0.460) whereas only the body mass index was an independent determinant of LA stiffness (p = 0.003, β-coefficient = 0.413). CONCLUSION In adolescents with obesity, we observed a specific LA remodeling, including higher volume and lower stiffness, which could constitute early signs of an altered LV diastolic function.
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Affiliation(s)
- Justine Paysal
- Avignon University, LAPEC EA4278, F-84000, Avignon, France.
- CHU Clermont-Ferrand, Néonatologie et Réanimation Pédiatrique, F-63000, Clermont-Ferrand, France.
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, F-63000, Clermont-Ferrand, France
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, F-63000, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CHU Clermont-Ferrand, Pédiatrie, F-63000, Clermont-Ferrand, France
- Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, F-63000, Clermont-Ferrand, France
| | - Daniel Terral
- CHU Clermont-Ferrand, Pédiatrie, F-63000, Clermont-Ferrand, France
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Reference growth curves to identify weight status (underweight, overweight or obesity) in children and adolescents: systematic review. Br J Nutr 2023:1-13. [PMID: 36695353 DOI: 10.1017/s0007114522003786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The identification of somatic growth, through reference curves, can be used to create strategies and public policies to reduce public health problems such as malnutrition and obesity and to identify underweight, overweight and obesity. The purpose of this systematic review was to identify studies providing reference growth curves for weight status in children and adolescents. A systematic search was conducted in eight databases and in gray literature (Google scholar). To assess the risk of bias/methodological quality of studies, the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-sectional Studies (NHLBI) was used. Overall, 86 studies that met the inclusion criteria were included. Through the values of reference growth curves for the identification of underweight, overweight and obesity, it was possible to verify that there is great variability among percentiles for the identification of underweight, overweight and obesity. The most prevalent percentiles for underweight were P3 and P5; for overweight, the most prevalent was P85 and the most prevalent percentiles for obesity were P95 and P97. The most prevalent anthropometric indicators were Body Mass Index (BMI), Waist Circumference (WC), Body Mass (BM) for age and height for age. Conclusion: Such data can demonstrate that the optimal growth must be reached, through the standard growth curves, but that the reference curves demonstrate a cut of the population growth, raising possible variables that can influence the optimal growth, such as an increase in the practice of physical activities and an awareness of proper nutrition.
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Comparative analysis of anthropometric indicators for diagnosing obesity and predicting cardiometabolic risk in Mexican adolescents. NUTR HOSP 2022; 39:513-519. [PMID: 35080416 DOI: 10.20960/nh.03897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION obesity is a cardiometabolic risk (CMR) factor in adolescents. It represents a public health problem that requires simple diagnostic strategies based on the determination of anthropometric indicators (AIs) such as body mass index (BMI), waist circumference (WC), conicity index (CONI), waist-to-height ratio (WHtR), and body fat percentage (BFP). The purpose of the current contribution was to analyze the utility of the aforementioned AIs for evaluating obesity as a CMR factor in Mexican adolescents. MATERIALS AND METHODS the design of the study is descriptive and cross-sectional. Nutritional status was established by using various AIs and as a CMR factor under the criteria of WHtR. Participating in the present investigation were 2,000 adolescents from 15 to 17 years of age, of which 1,079 (53.9 %) were female and 921 (46.1 %) were male. All were high school students in Tuxtla Gutiérrez, Chiapas, Mexico. RESULTS AND CONCLUSION the prevalence of obesity was influenced by gender. With the WHtR and BFP, male students exhibited a greater prevalence of obesity, while with the BMI and CONI, the percentage of obesity was similar between the two genders. BMI was significantly correlated with BFP, WC and WHtR, and was one of the AIs with the greatest area under the curve, showing a good capacity to predict cardiometabolic risk. BMI is a simple and adequate tool for diagnosing obesity and predicting CMR in adolescents.
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Distribution of waist-to-height ratio and cardiometabolic risk in children and adolescents: a population-based study. Sci Rep 2021; 11:9524. [PMID: 33947900 PMCID: PMC8096959 DOI: 10.1038/s41598-021-88951-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/08/2021] [Indexed: 12/12/2022] Open
Abstract
This study was performed to evaluate the waist-to-height ratio (WHtR) distribution and assess its relationship with cardiometabolic risk in children and adolescents. A total of 8091 subjects aged 10–18 years were included from a nationally representative survey. Participants were classified into three groups: (1) < 85th, (2) ≥ 85th and < 95th, and (3) ≥ 95th percentile of WHtR. The WHtR distribution varied with sex and age. Whereas WHtR decreased from age 10–15 years in boys and from age 10–12 years in girls, it slightly increased thereafter. Compared to the < 85th percentile group, the WHtR ≥ 85th and < 95th percentile group had an odds ratio (OR) of 1.2 for elevated blood pressure (BP), 1.89 for elevated triglycerides (TGs), 1.47 for reduced high-density lipoprotein cholesterol (HDL-C) and 4.82 for metabolic syndrome (MetS). The ≥ 95th percentile group had an OR of 1.4 for elevated BP, 2.54 for elevated glucose, 2.22 for elevated TGs, 1.74 for reduced HDL-C, and 9.45 for MetS compared to the < 85th percentile group. Our results suggest that sex- and age-specific WHtR percentiles can be used as a simple clinical measurement to estimate cardiometabolic risk.
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Dos Santos FD, Pinto EF, Moura ARLI, Carvalho Lima EVD, Souza MFD, Carvalho FO, Moraes JFVND. Blood pressure responses to the Cold Pressor Test according to body mass index and waist-to-height ratio in adolescents. REVISTA CIÊNCIAS EM SAÚDE 2020. [DOI: 10.21876/rcshci.v10i3.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objectives: to analyze the blood pressure (BP) values and responses to the Cold Pressor Test (CPT) according to the body mass index (BMI) and the waist-to-height ratio (WHtR). Methods: 166 adolescents of both sexes participated in the study. Participants underwent measurements of body mass, height and waist circumference. BMI and WHtR were calculated. BP was measured before (pre-test), during (test) and after CPT (recovery). The groups were compared using a mixed ANOVA with Bonferroni post hoc, and Odds Ratio calculation. The level of significance was p < 0.05. Results: prevalences of 16.9% of high BMI, 19.9% of increased WHR and 8.4% of pretest BP were found above the recommended. Participants with high BMI had increased systolic BP compared to their normal peers (113.0 ± 11.4 vs. 121.7 ± 11.6 mmHg; p = 0.003). Adolescents with elevated WHR had higher pre-test and recovery systolic BP (pre-test: 113.2 ± 11.4 vs. 119.6 ± 12.7 mmHg; p = 0.021; recovery: 111.9 ± 14.1 vs. 117.4 ± 14.0 mmHg; p = 0.044). Finally, individuals with BMI and WHtR above the recommended had 2.1 (95% CI 0.62 - 7.36) and 2.5 (95% CI 0.77 - 7.91) times, respectively, more likely to have high pre-test BP values. Conclusion: adolescents with increased BMI and WHtR have higher BP values compared to their normal peers.
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Marrodán Serrano MD, Román E, Carmenate M, González-Montero de Espinosa M, Herráez A, Alfaro EL, Lomaglio DB, López-Ejeda N, Mesa MS, Vázquez V, Méndez Pérez B, Meléndez JM, Moreno-Romero S, Prado C, Dipierri JE. Waist circumference percentiles for Hispanic-American children and comparison with other international references. Am J Hum Biol 2020; 33:e23496. [PMID: 32893427 DOI: 10.1002/ajhb.23496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Waist circumference (WC) constitutes an indirect measurement of central obesity in children and adolescents. OBJECTIVE To provide percentiles of WC for Hispanic-American children and adolescents, and compare them with other international references. MATERIALS AND METHODS The sample comprised 13 289 healthy children between 6 and 18 years coming from public schools of middle and low socioeconomic levels in different parts of Argentina, Cuba, Spain, Mexico, and Venezuela. The LMS method to calculate WC percentiles was applied. Sex and age differences were assessed using Student's t test and ANOVA (SPSS v.21.0). Comparisons were established with references from the United States, Colombia, India, China, Australia, Kuwait, Germany, Tunisia, Greece, and Portugal. RESULTS WC increases with age in both sexes. Boys show higher WC in P3, P50, and P97. Comparison of 50th and 90th percentiles among populations from diverse sociocultural and geographical contexts shows high variability, not all justified by the measurement method. DISCUSSION AND CONCLUSIONS Specific WC percentiles for sex and age, and P90 cut-off points are provided; these values are potentially useful to assess central obesity in Hispanic-American adolescent children.
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Affiliation(s)
- María Dolores Marrodán Serrano
- Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.,EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Estela Román
- Institute of Biology of Altitude, National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Margarita Carmenate
- Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain
| | | | - Angel Herráez
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain.,Department of Systems Biology, University of Alcalá, Alcalá de Henares, Spain
| | - Enma Laura Alfaro
- Institute of Biology of Altitude, National University of Jujuy, San Salvador de Jujuy, Argentina
| | - Delia Beatriz Lomaglio
- Center for the Study of Biological Anthropology, Faculty of Natural Sciences, National University of Catamarca, Catamarca, Argentina
| | - Noemí López-Ejeda
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain
| | - María Soledad Mesa
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Betty Méndez Pérez
- Institute of Economic and Social Research, Central University of Venezuela, Caracas, Venezuela
| | - Juana María Meléndez
- Department of Nutrition, Research Center in Food and Development (CIAD), Hermosillo, Sonora, Mexico
| | - Susana Moreno-Romero
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain
| | - Consuelo Prado
- EPINUT Research Group, Faculty of Medicine, Complutense University of Madrid, Spain.,Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain
| | - José Edgardo Dipierri
- Institute of Biology of Altitude, National University of Jujuy, San Salvador de Jujuy, Argentina
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Aranha LN, de Oliveira GMM. Waist Circumference: A Simple Measure for Childhood Obesity? Arq Bras Cardiol 2020; 114:538-539. [PMID: 32267327 PMCID: PMC7792731 DOI: 10.36660/abc.20200031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Luciana Nicolau Aranha
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Lawal Y, Bello F, Anumah FE, Bakari AG. Waist-height ratio: How well does it predict glucose intolerance and systemic hypertension? Diabetes Res Clin Pract 2019; 158:107925. [PMID: 31715203 DOI: 10.1016/j.diabres.2019.107925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 02/05/2023]
Abstract
AIM The aim of this study is to assess whether WHtR is a better predictor of glucose intolerance and systemic hypertension than some other obesity indices. METHODS This is a cross-sectional observational study among four hundred (4 0 0) participants in a Northern Nigerian population. Four (4) participants were eventually excluded due to incomplete data, therefore data from three hundred and ninety six (3 9 6) participants were used in the final analysis. The study assessed whether WHtR is a better predictor of glucose intolerance and systemic hypertension compared to some other obesity indices. Participants were recruited after due consent, then bio-data, blood pressure levels, and some anthropometric measurements were obtained. Subsequently, plasma glucose levels (fasting [FPG] and 2-hour post 75 g glucose load [2HrPPG]) were measured. Data was entered into Microsoft Excel, then analyzed using IBM SPSS version 23. RESULTS Data from three hundred and ninety six (3 9 6) participants (4 excluded due to incomplete details) were analyzed. Logistic regression of obesity indices showed that WHtR was the best predictor of glucose intolerance with odds ratio (OD) of 20.74 (CI 2.80-155, p < 0.001), followed by WC with OD of 1.89 (CI 1.83-3.94, p < 0.001), then WHR with OD of 1.69 (CI 1.06-8.22, p = 0.009). The least but significant predictor of glucose intolerance was BMI with odds ratio of 1.12 (CI 1.06-3.18, p < 0.001). Furthermore, logistic regression of obesity indices showed that WHtR was the strongest predictor of systemic hypertension with OD of 2.32 (CI 4.85-14.96, p < 0.001), followed by BMI (OD 1.99, CI 1.96-2.05, p = 0.031), then WC (OD 1.95, CI 1.90-1.99, p = 0.020). The weakest predictor of systemic hypertension was WHR (OD 1.26, CI 0.04-1.88, p = 0.181). CONCLUSION WHtR had the highest predictive power for both glucose intolerance and systemic hypertension compared to BMI, WC, and WHR.
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Affiliation(s)
- Yakubu Lawal
- Consultant Physician and Endocrinologist, Federal Medical Centre, Azare, Bauchi state, Nigeria.
| | - Fatima Bello
- Consultant Physician and Endocrinologist, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - F E Anumah
- Consultant Physician and Endocrinologist, College of Health Sciences, University of Abuja, Nigeria
| | - A G Bakari
- Consultant Physician and Endocrinologist, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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Ma C, Lu Q, Wang R, Yin F. Using height-corrected definition of metabolic syndrome in children and adolescents. J Pediatr Endocrinol Metab 2019; 32:429-438. [PMID: 31050656 DOI: 10.1515/jpem-2018-0414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/23/2019] [Indexed: 02/06/2023]
Abstract
Metabolic syndrome (MS) is common among children and adolescents. Age- and gender-specific references or age-, gender- and height-specific references were used in pediatric MS definitions. More recently, an increasing number of studies documented that the ratio of waist circumference (WC) to height (WHtR) and blood pressure to height (BPHR) were easy anthropometric indexes for detection of obesity and hypertension in children and adolescents. For these reasons, height-corrected MS definition was proposed. WHtR and BPHR were used as alternatives to WC and BP in the definition of MS. In the present review, we discuss the possibility of the height-corrected MS definition for identifying MS in children.
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Affiliation(s)
- Chunming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fuzai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, No. 258 Wenhua Road, Qinhuangdao 066000, Hebei Province, China, Phone: +86-335-3634208, Fax: +86-335-3032042
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