Original Article
A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth

https://doi.org/10.1016/j.jpeds.2004.12.028Get rights and content

Objective

Determine whether waist-to-height ratio (WHtR) or sex- and age-specific percentiles of body mass index (BMI) better identifies cardiovascular risk.

Study design

The third National Health and Nutrition Examination Survey (NHANES III) provided measurements on 7657 participants statistically weighted to represent 50.05 million youth 4 to 17 years of age. We estimated the subpopulations corresponding to BMI strata that were normal (<85th percentile), at risk for overweight (85th to <95th percentile), and overweight (≥95th percentile). We chose WHtR cutoff points (0.490 and 0.539) so that subpopulation sizes in the three WHtR strata would equal those in the three BMI strata. For 13 cardiovascular risk factors we compared mean levels among youth discordant for their BMI and WHtR strata.

Results

726 participants (representing 3.69 million youth) were identified as having WHtR stratum >BMI stratum. Compared with the 603 participants (representing 3.70 million youth) who were discordant in the opposite direction, weighted analyses showed they had higher mean levels of heart rate, low-density lipoprotein (LDL) cholesterol, fasting triglycerides, and total cholesterol (P <.015, adjusted for sex, age, and race-ethnicity). Their mean systolic blood pressure was lower, but this difference was eliminated after adjustment for their shorter stature.

Conclusion

WHtR, a simpler anthropometric index than sex- and age-specific BMI percentiles, better identifies youth with adverse cardiovascular risk factors.

Section snippets

Methods

Our analytic population was drawn from the third National Health and Nutrition Examination Survey (NHANES III), a probability sample of the noninstitutionalized US population studied in 1988–1994. This complex, multistage survey oversampled non-Hispanic blacks and Mexican Americans. Each participant was assigned a sampling weight that accounted for unequal selection probabilities (clustered design, planned oversampling, and differential nonresponse).10 Our final analytic population contained

Results

Our analysis of discordant subpopulations found that youth whose WHtR stratum was higher than their BMI-percentile stratum included a disproportionately high percentage of girls (55.7% ± 3.2%), a disproportionately low percentage of non-Hispanic blacks (7.0% ± 0.8%), and a disproportionately high percentage of Mexican Americans (13.9% ± 1.5%) when compared with our estimated total youth population. Those subpopulations whose BMI-percentile stratum was higher than their WHtR stratum had

Discussion

Our population-based comparison of two anthropometric indices demonstrated that WHtR could serve better than sex- and age-specific BMI percentiles for identifying US youth with high heart rate or adverse concentrations of LDL cholesterol, triglycerides, and total cholesterol. There also was a suggestion (nonsignificant) that youth with elevated total cholesterol/HDL cholesterol, apolipoprotein B, or apolipoprotein B/apolipoprotein AI would be better identified by WHtR. For adverse levels of HDL

References (46)

  • J. Wang et al.

    Comparisons of waist circumferences measured at 4 sites

    Am J Clin Nutr

    (2003)
  • K.M. Flegal et al.

    Prevalence of overweight in US children: comparison of US growth charts from the Centers for Disease Control and Prevention with other reference values for body mass index

    Am J Clin Nutr

    (2001)
  • A. Pietrobelli et al.

    Body mass index as a measure of adiposity among children and adolescents: a validation study

    J Pediatr

    (1998)
  • Z. Mei et al.

    Validity of body mass index compared with other body-composition screening indexes for the assessment of body fatness in children and adolescents

    Am J Clin Nutr

    (2002)
  • P. Gordon-Larsen et al.

    Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health

    Am J Clin Nutr

    (2004)
  • I.S. Okosun et al.

    Abdominal adiposity in U.S. adults: prevalence and trends, 1960-2000

    Prev Med

    (2004)
  • K.J. Ellis

    Visceral fat mass in childhood: a potential early marker for increased risk of cardiovascular disease

    Am J Clin Nutr

    (1997)
  • C.L. Ogden et al.

    Prevalence and trends in overweight among US children and adolescents, 1999-2000

    JAMA

    (2002)
  • D. Jolliffe

    Extent of overweight among US children and adolescents from 1971 to 2000

    Int J Obes Relat Metab Disord

    (2004)
  • C.L. Ogden et al.

    Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version

    Pediatrics

    (2002)
  • S.C. Savva et al.

    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)
  • M. Hara et al.

    Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren

    J Atheroscler Thromb

    (2002)
  • S.D. Hsieh et al.

    Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women

    Intern Med

    (1995)
  • Cited by (248)

    • New anthropometric indices in the definition of metabolic syndrome in pediatrics

      2019, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
    View all citing articles on Scopus
    View full text