Is the 90th Percentile Adequate? The Optimal Waist Circumference Cutoff Points for Predicting Cardiovascular Risks in 124,643 15-Year-Old Taiwanese Adolescents.

Jason Jiunshiou Lee,Chinyu Ho,Jade Chienyu Yeh,Hsin-Jen Chen,Sarah Deferranti,Nicole Huang,Jennifer L Baker

doi:10.1371/journal.pone.0158818

Abstract

Adolescent obesity has increased to alarming proportions globally. However, few studies have investigated the optimal waist circumference (WC) of Asian adolescents. This study sought to establish the optimal WC cutoff points that identify a cluster of cardiovascular risk factors (CVRFs) among 15-year-old ethnically Chinese adolescents. This study was a regional population-based study on the CVRFs among adolescents who enrolled in all the senior high schools in Taipei City, Taiwan, between 2011 and 2014. Four cross-sectional health examinations of first-year senior high school (grade 10) students were conducted from September to December of each year. A total of 124,643 adolescents aged 15 (boys: 63,654; girls: 60,989) were recruited. Participants who had at least three of five CVRFs were classified as the high-risk group. We used receiver-operating characteristic curves and the area under the curve (AUC) to determine the optimal WC cutoff points and the accuracy of WC in predicting high cardiovascular risk. WC was a good predictor for high cardiovascular risk for both boys (AUC: 0.845, 95% confidence interval [CI]: 0.833–0.857) and girls (AUC: 0.763, 95% CI: 0.731–0.795). The optimal WC cutoff points were ≥78.9 cm for boys (77th percentile) and ≥70.7 cm for girls (77th percentile). Adolescents with normal weight and an abnormal WC were more likely to be in the high cardiovascular risk group (odds ratio: 3.70, 95% CI: 2.65–5.17) compared to their peers with normal weight and normal WC. The optimal WC cutoff point of 15-year-old Taiwanese adolescents for identifying CVRFs should be the 77th percentile; the 90th percentile of the WC might be inadequate. The high WC criteria can help health professionals identify higher proportion of the adolescents with cardiovascular risks and refer them for further evaluations and interventions. Adolescents’ height, weight and WC should be measured as a standard practice in routine health checkups.

Highlights

Childhood and adolescent obesity has increased to alarming proportions globally because of sedentary lifestyles and unhealthy dietary habits in both developed and developing countries [1,2,3,4]
The area under the curve (AUC) identified in receiver-operating characteristic (ROC) analysis for the boys and girls were 0.845 (95% confidence interval [CI]: 0.833–0.857) and 0.763 (Figs 1 and 2)
Determining the shortest distance from the ROC curve to the upper-left corner ideal point indicated that the optimal waist circumference (WC) cutoff points are 78.9 cm for 15-year-old boys and 70.7 cm for 15-year-old girls

Summary

Introduction

Childhood and adolescent obesity has increased to alarming proportions globally because of sedentary lifestyles and unhealthy dietary habits in both developed and developing countries [1,2,3,4]. Abdominal obesity is associated with a higher risk of diabetes and cardiovascular disease [10,11,12]. The U.S National Institutes of Health guidelines suggest that the WC thresholds of cardio-metabolic risk in adults are 102 cm for men and 88 cm for women [14,15,16,17]. The International Diabetes Federation (IDF) consensus definition of metabolic syndrome in children and adolescents designates the 90th percentile of WC as the cutoff point for defining central obesity, with ethnicity-specific values for European-American, African-American, and Mexican-American populations [20,21,22]

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Conclusion