Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis

Yuan Jiang,Myanca Rodrigues,Weili Yan,Yin Wang,Xiaotian Chen,Yi Zhang,Hongyan Chen,Yalan Dou

doi:10.1186/s13098-021-00688-7

Abstract

ObjectiveTo provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used.MethodsSearches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR3), two (CMR2), one (CMR1), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95% CIs and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity.ResultsFifty-three observational studies were included. The AUSROC reached 0.91 (95% CI: 0.88–0.93), 0.85 (95% CI: 0.81, 0.88) and 0.75 (95% CI: 0.71, 0.79) for CMR3, CMR2, and CMR1, respectively. The pooled sensitivity and specificity for CMR3 reached 0.84 and exceeded 0.75 for CMR2. For CMR1, the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses.ConclusionsWHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.

Highlights

Childhood obesity is associated with various cardiometabolic risk factors (CMRs), such as elevated fasting blood glucose (FBG), elevated glycated haemoglobin levels, dyslipidaemia, and elevated blood pressure (BP) [1, 2]
Through evaluating the performance and robustness of waist-to-height ratio (WHtR) based on up-to-date studies, our meta-analysis extended previous findings to evaluate the practical values of WHtR as a screening tool in discriminating individual and clusters of CMRs
We explored the heterogeneity of the results, for the primary outcome CMR3, by only summarising studies that used identical CMR components, e.g. FBG, high-density leptin cholesterol (HDL-C), TG, BP, and central obesity

Summary

Introduction

Childhood obesity is associated with various cardiometabolic risk factors (CMRs), such as elevated fasting blood glucose (FBG), elevated glycated haemoglobin levels, dyslipidaemia, and elevated blood pressure (BP) [1, 2] The presence of these CMRs may be tracked to adulthood and is associated with an increased risk of cardiovascular and metabolic diseases [3]. Identifying the high-risk groups with CMRs from an early age people with obesity could benefit in improving health awareness and behaviour of children and further promote their long-term adherence [5]. This may be of great potential to prevent the development of advanced stages to cardiometabolic diseases. As the prevention and early detection of CMRs before the onset of obesity-related medical problems are critically important for children, obesity-related anthropometric indexes with easy measurement and classifications have been considered to detect paediatric CMRs rapidly and economically [8, 9]

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Conclusion