Abstract
ObjectivesThis study aimed to assess the accuracy of body mass index (BMI) percentile, waist circumference (WC) percentile, waist-height ratio, and waist-hip ratio for identifying cardiometabolic risk factors in Chinese children and adolescents stratified by sex and BMI categories.MethodsWe measured anthropometric indices, fasting plasma glucose, lipid profile and blood pressure for 15698 participants aged 6–17 in a national survey between September and December 2013. The predictive accuracy of anthropometric indices for cardiometabolic risk factors was examined using receiver operating characteristic (ROC) analyses. The DeLong test and Z test were used for the comparisons of areas under ROC curves (AUCs).ResultsThe prevalence of impaired fasting glucose, dyslipidemia, hypertension and cluster of risk factors were 2.9%, 27.3%, 10.5% and 5.7% respectively. The four anthropometric indices showed poor to fair discriminatory ability for cardiometabolic risk factors with the AUCs ranging from 0.53–0.72. Each index performed significantly better AUCs for dyslipidemia (0.59–0.63 vs. 0.56–0.59), hypertension (0.62–0.70 vs. 0.55–0.65) and clustered risk factors (0.70–0.73 vs. 0.60–0.64) in boys than that in girls. BMI percentile performed the best accuracy for hypertension in both sexes; WC percentile had the highest AUC for dyslipidemia and BMI percentile and waist-height ratio performed similarly the best AUCs for clustered risk factors in boys while BMI percentile, WC percentile and waist-height ratio performed similar and better AUCs for dyslipidemia and clustered risk factors in girls; whereas waist-hip ratio was consistently the poorest predictor for them regardless of sex. Though the anthropometric indices were more predictive of dyslipidemia, hypertension and clustered risk factors in overweight/obese group compared to their normal BMI peers, the AUCs in overweight/obese group remained in the poor range below 0.70.ConclusionsAnthropometric indices are not effective screening tools for pediatric cardiometabolic risk factors, even in overweight/obese children.
Highlights
Cardiometabolic risk factors among children and adolescents, including hyperglycemia, dyslipidemia, hypertension, etc, have increased with the global pandemic of childhood obesity over recent decades[1]
The four anthropometric indices showed poor to fair discriminatory ability for cardiometabolic risk factors with the area under the ROC curve (AUC) ranging from 0.53–0.72
Each index performed significantly better AUCs for dyslipidemia (0.59– 0.63 vs. 0.56–0.59), hypertension (0.62–0.70 vs. 0.55–0.65) and clustered risk factors
Summary
Cardiometabolic risk factors among children and adolescents, including hyperglycemia, dyslipidemia, hypertension, etc, have increased with the global pandemic of childhood obesity over recent decades[1]. Some studies have suggested that certain, not all, anthropometric indices were useful screening tools for identifying children and adolescents with elevated cardiometabolic risk[9,10,11,12,13]; on the contrary, other studies disapproved of anthropometric indices for predicting pediatric cardiometabolic risks due to the poor accuracy observed[14,15,16] In these studies, the discriminatory ability of BMI, WC, and waist-height ratio for cardiometabolic risk factors have been studied a lot while there were few studies on waist-hip ratio, a commonly used index for central obesity in adults. Further research is warranted to investigate the predictive accuracy of anthropometric indices for screening cardiometabolic risks
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