Abstract
Background and objectives Although Body Mass Index (BMI) is used to assess obesity, it does not always relate to central obesity, the main metabolic risk factor. Waist to height ratio (WHtR) is a simple index of central obesity. This study assessed its usefulness in detecting metabolic derangements in 5-15 year old Sri Lankan children. Method A cross sectional descriptive study on healthy 5-15 year old children was conducted in Colombo district. Height, weight and Waist Circumference (WC) were measured. WHtR and BMI (classified by WHO cutoff >2SD) were calculated. Obesity was defined by percentage fat mass measured by Bio Electrical Impedance Assay (BIA - InBody-230 BIA machine) and validated against Sri Lanka body composition equations. After a 12-hour overnight fast, blood was drawn for Fasting Blood Glucose (FBG) and lipid profile. Standard Oral Glucose Tolerance Test (OGTT) was performed to obtain Random Blood Glucose (RBG) at 2 hours. Metabolic Derangements (MetD) were defined as; WC for age >90th centile (UK standards); FBG>100mg/dl or RBG>140 mg/dl; HDL-cholesterol 150mg/dl; and systolic or diastolic blood pressure>+2SD for age (UK standards). Metabolic Syndrome (MetS) was diagnosed by high WC plus ≥2 other MetD. ROC curves were drawn to determine the optimal WHtR value that predicts MetS as well as ≥2 MetD. Using these cutoffs, WHtR was also validated against obesity determined by % fat mass. Results A total of 920 children (547 boys) were studied: 16.6% were obese/overweight and 55.6% had normal BMI. Close to 14% had central obesity. Those with normal BMI but having central obesity had higher total cholesterol and triglyceride levels, but were not statistically significant. WHtR detected more cases with abnormal cholesterol and HDL than BMI, but detection of cases with high triglycerides was similar to BMI. WHtR to detect MetS was 0.51 (sensitivity-1.00; specificity-0.83) in boys and 0.49 (sensitivity-0.83; specificity-0.83) in girls. To detect ≥2 MetD, WHtR was 0.42 (sensitivity-0.6; specificity-0.62) in boys and 0.45(sensitivity-0.62; specificity-0.62) in girls. Conclusions WHtR is valid in detecting metabolic derangements in this group of Sri Lankan children. The cut off values (0.5) described to detect MetS in this group of children is similar to the value described in the literature. A cutoff value of 0.45 would detect at least two MetD, thus enabling early detection of obesity related metabolic morbidity.
Highlights
Background and objectives Body MassIndex (BMI) is used to assess obesity, it does not always relate to central obesity, the main metabolic risk factor
Non communicable diseases (NCD) such as diabetes mellitus and cardiovascular disease are increasing all over the world with its onset occurring at a younger age
In 5-17 year old children in the Bogalusa heart study, Body Mass Index (BMI)-for-age and waist-to-height ratio did not differ in their ability to identify children with adverse metabolic risk
Summary
Background and objectives Body MassIndex (BMI) is used to assess obesity, it does not always relate to central obesity, the main metabolic risk factor. This study assessed its usefulness in detecting metabolic derangements in 5-15 year old Sri Lankan children. ROC curves were drawn to determine the optimal WHtR value that predicts MetS as well as ≥2 MetD Using these cutoffs, WHtR was validated against obesity determined by % fat mass. Conclusions WHtR is valid in detecting metabolic derangements in this group of Sri Lankan children. A cutoff value of 0.45 would detect at least two MetD, enabling early detection of obesity related metabolic morbidity. Lifestyle changes have resulted in an exponential rise in obesity, both childhood and adulthood This is associated with metabolic derangements such as dysglycaemia, dyslipidaemia and hypertension, and thereby directly contributing to the rise in NCD. It is not practical to periodically assess these in blood due to discomfort as well as cost, but an effective and practical surrogate marker would be of more use
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