Abstract
BackgroundPrevious studies have shown that waist-to-height ratio (WHtR) performed similarly well when compared to body mass index (BMI) and waist circumference (WC) for identifying cardiovascular risk factors. However, to our knowledge, the performance of these three adiposity indices for identifying left ventricular hypertrophy (LVH) and left ventricular geometric (LVG) remodeling in youth has not been assessed. We aimed to determine the utility of BMI, WC and WHtR for identifying LVH and LVG in Chinese children.MethodsThis study included 1,492 Chinese children aged 6-11 years. Adiposity indices assessed were BMI, WC and WHtR. LVH and high relative wall thickness (RWT) were defined using sex- and age-specific 90th percentile values of left ventricular mass index and RWT, respectively, based on the current population. LVG remodeling included concentric remodeling (CR), eccentric hypertrophy (EH) and concentric hypertrophy (CH), which was defined based on the combination of LVH and high RWT.ResultsThe magnitude of association of central obesity defined by WHtR with LVH [odds ratio (OR) =10.09, 95% confidence interval (CI) =6.66-15.29] was similar with general obesity defined by BMI (OR=10.49, 95% CI=6.97-15.80), and both were higher than central obesity defined by WC (OR=6.87, 95% CI=4.57-10.33). Compared with BMI, WHtR had better or similar predictive utility for identifying LVH, EH, and CH [the area under the curve (AUC): 0.84 vs. 0.79; 0.84 vs. 0.77; 0.87 vs. 0.88, respectively]; WC had worse or similar discriminatory utility with AUCs of 0.73, 0.70, 0.83, respectively.ConclusionWHtR performed similarly or better than BMI or WC for identifying LVH and LVG remodeling among Chinese children. WHtR provides a simple and convenient measure of central obesity that might improve the discrimination of children with cardiac structural damage.
Highlights
The prevalence of pediatric obesity has greatly increased worldwide, in low- and middle-income countries [1, 2]
Sex- and age-adjusted means for body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) were still higher among children with left ventricular hypertrophy (LVH) than those without LVH (BMI: 22.44 vs. 17.74 kg/m 2; WC: 72.88 vs. 61.91 cm; WHtR: 0.53 vs. 0.45)
About two thirds of children with LVH were classified as obese, irrespective of the indices (BMI, WC or WHtR) used to define obesity, which was around three times as high as the proportion for those without LVH
Summary
The prevalence of pediatric obesity has greatly increased worldwide, in low- and middle-income countries [1, 2]. Obesity increases the risk of left ventricular hypertrophy (LVH) and left ventricular geometric (LVG) remodeling [8,9,10,11] (markers of cardiac structural damage), which are independent predictors of cardiovascular disease (CVD) [12, 13]. LVH has been the most common target organ damage in children and adolescents with hypertension [17], and obesity is strongly associated with abnormal LVG modeling [8,9,10,11]. Assessing the presence of LVH and LVG in the early life using a simple and effective obesity-related indicator could be helpful to prevent target organ damage such as LVG remodeling in the short term and the CVD outcomes in the long term. We aimed to determine the utility of BMI, WC and WHtR for identifying LVH and LVG in Chinese children
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