Korean J Pediatr Gastroenterol Nutr.  2010 Sep;13(2):180-192. 10.5223/kjpgn.2010.13.2.180.

Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

• Gil JH
• Lee MN
• Lee HA
• Park H
• Seo JW

• KMID: 1459434
• DOI: http://doi.org/10.5223/kjpgn.2010.13.2.180

Abstract

PURPOSE
To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents.
METHODS
Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program.
RESULTS
The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC> or =90th percentiles.
CONCLUSION
The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

Keyword

Waist circumference to height ratio; Children; Adolescents; Overweight; Obesity; Body mass index; Cutoff values

MeSH Terms

Adolescent
Area Under Curve
Body Mass Index
Child
Humans
Mass Screening
Obesity
Overweight
Phenothiazines
ROC Curve
Waist Circumference
Phenothiazines

Figure

• 

  Fig. 1 Percentile curves of waist circumference-to-height ratio for Korean children and adolescents 2~18 years of age (A) Boys, (B) Girls. Dashed line shows universal cutoff value of 0.5 for adults. Age: completed age, e.g., 6 years= 6~<7 years etc.

• 

  Fig. 2 The area under curves of waist circumference-to-height ratio for diagnosing overweight and obesity were significantly higher than that of waist circumference in both sexes aged 6 to 18 years (A) Obese boys, (B) Obese girls, (C) Overweight and obese boys, (D) Overweight and obese girls.

Reference

1. Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006. 118:e1390–e1398.

2. Oh KW, Jang MJ, Lee NY, Moon JS, Lee CG, Yoo MH, et al. Prevalence and trends in obesity among Korean children and adolescents in 1997 and 2005. Korean J Pediatr. 2008. 51:950–955.

3. Kim YS, Park MJ. Time trend in height, weight, BMI and waist circumference of Korean adolescents; from the Korean National Health and Nutrition Examination Survey (KNHNES), 1998, 2001 and 2005. J Korean Soc Pediatr Endocrinol. 2007. 12:142–149.

4. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM. The predictive value of childhood body mass index values for overweight at age 35 y. Am J Clin Nutr. 1994. 59:810–819.

5. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord. 2000. 24:1453–1458.

6. Daniels SR, Morrison JA, Sprecher DL, Khoury P, Kimball TR. Association of body fat distribution and cardiovascular risk factors in children and adolescents. Circulation. 1999. 99:541–545.

7. Barlow SE. Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007. 120:Suppl 4. S164–S192.

8. Cho KY, Park H, Seo JW. The Relationship between lifestyle and metabolic syndrome in obese children and adolescents. Korean J Pediatr Gastroenterol Nutr. 2008. 11:150–159.

9. Yom HW, Shin JS, Lee HJ, Park SE, Jo SJ, Seo JW. The metabolic syndrome in obese children. Korean J Pediatr Gastroenterol Nutr. 2004. 7:228–238.

10. Seo JW. Obesity in children and adolescents. Korean J Pediatr. 2009. 52:1311–1320.

11. Kim JH, Lim IS. Correlation of measurements for body fat in obese children. Korean J Pediatr. 2004. 47:485–490.

12. Maynard LM, Wisemandle W, Roche AF, Chumlea WC, Guo SS, Siervogel RM. Childhood body composition in relation to body mass index. Pediatrics. 2001. 107:344–350.

13. Inoue S, Zimmet P, Caterson I, Chunming C, Ikeda Y, Kim YS, et al. The Asia-Pacific Perspective: Redefining Obesity and its Treatment. The International Diabetes Institute. 2000. Available from: URL//http://www.diabets.com.au/pdf/obesity_report.pdf.

14. Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3~19 y. Am J Clin Nutr. 2000. 72:490–495.

15. Weili Y, He B, Yao H, Dai J, Cui J, Ge D, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity (Silver Spring). 2007. 15:748–752.

16. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese school children. J Atheroscler Thromb. 2002. 9:127–132.

17. Hsieh SD, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Int J Obes Relat Metab Disord. 2003. 27:610–616.

18. Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circ J. 2009. 73:1643–1650.

19. Kahn HS, Imperatore G, Cheng JY. A population based comparison of BMI percentiles and waist-to height ratio for identifying cardiovascular risk in youth. J Pediatr. 2005. 146:482–488.

20. Ashwell M, Lejeune S, McPherson K. Ratio of waist circumference to height may be better indicator of need for weight management. BMJ. 1996. 312:377.

21. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005. 56:303–307.

22. McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message - 'keep your waist circumference to less than half your height'. Int J Obes (Lond). 2006. 30:988–992.

23. Sung RY, So HK, Choi KC, Nelson EA, Li AM, Yin JA, et al. Waist circumference and waist-to-height ratio of Hong Kong Chinese children. BMC Public Health. 2008. 8:324.

24. Lee DH, Hong YM, Lee KY. The committee for public health statistics, the committee for nutrition. 1998 Korean national growth charts. 1999. Seoul: The Korean Pediatric Society.

25. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008. 51:1–25.

26. 2007 Korean Children and Adolescents Growth Standard (commentary for the development of 2007 growth charts). Government report online. Korea Center for Disease Control and Prevention, The Korean Pediatric Society, The Committee for the Development of Growth Standard for Korean Children and Adolescents. 2007. 11. Seoul: Division of Chronic Disease Surveillance;Available from: URL://www.cdc.go.kr/webcdc/.

27. Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med. 2000. 45:23–41.

28. Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005. 47:458–472.

29. Byun JS, Kim MJ, Hwang YW, Kim MJ, Kim SY, Hwang IH. The usefulness of waist/height ratio as an obesity index. J Korean Acad Fam Med. 2004. 25:307–313.

30. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tatò L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res. 2001. 9:179–187.

31. Revenga-Frauca J, González-Gil EM, Bueno-Lozano G, De Miguel-Etayo P, Velasco-Martínez P, Rey-López JP, et al. Abdominal fat and metabolic risk in obese children and adolescents. J Physiol Biochem. 2009. 65:415–420.

32. Hsieh SD, Yoshinaga H. Do people with similar waist circumference share similar health risks irrespective of height? Tohoku J Exp Med. 1999. 188:55–60.

33. Daniels SR, Khoury PR, Morrison JA. The utility of body mass index as a measure of body fatness in children and adolescents; differences by race and gender. Pediatrics. 1997. 99:804–807.

34. Quak SH, Furnes R, Lavine J, Baur LA. Obesity Working Group. Obesity in children and adolescents. J Pediatr Gastroenterol Nutr. 2008. 47:254–259.

35. Hsieh SD, Yoshinaga H, Muto T, Sakurai Y, Kosaka K. Health risks among Japanese men with moderate body mass index. Int J Obes Relat Metab Disord. 2000. 24:358–362.

36. Ashwell M. The Ashwell Shape Chart-a public health approach to the metabolic risks of obesity. Int J Obes Relat Metab Disord. 1998. 22:3 Suppl. S213.

37. Lin WY, Lee LT, Chen CY, Lo H, Hsia HH, Liu IL, et al. Optimal cut-off values for obesity: using simple anthropometric indices to predict cardiovascular risk factors in Taiwan. Int J Obes Relat Metab Disord. 2002. 26:1232–1238.

38. Viggiano D, De Filippo G, Rendina D, Fasolino A, D'Alessio N, Avellino N, et al. O.Si.M.E. Study Group. Screening of metabolic syndrome in obese children: a primary care concern. J Pediatr Gastroenterol Nutr. 2009. 49:329–334.

39. Johnson ST, Kuk JL, Mackenzie KA, Huang TT, Rosychuk RJ, Ball GD. Metabolic risk varies according to waist circumference measurement site in overweight boys and girls. J Pediatr. 2010. 156:247–252.

40. Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr. 2003. 77:379–384.