(18-07-13) Body Mass Index, Waist Circumference, and Waist-to-Height-Ratio as Predictors of Cardiometabolic Risk in Childhood Obesity

Body Mass Index, Waist Circumference, and Waist-to-Height-Ratio as Predictors of Cardiometabolic Risk in Childhood Obesity Depending on Pubertal Development.
Blüher S, Molz E, Wiegand S, Otto KP, Sergeyev E, Tuschy S, L'allemand-Jander D, Kiess W, Holl RW; for the APV Initiative and the German Competence Net Obesity.
Source
Leipzig University Medical Center (S.B.), IFB Adiposity Diseases, Germany; and Department of Women and Child Health (S.B., E.S., W.K.), Hospital for Children and Adolescents, University Hospital of Leipzig, D-04103 Leipzig, Germany; Institute of Epidemiology and Medical Biometry (E.M., R.W.H.), University of Ulm, D-89081 Ulm, Germany; Department of Pediatric Endocrinology and Diabetology (S.W.), Charité Universitätsmedizin Berlin, Berlin, D-10117 Germany; Children's Hospital Wilhelmsstift (K.-P.O.), D-22149 Hamburg, Germany; SANA Hospital Lichtenberg (S.T.), 10365 Berlin, Germany; and7 Eastern Swiss Children's Hospital (D.A.-J.), CH-9006 St. Gallen, Switzerland.
Abstract
Context:The predictive value of body-mass-index (BMI), waist circumference (WC), waist-to height ratio (WtHR) to define cardiometabolic risk is unclear in childhood obesity.Objective:The associations between BMI, WtHR or WC and cardiometabolic risk markers were analyzed in a multicenter data collection of obese youth.Design and Subjects:BMI, WtHR and WC were retrospectively evaluated in 1,278 patients (11-18 years, 53% boys) from the German/Austrian/Swiss APV registry.Main outcome measures:Parameters were correlated with homeostasis model assessment for insulin resistance, fasting insulin, blood pressure, transaminases, lipids and uric acid, applying adjusted regression models, with age group, pubertal stage and gender as covariates.Results:Homeostasis model assessment for insulin resistance and fasting insulin were most strongly correlated with BMI, independent of age group or gender. Lipids, transaminases and uric acid were most strongly correlated with WC with stronger associations for boys. Correlations between BMI and WC as well as metabolic markers and systolic blood pressure showed only minor differences. The pattern of relationship changed during the course of pubertal development with the strongest associations for pubertal children. None of the parameters showed a dependency on WtHR that was superior to BMI or WC.Conclusions:There is only small additional benefit in using WC measurements for routine pediatric care in addition to BMI for predicting metabolic risk. For all parameters, the relationship is strongest during midpuberty, emphasizing that among obese pubertal adolescents, anthropometric measures (BMI and WC) best predict cardiometabolic comorbidities. WtHR does not seem to be superior to BMI or WC in predicting metabolic or cardiovascular risk related to childhood obesity.

Source: J Clin Endocrinol Metab. 2013 Jun 17. [Epub ahead of print]

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