Elsevier

Endocrine Practice

Volume 22, Issue 10, October 2016, Pages 1170-1176
Endocrine Practice

Original Article
Diagnostic Performance of Waist Circumference Measurements for Predicting Cardiometabolic Risk in Mexican Children

https://doi.org/10.4158/EP161291.ORGet rights and content

ABSTRACT

Objective: The accumulation of abdominal fat is associated with cardiometabolic abnormalities. Waist circumference (WC) measurements allow an indirect evaluation of abdominal adiposity. However, controversy exists over which WC reference values are the most suitable for identifying the pediatric population at risk. The aim of the study was to evaluate the ability of various WC indices to identify abdominal obesity as diagnostic tools for predicting cardiometabolic risk in Mexican children and adolescents.

Methods: Anthropometric measurements were performed and biochemical profiles determined in a crosssectional study that included 366 children and adolescents. Four parameters were used to evaluate abdominal obesity in our study group: (1) WC >90th percentile, according to the Fernández reference in a Mexican-American population measured by the National Center for Health Statistics (NCHS) technique; (2) WC >90th percentile, according to the Klünder reference in a Mexican population (measured by the World Health Organization [WHO] technique); (3) waist-to-height ratio (WHtR) >0.5 according to WHO; and (4) WHtR >0.5 according to NCHS. The ability of each of the indices to discriminate cardiometabolic abnormalities (fasting plasma glucose, dyslipidemia, and hypertension) was assessed.

Results: WHtR >0.5 according to WHO or NCHS references showed greater sensitivity to detect metabolic abnormalities compared to percentile reference parameters (74.3 to 100% vs. 59.0 to 88.9%; P<.05). However, the percentiles displayed more specificity to identify these alterations (46.2 to 62.2 vs. 21.3 to 46.9; P<.05). Area under the curve analysis showed that WHtR >0.5 can more readily detect hypertriglyceridemia (0.642), hypoalphalipoproteinemia (0.700), and a combination of two or more metabolic abnormalities (0.661), whereas WC >90th percentile, according to Klünder, better detected hyperglycemia (0.555).

Conclusion: WHtR >0.5 is a sensitive measure to identify pediatric patients with cardiometabolic alterations, despite its low specificity, and is a useful diagnostic tool to detect populations at risk. Based on the results of this study, we recommend preferential use of the Klünder waist circumference references over the Fernández method in Mexican pediatric populations.

Abbreviations:

AUC = area under the curve

BMI = body mass index

HDL = high-density lipoprotein

IDF = International Diabetes Federation

LDL = low-density lipoprotein

MS = metabolic syndrome

NCHS = National Center for Health Statistics

ROC = receiver operating characteristic

WC = waist circumference

WHO = World Health Organization

WHtR = waist-to-height ratio

Section snippets

INTRODUCTION

Childhood obesity is one of the most serious problems of the 21st century, and its prevalence has continued to rise at an accelerated rate (1). In Mexico, the prevalence of overweight and obesity in children and adolescents is approximately 34.4% (2). It is well known that obesity increases the risk of developing cardiovascular and metabolic disorders. One of the challenges physicians face is the timely identification of individuals at risk (3–5). Obesity is associated with insulin resistance

METHODS

We conducted a cross-sectional study in the Pediatric Obesity Clinic at the Hospital General de México, Eduardo Liceaga in Mexico City. Children and adolescents 10 to 18 years of age were recruited. Patients with overweight or obesity who attended the clinic for the first time were invited to participate. Normal-weight children (BMI ≥ 5th and < 85th percentile) were recruited from 17 urban-area elementary schools located in Mexico City. We recruited normal-weight children with the intention of

RESULTS

The study included a total of 366 children and adolescents, 290 (79.2%) of whom were classified with overweight or obesity and 76 (20.8%) of whom were of normal weight. Demographic and biochemical characteristics of all participants and their cardiometabolic risk variables are shown in Table 1.

The frequencies of abnormal values for different parameters of cardiometabolic risk were 7.7% for arterial hypertension, 10.7% for impaired fasting glycemia (prediabetes), 37.4% for hypertriglyceridemia,

DISCUSSION

The increased prevalence of childhood obesity is associated with comorbidities, in particular those associated with the development of abdominal obesity such as insulin resistance and MS (18). Evidence has suggested that abdominal obesity predisposes individuals to cardiometabolic risk, that this risk is independent of BMI (19,20), and that physicians can evaluate abdominal fat clinically through the measurement of WC. Our results were consistent with those published in the international

CONCLUSION

WHtR >0.5 is a sensitive measure for identifying pediatric patients at risk of cardiometabolic alterations. Despite its low specificity, it is a useful diagnostic tool to detect a population at risk. Based on the results of our study, we recommend preferential use of the Klünder WC references over those of Fernández in a Mexican pediatric population. We concur with other authors regarding communicating a simple and useful message to the population as a preventive measure of cardiometabolic

ACKNOWLEDGMENT

This work was supported by a grant from CONACyT SALUD-2012-01-181786, Mexico.

DISCLOSURE

The authors have no multiplicity of interest to disclose.

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