Reference Center for the Treatment of Children and Adolescents, Campos, Rio de Janeiro, Brazil.
BMC Pediatr. 2013 Jun 11;13:91. doi: 10.1186/1471-2431-13-91.
Childhood obesity is a public health problem worldwide. Visceral obesity, particularly associated with cardio-metabolic risk, has been assessed by body mass index (BMI) and waist circumference, but both methods use sex-and age-specific percentile tables and are influenced by sexual maturity. Waist-to-height ratio (WHtR) is easier to obtain, does not involve tables and can be used to diagnose visceral obesity, even in normal-weight individuals. This study aims to compare the WHtR to the 2007 World Health Organization (WHO) reference for BMI in screening for the presence of cardio-metabolic and inflammatory risk factors in 6-10-year-old children.
A cross-sectional study was undertaken with 175 subjects selected from the Reference Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro, Brazil. The subjects were classified according to the 2007 WHO standard as normal-weight (BMI z score>-1 and<1) or overweight/obese (BMI z score≥1). Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glycemia, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), Homeostatic Model Assessment--Insulin Resistance (HOMA-IR), leukocyte count and ultrasensitive C-reactive protein (CRP) were also analyzed.
There were significant correlations between WHtR and BMI z score (r=0.88, p<0.0001), SBP (r=0.51, p<0.0001), DBP (r=0.49, p<0.0001), LDL (r=0.25, p<0.0008, HDL (r=-0.28, p<0.0002), TG (r=0.26, p<0.0006), HOMA-IR (r=0.83, p<0.0001) and CRP (r=0.51, p<0.0001). WHtR and BMI areas under the curve were similar for all the cardio-metabolic parameters. A WHtR cut-off value of >0.47 was sensitive for screening insulin resistance and any one of the cardio-metabolic parameters.
The WHtR was as sensitive as the 2007 WHO BMI in screening for metabolic risk factors in 6-10-year-old children. The public health message "keep your waist to less than half your height" can be effective in reducing cardio-metabolic risk because most of these risk factors are already present at a cut point of WHtR≥0.5. However, as this is the first study to correlate the WHtR with inflammatory markers, we recommend further exploration of the use of WHtR in this age group and other population-based samples.
儿童肥胖是一个全球性的公共卫生问题。内脏肥胖，尤其是与心血管代谢风险相关的肥胖，已经通过身体质量指数（BMI）和腰围来评估，但这两种方法都使用了性别和年龄特定的百分位数表，并且受到性成熟的影响。腰高比（WHtR）更容易获得，不需要使用表格，并且可以用于诊断内脏肥胖，即使在体重正常的个体中也是如此。本研究旨在比较 WHtR 与 2007 年世界卫生组织（WHO）BMI 参考值，以筛查 6-10 岁儿童存在的心血管代谢和炎症风险因素。
这是一项横断面研究，在巴西里约热内卢坎波斯的儿童和青少年治疗参考中心选择了 175 名受试者。根据 2007 年 WHO 标准，受试者被分为正常体重（BMI z 评分>-1 和<1）或超重/肥胖（BMI z 评分≥1）。还分析了收缩压（SBP）、舒张压（DBP）、空腹血糖、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、甘油三酯（TG）、稳态模型评估-胰岛素抵抗（HOMA-IR）、白细胞计数和超敏 C 反应蛋白（CRP）。
WHtR 与 BMI z 评分（r=0.88，p<0.0001）、SBP（r=0.51，p<0.0001）、DBP（r=0.49，p<0.0001）、LDL（r=0.25，p<0.0008）、HDL（r=-0.28，p<0.0002）、TG（r=0.26，p<0.0006）、HOMA-IR（r=0.83，p<0.0001）和 CRP（r=0.51，p<0.0001）之间存在显著相关性。WHtR 和 BMI 的曲线下面积在所有心血管代谢参数方面相似。WHtR 截断值>0.47 对筛查胰岛素抵抗和任何一种心血管代谢参数均具有敏感性。
WHtR 与 2007 年 WHO BMI 一样敏感，可以筛查 6-10 岁儿童的代谢危险因素。“保持腰围小于身高一半”的公共卫生信息可以有效降低心血管代谢风险，因为在 WHtR≥0.5 的切点，大多数这些风险因素已经存在。然而，由于这是首次将 WHtR 与炎症标志物相关联的研究，我们建议进一步探索 WHtR 在该年龄组和其他基于人群的样本中的应用。
