Marcos Galván, Celina Ramírez-Ramírez, Guadalupe López-Rodríguez, Luis Martínez-Ureña, Gabriela Olvera-Mayorga, Patricia Olivo-Ramírez Diana, Teodoro Suárez Diéguez, Oscar Galván-Valencia
Nutritional Epidemiology Research Group (CAEPINUT), School of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, México.
Interdisciplinary Network of Experts in School Environments in Latin America, Pachuca, Hildago, México.
Am J Hum Biol. 2025 Jul;37(7):e70102. doi: 10.1002/ajhb.70102.
Body mass index (BMI) is a known indicator of adiposity. However, alternative measures have recently been proposed in children. We aimed to evaluate the validity of alternative adiposity indices (AIs)-BMI according to the World Health Organization (BMI-WHO) and the International Obesity Task Force (BMI-IOTF) standards, waist circumference (WC), and waist-to-height ratio (WHtR)-in detecting high body fat (HBF) in Mexican schoolchildren.
This cross-sectional analysis was conducted among 2189 schoolchildren in Hidalgo, Mexico. AIs including BMI-WHO, BMI-IOTF, WC, and WHtR were evaluated via anthropometry. Body fat (BF) was assessed using bioelectrical impedance analysis (BIA). The ability of the AIs to predict HBF was evaluated using sensitivity, specificity, and confidence intervals (95% CI). Agreements between AIs and BF were analyzed using Kappa correlation coefficients and Bland-Altman plots.
In detecting HBF, BMI-WHO showed a sensitivity of 98.2% (95% CI: 97.0-99.0) and a specificity of 59.3% (95% CI: 56.7-61.9), and WHtR showed 98.0% (95% CI: 96.6-98.8) and 57.4% (95% CI: 54.8-59.9), respectively. Among boys, moderate agreement was observed between HBF and BMI-WHO (Kappa = 0.52), WHtR (Kappa = 0.50), and WC (Kappa = 0.47), all with p < 0.001. Among girls, moderate agreement was found with BMI-WHO (Kappa = 0.45) and WHtR (Kappa = 0.41), also with p < 0.001. Bland-Altman analysis showed good agreement between HBF and WHtR and intermediate agreement with BMI-WHO.
BMI-WHO and WHtR demonstrate high validity for assessing HBF in schoolchildren. WHtR may serve as a practical alternative for routine screening and for evaluating the impact of interventions aimed at reducing risks associated with excessive BF accumulation.
体重指数（BMI）是一种已知的肥胖指标。然而，最近有人提出了针对儿童的替代测量方法。我们旨在评估根据世界卫生组织（BMI-WHO）和国际肥胖特别工作组（BMI-IOTF）标准的替代肥胖指数（AIs）——BMI、腰围（WC）和腰高比（WHtR）——在检测墨西哥学童高体脂（HBF）方面的有效性。
在墨西哥伊达尔戈州的2189名学童中进行了这项横断面分析。通过人体测量学评估包括BMI-WHO、BMI-IOTF、WC和WHtR在内的AIs。使用生物电阻抗分析（BIA）评估体脂（BF）。使用敏感性、特异性和置信区间（95%CI）评估AIs预测HBF的能力。使用Kappa相关系数和Bland-Altman图分析AIs与BF之间的一致性。
在检测HBF方面，BMI-WHO的敏感性为98.2%（95%CI：97.0-99.0），特异性为59.3%（95%CI：56.7-61.9），WHtR的敏感性和特异性分别为98.0%（95%CI：96.6-98.8）和57.4%（95%CI：54.8-59.9）。在男孩中，观察到HBF与BMI-WHO（Kappa = 0.52）、WHtR（Kappa = 0.50）和WC（Kappa = 0.47）之间存在中度一致性，所有p值均<0.001。在女孩中，发现BMI-WHO（Kappa = 0.45）和WHtR（Kappa = 0.41）之间存在中度一致性，p值也<0.001。Bland-Altman分析显示HBF与WHtR之间一致性良好，与BMI-WHO之间一致性中等。
BMI-WHO和WHtR在评估学童HBF方面显示出高有效性。WHtR可作为常规筛查以及评估旨在降低与过多BF积累相关风险的干预措施影响的实用替代方法。
