Huo Jiawen, Liu Jianfeng, Chen Jiying, Li Qiaolin, Shen Lanling, Liang Juanjuan, Jiang Jie
Department of Paediatrics, The Affiliated Second Hospital, Hengyang Medical school, University of South China, Hengyang, China.
Department of Nephrology, The Affiliated Second Hospital, Hengyang Medical school, University of South China, Hengyang, China.
PLoS One. 2025 Jul 23;20(7):e0324354. doi: 10.1371/journal.pone.0324354. eCollection 2025.
Albuminuria is a recognized marker of early kidney damage and cardiometabolic risk in pediatric populations. While central obesity is known to contribute to renal dysfunction, the relevance of the weight-adjusted waist index (WWI), a novel indicator of central adiposity, has not been fully explored in children and adolescents.
This study included 4,000 participants aged 3-19 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. WWI was calculated as waist circumference divided by the square root of body weight. Albuminuria was defined as an albumin-creatinine ratio (ACR) > 30 mg/g. Multivariable logistic regression, subgroup analyses, threshold effect modeling, and receiver operating characteristic (ROC) curves were used to evaluate the association between WWI and albuminuria.
Higher WWI was significantly associated with lower odds of albuminuria in the fully adjusted model (OR = 0.64; 95% CI: 0.55-0.75). This inverse relationship was strongest among adolescents (13-19 years), modest in children aged 7-12 years, and not significant in the 3-6-year group. In the youngest group, a U-shaped association was identified, with an inflection point at 11.73 cm/√kg. ROC analysis showed WWI had superior discriminatory ability (AUC = 0.628) for albuminuria compared to BMI, waist circumference, height, and weight.
WWI demonstrates an age-dependent and non-linear association with albuminuria in U.S. children and adolescents. These findings suggest that WWI may offer a more refined anthropometric indicator of renal risk in youth and support its potential as a screening tool in pediatric populations.
蛋白尿是儿童群体早期肾脏损伤和心脏代谢风险的公认标志物。虽然已知中心性肥胖会导致肾功能不全，但体重调整腰围指数（WWI）作为一种新的中心性肥胖指标，在儿童和青少年中的相关性尚未得到充分研究。
本研究纳入了2017 - 2020年美国国家健康与营养检查调查（NHANES）中4000名3 - 19岁的参与者。WWI的计算方法是腰围除以体重的平方根。蛋白尿定义为白蛋白 - 肌酐比值（ACR）>30mg/g。采用多变量逻辑回归、亚组分析、阈值效应模型和受试者工作特征（ROC）曲线来评估WWI与蛋白尿之间的关联。
在完全调整模型中，较高的WWI与较低的蛋白尿几率显著相关（OR = 0.64；95%CI：0.55 - 0.75）。这种负相关关系在青少年（13 - 19岁）中最强，在7 - 12岁儿童中适中，在3 - 6岁组中不显著。在最年幼的组中，发现了一种U型关联，拐点为11.73cm/√kg。ROC分析表明，与体重指数（BMI）、腰围、身高和体重相比，WWI对蛋白尿具有更好的鉴别能力（AUC = 0.628）。
在美国儿童和青少年中，WWI与蛋白尿呈现出年龄依赖性和非线性关联。这些发现表明，WWI可能为青少年肾脏风险提供一个更精细的人体测量指标，并支持其作为儿科群体筛查工具的潜力。
