The use of Waist-to-Height Ratio for nutritional assessment in the first phase of adolescence
DOI:
https://doi.org/10.12957/demetra.2023.69325Keywords:
Nutrition Assessment. Adolescent. Nutrition, Public Health. Anthropometry. Waist-to-Height Ratio.Abstract
Objective: This study evaluated the performance of the Waist-to-Height Ratio (WHR) as an additional indicator of nutritional status in the first phase of adolescence. Methods: This is a cross-sectional study, developed in 2016/2017, with 148 adolescents (10 to 13 years old) from two public schools of Macaé, a municipality in Rio de Janeiro, Southeast Brazil. We collected information on sexual maturation, weight, height, and waist circumference (WC). The Kappa Test was performed to verify the accordance among Body Mass Index-for-Age (BMI/A), WC, and WHR in relation to health risk screening. The maximum limits of sensitivity and specificity of WHR according to BMI/A were analyzed by ROC curve (Receiver Operating Characteristics). Results: Among the participants, 51.4% were girls, and more than 60% were in the first two stages of sexual maturation. The prevalence of excess weight (overweight+obesity) was 31.8%, obesity 17.6%, and high WHR 20.3%, with no difference according to sex and sexual maturation. WHR showed good agreement with excess weight (Kappa=0.707) and obesity (Kappa=0.780). The agreement between BMI/A and WC was poor. The value 0.45 was the most appropriate WHR cutoff point to identify adolescents with excess weight. Conclusions: This study suggests that WHR performs better than WC as an additional indicator of nutritional status in early adolescence. WHR brings information on central adiposity weighted by height, does not require a comparison curve, and has a cutoff point, which may facilitate screening in health services and epidemiological studies.
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References
Willett W, Hu F. Anthropometric measures and body composition. In: Nutritional Epidemiology. 3rd ed. New York: Oxford University Press; 2013. p. 213–40.
World Health Organization Expert Committee on Physical status: the use and interpretation of anthropometry. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee [Internet]. Geneva: World Health Organization; 1995. (WHO technical report series). Available from: https://apps.who.int/iris/bitstream/handle/10665/37003/WHO_TRS_854.pdf;jsessionid=BCE75CF3509DE0D861F67A4296AA342B?sequence=1
World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: World Health Organization; 2000. (WHO technical report series).
de Quadros TMB, Gordia AP, Andaki ACR, Mendes EL, Mota J, Silva LR. Utility of anthropometric indicators to screen for clustered cardiometabolic risk factors in children and adolescents. J Pediatr Endocrinol Metab. 2019 Jan 28;32(1):49–55.
Faria ER de, Gontijo CA, Franceschini S do CC, Peluzio M do CG, Priore SE, Faria ER de, et al. Composição corporal e risco de alterações metabólicas em adolescentes do sexo feminino. Rev Paul Pediatr. 2014 Jun;32(2):207–15.
Gomes F da S, Anjos LA dos, Vasconcellos MTL de. Antropometria como ferramenta de avaliação do estado nutricional coletivo de adolescentes. Rev Nutr. 2010 Aug;23(4):591–605.
Burgos MS, Burgos LT, Camargo MD, Franke SIR, Prá D, Silva AMV da, et al. Relationship between anthropometric measures and cardiovascular risk factors in children and adolescents. Arq Bras Cardiol. 2013 Oct;101(4):288–96.
Gomes F da S, Anjos LA dos, Vasconcellos MTL de. Influence of different body mass index cut-off values in assessing the nutritional status of adolescents in a household survey. Cad Saúde Pública. 2009 Aug;25(8):1850–7.
Lichtenauer M, Wheatley SD, Martyn-St James M, Duncan MJ, Cobayashi F, Berg G, et al. Efficacy of anthropometric measures for identifying cardiovascular disease risk in adolescents: review and meta-analysis. Minerva Pediatr. 2018 Aug;70(4):371–82.
World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development [Internet]. Geneva: World Health Organization; 2006. 312 p. Available from: https://www.who.int/publications-detail-redirect/924154693X
Global BMI Mortality Collaboration null, Di Angelantonio E, Bhupathiraju S, Wormser D, Gao P, Kaptoge S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016 Aug 20;388(10046):776–86.
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007 Sep;85(9):660–7.
Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020 Mar;16(3):177–89.
International Diabetes Federation. The IDF consensus definition of the Metabolic Syndrome in children and adolescents [Internet]. Belgium: International Diabetes Federation; 2007. 24 p. Available from: https://www.idf.org/e-library/consensus-statements/61-idf-consensus-definition-of-metabolic-syndrome-in-children-and-adolescents.html
Xi B, Zong X, Kelishadi R, Litwin M, Hong YM, Poh BK, et al. International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years. J Clin Endocrinol Metab. 2020 Apr 1;105(4).
Ashwell M, Gibson S. A proposal for a primary screening tool: `Keep your waist circumference to less than half your height’. BMC Medicine. 2014 Nov 7;12(1):207.
Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value. Nutr Res Rev. 2010 Dec;23(2):247–69.
Tanner JM. Growth at Adolescence. 2nd ed. Oxford: Blackwell Scientific Publications; 1962.
Altman D. Practical Statistics for Medical Research. London: Chapman and Hall; 1991.
Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005 Aug;56(5):303–7.
Graves L, Garnett SP, Cowell CT, Baur LA, Ness A, Sattar N, et al. Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort. Pediatr Obes. 2014 Oct;9(5):327–38.
Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening pediatric cardio-metabolic risk factors: a meta-analysis. Obes Rev. 2016 Dec;17(12):1258–75.
Pereira PF, Serrano HMS, Carvalho GQ, Lamounier JA. Circunferência da cintura e relação cintura/estatura: úteis para identificar risco metabólico em adolescentes do sexo feminino? Rev Paul Pediatr. 2011;29(3):372–7.
Alvarez MM, Vieira ACRE, Sichieri R, Veiga GV da. [Association between central body anthropometric measures and metabolic syndrome components in a probabilistic sample of adolescents from public schools]. Arq Bras Endocrinol Metabol. 2008 Jun;52(4):649–57.
Sant’Anna M de SL, Priore SE, Franceschini S do CC. Métodos de avaliação da composição corporal em crianças. Rev Paul Pediatr. 2009 Sep;27(3):315–21.
Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr. 2000 Aug 1;72(2):490–5.
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