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Sensitivity and specificity of waist-to-height ratio cutoffs by gender and age according to the receiver operating characteristic (ROC) curve analysis for obesity based on the World Health Organization (WHO) criteria
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This study aimed to describe the distribution of waist-to-height ratio (WHtR) percentiles and cutoffs for obesity in Brazilian adolescents. A cross-sectional study including adolescents aged 10 to 15 years was conducted in the city of São Paulo, Brazil; anthropometric measurements (weight, height, and waist-circumference) were taken, and WHtRs were...
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Context 1
... cutoffs by age and gender showed high sen- sitivity (82.8-91.7% and 89.2-95% in females and males respectively) and high specificity (84.0-94.1% and 89.2-95.5% in females and males respectively) based on WHO criteria for obesity (Table 4). Cen- tral obesity was seen in 18.57% of girls and 20.96% of boys based on the cutoffs proposed in this study. ...
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Introduction. To date, growth centiles of children and adolescents have not been created in Ukraine. Therefore, the aim of this study was to construct reference growth charts for height, weight, and body mass index (BMI) of Ukrainian school-aged children and to compare them with World Health Organization references from 2007 for children’s BMI. Mat...
Citations
... 17 We defined high WHR as WHR ‡85th percentile for age and sex. 6,[18][19][20] Data Analysis Data were summarized using frequencies with percentages and measures of central tendency and dispersion, including the mean with standard deviation (SD) or median with interquartile range [IQR] for variables on the continuous scale as appropriate. To identify descriptive pretermterm differences, we used the independent samples t-test or Wilcoxon rank-sum test of variables on the continuous scale as indicated, depending upon meeting normalcy assumptions. ...
Background: Early-life factors such as preterm birth or very low birthweight (VLBW) are associated with increased cardiovascular disease risk. However, it remains unknown whether this is due to an increased risk of obesity (unhealthy central adiposity) because studies have predominantly defined obesity based on BMI, an imprecise adiposity measure. Objective: Investigate if adolescents born preterm with VLBW have a higher risk of unhealthy central adiposity compared to term-born peers. Study Design: Cross-sectional analysis of data from a prospective cohort study of 177 individuals born preterm with VLBW (<1500 g) and 51 term-born peers (birthweight ≥2500 g). Individuals with congenital anomalies, genetic syndromes, or major health conditions were excluded. Height, weight, waist circumference, skin fold thickness, and dual energy X-ray absorptiometry body composition were measured at age 14 years. We calculated BMI percentiles and defined overweight/obesity as BMI ≥85th percentile for age and sex. We estimated the preterm-term differences in overweight/obesity prevalence and adiposity distribution with multivariable generalized linear models. Results: There was no difference in small for gestational age status or overweight/obesity prevalence. Compared to term, youth born preterm with VLBW had lower BMI z-score [β -0.38, 95% confidence limits (CL) -0.75 to -0.02] but no differences in adiposity apart from subscapular-to-triceps ratio (STR; β 0.18, 95% CL 0.08 to 0.28). Conclusions: Adolescents born preterm with VLBW had smaller body size than their term-born peers and had no differences in central adiposity except greater STR.
... Specifically, energy-dense, nutrientpoor foods, reduced levels of physical activity (PA), sedentary behaviors, the globalized food market, and economic interests are all aspects of the obesogenic environment that can lead to the increased incidence of this disease [6]. Brazilian adolescents and young adults are not impervious to poor health behaviors and obesity [7,8]. On average, Brazilian adolescents and young adults are exceeding the recommended consumption of energy-dense, nutrient-poor foods, and reduced intake of fruit, vegetables, and whole grains [9][10][11]. ...
Little is known about how behaviors to control weight are associated with
diet quality among youth from low- and middle-income countries. The aim of this study
was to examine associations between efforts to control weight (ECW) and diet quality
among Brazilian adolescents and young adults. Methods: Data from 731 participants
(17.89±4.92 years, 51.1% female) of the 2015 Health Survey of São Paulo was used
for this cross-sectional study. Dietary intake was assessed using a 24h dietary recall
and diet quality was calculated using the Brazilian Healthy Eating Index - Revised
(BHEI-R). Participants reported their ECW, weight satisfaction, and sociodemographics.
Descriptive statistics and linear regressions were calculated to
investigate associations between ECW and diet quality. Results: Approximately
47.7% of participants were dissatisfied with their current weight, and 41.0% reported
ECW. Reported strategies to control weight included increased physical activity, taking
care of what they eat, and dieting (8.2%, 3.1%, and 2.5%, respectively). After adjusting
for age, sex, race/ethnicity, and body mass index, reporting at least one ECW (ß= 0.08;
95%CI 0.02, 0.13), taking care of what to eat (ß= 0.15; 0.08, 0.22), and being satisfied
with their weight (0.08; 0.02, 0.13) were all associated with a higher overall BHEI-R
score. Conclusion: Overall diet quality score showed a small increase in participants
reporting ECW. Further studies should be conducted to provide strategies used by
adolescents from low- and middle-income countries to control their weight. Thus,
developing public health policies, and behavioral-change strategies.
... We found that girls who attained menarche early had higher WC, HC and lower WHR, indicating that girls with early menarche had greater adiposity as compared to those who attain menarche late. Higher mean WHtR values were observed in menarcheal as compared to non-menarcheal girls between the ages of 11-15 years, thereby indicating higher adiposity trend among girls in these age groups (de Padua Cintra, Zanetti Passos, Dos Santos, da Costa Machado, & Fisberg, 2014). ...
Introduction
Onset age at menarche has been considered an important indicator of reproductive maturity in females and reflects the health status of the population. The purpose of this study was to determine the mean menarcheal age and to examine whether anthropometric and socio‐economic status (SES) influences age at menarche in the girls from Punjab province of Pakistan.
Methods
In this population‐based cross‐sectional study, 10,050 school‐going girls aged 8–16 years from 35 schools across 12 districts of Punjab were recruited. Menarcheal data was obtained by using a questionnaire, while the anthropometric data were obtained by the measurements of standing height, body weight, waist, and hip circumference. The anthropometric indices of pre‐ and post‐menarcheal girls were compared. Student's t‐test, ANOVA, and post‐hoc Tukey's test was applied for comparison between two and multiple groups respectively, P < 0.05 was considered statistically significant.
Results
There was a normal distribution of age at menarche and mean was 12.4 years in the study population. The girls who reached menarche were found to be taller and heavier with higher BMIs, having a greater waist and hip circumference as compared to their pre‐menarcheal peers. Waist‐hip‐ratio was less, and the waist‐to‐height ratio was higher in post‐menarcheal as compared to pre‐menarcheal girls. The girls belonging to low SES had delayed onset of menarche as compared to those belonging to middle/high SES.
Conclusion
The age at menarche was associated with SES and changes in various anthropometric measurements reflecting the growth status of girls.
... A categorização do IMC foi realizada de acordo com os pontos de corte do Centers for Disease Control and Prevention (CDC) 15 e da Organização Mundial da Saúde (OMS), 16,17 sendo: baixo peso (percentil 1º até percentil 5), eutrófico (percentil 5 até percentil 85), sobrepeso (percentil 85 até percentil 95) e obeso (acima do percentil 95). A RCE foi obtida por meio da divisão da CC (cm) pela estatura (cm) e, posteriormente, classificada de acordo com os pontos de corte estabelecidos por Cintra et al. 18 (sobrepeso: ≥0,443 para meninas e ≥0,439 para meninos; obesidade: ≥0,475 para meninas e ≥0,489 para meninos) e Sardinha et al. 12 (sobrepeso: ≥0,45 no sexo masculino e ≥0,46 no sexo feminino; obesidade: ≥0,50 no sexo masculino e ≥0,52 no sexo feminino). A CC foi medida com uma fita métrica no ponto médio entre o final da crista ilíaca e a última costela, de acordo com os procedimentos sugeridos pelo CDC, 12 e a CP, com uma fita métrica flexível, com o avaliado em pé e mantendo a cabeça ereta, na linha da cartilagem cricoide. ...
... 25 Contudo, apesar de sua popularidade e facilidade de utilização, sua capacidade de detecção de obesidade regional e de predição de fatores de risco é mais fraca do que outras ferramentas, como a CC e a RCE. [11][12][13]26,27 A mediana da RCE apresentada neste estudo pelos adolescentes de ambos os sexos foi menor do que a encontrada nos estudos de Sardinha et al. 12 (0,44 para meninos e 0,44 para meninas) e de Cintra et al. 18 (0,45 para meninos e 0,44 para meninas). Entretanto, os adolescentes deste estudo apresentaram maior prevalência de excesso de peso do que os do estudo de Cintra et al. 18 (20,9% meninos e 18,5% nas meninas). ...
... [11][12][13]26,27 A mediana da RCE apresentada neste estudo pelos adolescentes de ambos os sexos foi menor do que a encontrada nos estudos de Sardinha et al. 12 (0,44 para meninos e 0,44 para meninas) e de Cintra et al. 18 (0,45 para meninos e 0,44 para meninas). Entretanto, os adolescentes deste estudo apresentaram maior prevalência de excesso de peso do que os do estudo de Cintra et al. 18 (20,9% meninos e 18,5% nas meninas). ...
Objective:
To identify the prevalence of overweight in adolescents according to different classification criteria for obesity and somatic maturation stages.
Methods:
Cross-sectional study in 10 schools in a city from Southern Brazil, with 1715 adolescents. Height, weight, waist circumference, and neck circumference (NC) data were collected. Body Mass Index was classified according to World Health Organization (WHO) and Centers for Disease Control and Prevention criteria, and the waist-to-height ratio (WHtR) was classified according to Brazilian and European cut-off points. Somatic maturation was obtained through the Peak Height Velocity. The prevalence data were compared between sex and stages of somatic maturation; the concordance between different criteria was verified.
Results:
The prevalence of overweight was high in both sexes; WHO criteria showed that 34.5% of boys and 29.3% of girls were overweight. For the WHtR, the prevalence was 28.4% in boys and 23.7% in girls. NC classified 13.8% of boys and 15.8% of girls as being overweight. The prevalence of overweight was higher in adolescents before complete somatic maturation.
Conclusions:
The prevalence of overweight was high among adolescents. The boys presented higher frequency of overweight, except if NC was used to classify them. Adolescents before somatic maturation had a higher prevalence of overweight. NC showed a lower ability to track obese adolescents.
... Also, percentile for WC and WHtR has been developed to identify obesity-related health risk more appropriately. 14,33,[47][48][49][50][51] However, the anthropometric measures should be used wisely as it is influenced by ethnicity, age and velocity of growth of children and adolescents. 51 This study also has some limitations. ...
Objective: Increased prevalence of elevated blood pressure in children and adolescents was associated with increased body weight and measures. Also, prevalence of elevated blood pressure varies between countries. This study is to investigate the prevalence of elevated blood pressure in Indonesian children and its relationship with bodyweight and anthropometric measures.
Methods: This cross-sectional study involved 1010 elementary students aged 8–12 years (479 girls, 531 boys). The anthropometric measures and blood pressure were assessed. Elevated blood pressure (EBP) was determined if at the 90th percentile or above for gender, age, and height. Independent t-test, Chi-square, Pearson correlation, and multivariate logistic regression were applied. Significance was determined at p
... The cut-offs in this study is close to the age specific cut-offs of 0.467-0.506 used by Cintra et al., in the Brazilian study and they reported excess body weight in 28.15% of their adolescents [32]. ...
In Nigeria, indices predictive of adolescent central adiposity are lacking. This study aimed to develop age- and gender- specific cut-offs for WC and WHtR for Nigerian adolescents.
Methods: Cross-sectional study involving 2,995 students aged 9-19 years (1,187 boys and 1,808 girls) in 20 schools in the Federal Capital Territory Abuja, Nigeria, using a multistage cluster sampling design. Weight, height, Waist circumference (WC), body mass index (BMI), waist to height ratio was measured and Percentiles calculated using the LMS method. The receiver operating characteristic (ROC) curves and areas under the curves (AUCs) were employed to derive optimal age- and sex-specific WC and WHtR references for predicting abdominal obesity.
Results: At age 13 and 14, the mean WC, WHtR and BMI were significantly higher in girls than boys while the mean WHtR was significantly higher in girls at ages 13 through 18 years. The WC increased with age in both genders from the 5th through the 50th percentile with a significant fall thereafter. The WHtR in girls increased with age up to 15 years and plateaued across other percentiles. In boys, WHtR values decreased continuously.
The WC cut-offs according to WHO criteria for obesity ranged from 73.99 cm - 84.00 cm and 67.99 cm - 82.98 cm among girls and boys respectively. The WHtR cut-offs ranged from 0.461 to 0.506 and 0.438-0.488 for girls and boys across all ages. Identifying central obesity in girls, the AUC for WHtR and WC were 0.9396 (95% CI, 0.9207 - 0.9585) and 0.9297 (95% CI, 0.9100 - 0.9494) and in boys, 0.9638 (95% CI, 0.9463 - 0.9814) and 0.9169 (95% CI, 0.8880 - 0.9459) respectively. .
Conclusion: The age- and gender-specific cut-offs from this study may be used as surrogate markers to identify central obesity and also for further research to evaluate their relationship to adverse metabolic outcomes in Nigerian adolescents.
... In Norway, they found that P85 and P95 of WC were cut-offs to define overweight and obesity [26]. Other studies used different methods to find cutoff points: (1) according to BMI based on the World Health Organization criteria, de Pá dua Cintra et al. found two cut-off points of WTHR in 2014: 0.443 in girls and 0.439 in boys for overweight in Brazilian children aged 10-15 years and 0.475 and 0.489 for obesity in boys and girls, respectively [27]. Rerksuppaphol et al. [28] found 58.25 to be the optimal WC cut-off point for overweight and 64.90 for obesity in boys. ...
Abdominal obesity for children:
Waist circumference (WC) and waist-to-height ratio (WTHR) reference curves are used to assess the risk of cardiovascular disease in children. The aim of this study was to develop age- and sex-smoothed WC and WTHR reference curves for Tunisian children. Data were collected during the period 2014-2015 in a cross-sectional study including 2308 children aged 6-18 years. The percentiles of WC and WTHR were developed using the LMS method. The optimal percentiles, which are associated with the body mass index (BMI) according to International Obesity Task Force (IOTF) criteria to identify overweight/obesity and with the 0.5 boundary value of WTHR to estimate cardiovascular risk, were identified by ROC curves and the Youden index (j). The results show the smoothed percentiles of WC and WTHR reference curves for Tunisian children. A comparison of the 50th percentiles with other references showed different trends in WC values. The 75th percentiles of WC and WTHR are the optimal percentiles that correspond to both PBMI25 (the percentile linked to BMI≥25) and the 0.5 boundary value. However, the 90th percentiles correspond to PBMI30 (the percentile linked to BMI≥30) in boys and girls.
Conclusion:
The new WC and WTHR reference curves can be added to clinical tools to help specialists in pediatric and physical health to reduce cardiovascular risk in Tunisian children.
... In Norway, they found that P85 and P95 of WC were cut-offs to define overweight and obesity [26]. Other studies used different methods to find cutoff points: (1) according to BMI based on the World Health Organization criteria, de Pá dua Cintra et al. found two cut-off points of WTHR in 2014: 0.443 in girls and 0.439 in boys for overweight in Brazilian children aged 10-15 years and 0.475 and 0.489 for obesity in boys and girls, respectively [27]. Rerksuppaphol et al. [28] found 58.25 to be the optimal WC cut-off point for overweight and 64.90 for obesity in boys. ...
This study investigated the physiological responses and time structure of kickboxing styles (full contact, light contact, and point fighting). Blood lactate [La] before and after combats, mean heart rate (HRmean), percentage of time spent in HR zones, and rating of perceived exertion were assessed. Time spent in high-intensity activities (HIAs), low-intensity activities (LIAs), and referee pauses (P) were recorded according to rounds (R) and kickboxing styles. [La] increased statistically significant after kickboxing combats (p < 0.001) and was higher after light contact compared with point fighting (p = 0.029). HRmean did not differ between kickboxing specialties (p = 0.200). However, more time was spent on HR zones 4 and 5 (Z4: 80–90% and Z5: 90–100% HRmax) than in other zones (all p < 0.001). Rating of perceived exertion scores were higher after light and full contact combats compared with point fighting (p = 0.007 and 0.093, respectively). High-intensity activities, LIAs, and pauses did not statistically differ across rounds (p > 0.05). Moreover, HIA values were lower than LIA (all p < 0.001), and HIA and LIA were higher than pause for all rounds and styles (all p < 0.001). Full contact elicited higher HIA compared with point fighting (p = 0.003, 0.001, and 0.002 for round 1, 2, and 3, respectively). Coaches and strength and conditioning professionals should emphasize anaerobic and muscle power development for all disciplines, especially for full and light contact and maximal aerobic power enhancement by targeting specific HR zones. Moreover, training regimen may include high-intensity interval training to mimic these sports' specificity using the effort-pause ratios according to different kickboxing sports.
... This measure is much easier to calculate than BMI, does not require sophisticated tables, and can be utilized to determine visceral obesity, even in normal-weight subjects 30) . In addition, waist-to-height ratio integrates waist circumference as a measure of abdominal obesity and adjusts for a subject's body size by dividing their height 31) . It incorporates the advantages of both BMI and waist-to-hip ratio by accounting for height and abdominal adiposity 32) . ...
Purpose:
Liver metabolism plays a pivotal role in the development of metabolic disorders. We aimed to investigate the clinical and laboratory risk factors associated with alanine aminotransferase (ALT) levels in young adolescents from an urban population in Korea.
Methods:
A population of 120 apparently healthy adolescents aged 12-13 years was included in the cross-sectional design study; 58 were overweight or obese and 62 were of normal weight. We estimated anthropometric and laboratory measurements, including waist-to-height ratio, blood pressure, insulin sensitivity, aspartate and alanine aminotransferases (AST and ALT), and lipid profiles.
Results:
The mean ages of the overweight or obese and normal weight participants were 12.9 ± 0.3 and 13.0 ± 0.3 years, respectively. Height, weight, body mass index, waist circumference, waist-to-height ratio, systolic and diastolic blood pressure, AST/ALT, total cholesterol, low-density lipoprotein-cholesterol, triglyceride, insulin, and the homeostatic model assessment of insulin resistance (HOMA-IR) score were significantly higher and the high-density lipoprotein-cholesterol and quantitative insulin-sensitivity check index were significantly lower in the overweight/obese participants in comparison to the normal-weight participants (all P<0.05). In multivariate linear regression analysis, waist-to-height ratio, systolic blood pressure, and HOMA-IR score were independently and positively associated with serum ALT levels.
Conclusion:
Screening for ALT levels in adolescents may help to differentiate those at risk of metabolic abnormalities and thus prevent disease progression at an early age.
... Height was measured with a stadiometer (Alturexata®, Belo Horizonte, Brazil) with scale in centimeters. BMI was calculated by the quotient between body weight and square height (kg/m 2 ) and the nutritional status was defined by BMI for age according to the World Health Organization (WHO) classification: normal weight (3th # BMI # 85th); overweight (85th < BMI # 97th); and obesity (BMI > 97th) (Cintra et al., 2014). Waist circumference (WC) was measured using a 1.5m inelastic and flexible tape with 0.01m interval. ...
... In addition, scientific literature about other measures of nutritional assessment in adolescenceinstead of BMI classified by WHO 2006 (Cintra et al., 2014) is relatively scarce in Brazil. Thus, more studies are needed to establish and standardize cutoff points to evaluate parameters for determination of central obesity and adiposity in Brazilian teenagers' population. ...
Purpose
The purpose of this paper is to evaluate anthropometric data, body composition and food intake of teenagers.
Design/methodology/approach
This paper involves a cross-sectional study with 132 teenagers aged 15 to 19 years old from a public school of Minas Gerais, Brazil. Anthropometric measurements, body composition, food intake and sport practice were obtained. The authors performed Student’s t -test, X 2 or Fisher’s exact tests and Pearson’s correlation to evaluate anthropometric variables, nutritional status and sport practice.
Findings
Regarding the nutritional status, 81.8 per cent of the teenagers were of normal weight, 10.6 per cent were overweight and 7.6 per cent were obese. Female teenagers had higher values of body fat analyzed by skinfold thickness, fat mass, fat mass index and body fat percentage, while male had higher lean mass evaluated by fat-free mass and fat-free mass index. For both genders, it was observed that there was low intake of fruits and vegetables and daily intake of sweets, soda, salt snacks and fast food like sandwiches and pizza. Only 54.5 per cent of teenagers reported performing physical exercise and there was association between sedentary lifestyle with higher intake of sweets and soft drink.
Originality/value
This paper summarized several methods to assess nutritional status and body composition of teenagers.
