Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

Joo Hyun Gil; Mi Na Lee; Hye Ah Lee; Hyesook Park; Jeong Wan Seo

doi:10.5223/kjpgn.2010.13.2.180

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Gil, Lee, Lee, Park, and Seo: Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

Original Article

Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition

Korean Journal of Pediatric Gastroenterology and Nutrition 2010; 13(2): 180-192.

Published online: 30 September 2010

DOI: https://doi.org/10.5223/kjpgn.2010.13.2.180

Usefulness of the Waist Circumference-to-Height Ratio in Screening for Obesity in Korean Children and Adolescents

Joo Hyun Gil, M.D., Mi Na Lee, M.D., Hye Ah Lee^*, Hyesook Park, M.D.^*, Jeong Wan Seo, M.D.

Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea.

^*Department of Preventive Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Corresponding author (jwseo@ewha.ac.kr)

Received 13 August 2010 Revised 17 August 2010 Accepted 3 September 2010

Abstract

Purpose

To evaluate the feasibility and usefulness of the waist circumference-to-height ratio (WHTR) in screening for obesity in Korean children and adolescents.

Methods

Data, including body mass index (BMI), waist circumference (WC), and height, were obtained from the national growth surveys for children and adolescents in 2005. The WHTR was calculated dividing WC by height in subjects 2~18 years of age. Overweight and obese were defined by BMI percentiles for age and gender. The receiver operating characteristic (ROC) analysis was performed to find out the optimal cutoff values of WHTR that matched BMI-determined overweight and obesity using the STATA program. The area under the curve (AUC), a measure of diagnostic power, of WHTR was compared to WC. The influence of age on WHTR was analyzed by the SAS program.

Results

The WHTR significantly decreased with age, and had less correlation with age in the 6~18-year-old age group than the 2~5-year-old age group. Furthermore, the WHTR also had less correlation with age than WC in the 6~18-year-old age group. The AUC of WHTR in identifying overweight and obesity was significantly higher than the AUC of WC in the 6~18-year-old age group. The optimal cutoff values were 0.51 in boys and 0.49 in girls for obesity, and 0.48 in boys and 0.47 in girls for overweight, with all having the AUC>0.9. The optimal cutoff values of WHTR had a higher sensitivity for diagnosing obesity than WC≥90th percentiles.

Conclusion

The WHTR is an easy, accurate, and less age-dependent index with high applicability in screening for obesity in children and adolescents.

Keywords: Waist circumference to height ratio, Children, Adolescents, Overweight, Obesity, Body mass index, Cutoff values

Figures and Tables

Fig. 1

Percentile curves of waist circumference-to-height ratio for Korean children and adolescents 2~18 years of age (A) Boys, (B) Girls. Dashed line shows universal cutoff value of 0.5 for adults. Age: completed age, e.g., 6 years= 6~<7 years etc.

Fig. 2

The area under curves of waist circumference-to-height ratio for diagnosing overweight and obesity were significantly higher than that of waist circumference in both sexes aged 6 to 18 years (A) Obese boys, (B) Obese girls, (C) Overweight and obese boys, (D) Overweight and obese girls.

Table 1

Sample Size before and after Excluding Outliers

Age: completed age, e.g. 6 years= 6~<7 years etc. Outlier≤-3SD, ≥3SD.

Table 2

Correlation between Variables in Children and Adolescents

^*p<.0001. WC: waist circumference; BMI: body mass index; WHTR: waist circumference to height ratio, Age: completed age, e.g. 6 years=6~<7 years etc.

Table 3

Waist Circumference-to-Height Ratio in the Normal, Overweight, and Obesity Groups 6~18 Years of Age

There are significant differences among groups in all ages (p<0.0001). BMI: body mass index, WHTR: waist circumference-to-height ratio, Age: completed age, e.g. 6 years=6~<7 years etc.

Table 4

Waist Circumference in the Normal, Overweight, and Obesity Groups 6~18 Years of Age

There are significant differences among groups in all ages (p<.0001). BMI: body mass index, WC: waist circumference, Age: completed age, e.g. 6 years=6~<7 years etc.

Table 5

The Optimal Cutoff Values of Waist Circumference-to-Height Ratio in Screening for Body Mass Index-determined Overweight and Obesity in Children and Adolescents 6~18 Years of Age

AUC: area under curve, BMI: body mass index.

Table 6

Comparison of Diagnostic Accuracy of Waist Circumference≥90th Percentiles and Optimal Cutoff Values of the Waist Circumference-to-Height Ratio in Screening for Body Mass Index-determined Obesity in Children and Adolescents 6~18 Years of Age

WC: waist circumference, WHTR: waist circumference-to-height ratio. ^*Reference to optimal value in Table 5.

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