Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study.
BACKGROUND
Several investigators have concluded that the waist-to-height ratio is more strongly associated with cardiovascular disease risk factors than is the body mass index (BMI; in kg/m(2)).


OBJECTIVE
We examined the relation of the BMI-for-age z score and waist-to-height ratio to risk factors (lipids, fasting insulin, and blood pressures). We also compared the abilities of these 2 indexes to identify children with adverse risk factors.


METHODS
Children aged 5-17 y (n=2498) in the Bogalusa Heart Study were evaluated.


RESULTS
As assessed by the ability of the 2 indexes to 1) account for the variability in each risk factor and 2) correctly identify children with adverse values, the predictive abilities of the BMI-for-age z score and waist-to-height ratio were similar. Waist-to-height ratio was slightly better (0.01-0.02 higher R(2) values, P<0.05) in predicting concentrations of total-to-HDL cholesterol ratio and LDL cholesterol, but BMI was slightly better in identifying children with high systolic blood pressure (0.03 higher R(2), P<0.05) in predicting measures of fasting insulin and systolic and diastolic blood pressures. On the basis of an overall index of the 6 risk factors, no difference was observed in the predictive abilities of BMI-for-age and waist-to-height ratio, with areas under the curves of 0.85 and 0.86 (P=0.30) and multiple R(2) values of 0.320 and 0.318 (P=0.79). This similarity likely results from the high intercorrelation (R(2)=0.78) between the 2 indexes.


CONCLUSIONS
BMI-for-age and waist-to-height ratio do not differ in their abilities to identify children with adverse risk factors. Although waist-to-height ratio may be preferred because of its simplicity, additional longitudinal data are needed to examine its relation to disease.
Freedman
David S
DS
Divisions of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, GA, USA. dfreedman@cdc.gov
Kahn
Henry S
HS
Mei
Zuguo
Z
Grummer-Strawn
Laurence M
LM
Dietz
William H
WH
Srinivasan
Sathanur R
SR
Berenson
Gerald S
GS
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D001827:Body Height / Q000502:physiology*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood
D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol