LMS tables for waist-circumference and waist-height ratio Z-scores in children aged 5-19 y in NHANES III: association with cardio-metabolic risks.
BACKGROUND
In adults, anthropometric measures of central adiposity, such as waist-height ratio (WHtR) and waist circumference (WC), are more strongly associated with cardio-metabolic risks than BMI.


METHODS
To provide similar quantitative tools for North American children, we created smoothed centile charts and LMS tables for WHtR and WC based on data from the US National Health and Nutrition Survey, cycle III (NHANES III, N = 11,930 aged 2-24 y 1988-1994).


RESULTS
Applying these reference charts to subsequent NHANES survey cycles, 1999-2012) demonstrated a significant mean increase in both Z-scores of approximately 0.30 SD. In measuring the strength of the association between anthropometric measures and cardio-metabolic risk factors, a unit change in Z-scores for WHtR, WC, and BMI significantly increased the odds of an adverse outcome in all cases (1.18-2.03, P < 0.0001). Z-scores for both measures of central adiposity were significantly more strongly associated with cardio-metabolic comorbidities than BMI-Z.


CONCLUSIONS
Since Z-scores permit standardized comparisons across ages and genders, they are useful measures of central adiposity in both clinical or research settings. By providing LMS tables for children and adolescents based on North American reference data, we hope to provide quantitative tools for the study of obesity and its complications.
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.|Child Health Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Atul K
AK
Sharma
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Daniel L
DL
Metzger
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.|Child Health Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Carrie
C
Daymont
Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Stasia
S
Hadjiyannakis
Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.|Child Health Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Celia J
CJ
Rodd
D050154:Adiposity; D000293:Adolescent; D000367:Age Factors; D000886:Anthropometry / Q000379:methods*; D001827:Body Height; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D009749:Nutrition Surveys; D016017:Odds Ratio; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012016:Reference Values; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult