title: Body Mass Index, Waist Circumference, and the Clustering of Cardiometabolic Risk Factors in Early Childhood.
abstract: BACKGROUND
  Obesity has its origins in early childhood; however, there is limited evidence of the association between anthropometric indicators and cardiometabolic risk factors in young children. Our aim was to evaluate the associations between body mass index (BMI) and waist circumference (WC) in relation to cardiometabolic risk factors and to explore the clustering of these factors.
  
  
  METHODS
  A cross-sectional study was conducted in children aged 1-5 years through TARGet Kids! (n = 2917). Logistic regression was used to evaluate associations between BMI and WC z-scores and individual traditional and possible non-traditional cardiometabolic risk factors. The underlying clustering of these measures was evaluated using principal components analysis (PCA).
  
  
  RESULTS
  Child obesity (BMI z-score >2) was associated with high (>90th percentile) leptin [odds ratio (OR) 8.15, 95% confidence interval (CI) 4.56, 14.58] and insulin (OR = 1.76; 95% CI 1.05, 2.94). WC z-score >1 was associated with high insulin (OR 1.59, 95% CI 1.11, 2.28), leptin (OR 5.48, 95% CI 3.48, 8.63) and 25-hydroxyvitamin D < 75 nmol/L (OR 1.39, 95% CI 1.08, 1.79). BMI and WC were not associated with other traditional cardiometabolic risk factors, including non-High Density Lipoprotein (HDL) cholesterol, and glucose. Among children 3-5 years (n = 1035) the PCA of traditional risk factors identified three components: adiposity/blood pressure, metabolic, and lipids. The inclusion of non-traditional risk factors identified four additional components but contributed minimally to the total variation explained.
  
  
  CONCLUSIONS
  Anthropometric indicators are associated with selected cardiometabolic risk factors in early childhood, although the clustering of risk factors suggests that adiposity is only one distinct component of cardiometabolic risk. The measurement of other risk factors beyond BMI and WC may be important in defining cardiometabolic risk in early childhood.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
authors.forename: Laura N
authors.identifier: http://orcid.org/0000-0002-6106-5073
authors.initials: LN
authors.lastname: Anderson
authors.affiliation: The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jill
authors.initials: J
authors.lastname: Hamilton
authors.affiliation: Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Hanley
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.|Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.affiliation: The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Maguire
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.affiliation: Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.|Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Birken
mesh_terms: D050154:Adiposity / Q000502:physiology; D015415:Biomarkers / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D050356:Lipid Metabolism / Q000502:physiology; D008297:Male; D008659:Metabolic Diseases / Q000209:etiology* / Q000503:physiopathology; D063766:Pediatric Obesity / Q000503:physiopathology; D012307:Risk Factors; D055105:Waist Circumference / Q000502:physiology*
chemical_list: D015415:Biomarkers
keywords: Pediatric obesity; cardiovascular; metabolic; preschool children