title: Is the 90th Percentile Adequate? The Optimal Waist Circumference Cutoff Points for Predicting Cardiovascular Risks in 124,643 15-Year-Old Taiwanese Adolescents.
abstract: Adolescent obesity has increased to alarming proportions globally. However, few studies have investigated the optimal waist circumference (WC) of Asian adolescents. This study sought to establish the optimal WC cutoff points that identify a cluster of cardiovascular risk factors (CVRFs) among 15-year-old ethnically Chinese adolescents. This study was a regional population-based study on the CVRFs among adolescents who enrolled in all the senior high schools in Taipei City, Taiwan, between 2011 and 2014. Four cross-sectional health examinations of first-year senior high school (grade 10) students were conducted from September to December of each year. A total of 124,643 adolescents aged 15 (boys: 63,654; girls: 60,989) were recruited. Participants who had at least three of five CVRFs were classified as the high-risk group. We used receiver-operating characteristic curves and the area under the curve (AUC) to determine the optimal WC cutoff points and the accuracy of WC in predicting high cardiovascular risk. WC was a good predictor for high cardiovascular risk for both boys (AUC: 0.845, 95% confidence interval [CI]: 0.833-0.857) and girls (AUC: 0.763, 95% CI: 0.731-0.795). The optimal WC cutoff points were ≥78.9 cm for boys (77th percentile) and ≥70.7 cm for girls (77th percentile). Adolescents with normal weight and an abnormal WC were more likely to be in the high cardiovascular risk group (odds ratio: 3.70, 95% CI: 2.65-5.17) compared to their peers with normal weight and normal WC. The optimal WC cutoff point of 15-year-old Taiwanese adolescents for identifying CVRFs should be the 77th percentile; the 90th percentile of the WC might be inadequate. The high WC criteria can help health professionals identify higher proportion of the adolescents with cardiovascular risks and refer them for further evaluations and interventions. Adolescents' height, weight and WC should be measured as a standard practice in routine health checkups.
authors.affiliation: Department of Family Medicine, Yangming Branch, Taipei City Hospital, Taipei City, Taiwan.|Department of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.|Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
authors.forename: Jason Jiunshiou
authors.identifier: http://orcid.org/0000-0003-3638-8492
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Yangming Branch, Taipei City Hospital, Taipei City, Taiwan.|Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.|Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.|Department of Leisure Industry and Health Promotion, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
authors.forename: ChinYu
authors.initials: C
authors.lastname: Ho
authors.affiliation: Department of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: Hsin-Jen
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Department of Family Medicine, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
authors.forename: Jade Chienyu
authors.initials: JC
authors.lastname: Yeh
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, United States of America.
authors.forename: Sarah
authors.initials: S
authors.lastname: deFerranti
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D019540:Area Under Curve; D044466:Asian People; D001827:Body Height; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000503:physiopathology*; D002319:Cardiovascular System; D002947:Cities; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D012372:ROC Curve; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D055105:Waist Circumference; D049629:Waist-Hip Ratio