title: Establishing Waist-to-Height Ratio Standards from Criterion-Referenced BMI Using ROC Curves in Low-Income Children.
abstract: The purpose of this study was to establish health-related waist-to-height ratio (WHtR) cut-points associating with FITNESSGRAM's body mass index (BMI) criterion-referenced standards in low-income children. A secondary aim was to examine the classification agreement between the derived WHtR cut-points and various cardiometabolic blood markers using current recommendations. Participants were 219 children from low-income schools (mean age = 10.5 ± 0.6 years). Waist circumference, height, weight, and cardiometabolic blood markers were collected in a fasting state before school hours. Receiver operating characteristic (ROC) curves were used to determine WHtR cut-points that associated with a child meeting FITNESSGRAM's age- and sex-specific criterion-referenced standards for BMI. The derived WHtR cut-point was 0.50 (AUC = 0.89,p< 0.001; sensitivity = 0.86, specificity = 0.82, and accuracy = 84.3%). Classification agreement using the derived WHtR cut-point with various blood marker standards was statistically significant but considered weak to fair (kappa 0.14-0.34, agreement = 59%-67%, andp< 0.01). The WHtR cut-point of 0.50 can be used with strong accuracy to distinguish low-income children who met FITNESSGRAM's criterion-referenced standards for body composition; however, the evidence was weaker for its use in distinguishing low-income children meeting specific cardiometabolic blood marker recommendations.
authors.affiliation: Department of Health, Kinesiology, and Recreation, University of Utah, 250 S. 1850 E., HPER North, RM 241, Salt Lake City, UT 84112, USA.
authors.forename: Ryan D
authors.identifier: 0000-0002-5933-4633
authors.initials: RD
authors.lastname: Burns
authors.affiliation: Department of Health, Kinesiology, and Recreation, University of Utah, 250 S. 1850 E., HPER North, RM 241, Salt Lake City, UT 84112, USA.
authors.forename: Timothy A
authors.identifier: 0000-0002-8234-3546
authors.initials: TA
authors.lastname: Brusseau
authors.affiliation: Department of Health, Kinesiology, and Recreation, University of Utah, 250 S. 1850 E., HPER North, RM 241, Salt Lake City, UT 84112, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Fang
authors.affiliation: School of Community Health Sciences, University of Nevada, Reno, 1664 North Virginia Street, Reno, NV 89557, USA.
authors.forename: You
authors.initials: Y
authors.lastname: Fu
authors.affiliation: College of Physical Activity and Sport Sciences, West Virginia University, P.O. Box 6116, 375 Birch St., Morgantown, WV 26505-6116, USA.
authors.forename: James C
authors.identifier: 0000-0002-8348-6987
authors.initials: JC
authors.lastname: Hannon
mesh_terms: D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000097:blood / Q000175:diagnosis*; D011203:Poverty; D012372:ROC Curve; D012680:Sensitivity and Specificity; D065927:Waist-Height Ratio; D014903:West Virginia