title: Comparing Two Waist-to-Height Ratio Measurements with Cardiometabolic Risk Factors among Youth with Diabetes.
abstract: BACKGROUND
  Waist circumference (WC) is commonly measured by either the World Health Organization (WHO) or National Health and Nutrition Examination Survey (NHANES) protocol.
  
  
  OBJECTIVE
  Compare the associations of WHOvs. NHANES WC-to-height ratio (WHtR) protocols with cardiometabolic risk factors (CMRFs) in a sample of youth with diabetes.
  
  
  METHODS
  For youth (10-19 years old with type 1 [N=3082] or type 2 [N=533] diabetes) in the SEARCH for Diabetes in Youth Study, measurements were obtained of WC (by two protocols), weight, height, fasting lipids (total cholesterol, triglycerides, HDL cholesterol, Non-HDL cholesterol) and blood pressures. Associations of CMRFs with WHO and NHANES WHtR were modeled stratified by body mass index (BMI) percentiles for age/sex: lower BMI (<85thBMI percentile; N=2071)vs. higher BMI (≥85thpercentile; N=1594).
  
  
  RESULTS
  Among lower-BMI participants, both NHANES and WHO WHtR were associated (p<0.005) with all CMRFs except blood pressure. Among higher-BMI participants, both NHANES and WHO WHtR were associated (p<0.05) with all CMRFs. WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides, non-HDL cholesterol, and systolic blood pressure in lower-BMI participants. Among high-BMI participants, WHO WHtR was more strongly associated (p<0.05) than NHANES WHtR with triglycerides and systolic blood pressure.
  
  
  CONCLUSIONS
  Among youth with diabetes, WHtR calculated from either WC protocol captures cardiometabolic risk. The WHO WC protocol may be preferable to NHANES WC.
authors.affiliation: University of Washington and Seattle Children's Hospital, Seattle, WA 98122, USA.
authors.forename: Lenna L
authors.initials: LL
authors.lastname: Liu
authors.affiliation: Centers for Disease Control and Prevention, Mail Stop K-10, 4770 Buford Highway, NE Atlanta, GA 30341-3717, USA.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Kahn
authors.affiliation: 1001 Arbolado Road, Santa Barbara, CA 93103, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Pettitt
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Morgan
authors.affiliation: Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, P. O. Box 6511, Mail Stop A140, Aurora, CO 80045, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Mail Location 7012, Cincinnati, OH 45229, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Crimmins
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, 2211 McGavran Greenberg, CB 7461, Chapel Hill, NC 27599-7461, USA.
authors.forename: Archana P
authors.initials: AP
authors.lastname: Lamichhane
authors.affiliation: Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Liese
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
keywords: Body Mass Index; Cardiovascular Risk; Diabetes; Waist Circumference