Appropriate neck circumference and waist-to-height ratio cut-off points as predictors of obesity and cardiovascular risk in adolescents / Pontos de corte da circunferência do pescoço e da relação cintura-estatura como preditores da obesidade e risco cardiovascular em adolescentes

ABSTRACT OBJECTIVE To determine neck circumference (NC) and waist-to-height ratio (WHtR) cut-off points as predictors of obesity and cardiovascular risk in adolescents. METHODS Cross-sectional study developed with a subsample of 634 adolescents aged 18 and 19 years belonging to the third phase of the "RPS" cohort (Ribeirão Preto, Pelotas and São Luís) carried out in 2016. The area under the ROC curve (AUC) was identified to assess the predictive capacity of NC and WHtR in relation to the percentage of body fat (%BF), obtained by air displacement plethysmography (ADP), and the cardiovascular risk estimated by the Pathobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTS The prevalence of obesity by %BF was 7.6% in males and 39.4% in females (p-value <0.001), and the high PDAY risk was 13.8% and 10.9%, respectively. For males, NC cut-off point was 44.0 cm and the AUCs were 0.70 (95%CI 0.58-0.83) to predict obesity and 0.71 (95%CI 0.62-0.80) to predict high cardiovascular risk; for females, NC cut-off point was 40 cm and the AUCs were 0.75 (95%CI 0.69-0.80) and 0.63 (95%CI 0.53-0.73), respectively. WHtR cut-off point was 0.50 for both sexes; for males, the AUCs to predict obesity and high risk according to PDAY were 0.90 (95%CI 0.80-0.99) and 0.73 (95%CI 0.63-0.82), respectively; for females, they were 0.87 (95%CI 0.83-0.90) and 0.55 (95%CI 0.45-0.65), respectively. CONCLUSION WHtR and NC are good discriminators to assess obesity and cardiovascular risk in adolescents, especially in males.

RESUMO OBJETIVO Determinar os pontos de corte da circunferência do pescoço (CP) e da relação cintura-estatura (RCEst) para a predição da obesidade e do risco cardiovascular em adolescentes. MÉTODOS Estudo transversal desenvolvido com uma subamostra de 634 adolescentes de 18 e 19 anos de idade pertencentes à terceira fase da coorte "RPS" (Ribeirão Preto, Pelotas e São Luís) realizada em 2016. Identificou-se a área sob a curva ROC (AUC) para avaliar a capacidade preditiva da CP e RCE em relação ao percentual de gordura corporal (%GC), obtido pela pletismografia por deslocamento de ar (PDA), e do risco cardiovascular estimado pelo Phatobiological Determinants of Atherosclerosis in Youth (PDAY). RESULTADOS A prevalência de obesidade pelo %GC foi de 7,6% no sexo masculino e 39,4% no sexo feminino (p-valor < 0,001) e o alto risco para PDAY foi de 13,8% e 10,9%, respectivamente. Para a CP, o ponto de corte identificado para o sexo masculino foi de 44,0 cm e as AUC foram de 0,70 (IC95% 0,58-0,83) para predição de obesidade e de 0,71 (IC95% 0,62-0,80) para predição do alto risco cardiovascular; e para o sexo feminino foi de 40 cm e as AUC foram de 0,75 (IC95% 0,69-0,80) e de 0,63 (IC95% 0,53-0,73), respectivamente. Para a RCEst, o ponto de corte identificado foi de 0,50 para ambos os sexos e as AUC para a predição da obesidade e do alto risco segundo o PDAY foram de 0,90 (IC95% 0,80-0,99) e 0,73 (IC95% 0,63-0,82), respectivamente, para o sexo masculino; e de 0,87 (IC95% 0,83-0,90) e 0,55 (IC95% 0,45-0,65), respectivamente, para o sexo feminino. CONCLUSÃO RCEst e CP como bons discriminadores para avaliar a obesidade e risco cardiovascular em adolescentes, especialmente no sexo masculino.

Relationship between cardiometabolic index and hyperuricemia in health examination population / 中华健康管理学杂志

Objective:To investigate the relationship between cardiometabolic index (CMI) and hyperuricemia (HUA) in the health examination population.Methods:It was a cross-sectional study. A total of 21 720 individuals who received health examinations in Xiangya hospital, Central South University between 2020 and 2021 were recruited in this study. Multivariate logistic regression analysis was used to determine the independent correlation between CMI and HUA, and stratified analysis was applied to check whether there were population differences. Then the predictive value of CMI for hyperuricemia in the health examination population was evaluated with the area under the receiver operator characteristic (ROC) curve.Results:Among the 21 720 subjects, 4 418 (20.34%) were detected with HUA. In the HUA group, the body mass index (BMI), waist-to-hip ratio, CMI, total cholesterol, triglyceride, systolic blood pressure, diastolic blood pressure, fasting blood glucose, 2-hour postprandial blood glucose, and blood creatinine levels were all significantly higher than those in the normal uric acid group, while high-density lipoprotein and epidermal growth factor receptor (eGFR) were significantly lower (all P<0.05). Multiple logistic regression analysis showed that after adjusting for relevant factors, CMI was significantly positively correlated with HUA ( OR=1.16, 95% CI: 1.129-1.192); and with the increase of CMI, the risk of HUA increased gradually. Stratified analysis and interaction test according to gender, age, BMI, hypertension, abnormal blood glucose and glomerular filtration rate indicated that CMI was positively associated with the occurrence of HUA in all populations. Compared with that in people with abnormal blood glucose, the correlation between CMI and HUA was more obvious in people with normal blood glucose. The area under the ROC curve (AUC) for CMI to predict HUA was 0.723(95% CI: 0.715-0.731), with a specificity of 0.636 and a sensitivity of 0.698, and the cut-point was 0.693. Conclusion:There was a significant positive correlation between CMI and HUA in the health examination population, which has good predictive value for HUA.

Relación inversa entre la altitud y el riesgo cardiometabólico en la población peruana: resultados de una encuesta de base poblacional e importancia de la relación cintura-talla como indicador de riesgo cardiometabólico

Presentación: En el presente artículo exponemos nuestra valoración crítica de un estudio observacional publicado en la revista International Journal of Environmental Research and Public Health el año 2022. Conclusiones del estudio: Se identificó una asociación inversa entre vivir a mayor altura y el nivel de riesgo cardiometabólico en la población adulta peruana. Sin embargo, la prevalencia de riesgo cardiometabólico en las diferentes categorías altitudinales evaluadas se mantiene por encima del 82% (80.9 - 84.6), lo que representa una gran proporción de la población en riesgo en cada altitud. Comentario crítico: El estudio es relevante por el uso de la relación cintura-talla, considerado como un indicador antropométrico con gran precisión para estimar el riesgo cardiometabólico, ser un estudio de bajo riesgo de sesgo y tener representatividad nacional. Por otro lado, es importante porque la relación cintura-talla es económica y fácil de usar, además de ser superior al IMC, ideal para aplicarlo en Perú. Además la conclusión general del estudio es válida, sin embargo, la falta de evaluación de la temporalidad por la misma característica del estudio (tipo transversal) y el sesgo residual que tiene al no evaluar algunas variables, hace necesario que se realicen estudios longitudinales para poder apoyar los resultados del estudio.La presente revisión crítica encuentra validez interna de los resultados del estudio, pero al momento no serían aplicables para generalizarse en toda la población por el sesgo residual.

Presentation: This article presents our critical appraisal of an observational study published in the International Journal of Environmental Research and Public Health in 2022. Conclusions of the Study: An inverse association was identified between living at higher altitudes and the level of cardiometabolic risk in the Peruvian adult population. However, the prevalence of cardiometabolic risk in the different altitude categories evaluated remains above 82% (80.9 - 84.6), which represents a large proportion of the population at risk at every altitude. Critical comment: The study is relevant because of the use of the waist-height ratio, considered an anthropometric indicator with greater precision for estimating cardiometabolic risk, being a study with a low risk of bias, and having national representativity. In addition, it is important because the waist-height ratio is inexpensive and easy to use. It is also superior to BMI and ideal for application in Peru. In addition, the general conclusion of the study is valid; however, the lack of evaluation of temporality due to the same characteristic of the study (cross-sectional study) and the residual bias that it has by not evaluating some variables, makes it necessary to carry out a longitudinal study to be able to support the results of the study. The present critical review finds internal validity in the results of the study, but at the moment they would not be applicable to generalize to the entire population due to the residual bias.

Effect of age and menopause on anthropometric parameters in non-obese and obese South Indian women

Background: Men and women show differences in the distribution of body fat. Women tend to store more fat subcutaneously compared to men. Fat distribution changes in postmenopausal women. Understanding the changes in anthropometry with age and menopausal status is important in the context of deriving population, age, and gender-specific cutoff levels for obesity indices. Aims and Objectives: This study was conducted with the objectives of measuring Waist Circumference (WC), Waist-Hip Ratio (WHR), and Waist-Height Ratio (WHtR) in South-Indian women and determining the effect of age and menopause on the anthropometric parameters in non-obese and obese women. Materials and Methods: 290 women between the age group of 30 to 70 years participated in this analytical cross-sectional study. Age and menopausal status were recorded. Anthropometric parameters such as weight, height, WC, and hip circumference were measured. Body-mass index, WHR, and WHtR were derived. The data were analyzed to compare mean values of anthropometric parameters between premenopausal and postmenopausal women using unpaired t-test. The difference in anthropometric status was also compared between those with Body mass index (BMI) in the non-obese range and those with BMI in the obese range in relation to menopausal status. Results: A higher proportion of women were classified as having abdominal obesity based on WHtR cutoff compared to classifying using WC cutoff. Postmenopausal women showed higher mean values of all measured anthropometric parameters, but the difference was significant only for WHR. When the study subjects were analyzed based on BMI categories, a significant difference between pre and post-menopausal women was recorded in WHtR values in the non-obese BMI group, but not in the obese BMI group when analyzed by unpaired t-test. Conclusion: Anthropometric parameters show an increasing trend as age advances. There is a difference in mean values of all parameters between pre and post-menopausal women, though statistical significance was seen only for WHR and WHtR in different sub-groups based on BMI. Further studies are needed to decide on the need for separate cutoff values for postmenopausal women.

Poor Trunk Flexibility is Associated with Cardiovascular Risk Factors

Abstract Background: Poor flexibility is a predictor of reduced physical activity. The association between trunk flexibility and cardiovascular risk factors (CVRFs) is not well understood. Objective: To identify the prevalence of CVRFs and their association with trunk flexibility in individuals participating in a community-based health education program. Methods: Volunteers (51 men, 48 women) aged 20-85 years old, participants in a community-based health education program in the city of Santo Antônio de Goiás, Brazil, were selected for this study. Anthropometric measures including body mass, height, body mass index (BMI), waist circumference (WC) and waist/height ratio (WHtR) were evaluated. Physical activity level was evaluated based on leisure activity participation, and trunk flexibility was evaluated by the sit and reach test. Data distribution was assessed using the Shapiro-Wilk test; Pearson's chi-square or Fisher's exact and Student t tests were performed for comparisons. To analyze the association between trunk flexibility and concomitant CVRFs, Spearman's correlation test and linear regression were employed. Statistical significance was defined as p < 0.05. Results: 7.2% of the volunteers had no CVRF, 10.3% had only one CVRF and 82.5% had two or more CVRFs, with no differences between sexes. Increased abdominal adiposity, as assessed by WHtR (p = 0.0097), and systemic arterial hypertension (p = 0.0003) were the most prevalent CVRFs, with differences between age groups. A strong negative correlation was found between mean trunk flexibility and the number of concomitant CVRFs (r = -0.96, p < 0.0028). Conclusion: The strong negative correlation between trunk flexibility and concomitant CVRF indicates an increased risk for cardiovascular events. Therefore, trunk flexibility measurement may be an additional tool for health promotion and prevention of cardiovascular and associated diseases in community health programs.

Relación del Índice cintura/talla con la morbilidad y el riesgo cardiometabólico en adultos pinareños / Relation waist-to-height index with morbidity and cardiometabolic risk in the adults from Pinar del Rio province

RESUMEN Introducción: el índice cintura-talla es un indicador antropométrico que ha captado la atención como índice útil para medir la adiposidad central y el riesgo cardiometabólico. Objetivo: mostrar la relación del índice cintura-talla con la morbilidad y el riesgo cardiometabólico en adultos pinareños. Métodos: se realizó una investigación observacional, analítica y transversal en 164 trabajadores de la Universidad de Ciencias Médicas de Pinar del Río y del Policlínico Jesús Lemus Mirabal, entre septiembre de 2018 y febrero de 2019. Se realizaron mediciones antropométricas, de tensión arterial y determinaciones hematológicas además de ultrasonido abdominal. Se utilizaron pruebas no paramétricas U de Mann-Whitney para la comparación de medias. Resultados: la edad promedio de la serie de estudio fue de 48,4±12,58 años. Los indicadores antropométricos circunferencia de la cadera, de la cintura e índice de masa corporal, mostraron valores promedios mayores en el grupo con ICT ≥0,5. En los sujetos que presentaron ICT≥0,5 se encontraron mayores niveles promedios de tensión arterial sistólica, diastólica, glucemia, colesterol, triglicéridos y ácido úrico que los que presentaron ICT aceptables (p<0,05). El ICT mostró correlación positiva y significativa (p<0,05) con los valores de todos los parámetros hematobioquímicos empleados. Los valores anómalos de riesgo cardiometabólico se concentraron entre los que tuvieron ICT≥0,50. Conclusiones: el índice cintura-talla es un índice simple y válido para identificar adultos con mayor riesgo cardiometabólico y morbilidad por enfermedades crónicas no trasmisibles.

ABSTRACT Introduction: waist-to-height index is an anthropometric indicator that has captured interests as useful marker to measure the central adiposity and cardiometabolic risk. Objective: to demonstrate the relation of waist-to-height index with morbidity and cardiometabolic risk in the adults from Pinar del Rio province. Methods: and observational, analytical and cross-sectional research was carried out in 164 workers from Pinar del Rio University of Medical Sciences and Jesus Lemus Mirabal Polyclinic between September 2018 and February 2019. Anthropometric measures, measurement of blood pressure, hematological determination and an abdominal ultrasound were assessed; using the non-parametric tests of U and of Mann-Whitney for the comparison. Results: the average age of the series of study was 48,4±12,58 years old. The anthropometric indicators of hip and waist circumferences and the body mass index [BMI] showed higher average values in the group with BMI ≥0,5. In the subjects who presented BMI ≥0,5 were found higher average levels of systolic and diastolic blood pressure, blood glucose, cholesterol, triglycerides and uric acid, than those who presented acceptable TBI values(p<0,05). The BMI showed positive and significant correlation (p<0,05) with the values of all the hematological-biochemical parameters applied. The anomalous values of cardiometabolic risk were concentrated among those showing BMI ≥0,50. Conclusions: the waist-to-height index is a simple and valid indicator to identify the adults with increased cardiometabolic risk and morbidity from chronic noncommunicable diseases.

Índice cintura-talla e índice de masa corporal como predictores de riesgo cardiometabólico en niños y adolescentes / Waist size index and body mass index as predictors of cardiometabolic risk in children and adolescents

Objetivo: comparar la utilidad del índice cintura-talla y el índice de masa corporal para detectar factores de riesgo cardiometabólicos en niños de 5-18 años, atendidos en la consulta externa del Hospital Infantil Regional Universitario Doctor Arturo Grullón en el período octubre-diciembre del año 2016. Método: se realizó un estudio observacional, comparativo, de corte transversal y fuente primaria, con una muestra de 118 pacientes. Se midieron las variables sociodemográficas (edad y sexo), antropométricas (peso, talla, IMC, ICT, PC, TA), y laboratorios (glicemia, ALT, colesterol, triglicéridos, HDL, LDL). Para el análisis cuantitativo se calculó el promedio y la desviación estándar, para el análisis cualitativo se utilizó la prueba estadística chi-cuadrado. Resultados: tanto el ICT como el IMC detectan de manera similar las alteraciones de la presión arterial sistólica (ICT=15.9 %, IMC=15 %), diastólica (ICT=20.4 %, IMC= 21.8 %), obesidad (ICT=69.5 %, IMC=73.7 %), HDL (ICT=6.8 %, IMC=5.6 %). En relación a la evaluación de la obesidad ambos índices arrojaron resultados afines, 69.5 % para ICT y 73.7 % el IMC. En la valoración de los niveles altos de ALT se obtuvieron resultados similares, presentando el ICT un 8.1 % y el IMC un 8.9 %. Conclusión: se demostró que tanto el ICT como el IMC son buenos predictores de factores de riesgos cardiometabólicos.

Objective: To compare the utility of the WSI and BMI in detecting cardiometabolic risks on children between 5-18 years, during external consult in Hospital Infantil Regional Universitario Dr. Arturo Grullón in the period of October-December 2016. Methods: A cross-sectional, primary source, observational design study was conducted with a sample of 118 patients. The variables measured for this study included sociodemographic (age and sex), anthropometric (weight, height, BMI, ICT, PC), and laboratories (glycemia, ALT, cholesterol, triglycerides, HDL, LDL). The quantitative analysis was carried out by calculating the average and the standard deviation. As for the qualitative analysis, the statistical test χ² was used. Results: Both the WSI and the BMI proved to be effective in detecting changes in Systolic (WSI = 15.9%, BMI = 18.4%) and Diastolic Blood Pressure (WSI = 20.4%, BMI = 18.6%), obesity (WSI = 69.5%, BMI = 73.7%), HDL (WSI = 29.3%, BMI = 29.9%). Regarding the detection of obesity, both rates showed similar results, 69.5% for ICT, and 73.7% for BMI. Comparable results were obtained in the assessment of high levels of ALT, with the ICT at 8.1% and the BMI at 8.9%. Conclusions: WSI and BMI are both useful to detect cardiometabolic risk factors.

Relationship between body mass index and waist-to-height ratio in childhood

SUMMARY OBJECTIVE: To evaluate whether there is an association between the body mass index z-score and waist-to-height ratio of children and adolescents. METHODS: This was a cross-sectional study conducted in a school in Santo André, SP, between June and August 2019. Body mass index was measured for all participants, adopting the z-score cutoff of +2 recommended by the World Health Organization. The waist-to-height ratio was determined in children over two years of age and considered abnormal when ≥0.5. The qualitative variables are presented as absolute numbers and percentages. To compare qualitative data, we used the χ2 test or Fisher's exact test. Pearson's test was applied to assess the correlation between BMI and waist-to-height ratio. The level of significance adopted was 5%. RESULTS: The body mass index was calculated for 518 children and the waist-to-height ratio for 473 children. Regarding body mass index, 60.6% of the participants had normal weight, 3.1% were underweight, and 36.3% were overweight. overweight (24.7%) and obesity (22.7%) were more prevalent in adolescents. The waist-to-height ratio was abnormal in 50.5% of the sample. There was an increasing association between body mass index and waist-to-height ratio with age, according to the Pearson correlation coefficients for the age groups <5 years (r=0.459; p<0.001), 5 to 10 years (r=0.687; p<0.001) and >10 years (r=0.805; p<0.001). CONCLUSION: There was a significant correlation between body mass index and waist-to-height ratio. This association was higher in adolescents. The waist-to-height ratio is easy to apply and may be useful as a predictor of cardiometabolic risk.

Relationship between fiber intake and cardiovascular risk factors in adolescents with systemic lupus erythematosus / Relação entre consumo de fibra e fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico

ABSTRACT Objective: To evaluate the fiber intake and the relationship with cardiovascular risk factors in adolescents with juvenile systemic lupus erythematosus. Methods: This is a cross-sectional in which adolescents with juvenile systemic lupus erythematosus were evaluated. The dietary consumption was assessed by the 24-hour recall; nutritional status was classified according to the Body Mass index/Age by Sex; abdominal obesity was assessed through waist circumference, waist-to-height ratio and glucose and lipid metabolism. The data were analyzed using Statistical Software for Professionals 14 and all statistical analyses used an alpha error of 5%. Results: 52 patients were evaluated, with a mean age of 16.7±1.5 years. Inadequate fiber consumption occurred in 61.5% (n=32) of them. Average of waist circumference measures (81.4 vs. 75.5 cm; p=0.02), waist-to-height ratio (0.51 vs. 0.47; p=0.02) and systolic blood pressure (122.1 vs. 114.8 mmHg; p=0.03) were higher in those who had inadequate fiber intake. Among the cardiovascular risk factors evaluated, the waist/height ratio showed a significant negative correlation with fiber consumption (r=-0.3; p=0.04), that is, the higher the fiber consumption, the lower the value of the waist ratio /stature. Conclusions: Low dietary fiber intake in adolescents with systemic lupus erythematosus juvenile is related to higher abdominal adiposity and consequently with increased cardiovascular risk.

RESUMO Objetivo: Avaliar o consumo de fibras e analisar a sua relação com os fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico juvenil. Métodos: Trata-se de um estudo transversal em que foram avaliados adolescentes com lúpus eritematoso sistêmico juvenil. O consumo alimentar foi avaliado pelo recordatório de 24 horas; o estado nutricional, classificado de acordo com o índice de massa corporal/idade, segundo o sexo; e a obesidade abdominal, analisada por meio da circunferência da cintura e razão cintura/estatura e do metabolismo glicídico e lipídico. Os dados foram analisados no Statistical Software for Professionals 14, e todas as análises estatísticas usaram erro alfa de 5%. Resultados: Foram avaliados 52 pacientes, com média de idade de 16,7±1,5 anos. O consumo inadequado de fibras ocorreu em 61,5% (n=32) dos adolescentes e evidenciou que a média das medidas da circunferência da cintura (81,4 vs. 75,5 cm; p=0,02), a relação cintura/estatura (0,51 vs. 0,47; p=0,02) e a pressão arterial sistólica (122,1 vs. 114,8 mmHg; p=0,03) foram maiores naqueles que tiveram consumo inadequado de fibras. Entre os fatores de risco cardiovascular avaliados, a relação cintura/estatura apresentou correlação negativa significante com consumo de fibras (r=-0,3; p=0,04). Ou seja, quanto maior o consumo de fibras, menor o valor da relação cintura/estatura. Conclusões: A baixa ingestão de fibras da dieta nos adolescentes com lúpus eritematoso sistêmico juvenil está relacionada com maior adiposidade abdominal e, consequentemente, com maior risco cardiovascular.

Association between "a body shape index" and mortality: Bambuí Cohort Study of Aging, Brazil / Associação entre "a body shape index" e mortalidade: o Estudo de Coorte de Idosos de Bambuí, Brasil / Asociación entre "a body shape index" y mortalidad: estudio de una Cohorte Ancianos de Bambuí, Brasil

This article aims to evaluate the joint and separate association between abdominal and general adiposity indicators and mortality. Data was collected from 1,366 older adults in the Bambuí Cohort Study of Aging with complete information for all variables of interest. The outcome variable was all-cause time until death; exposure variables were a body shape index (ABSI), waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI), assessed at the beginning of the study, and at the 3rd, 5th and 11th year of follow-up. Association between the quartiles of anthropometric indicators and mortality was calculated using an extended Cox proportional hazards model and adjusted for socioeconomic and behavioral confounding factors. Older adults in the 4th ABSI quartile had a higher risk of mortality regardless of BMI (1.27; 95%CI: 1.01-1.58), but this association was not observed in sensitivity analyses. Older adults in the 2nd, 3rd and 4th BMI quartiles had a lower risk of mortality, even when adjusted for WC or ABSI. WC and WHtR showed no association consistent with all-cause mortality after adjustment for confounding factors. Considering the loss of significance in the sensitivity analyses, ABSI's predictive capacity for mortality is still weak. Thus, adopting ABSI in clinical practice or in epidemiological surveys, in conjunction or replacing BMI and WC, requires more in-depth studies.

O estudo teve como objetivo avaliar a associação isolada e independente entre indicadores de adiposidade abdominal e índice de massa corporal (IMC) e mortalidade. O estudo usou dados de 1.366 idosos que tinham informações completos para todas as variáveis independentes no Estudo de Coorte de Idosos de Bambuí, Brasil. A variável dependente foi o tempo até o óbito por todas as causas, e as variáveis de exposição foram o índice de forma corporal (a body shape index - ABSI), circunferência de cintura (CC), razão cintura/estatura (RCE) e IMC, medidos na linha de base e aos 3º, 5º e 11º anos de seguimento. A associação entre os quartis de indicadores antropométricos e a mortalidade foi investigada usando um modelo estendido de riscos proporcionais de Cox ajustado por fatores de confusão socioeconômicos e comportamentais. Os idosos do 4º quartil do ABSI mostraram maior risco de mortalidade, independentemente de IMC (1,27; IC95%: 1,01-1,58), mas a associação não foi mantida nas análises de sensibilidade. Os idosos do 2º, 3º e 4º quartis de IMC mostraram risco menor de mortalidade, associação esta que foi mantida após ajustar para CC ou ABSI. Por outro lado, a CC e a RCE não mostraram associações consistentes com a mortalidade geral depois de ajustar para fatores de confusão. As análises mostraram que a capacidade preditiva do ABSI para mortalidade ainda é fraca, considerando a perda de significância nas análises de sensibilidade. Portanto, a possibilidade de adoção do ABSI na prática clínica ou em inquéritos epidemiológicos para complementar ou substituir o IMC e CC ainda precisa ser explorada com maior profundidade em estudos futuros.

El objetivo de este artículo es evaluar la asociación conjunta y separada entre los indicadores de adiposidad abdominal y general, y la mortalidad. Los datos se recogieron de 1.366 adultos mayores en el estudio de Cohorte Ancianos de Bambuí, Brasil, con información completa para todas las variables de interés. El resultado de la variable fue por cualquier causa hasta la muerte; las variables de exposición fueron índice de forma corporal (a body shape index - ABSI por sus siglas en inglés), circunferencia de cintura (WC), proporción cintura-altura (WHtR) e índice de masa corporal (BMI), evaluados al principio del estudio, y en el 3º, 5º y 11º año de seguimiento. Se calculó la asociación entre los cuartiles de indicadores antropométricos y mortalidad, usando un modelo extendido de Cox de riesgos proporcionales, y ajustado por factores de confusión socioeconómicos y comportamentales. Los adultos más viejos en el 4º cuartil ABSI tuvieron un riesgo mayor de mortalidad, independientemente del BMI (1,27; 95%CI: 1,01-1,58), pero esta asociación no fue observada en los análisis de sensibilidad. Los adultos más viejos en los 2º, 3º y 4º cuartiles de BMI tuvieron un riesgo más bajo de mortalidad, incluso cuando fue ajustado por WC o ABSI. WC y WHtR no mostraron asociación consistente con todas las causas de mortalidad tras el ajuste para factores de confusión. Considerando la pérdida de significación en los análisis de sensibilidad, la capacidad predictiva de ABSI para la mortalidad es todavía débil. De este modo, adoptar ABSI en la práctica clínica o en encuestas epidemiológicas, en conjunción o reemplazando BMI y WC, requiere más estudios en profundidad.

Predicting Metabolic Syndrome Using Anthropometric Indices among Chinese Adolescents with Different Nutritional Status: A Multicenter Cross-sectional Study / 生物医学与环境科学（英文）

Objective@#To evaluate the predictive performance of anthropometric indices for metabolic syndrome (MetS) among Chinese adolescents with different nutritional status.@*Methods@#We recruited 9,513 adolescents aged 10-18 years from seven provinces in China during September 2014. Anthropometric indices and blood pressure were measured at recruitment, and blood samples were collected for determining fasting plasma glucose and lipid profile. Receiver operating characteristic (ROC) analyses were used to assess the predictive performance of anthropometric indices, including body mass index (BMI) percentile, waist circumference percentile, waist-height ratio, and waist-hip ratio.@*Results@#Overall, the four anthropometric indices showed good accuracy for predicting MetS with areas under ROC curves (AUCs) ranging from 0.86 to 0.94; similar AUCs ranging from 0.73 to 0.99 were observed for participants with normal weight. The performance of all four indices was poor in overweight and obese participants, with AUCs ranging from 0.66 to 0.77 and from 0.60 to 0.67, respectively. Waist circumference showed relatively better performance in all the subgroup analyses.@*Conclusions@#We suggest using anthropometric indices with the cutoff values presented here for predicting MetS in the overall and normal-weight adolescent population, but not in the overweight and obese adolescent population where more specific screening tests are required.

Correlación y concordancia de los índices circunferencia/cintura y circunferencia/talla con el índice de masa corporal / Correlation and concordance of circunference waist and waist to height index with body mass index

OBJETIVO: analizar la correlación y concordancia de las medidas antropométricas de la circunferencia/talla y circunferencia cintura según ATP-III, IDF para Sudamérica y Europa con el Indice de Masa Corporal en pacientes adultos. MÉTODOS: se realizó un estudio observacional, analítico de corte transversal en 339 pacientes tomando en cuenta variables como sexo, edad, peso, talla, índice de masa corporal, circunferencia cintura, circunferencia/talla y diagnóstico bajo criterios de inclusión y exclusión establecidos por el Seguro Social Universitario de la Universidad Mayor de San Simón. Se utilizó la prueba de chi-cuadrado, correlación de Pearson, Índice de fiabilidad α-Cronbach y Concordancia Kappa de Cohen para los indicadores evaluados. RESULTADOS: el 66,4% de la muestra corresponde al sexo femenino. La mayor correlación (0,65) y concordancia (0,32) observada fue en el sexo masculino entre la Circunferencia Cintura y Circunferencia/Talla con el IMC. CONCLUSIÓN: existe una mejor una mejor concordancia y fiabilidad de los parámetros clínicos de riesgo Circunferencia Cintura y Circunferencia/Talla con el Indice de Masa Corporal de acuerdo a criterios de la ATP-III en la población evaluada.(AU)

OBJECTIVE: to analyze the correlation and concordance between Waist Circumference and Waist-Height Ratio with Body Mass Index according to ATP-III and IDF for Sudamerica and Europe criteria in adults. METHODS: an observational, analytical and cross-sectional study was carried out in 339 patients. The variables were gender, age, weight, height, body mass index, waist circumference, waist-height ratio and diagnosis under inclusion and exclusion criteria stablished by Seguro Social Universitario of the Universidad Mayor of San Simón. It was calculated the Chi-squared test, Pearson´s correlation, Cronbach´s alpha reliability and Kappa concordance coefficients. RESULTS: the 66,4% of the sample is female. There is more correlation (0.65) and concordance (0.32) between Waist Circumference and Waist-Height Ratio with Body Mass Index in males. CONCLUSION: there is a better correlation and reliability between clinical risk indicators and cut points to, Waist Circumference and Waist-Height Ratio according to ATP-III criteria, with Body Mass Index in the evaluated population.(AU)

Acurácia da relação cintura-altura comparada ao índice de massa corpórea no diagnóstico de sobrepeso e obesidade infantil / Accuracy of the waist-height ratio compared to the body mass index in the diagnosis of overweight and childhood obesity

Objetivo: Avaliar a acurácia da relação cintura-altura (RCA) em comparação ao Índice de Massa Corpórea (IMC) no diagnóstico de sobrepeso e obesidade em crianças de 9 a 12 anos, além de estabelecer um ponto de corte ideal da RCA. Método: Estudo transversal, sendo a população estudada escolares de nove a doze anos, de quatro escolas. Os dados foram tabulados no Programa Microsoft Excel 2013. As medidas de associação foram feitas através do teste de ANOVA seguida de Tukey. Foram calculados os pontos de corte da RCA para sobrepeso e obesidade com suas respectivas acurácias, através da análise das curvas Receiver Operating Characteristics (ROC). Resultados: Observou-se uma elevada prevalência de excesso de peso na faixa etária selecionada, enquanto que o baixo peso apresentou uma menor ocorrência. A análise da RCA através da Curva ROC mostrou uma área sob a curva (ASC) de 0,915 para o diagnóstico de obesidade, sendo o ponto de corte de 0,45. Para o sobrepeso, a RCA mostrou uma área sob a curva de 0,857, com ponto de corte de 0,43.Diferenças entre as idades e os sexos não foram estatisticamente significativas. Conclusões: A RCA se mostrou um bom preditor para a triagem de obesidade infantil, porém sua acurácia para o diagnóstico de sobrepeso não foi satisfatória. São necessários novos estudos que demonstrem a eficácia desse indicador, afim de que o mesmo se consolide como medida diagnóstica do excesso de peso infantil.

Objective: To evaluate the accuracy of the waist-to-height ratio (WHtR) compared to Body Mass Index (BMI) for diagnosis of overweight and obesity in children aged 9 to 12 years old. Method: Cross-sectional study, with the studied population being schoolchildren aged 9 to 12 years old. The data were tabulated in the Microsoft Excel 2013 program. The measures of association were made through the ANOVA test followed by Tukey. The cutoff points of the (WHtR) for overweight and obesity were calculated through the analysis of the Receiver Operating Characteristics (ROC) curves. Results: There was a high prevalence of overweight in the selected age group The WHtR analysis using ROC curve showed an area under the curve (AUC) of 0.915 for the diagnosis of obesity, with a cutoff point of 0.45. For overweight, the WHtR showed an area under the curve of 0.857, with cutoff point of 0.43. Differences between ages and genders were not statistically significant. Conclusions: The WHtR proved to be a good predictor for the screening of childhood obesity, but its accuracy for the diagnosis of overweight was not satisfactory. Further studies are needed to demonstrate the effectiveness of this indicator, in order to consolidate it as a screening measure for childhood overweight.

Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance / A razão cintura/estatura é tão confiável quanto marcadores bioquímicos para discriminar resistência à insulina

Abstract Objective: Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. Methods: This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8 -14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16. Results: Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers. Conclusion: The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.

Resumo Objetivo: Considerando a importância de incorporar ferramentas simples e de baixo custo no cenário clínico-pediátrico para a triagem de resistência à insulina, o presente estudo buscou investigar se a razão cintura/estatura é comparável a marcadores bioquímicos na discriminação de resistência à insulina em crianças e adolescentes. Métodos: Este estudo transversal envolveu estudantes de nove escolas públicas. No total, 296 crianças e adolescentes, de ambos os sexos, com idades entre 8 e 14 anos, compuseram a amostra. A razão cintura/estatura, o índice triglicerídeos/glicose e a razão triglicerídeos/HDL-C foram determinados de acordo com protocolos padrão. A resistência à insulina foi definida por meio do modelo de avaliação homeostática para resistência insulínica, com ponto de corte ≥ 3.16. Resultados: Idade, índice de massa corporal, frequência de excesso de peso, circunferência da cintura, razão cintura/estatura, insulina, glicemia, modelo de avaliação homeostática para resistência insulínica, triglicerídeos, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C foram maiores entre meninos e meninas com resistência à insulina. Também foram observadas, em ambos os sexos, correlações moderadas de todos os indicadores (razão cintura/estatura, índice triglicerídeos/glicose e razão triglicerídeos/HDL-C) com o modelo de avaliação homeostática para resistência à insulina. As áreas sob as curvas ROC foram semelhantes entre a razão cintura/estatura e os marcadores bioquímicos. Conclusão: Os indicadores forneceram poder discriminatório similar para a resistência à insulina. No entanto, levando em conta o custo-benefício, sugerimos que a razão cintura/estatura pode ser uma ferramenta útil para a triagem de resistência à insulina em populações pediátricas.

Relação cintura/estatura e índice de conicidade estão associados a fatores de risco cardiometabólico em idosos / Waist-to-height ratio and the conicity index are associated to cardiometabolic risk factors in the elderly population

Resumo O objetivo deste estudo foi determinar e comparar a magnitude da associação entre indicadores antropométricos com fatores de risco cardiometabólico em idosos. Trata-se de estudo transversal com 402 idosos atendidos pela Estratégia Saúde da Família no município de Viçosa-MG. Os fatores de risco considerados foram o excesso de gordura corporal, hipertensão arterial, alteração da glicemia e dos lipídeos séricos. A associação entre o índice de conicidade (IC) e a relação cintura/estatura (RCE) com os fatores de risco cardiometabólico foi avaliada pela análise de regressão linear múltipla. A amostra foi composta por 60,4% de mulheres e 36,3% de idosos com excesso de peso. O índice de conicidade e a relação cintura/estatura estiveram elevados em 57,2% e 88,1% dos idosos, respectivamente. Os resultados demonstraram que o aumento da gordura corporal, da pressão arterial diastólica, dos triglicerídeos, da glicemia e a redução do HDL-colesterol estão relacionados a maiores valores dos índices antropométricos avaliados. No entanto, a relação cintura/estatura apresentou maior magnitude de associação com os fatores de risco cardiometabólico do que o índice de conicidade.

Abstract The purpose of this study was to determine and compare a magnitude of the association between anthropometric indicators with risk of cardiometabolic risk in the elderly. This is a cross-sectional study with 402 elderly people attended by the Family Health Strategy in the city of Viçosa-MG. Risk factors for excess body fat, hypertension, blood glucose and serum lipid changes. An association between conicity index (CI) and waist-to-height ratio (WtHR) with cardiometabolic risk factors was assessed by multiple linear regression analysis. Sample was composed of 60.4% of women and 36.3% of overweight elderly. The connectivity index and a waist-to-height ratio were higher in 57.2% and 88.1% in the elderly, respectively. The results showed that the increase in body fat, diastolic blood pressure, triglycerides, glycemia and reduction of HDL-cholesterol are related to higher values of anthropometric indices evaluated. However, the waist-to-height ratio presented a greater magnitude of association with the cardiometabolic risk factors than the connectivity index.

Which is a better marker for overweight: waist height ratio or waist circumference?

Background: The global prevalence of obesity has been increasing. Body mass index, waist circumference and waist height ratio have been widely used for nutritional assessment. Waist height ratio has the advantage of taking into account abdominal obesity as well as height associated with body fat accumulation or distribution. The objective of this study was to suggest cut off points for waist circumference and waist height ratio to identify overweight in Omani adults.Methods: Weight, height, waist circumference and waist height ratio were measured for all participants. Pearson’s correlation was used to determine correlation of BMI with waist circumference and waist height ratio. ROC curve was used to identify AUC and specific cut off point for anthropometric indicators.Results: The largest proportion of overweight was picked up by waist height ratio across both the genders. Correlation of BMI with waist height ratio was stronger (r=0.699) than correlation with waist circumference (r=0.589) for both the genders. Maximum AUC was for waist height ratio in males (AUC=0.833, 95% CI=0.791-0.875). The specific cut off point for waist circumference in males and females was 89.5cm and 87.6cm respectively. The specific cut off point for waist height ratio in males and females was 0.53 and 0.57 respectively.Conclusions: Maximum participants were found overweight by waist height ratio followed by waist circumference and the least by BMI. The higher cut off points should be used in this population for identifying overweight people.

Obesity-associated Hypertension among Primary School Children in Sarawak: A Cross-sectional Study

@#Hypertension has been recognised as an important public health issue, affecting paediatric population. This study aimed to determine the prevalence of hypertension and its relationship with obesity among different ethnic, gender primary school children in Kuching division, Sarawak. It was a cross-sectional study using multistage sampling. Data was collected using anthropometric equipment and digital blood pressure monitor. Data was analysed using SPSS version 20. A total of 1314 respondents participated. 36.9% of the respondents were overweight and obese, 31% were overfat and obese, 29% had abnormal waist circumference and 32.8% had abnormal waist-height ratio (WHtR). About 22.1% of the respondents were found to be in pre-hypertension and hypertension stage. There were significant differences in overweight and obese, overfat and obese, WHtR between males and females. Indigenous Sarawak reported to have the highest number of hypertensive at risk, overweight and obese, overfat and obese, abnormal waist circumference and WHtR. Those respondents who were hypertensive were found to be overweight and obese, overfat and obese, with abnormal waist circumference and WHtR. Screening of potential risk factors at a young age would help to reduce the incidents of chronic disease in the adulthood. Blood pressure measurement should be included in the routine physical examination, to identify high risk children for further investigation.

Resistin and visfatin concentrations are related to central obesity and inflammation in Brazilian children

Background:The evidence that cardiovascular disease begins in childhood and adolescence, especially in the presence of excess weight, is associated with dysfunction on adipokine pro-inflammatory secretion. These affect glucose metabolism and lead to other complications related to insulin resistance and cardiovascular disease. This study assessed the association of anthropometric and metabolic parameters related to obesity, cardiovascular risk,and insulin resistance with concentrations of resistin and visfatin, in children. Methods: A cross-sectional study was developed with 178 children of 6­10 years old enrolled in public city schools. Anthropometric data, composition body, clinical, and biochemical were measured according to standard procedures. We used multiple regression models by stepwise method to evaluate the associations of resistin and visfatin with variables of interest.RESULTS: In healthy weight children, resistin was associated with LDL cholesterol, visfatin, atherogenic index, andwaist-to-height ratio, whereas in obese children resistin was associated with visfatin and interaction between conicity index and HOMA-AD. Furthermore, in healthy weight children, visfatin was associated to resistin and triceps skinfold thickness and negatively associated to HOMA-AD, while in obese ones visfatin was associated with waist-to-height ratio, atherogenic index, resistin, and interaction between trunk adiposity index and adiponectin and wasnegatively associated with the HOMA-IR index.CONCLUSIONS:Our study shows an association between anthropometric and biochemical variables related tovisceral fat and inflammation. These results suggest the resistin and visfatin as good pro-inflammatory markers. In addition, both adipokines are strongly related to central obesity, in children. In addition, both adipokines are strongly related to central obesity, in children.

Abdominal obesity in schoolchildren: association with socioeconomic and demograhic indicators / Obesidade abdominal em escolares: associação com indicadores socioeconômicos e demográficos

Obesity among children is considered a concern in public health in Brazil. Careful attention must be given to abdominal obesity because of its association with heart diseases and metabolic problems that may reach children. This study aimed to analyze the association between abdominal obesity, and socioeconomic and demographic indicators in schoolchildren engaged in elementary public schools in the city of Santa Izabel do Oeste (Southern Brazil). A cross-sectional investigation was carried out to investigate waist circumference (WC) and waist to height ratio (WHR). Univariate and multivariate logistic regressions were used to analyze associations. A sample of 361 students from 5 to 9 years old (mean 7.82±1.3) was analyzed, of which 19.1% presented high WC, 22.7% high WHR, and 16.1% had high measurements in both. Among socioeconomic factors ≥11 years of maternal education was significantly associated to high WHR (OR= 1.79; CI95%=1.02- 3.15). The active transport provoked lower odds of both WC (OR=0.28 [95% CI=0.09-0.86]) and WHR (OR=0.20 [95% CI=0.07-0.58]). The findings show that schoolchildren whose mothers had higher educational level present higher odds for elevated WHR. Using active transportation was significantly and inversely associated to odds of both higher WHR and WC. The results indicate the importance of adopting strategies to improve the practice of physical activities that result in higher energetic expenditure. Adopting continues actions to promote health food intake are also necessary. Both actions could be planned on behalf of the Health in School Program and the School Feeding Program.

A obesidade em crianças é considerada um problema de saúde pública no Brasil. Importante atenção deve ser dada à obesidade abdominal, visto que se associa a doenças cardiovasculares e distúrbios metabólicos que podem surgir já na infância. Assim, este estudo objetivou analisar a associação entre obesidade abdominal e indicadores socioeconômicos e demográficos, em escolares do ensino fundamental, matriculados em escolas públicas de Santa Izabel do Oeste­PR. Foi realizado estudo transversal, que investigou circunferência da cintura (CC) e razão cintura-estatura (RCE). Para as análises de associação, utilizou-se regressão logística bivariada e multivariada. Analisaram-se 361 escolares de 5 a 9 anos de idade (7,82 ± 1,3). Destes, 19,1% apresentaram CC elevada, 22,7% RCE elevada, e 16,1% ambas as medidas elevadas. Dentre os fatores socioeconômicos, a escolaridade materna ≥11 anos de estudo associou-se significativamente à RCE elevada (OR= 1,79; IC95%=1,02-3,15). A utilização de transporte ativo resultou em menor razão de chances para obesidade abdominal considerando-se tanto CC (OR=0,28 [IC95%=0,09-0,86) quanto RCE (OR=0,20 [IC 95%=0,07-0,58]). Os resultados mostraram que crianças cujas mães possuíam maior escolaridade apresentaram maiores chances para aumento da RCE. Utilizar transportes ativos se associou inversamente às chances de presença de RCE e CC altas. Ambos os resultados indicam a importância de se adotarem mais estratégias para aumentar a prática de atividades físicas que resultem em gasto calórico entre estes escolares, assim como adotar ações contínuas para a promoção da alimentação adequada e saudável, que poderiam ser planejadas no âmbito do Programa Saúde na Escola e do Programa de Alimentação Escolar.

Application of an obesity evaluation index for the screening of type 2 diabetes mellitus / 中华健康管理学杂志

Objective This study investigated the application value of waist-to-height ratio (WHtR), body mass index (BMI), and waist-to-hip ratio (WHR) in screening for type 2 diabetes mellitus (T2DM) and high risk of T2DM. Methods A total of 7 582 subjects aged 40-75 years were randomly selected and stratified based on the results of an oral glucose tolerance test (OGTT) administered during a standard screening for T2DM in the Shougang community.Three anthropometric indices(WHtR,BMI,and WHR) were compared, with the optimal cutoffs for WHtR, BMI, and WHR identified using receiver operating characteristic curve (ROC) analysis. Using multivariate logistic regression analysis and the area under the curve(AUC)of ROC,the associations between BMI,WHR,and WHtR and T2DM were analyzed by group: normal glucose tolerance group (n= 3 080), T2DM high-risk group (n= 2 992 cases), and T2DM group(n=1 510).Results Logistic regression analysis showed that BMI,WHR,WHtR,and family history of diabetes were positively correlated with T2DM and high risk of T2DM(P<0.05 and P<0.01,respectively);WHtR was most significant, with odds ratios of 90.409 and 69.285, respectively. WHtR had the greatest AUC under the ROC in men,whereas BMI had the greatest AUC in women.The optimal cutoffs values for the detection of T2DM were 0.51, 25.47 kg/m2, and 0.91 for WHtR, BMI, and WHR in men, respectively, and 0.52, 24.95 kg/m2, and 0.86 for WHtR, BMI, and WHR in women, respectively. WHtR was more efficient than WHR and BMI based on the AUC. The optimal cutoff values for detecting a high risk for T2DM were 0.51,25.30 kg/m2,and 0.91 for WHtR,BMI,and WHR in men and 0.51,24.81 kg/m2,and 0.86 for WHtR, BMI, and WHR in women, respectively. Conclusion Waist-to-height ratio may be a more effective index for diagnosing type 2 diabetes mellitus and identifying individuals at high risk for T2DM than BMI or WHR.