Exploration and validation of clinical obesity screening in childrenand adolescents based on body mass index, waist circumference, and waist-to-height ratio

Abstract

Objective To develop a combined criterion for screening clinical obesity based on body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and to evaluate its performance in identifying obesity-related metabolic risk among Chinese children and adolescents. Methods Data were obtained from physical examinations and blood biochemical measurements of 15 850 children and adolescents aged 6 - 17 years who participated in a multicenter intervention study. A positive combined criterion was defined as exceeding the corresponding cutoffs for at least two of the three anthropometric indicators: BMI, WC, and WHtR. The obesity detection rate based on the combined criterion was compared with that based on the national health industry standard for BMI-based screening. Receiver operating characteristic curve analysis was performed to evaluate the predictive performance of the BMI-based standard, the combined criterion, and different pairwise anthropometric combinations for metabolic abnormalities. The associations of discordant screening results based on the combined criterion and the BMI standard with metabolic abnormalities were further analyzed. Results The obesity detection rate using the combined criterion was 13.95%, significantly higher than the 12.09% rate using the BMI-based standard (P<0.05).The AUC values for the combined criterion in predicting low high-density lipoprotein cholesterol(HDL-C), elevated triglycerides(TG), dyslipidemia, and cardiometabolic risk factor clustering(CRFC) were higher than those of the BMIbased standard; the AUC values for the combined criterion in predicting low HDL-C, elevated TG, and dyslipidemia were higher than those of the combination of the three pairwise anthropometric combinations, and all differences were statistically significant (P<0.05).Multivariable logistic regression showed that children and adolescents who were positive according to the composite criterion but negative according to the BMI-based standard had significantly higher risks of low high-density lipoprotein cholesterol, elevated triglycerides, dyslipidemia, and cardiometabolic risk factor clustering than those who were negative according to the composite criterion but positive according to the BMI-based standard (P<0.05). Conclusion Compared with the BMI-based national health industry standard alone, the combined criterion based on BMI, WC, and WHtR may improve the identification of obesity-related metabolic risk in children and adolescents, particularly among individuals who do not meet BMI-defined obesity criteria but have central obesity and metabolic abnormalities.

Keywords

clinical obesity / body mass index / waist circumference / waist-to-height ratio / children and adolescents