Waist-to-height ratio associated cardiometabolic risk phenotype in children with overweight/obesity

Authors: UKEGBU, TOCHI - City College Of New York; WYLIE-ROSETT, JUDITH - Albert Einstein College Of Medicine; GROISMAN-PERELSTEIN, ADRIANA - Jacobi Medical Center; DIAMANTIS, PAMELA - Jacobi Medical Center; RIEDER, JESSICA - Albert Einstein College Of Medicine; GINSBERG, MINDY - Albert Einstein College Of Medicine; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SHANKAR, VISWANATHAN - Albert Einstein College Of Medicine

Submitted to: BioMed Central(BMC) Public Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 7/28/2023
Publication Date: 8/15/2023
Citation: Ukegbu, T.E., Wylie-Rosett, J., Groisman-Perelstein, A., Diamantis, P.M., Rieder, J., Ginsberg, M., Lichtenstein, A.H., Matthan, N., Shankar, V. 2023. Waist-to-height ratio associated cardiometabolic risk phenotype in children with overweight/obesity. BioMed Central (BMC) Public Health. https://doi.org/10.1186/s12889-023-16418-9.
DOI: https://doi.org/10.1186/s12889-023-16418-9

Interpretive Summary: Childhood overweight/obesity is associated with an elevated risk of insulin resistance and cardiometabolic disorders. The aim of this study was to determine the value of waist-to-height ratio as a rapid screening tool for the early identification of children at elevated risk for cardiometabolic disorders. Baseline data from the Family Weight Management Study randomized controlled trial was used to assess the relation of waist-to-height ratio with cardiometabolic risk factors. Higher waist-to-hip ratio in children was associated with an overall less favorable cardiometabolic profile. These findings suggest that waist-to-hip ratio may be a practical screening tool in pediatric populations to identify children with cardiometabolically unhealthy phenotypes in public health settings.

Technical Abstract: Background: Higher childhood overweight/obesity has been associated with an elevated risk of insulin resistance and cardiometabolic disorders. Waist-to-height ratio (WHtR) may be a simple screening tool to identify children at risk for cardiometabolic associated obesity. This study investigated whether being in the upper tertile for WHtR predicted the odds of insulin resistance, elevated liver enzyme concentrations, and cardiometabolic risk factor measures using cross-sectional data from the Family Weight Management Study randomized controlled trial. Methods: Included was baseline data (n=360, 7-12 years, mean Body Mass Index >/=85th percentile for age and sex). WHtR were grouped into tertiles by sex, male: 0.55-0.59(T3); female: 0.56-0.6(T3). The Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used to categorize participants as insulin-resistant (HOMA-IR >/= 2.6) and insulin-sensitive (HOMA-IR < 2.6). Liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were categorized as normal vs. elevated (AST of < 36.0 microkat/L or >/= 36.0 microkat/L; ALT of < 30.0 microkat/L or >/= 30.0 microkat/L). We examined differences in baseline cardiometabolic risk factors by WHtR tertiles and sex-specific multivariable logistic regression models to predict IR and elevation of liver enzymes. Results: Study participants had a mean WHtR of 0.59 ([SD: 0.06)]). Irrespective of sex, children in WHtR T3 had higher BMIz scores, blood pressure, triglycerides, 2-hr glucose, fasting, 2-hr insulin and lower HDL-C concentrations compared to those in T2 and T1. After adjusting for covariates, the odds of elevated IR (using HOMA-IR >2.6) were over 5fold higher among children in T3 versus T1 (males) and T2 and T3 versus T1 (females). The odds of elevated ALT values (>/=30) were 2.9 fold higher among female children in T3 compared to T1. Conclusion: WHtR may be a practical screening tool in pediatric populations with overweight/obesity to identify children at risk of IR and cardiometabolically unhealthy phenotypes in public health settings.