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Central obesity has been shown to better indicate health risks compared to general obesity. Measures of central obesity include waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and waist circumference (WC). The National Institute of Health and Care Excellence (NICE) recently recommended the use of WHtR alongside body mass index (BMI) to identify risks in adults and children, whilst recognising the need for more evidence relating to WHtR in children. This study explores risk thresholds for central obesity measures throughout adolescence. It compares these with those currently recommended in England and discusses whether these thresholds are age- and sex-specific. Data on adolescents aged 11 to 18 years from the Health Survey for England (HSE) during 2005 to 2014 was used to calculate WHtR, WHR and WC percentiles. Next, smoothed lambda-mu-sigma (LMS) curves were created and the percentiles which align with the adult thresholds at age 18 years identified. This allows the most appropriate risk related thresholds for each measure during adolescence to be determined. WHtR LMS curves are stable and flat throughout adolescence. WHR decreases in girls and WC increases in both boys and girls, during adolescence. Across all measures, there is slightly more fluctuation in higher percentiles, and in girls' WHR. In practice, WHtR thresholds are simple to use to identify central obesity related risks. In particular, they are recommended because the same thresholds can be used for males and females and for adolescents and adults. The results support NICE guidance to use WHtR thresholds alongside BMI thresholds to identify individual risk. This study uses central obesity measures, including waist-to-height and waist-to-hip ratios, to investigate risk-related thresholds for adolescents. It is the first to do so using English data. It provides support for current NICE recommendations to use adult waist-to-height thresholds in adults and children, alongside BMI measures in clinical and non-clinical settings. [ABSTRACT FROM AUTHOR]

Background: Although numerous studies have indicated the utility of waist-to-height ratio (WHtR) in early screening for individuals with adverse cardiometabolic health, there is controversy on using WHtR as a one-size-fits-all approach, including in older adults. Objectives: Our study aims to identify the pooled diagnostic accuracy of WHtR in screening for metabolic syndrome (MetS) and its components among older adults. Methods: A systematic review of observational studies was performed using 4 databases. A diagnostic meta-analysis with a random effects model was conducted, and the pooled area under the summary receiver operating characteristic curve, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (dOR) of each outcome compared with WHtR, body mass index (BMI), and waist circumference (WC) were calculated, with sex-stratified analysis. Results: A total of 17 studies with 74,520 participants were included. As reflected by the dOR, WHtR (7.65; 95% CI: 6.00, 9.75) performed better than BMI (5.17; 95% CI: 4.75, 5.62) and WC (5.77; 95% CI: 4.60, 7.25) in screening for MetS among older adults and was potentially better among males. For hyperglycemia, hypertension, and dyslipidemia, the performances of WHtR, BMI, and WC were comparable. Conclusion: More studies focusing on older adults are still needed to determine the cutoff values of WHtR to screen for MetS. The search strategy was registered in PROSPERO as CRD42022350379. [ABSTRACT FROM AUTHOR]

To assess the relationship between waist-to-height ratio (WHtR) and the incidence of type 2 diabetes (T2D)/impaired fasting glucose (IFG) and to explore to what extent these associations are mediated by blood pressure, lipids and other indicators related to liver and kidney metabolism. This study was based on a functional community cohort included 6109 participants which were divided into two sub-cohorts. One sub-cohort included participants with normal fasting glucose (n = 5563), another included IFG individuals at baseline (n = 546). Cox regression models were used to evaluate the relationships of WHtR with T2D/IFG. Four-year time-dependent receiver operating characteristic (ROC) curve and area under curve (AUC) were calculated to estimate the discriminatory power of WhtR and other anthropometric indices on T2D. Mediation analysis was performed to estimate which risk factors mediate the association between WHtR and T2D. Significant positive associations were found between WHtR and the incidence of T2D/IFG in both sub-cohort. WhtR was a useful predictor of T2D (P < 0.05). Mediation analysis showed that HOMA-IR (0.45 %), SBP (5.10 %), triglycerides (11.02 %), creatinine (9.36 %) and combined kidney indicators (17.48 %) partly mediated the effect of WHtR on T2D in men. For women, this association was partly mediated by SBP (13.86 %), HDL (24.54 %), ALT (6.29 %), UA (22.58 %) and combined kidney indicators (39.51 %). WHtR was an independent risk factor for the development of T2D and IFG. This association was partly mediated by HOMA-IR, SBP, lipids and other liver and kidney metabolism indicators. • Strong correlations were found between WhtR and T2D/IFG. • WhtR was a useful indices in predicting T2D. • Association between WHtR and T2D were mediated by HOMA-IR, SBP, lipids and other liver and kidney indicators. [ABSTRACT FROM AUTHOR]

• Obesity raises type 2 diabetes risk, but the best index and cut-off remain unclear. • This study aims to identify the best diabetes predictor and cut-off values by sex. • WHtR is the best predictor of type 2 diabetes risk in men with a cut-off of 0.497. • wBMI and WHtR are superior in women, with cut-offs of 0.510 and 18.6 kg/m. • These indices are useful for assessing the risk of type 2 diabetes. To compare the predictive abilities of body mass index (BMI), waist circumference (WC), waist-corrected BMI (wBMI), a body shape index (ABSI), and waist-to-height ratio (WHtR) for the incidence of type 2 diabetes and determine the practical cut-off values for the Japanese population. This study used data from 155,623 participants who had medical checkups with Panasonic Corporation between 2008 and 2021. Predictive abilities of anthropometric indices were evaluated at 13 years using time-dependent receiver operating characteristic (ROC) curve analyses. 8,800 developed type 2 diabetes during the study period. The area under the ROC curve for the WHtR was high (0.717, 95 % confidence interval [CI]: 0.710–0.724), with cut-off value of 0.497 in men, while those for wBMI (0.829, 95 % CI: 0.808–0.848) and WHtR (0.826, 95 % CI: 0.806–0.845) were high in women, with cut-off values of 18.6 kg/m and 0.510, respectively. It was also showed WHtR was the most effective in men, while WHtR and wBMI outperformed WC and were comparable to BMI in women for predicting type 2 diabetes. WHtR demonstrated superior effectiveness in predicting type 2 diabetes in men, while both WHtR and wBMI showed higher effectiveness than WC and were almost equivalent to BMI in women. [ABSTRACT FROM AUTHOR]

Background and Aims: Observational studies reveal that different body fat measures are associated with cardiometabolic disease with different effects. However, causality is not reflected by such observations. To explore and compare the causal relationships of general obesity (measured by body mass index (BMI)), adipose obesity (measured by fat mass percentage (FMP)) and central obesity (measured by waist-to-height ratio (WHtR)) with cardiometabolic traits among children.Methods and Results: We conducted one sample Mendelian randomization (MR) analysis in 3266 children from Beijing Children and Adolescents Metabolic Syndrome Study. Genetic instruments based on 28 SNPs were performed to explore and compare the causal associations of genetically BMI, FMP and WHtR with cardiometabolic traits. The genetic instruments were robustly correlated with observed BMI, FMP and WHtR. Each genetically 1-SD increment in BMI, FMP and WHtR were causally associated with increment in systolic blood pressure (SBP), diastolic blood pressure (DBP), log-transformed fasting plasma glucose (FPG), log-transformed HOMA-β, and decrease in log-transformed high-density lipoprotein cholesterol (HDL), respectively (all P < 0.05 after Bonferroni correction). The receiver operating characteristic curve indicated that BMI and FMP showed stronger effects on SBP, DBP, HOMA-β and HDL than WHtR (all P < 0.05). We also observed causal associations of BMI and FMP with log-transformed fasting insulin and HOMA-IR.Conclusions: The MR analysis based on population-based cohort indicated a causal relationship of adiposity and body fat distribution with cardiometabolic traits. When compared with central obesity, general obesity and adipose obesity might own stronger effects on blood pressure and blood lipids among children. [ABSTRACT FROM AUTHOR]

Only limited information is available on the usefulness of the waist-to-height ratio (WHtR) as an abdominal obesity marker in children. Our aim was to compare the ability of a WHtR >90th percentile, a WHtR ≥0.50, a WHtR ≥0.55 and a BMI z-score ≥2 SD to predict cardiometabolic risk in children followed-up at different ages. We evaluated data from 660 children at 5, 8 and 11 years of age who participated in the Childhood Obesity Project trial in 5 European countries. We classified children with or without cardiometabolic (CMet) risk (yes vs. no) according to the presence of ≥ 2 parameters (blood pressure, HOMA-IR, triglyceride levels and high-density lipoprotein (HDL) cholesterol levels) ≥90th percentile. The odds ratio for CMet risk in children at all followed-up ages was statistically significant for all measures. The OR for the WHtR≥0.55 cut-off was 29.1 (5.6, 151.7) at 5 years of age, 11.8 (4.1, 33.8) at 8 year of age and 3.6 (1.7, 7.7) at 11 years of age, compared to the WHtR<0.55 cut-off. The WHtR≥0.55 cut-off showed a higher OR at younger ages than the BMI z-score ≥2SD, WHtR ≥90th percentile and WHtR≥0.50 cut-offs and a higher positive predictive value (82% at 5 years of age compared to 55%, 36% and 41%, respectively). A WHtR≥0.55 is a suitable cut-off for screening children at high cardiometabolic risk in the general young European population. [ABSTRACT FROM AUTHOR]

Background: Few studies have been conducted on the associations of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cognitive impairment among Chinese older adults through a prospective design.Objective: This study was aimed to evaluate the associations of BMI, WC, and WHtR with cognitive impairment.Methods: We included participants aged 65 years and older in 2014 at baseline and 2018 follow-up surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). BMI, WC, and WHtR were calculated from measured weight, height, and waist circumference. Mini-Mental State Examination was utilized to assess cognitive impairment. Modified Poisson regression was used for calculating prevalence ratios, risk ratios, and 95% confidence intervals.Results: A total of 5156 participants were included in 2014 at baseline. The prevalence of cognitive impairment was 42.5%, 26.7%, and 21.2% in underweight, normal-weight, and overweight/obesity participants defined by BMI categories, respectively, and 24.1% and 26.8% in central obesity participants defined by WC and WHtR cutoffs, respectively. Prospectively, participants with underweight were more likely to suffer from cognitive impairment (RR = 1.258, 95% CI: [1.016, 1.559]), but no risk was found among participants with overweight/obesity after adjustment. Regardless of whether covariates were adjusted or not, no effect on cognitive impairment was found in participants with WC and WHtR groups in the follow-up survey.Conclusions: Underweight may be a significant risk factor for the cognitive impairment of Chinese older adults. Weight management programs targeting older adults should attach importance to achieving and maintaining optimal body weight and improving cognitive function. [ABSTRACT FROM AUTHOR]

Background and Aims: Cardiometabolic multimorbidity (CM) is an increasing public health burden. This study aimed to evaluate the association of waist-to-height ratio (WHtR), waist circumference (WC), waist divided by height0.5 (WHT.5R) and body mass index (BMI) with the risk of CM.Methods and Results: We used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 10,521 participants aged 45 years and over were recruited, including 8807 individuals with 0 cardiometabolic diseases at baseline (stage I) and 1714 individuals with 1 cardiometabolic disease at baseline (stage II). CM was defined as self-reporting of two or more of the following conditions: stroke, diabetes and heart disease. Logistic regression was conducted to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). The net reclassification index (NRI) and integrated discrimination improvement (IDI) were used to evaluate the incremental predictive value beyond conventional factors. In stage I, an increased risk of CM was observed among participants with WHtR ≥0.5 (OR: 1.76, 95% CI: 1.05-2.97), WC ≥ 90 cm (men) + WC ≥ 80 cm (women) (OR: 2.06, 95% CI: 1.29-3.27), WHT.5R ≥ 6.54 cm0.5 (OR: 1.81, 95% CI: 1.16-2.83) or BMI ≥24 kg/m2 (OR: 1.48, 95% CI: 0.98-2.24). Furthermore, the NRI and IDI of WHtR, WC and WHT.5R were all higher than those of BMI. In stage II, the adjusted ORs (95% CIs) of WHtR, WC, WHT.5R and BMI were 2.04 (1.24-3.35), 1.89 (1.29-2.77), 1.86 (1.24-2.78) and 1.47 (1.06-2.04), respectively. In addition, WC exhibited the highest NRI and IDI.Conclusion: WHtR, WC, WHT.5R and BMI are independent predictors of CM in the middle-aged and older Chinese population. WHtR, WC and WHT.5R show better abilities in predicting CM than BMI. [ABSTRACT FROM AUTHOR]

The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV). We analyzed data from 34,224 youths (51.0 % boys, aged 6–18 years) with CMRFs, 5004 (49.5 % boys, aged 6–18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6–17 years) with PWV measurement from 20 pediatric samples across 14 countries. WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75–0.78) to 0.78 (0.76–0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74–0.79) to 0.77 (0.74–0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64–0.71) to 0.70 (0.66–0.73) for high cIMT (≥P95 values) and from 0.60 (0.58–0.66) to 0.62 (0.58–0.66) for high PWV (≥P95 values). Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings. • WHtR, WC, and BMI had similar performance in discriminating youths with ≥3 cardiometabolic risk factors. • WHtR, WC, and BMI also showed similar performance in discriminating youths with subclinical vascular outcomes. • A single adiposity index (WHtR, WC, or BMI) performed similarly well with the combined indices. • WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings. [ABSTRACT FROM AUTHOR]

It is crucial to have simple and appropriate measures to identify people with adiposity-related risk. We compared the associations of mortality with body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and body fat percentage (BF%) in a prospective cohort. A total of 463,002 adults were recruited between 1996 and 2017. Vital data were obtained from the National Death Registry System in Taiwan. Cox proportional hazards model was used to assess the associations of BMI, WC, WHtR, and BF% with mortality. Clear U-shape relationships were observed for all four parameters. In both men and women, the lowest risk of mortality was observed in the BMI category of 23.5–24.9 kg/m2. Regarding WC, men in the third quintile (79.0–82.9 cm) and women in the fourth quintile (70.0–74.9 cm) had the lowest risk of mortality. For WHtR, men in the third quintile (0.46–0.49) and women in the fourth quintile (0.45–0.48) had the lowest risk of mortality. For BF%, both men and women in the fourth quintile (24.0–27.2% and 28.7–32.8%, respectively) had the lowest risk of mortality. The WC, WHtR, and BF% exhibited slightly associations with the risk of mortality across the three BMI categories [low (10.8–20.9 kg/m2), normal (21.0–27.4 kg/m2) and high (27.5–51.7 kg/m2)]. C-statistics of the four parameters ranged from 0.51 to 0.69. Our results suggest that BMI should remain the primary marker for screening excessive adiposity. However, our findings also support the use of the WC, WHtR, and/or BF%, in addition to BMI when assessing the risk of mortality. [ABSTRACT FROM AUTHOR]

The prevalence of childhood obesity has been increasing worldwide. The connection between iron deficiency and obesity has received much research interest. The present study examined the profiles of anemia among school-aged children categorized by obesity-related index in Shandong, China. A total of 20,172 children aged 7, 9, 12, and 14 years participated in the study, whose hemoglobin (Hb) concentration was measured by laboratory technicians. The prevalence rates of anemia among children within each subgroup categorized by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) were determined. On the whole, 3.99% of boys and 6.68% of girls suffer from anemia. Disparities in the prevalence of anemia were observed between different subgroups categorized by BMI, WC and WHtR. For both boys and girls, the prevalence of anemia increased with the severity of thinness and obesity, suggesting that both severe thinness and severe obesity are associated with an elevated prevalence of anemia. In the era of the obesity pandemic, obesity could potentially add to the burden of anemia, suggesting that obese children should not be ignored when establishing strategies targeted at preventing anemia. [ABSTRACT FROM AUTHOR]

Home-based self-screening and monitoring for obesity is particularly valuable for the prevention and control of chronic diseases. This study aimed to identify an anthropometric index suitable for home-based obesity screening in children and adolescents. The design of this study is a cross-sectional study. A total of 14,042 students (6–17 years) from the Qibao Community, Minhang District, Shanghai, were studied in 2018. The percentage body fat (PBF), height, weight, waist circumference (WC) and hip circumference were measured. Body mass index (BMI), triponderal mass index (TMI), body adiposity index (BAI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were calculated. Partial correlation analysis was used to evaluate the relationships between these indices and PBF, and receiver operating characteristic (ROC) curves were used to evaluate their performance for obesity screening. BMI, TMI, WC and WHtR were found to strongly correlate with PBF (r ≥ 0.830, all P < 0.001). The optimal index for obesity screening in children (6–11 years) was BMI (area under the ROC curve [AUC] = 0.980 for boys and 0.981 for girls) and in adolescents (12–17 years) was TIM (AUC = 0.976 for boys and 0.945 for girls); however, the optimal cut-off values for BMI and TMI differed among the subgroups. The ROC curve analysis showed that WHtR had similar cut-off values in each subgroup (0.45 for boys of 6–11 years and 0.43 for the other subgroups), excellent performance in children (AUC>0.90) and good performance in adolescents (AUC = 0.960 for girls and 0.878 for boys). Owing to its accuracy and stable cut-off value for defining obesity, WHtR should be recommended for home-based obesity screening in children and adolescents. • Home-based obesity screening is important for children and adolescents. • The performance of anthropometric indicators are different in obesity screening. • WHtR is the best choose for obesity screening in children but not BMI. [ABSTRACT FROM AUTHOR]

Waist circumference (WC) and waist-to-height ratio (WTHR) reference curves are used to assess the risk of cardiovascular disease in children. The aim of this study was to develop age- and sex-smoothed WC and WTHR reference curves for Tunisian children. Data were collected during the period 2014–2015 in a cross-sectional study including 2308 children aged 6–18 years. The percentiles of WC and WTHR were developed using the LMS method. The optimal percentiles, which are associated with the body mass index (BMI) according to International Obesity Task Force (IOTF) criteria to identify overweight/obesity and with the 0.5 boundary value of WTHR to estimate cardiovascular risk, were identified by ROC curves and the Youden index (j). The results show the smoothed percentiles of WC and WTHR reference curves for Tunisian children. A comparison of the 50th percentiles with other references showed different trends in WC values. The 75th percentiles of WC and WTHR are the optimal percentiles that correspond to both PBMI25 (the percentile linked to BMI ≥ 25) and the 0.5 boundary value. However, the 90th percentiles correspond to PBMI30 (the percentile linked to BMI ≥ 30) in boys and girls. The new WC and WTHR reference curves can be added to clinical tools to help specialists in pediatric and physical health to reduce cardiovascular risk in Tunisian children. [ABSTRACT FROM AUTHOR]

Objective(s): To investigate the associations between adiposity in childhood, and adiposity change from childhood to adulthood, with pregnancy hypertension.Study Design: The study followed-up 985 girls from the 1985 Australian Schools Health and Fitness Survey (aged 9-15 years) who were ever pregnant in 2004-2006 and/or 2009-2011. In childhood, overweight and obesity were defined by age-sex-specific international standard for body mass index (BMI) and in adulthood as BMI ≥ 25 kg/m2. Childhood and adult abdominal obesity were defined as waist-to-height ratio (WHtR) ≥ 0.5. A subsample of adults had abdominal obesity measures (n = 549).Main Outcome Measures: Pregnancy hypertension was self-reported as having had high blood pressure during or due to pregnancy.Results: Childhood overweight/obesity (relative risk [RR] = 1.66, 95% confidence interval [CI]:1.07-2.52) and abdominal obesity (RR = 2.55, 95% CI:1.34-4.85) were associated with higher risks of pregnancy hypertension after adjustment for age, socioeconomic status and parity. Further adjustment for adult BMI attenuated the association for childhood overweight/obesity which was no longer statistically significant (RR = 1.28, 95% CI:0.79-2.07). The association with childhood abdominal obesity persisted after adjustment for adult WHtR (RR = 2.15, 95% CI:1.10-4.20). Compared to participants with persistently normal BMI or WHtR, those who were overweight/obese in adulthood only (RR = 1.49, 95% CI:1.10-2.02), persistently overweight/obese (RR = 2.06, 95% CI:1.29-3.29) or persistently abdominally obese (RR = 3.09, 95% CI:1.54-6.20) had increased risks of pregnancy hypertension.Conclusion(s): Childhood adiposity was associated with increased risk of pregnancy hypertension, with the association of childhood abdominal obesity independent of adult abdominal obesity. Women who were persistently overweight/obese or abdominally obese since childhood had the highest risk of pregnancy hypertension. [ABSTRACT FROM AUTHOR]

Abstract Elevated resting heart rate (RHR) and obesity are important risk factors for hypertension. However, studies are rare on the combined impact of RHR and obesity on prehypertension and hypertension. This study aimed to investigate the association between RHR and hypertension with different waist-to-height ratio (WHtR) in Chinese. The population-based cross-sectional study was conducted during 2013-2015 in Henan province, China, and 15,536 participants aged ≥15 years were included. RHR was classified according to sex-specific quartiles. The cutoff value of WHtR was 0.5 in both sexes. Multilinear and multilogistic regression models were used to evaluate the association of RHR and WHtR with prehypertension and hypertension. In both sexes, higher RHR was associated with higher blood pressure and lower pulse pressure. Compared with the lowest RHR quartile, participants in the highest RHR quartile had an increased risk of prehypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.18–1.65; OR: 1.27, 95% CI: 1.09–1.48) and hypertension (OR: 1.75, 95% CI: 1.43–2.15; OR: 1.36, 95% CI: 1.13–1.63) for male and female, respectively, after fully adjusting the data. In addition, adjusted ORs for prehypertension and hypertension of participants with high WHtR and high RHR were 2.91 (95% CI: 2.38–3.55) and 6.28 (4.96–7.97) for male and 2.45 (2.05–2.93) and 4.63 (3.66–5.85) for female, respectively, compared with the normal WHtR and normal RHR. In conclusion, elevated RHR was significantly associated with the risk of prehypertension and hypertension in Chinese and WHtR as a measure of abdominal obesity further increased this association. Highlights • Elevated resting heart rate (RHR) was associated with the risk of hypertension. • High waist-to-height ratio increased the association of RHR with hypertension, particularly for male. • The population with high RHR and high waist-to-height ratio should be highlighted in preventing hypertension. [ABSTRACT FROM AUTHOR]

Aims: Visceral adiposity measured by computed tomography (CT) as intra-abdominal fat area (IAFA) predicts metabolic diseases. Existing adiposity surrogates have not been systematically compared to a regression-based model derived in individuals of Japanese ancestry. We developed and validated a method to estimate IAFA in individuals of Japanese ancestry and compared it to existing adiposity surrogates.Methods: We assessed age, BMI, waist circumference (WC), fasting lipids, glucose, smoking status, grip strength, mid-thigh circumference (MTC), humeral length, leg length, and IAFA by single-slice CT at the umbilicus for 622 Japanese Americans. We used stepwise linear regression to predict IAFA and termed the predicted value the Estimate of Visceral Adipose Tissue Area (EVA). For men, the final model included age, BMI, WC, high-density lipoprotein cholesterol (HDLc), glucose, and MTC; for women, age, BMI, WC, HDLc, low-density lipoprotein cholesterol, glucose, and MTC. We compared goodness-of-fit (R2) from linear regression models and mean-squared errors (MSE) from k-fold cross-validation to compare the ability of EVA to estimate IAFA compared to an estimate by Després et al., waist-to-height ratio, WC, deep abdominal adipose tissue index, BMI, lipid accumulation product, and visceral adiposity index (VAI). We classified low/high IAFA using area under receiver-operating characteristic curves (AUROC) for IAFA dichotomized at the 75th percentile.Results: EVA gave the least MSE and greatest R2 (men: 1244, 0.61; women: 581, 0.72). VAI gave the greatest MSE and smallest R2 (mean 2888, 0.08; women 1734, 0.14).Conclusions: EVA better predicts IAFA in Japanese-American men and women compared to existing surrogates for adiposity. [ABSTRACT FROM AUTHOR]

This study investigates changes in the distribution of body mass for adult Australians between 1995 and 2017/18. Using three nationally representative health surveys, we first apply the parametric generalised entropy (GE) class of inequality indices to measure the level of disparity in the body mass distribution. Results from the GE measure reveal that, while growth of body mass inequality is a population-wide experience, demographic and socio-economic factors explain only a modest portion of total inequality. We then apply the relative distributions (RD) method to garner richer insights on changes to the body mass distribution. The non-parametric RD method reveals growth in the proportion of adult Australians falling into the upper deciles of the body mass distribution since 1995. Then, hypothetically keeping the shape of the distribution unchanged, we discern that body mass increases across all deciles of the distribution (location effect) is an important contributor to the observed distributional change. After removing the location effect, however, we find a non-trivial role for distributional shape changes (growth of the proportion of adults at the upper and lower parts of the distribution as the proportion in the middle diminish). While our findings support current policy directions that target the population as a whole, factors driving shape changes to the body mass distribution also need consideration when designing anti-obesity campaigns, especially when aimed at women. • Growth of body mass inequality in Australia is a population-wide experience. • There is also a growth in the proportion of Australians falling into the upper deciles of the body mass distribution. • The location effect is an important driver of the overall distributional change. • Distributional shape change in the form of polarisation is also a non-trivial source of change, especially for women. [ABSTRACT FROM AUTHOR]

Waist-to-height ratio (WHtR) is one of the anthropometric measures associated with cardiovascular risk (CVR). However, WHtR cut-off points may vary depending according to population characteristics, including sex and height. To identify optimal WHtR cut-off points to predict CVR factors by sex in Mexican adults according to height. Information from adults >20 years (n = 3550) from the 2016 National Health and Nutrition Survey were analyzed. Prevalence of high WHtR, CVR factors (glucose and insulin, lipid profile (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and blood pressure were estimated by sex and height (short height <1.60 and <1.50 m in men and women, respectively). The maximum proximity procedure was used to establish the point of maximum simultaneous sensitivity and specificity using the operating characteristic curve of the receiver. The estimates were stratified by sex and height condition. The WHtR cut-off points identified to predict CVR were higher than those suggested for international use (≥0.5), being significantly higher (p <0.0001) for women (0.61) than for men (0.56). Also, the WHtR cut-off points were higher for short stature (men 0.58 and 0.56, women 0.63 and 0.58, with short and normal stature, respectively). The WHtR cut-off points for predicting CVR in the Mexican population were higher than 0.5 in both sexes and it was higher for individuals with short stature. The identified cut-off points may be an additional tool in screening the adult population in Mexico to predict CVR. [ABSTRACT FROM AUTHOR]

Objective To calculate the percent weight reduction required to achieve minimal clinically important improvement (MCII) in health-related quality of life (HRQOL). Design Secondary data analysis from the longitudinal cohort of a single-blinded, cluster-randomized community trial to test the efficacy of the faith-based adaptation of the Diabetes Prevention Program. Setting African-American churches. Participants This study included 472 congregants with a body mass index of ≥ 25 and fasting plasma glucose < 126 mg/dl. Main outcome measure Percent weight reduction required to achieve the MCII in HRQOL measured by two instruments, SF-12 and EQ-5D, one year following baseline. Analysis The percent weight reduction required to achieve established MCII in SF-12 Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and EQ-5D Health Status (HS) at one-year follow-up were calculated using fitted linear regression models. In addition to models for the total sample, we generated models, stratified by baseline BMI, PCS, and HS, to calculate the percent weight reduction required to achieve MCII in HRQOL for those most in need of weight reduction and those in need of improved HRQOL. Results The percent weight reduction was a significant predictor of improvement in the SF-12PCS and the EQ-5DHS but not SF-12MCS. To achieve a MCII in SF-12PCS and EQ-5DHS, 18% and 30% weight reductions were required, respectively. A smaller percent weight reduction was required when the baseline BMI was ≥ 40. Conclusions and implications Improvements in HRQOL among African-American congregants seeking weight reduction required more than the 3–5% weight reduction associated with improvements in physical health. [ABSTRACT FROM AUTHOR]

Background: Little is known about intergenerational differences in associations of urbanization-related lifestyle behaviors with cardiometabolic risk factors in children and their parents in rapidly urbanizing China. Objective: We tested the intergenerational differences in longitudinal associations of away-from-home eating, snacking, screen time, and leisure-time sports with high waist-to-height ratio (WHtR), elevated blood pressure (BP), elevated glycated hemoglobin (HbA1c), and elevated C-reactive protein (CRP) among Chinese children and their parents. Design: We studied children enrolled in the longitudinal China Health and Nutrition Survey (1991-2009, 7 surveys) aged 7-17 y in ≥2 surveys (average follow-up: 2.3 surveys out of a possible 4 surveys with the age restriction; n = 3875, including 1175 siblings) and their parents (2947 mothers, 2632 fathers) living in the same household. We used 3 consecutive interviewer-administered 24-h dietary recalls to derive a 3-d average for away-from-home eating (nonconsumer, >0 and <1 meal/d, or ≥1 meals/d) and consumption of fruit or vegetable snacks (any or none) and other snacks (any or none) and a selfreported 7-d physical activity recall for screen time (≤1, >1 and ≤2, or >2 h/d) and leisure-time sports (any or none). Random-effects logistic regression was used to examine the associations of lagged (average: 3 y) behaviors with cardiometabolic risk factors (WHtR, BP, HbA1c, and CRP). Results: We detected intergenerational differences in associations between lagged behaviors and risk factors (P-interaction < 0.1). Generation-specific models showed that lagged away-from-home eating of ≥1 meal/d (compared with none) was negatively associated with parents' high WHtR (OR: 0.68; 95% CI: 0.53, 0.88) but positively associated with children's high WHtR (OR: 1.46; 95% CI: 1.01, 2.12). Lagged fruit and vegetable snack consumption was negatively related to parents' (OR: 0.76; 95% CI: 0.59, 0.97) and children's (OR: 0.58; 95% CI: 0.33, 1.00) high WHtR. Lagged screen time (>2 compared with ≤1 h/d) was positively associated with parents' (OR: 2.58; 95% CI: 1.56, 4.28) and children's high WHtR (OR: 2.26; 95% CI: 1.06, 4.83). Conclusion: Parent-offspring differences in associations between lifestyle behaviors and cardiometabolic risk factors provide insight into intergenerational differences in cardiometabolic risk with urbanization. [ABSTRACT FROM AUTHOR]

Background This study evaluated the feasibility and accuracy of the height-corrected definition for identifying metabolic syndrome (MS). Methods In 2006, anthropometric and biochemical measurements were assessed in a cross-sectional population-based study of 3136 Han adolescents, aged 13–17 years. MS was defined according to the definitions of Cook et al, International Diabetes Federation, and the Society of Pediatrics, Chinese Medical Association. Waist-to-height and blood pressure-to-height ratios were alternatives to waist circumference and blood pressure in the height-corrected definition. Results According to the MS definition and the height-corrected MS definition, this agreement would be classified as “very good” (National Cholesterol Education Program kappa coefficients: 0.850 in boys and 0.816 in girls; International Diabetes Federation kappa coefficients: 0.953 in boys and 0.807 in girls; Society of Pediatrics, Chinese Medical Association kappa coefficients: 0.932 in boys; p < 0.001) and “good” (Society of Pediatrics, Chinese Medical Association kappa coefficients: 0.737 in girls; p < 0.001). Conclusion The present study demonstrates that the height-corrected definition of MS is a simple, inexpensive, and accurate tool for identifying MS in Han adolescents. [ABSTRACT FROM AUTHOR]

Background Childhood obesity has increased dramatically during the past decades, both in developing and developed countries. The present study examined the prevalence and regional disparities in general and central obesity among children and adolescents in Shandong, China. Methods A total of 30,459 students (15,249 boys and 15,210 girls) aged 7–18 years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The BMI cutoff points recommended by the International Obesity Task Force (IOTF) were used to define general obesity. Central obesity was defined as WHtR ≥ 0.5. Both BMI and WHtR were used to define three types of obesity as follows: general obesity only, central obesity only and combined obesity. Results The overall prevalences of general obesity only, central obesity only and combined obesity were 10.99, 8.47 and 8.70% for boys and 9.47, 5.12 and 3.19% for girls, respectively. The sum of the prevalence of the three types of obesity was 28.16% for boys and 17.78% for girls, boys had higher prevalence of obesity than girls ( P < 0.01). Substantial urban-rural and regional disparities exist in childhood obesity, children and adolescents from urban, coastal and high socioeconomic status (SES) districts showed a higher prevalence of obesity than their counterparts from rural, inland and low SES districts ( P < 0.01). Conclusion The widespread prevalence of obesity in children and adolescents has become an important public health concern. Results from this study also suggested that the additional measurement of WC (WHtR) is better than BMI alone to identify obese individuals, distinguishing the types of obesity and examining the prevalence of various types of obesity is useful in practice. [ABSTRACT FROM AUTHOR]

Background Waist-to-height ratio (WHtR) is proposed as a simple, valid and convenient measure of abdominal obesity and health risks in practice. The present study examined the distribution of nutritional status among children and adolescents categorized by WHtR cut-offs. Methods A total of 30,459 students (15,249 boys and 15,210 girls) aged 7–18 years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and WHtR were calculated. The grades of nutritional status (thinness, normal weight, overweight and obesity) was defined by the international BMI cut-offs. All subjects were divided into three groups (low, moderate and high) according to their WHtR, BMI level and the distribution of nutritional status among the three groups were compared. Results In both boys and girls, significant differences in BMI level and the nutritional status were observed among the three groups. Children and adolescents aged 7–18 years in the ‘high WHtR group’ (≥ 0.5) had higher BMI than those in the ‘low WHtR group’ (< 0.4) by 6.00–10.15 kg/m 2 for boys and 5.24–9.51 kg/m 2 for girls. ‘low WHtR group’ had higher prevalence of thinness, and ‘high WHtR group’ had higher prevalence of overweight and obesity. The optimal distribution of nutritional status is found in the ‘moderate WHtR group’ (between 0.4 and 0.5) with the highest proportion of normal weight and low prevalence of thinness and obesity. Conclusion WHtR is associated with nutritional status, which could be an indicator of nutritional status and early health risk. It is necessary to develop optimal boundary values in the future. [ABSTRACT FROM AUTHOR]

Background The aim of the study was to compare the efficiency of bioelectrical indices (percentage body fat, PBF; visceral fat index, VFI) and various anthropometric measures (body mass index, BMI; waist circumference, WC; waist-to-height ratio, WHtR) on determining hypertension in Chinese. Methods We conducted the community-based cross-sectional survey during August of 2013 to August of 2015 in 66 sample sites selected by multistage random sampling method from Henan province. 14,364 residents were included in the study. Results In both genders, VFI and PBF tended to rise with age. However, for each age-specific group, men consistently had significantly greater VFI than women (all P < 0.0001) and women had considerably higher PBF (all P < 0.0001). The odds ratios and area under the ROC curves (AUCs) for hypertension associated with adiposity indices decreased with age. In younger (15 ~ 34 year) men and women, VFI had the highest crude (2.43–7.95) and adjusted (2.40–11.63) odds ratio for hypertension. The AUCs for PBF, VFI and WHtR were significantly larger than those for BMI and WC (all P < 0.01). Whereas no statistically significant difference were found in AUCs among PBF, VFI and WHtR (all P > 0.10). Additionally, VFI and PBF yielded the greatest Youden index in identifying hypertension in men (0.27) and women (0.34), respectively. Optimal cutoffs for VFI/PBF were 11.70/24.45 and 7.55/33.65 in men and women, respectively. Conclusions VFI and PBF could be better candidates for identifying hypertension in men and women, respectively. Adolescents and young adults should be highlighted in preventing hypertension by control of excess body and visceral fat. [ABSTRACT FROM AUTHOR]

Background In sub-Saharan Africa, there is no precise use of metabolic syndrome (MetS) definitions and risk factors screening indices in many clinical and public health services. Methods proposed and used in Western populations are adopted without validation within the local settings. The aim of the study is to assess obesity indices and cut-off values that maximise screening of MetS and risk factors in the Nigerian population. Method A consolidated analysis of 2809 samples from four population-based cross-sectional study of apparently healthy persons ≥ 18 years was carried out. Optimal waist circumference (WC) and waist-to-height ratio (WHtR) cut points for diagnosing MetS and risk factors were determined using Optimal Data Analysis (ODA) model. The stability of the predictions of the models was also assessed. Results Overall mean values of BMI, WC and WHtR were 24.8 ± 6.0 kg m −2 , 84.0 ± 11.3 cm and 0.52 ± 0.1 respectively. Optimal WC cut-off for discriminating MetS and diabetes was 83 cm in females and 85 cm in males, and 82 cm in females and 89 cm in males, respectively. WC was stable in discriminating diabetes than did WHtR and BMI, while WHtR showed better stability in predicting MetS than WC and BMI. Conclusion The study shows that the optimal WC that maximises classification accuracy of MetS differs from that currently used for sub-Saharan ethnicity. The proposed global WHtR of 0.50 may misclassify MetS, diabetes and hypertension. Finally, the WC is a better predictor of diabetes, while WHtR is a better predictor of MetS in this sample population. [ABSTRACT FROM AUTHOR]

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Objective Waist circumference, waist-to-hip ratio and waist-to-height ratio, which are the indicators or measures of abdominal adiposity, have long been hypothesized to increase the risk of stroke; yet evidence accumulated till date is not conclusive. Here, we conducted a dose-response meta-analysis to summarize evidences of the association between these measures of abdominal adiposity and the risk of stroke. Methods PubMed and Web of Science databases were searched from inception to May 2015. Two investigators independently conducted the study selection and data extraction. Dose-response relationships were assessed by the generalized least squares trend estimation, while the summary effect estimates were evaluated by the use of fixed- or random-effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Publication bias of the literature was evaluated using Begg's and Egger's test. Results Altogether 15 prospective cohort studies were identified in this study. The summary of relative risks (95% confidence intervals) of stroke for the highest versus the lowest categories was 1.28 (1.18-1.40) for waist circumference, 1.32 (1.21-1.44) for waist-to-hip ratio, and 1.49 (1.24-1.78) for waist-to-height ratio. For a 10-cm increase in waist circumference, the relative risk of stroke increased by 10%; for a 0.1-unit increase in waist-to-hip ratio, the relative risk increased by 16%; and for a 0.05-unit increase in waist-to-height ratio, the relative risk increased by 13%. There was evidence of a nonlinear association between waist-to-hip ratio and stroke risk, P nonlinearity =0.028. Conclusion Findings from our meta-analysis indicated that waist circumference, waist-to-hip ratio, and waist-to-height ratio were positively associated with the risk of stroke, particularly ischemic stroke. [ABSTRACT FROM AUTHOR]

Summary Problem To evaluate the associations of different anthropometric measurements on earlier exam with subsequent gestational diabetes mellitus (GDM) in Aboriginal women. Methods This is a nested case–control study. Anthropometric measurements were conducted at baseline from 1992 to 1995 in a remote Aboriginal community. All subsequent pregnancies among the original participants were identified through review of hospital records of 20 years. Thirty-two women developed GDM and 99 women were hospitalised for pregnancy-related conditions other than GDM. The association between body mass index (BMI), weight, height, waist circumference, hip circumference, waist-to-hip ratio and waist-to-height ratio with subsequent GDM was examined. Results Our results showed an increased risk of GDM with increase in one standard deviation of BMI (OR = 2.0; 95% CI: 1.3, 3.1), weight (OR = 1.7; 95% CI: 1.1, 2.7), waist circumference (OR = 1.8; 95% CI: 1.1, 3.0) and waist-to-height ratio (OR = 2.3; 95% CI: 1.4, 3.9). High BMI (BMI ≥ 25 kg/m 2 ) was associated with subsequent GDM (OR = 2.8; 95% CI: 1.0, 7.8). Conclusions BMI and waist-to-height ratio are better predictors than other anthropometric indices of GDM in Aboriginal women. Given that these measures are associated with future GDM, interventions to reduce BMI, weight and waist circumference in young women need to be assessed for their potential to prevent GDM. [ABSTRACT FROM AUTHOR]

Background: The environmental and behavioral risk factors associated with central obesity and/or inflammation in populations exposed to both obesogenic and pathogenic environments remain unclear. Objectives: We tested which of the characteristics distinguished 3 risk groups--high waist-to-height ratio (WHtR; >0.5) without inflammation [high-sensitivity C-reactive protein (hs-CRP) <3 mg/L], normal WHtR (#0.5) with inflammation (hs-CRP: 3-10 mg/L), and high WHtR with inflammation--from the referent group with normal WHtR without inflammation and, secondarily, which factors differed between the groups with high WHtR with and without inflammation. Methods: The analytic sample included 8068 adults participating in the China Health and Nutrition Survey in 2009. Adjusted multinomial and logistic regression models were used to assess the risk of being in one of the "unhealthy" groups compared with the referent group. Results: Men with high WHtR with and without inflammation were more likely to live at higher urbanicity (57-63%) and have higher incomes (26^12%) and household sanitation (26-67%) and were >40% less likely to have high physical activity than the healthy referent group. Men with high WHtR with inflammation had higher odds of infectious symptoms than those with high WHtR without inflammation (OR: 1.73; 95% CI: 1.15, 2.61). Women with high WHtR without inflammation were less likely to have high household sanitation (44%) or perform high levels of physical activity (24%) and were 34% more likely to consume more fiber than the healthy referent group. Women with high WHtR and inflammation were more likely than those with high WHtR without inflammation to have infectious symptoms (OR: 1.45; 95% CI: 1.01, 2.07) and less likely to have higher fiber intake (OR: 0.77; 95% CI: 0.60,1.00) or physical activity (OR: 0.55; 95% CI: 0.41, 0.73). Conclusion: These results document different underlying pathogenic and obesogenic risk factors for visceral adiposity with and without inflammation in Chinese adults, suggesting that context-specific approaches may be needed to prevent and treat inflammation. [ABSTRACT FROM AUTHOR]

Background and aim We tested the hypothesis that an intervention with a Mediterranean diet (MeDiet) could mitigate the well-known harmful effects of abdominal obesity on cardiovascular health. Methods and results We assessed the relationship between baseline waist-to-height ratio (WHtR) and major cardiovascular events during a median follow-up of 4.8 years in the Prevention with Mediterranean Diet (PREDIMED) randomized primary prevention trial, which tested a MeDiet against a control diet (advice on a low-fat diet). We also examined whether the MeDiet intervention was able to counteract the detrimental cardiovascular effects of an increased WHtR. The trial included 7447 participants (55–80 years old, 57% women) at high cardiovascular risk but free of cardiovascular disease (CVD) at enrollment. An increased risk of CVD events (myocardial infarction, stroke, or cardiovascular death) was apparent for the highest versus the lowest quartile of WHtR (multivariable-adjusted hazard ratio: 1.98) (95% confidence interval: 1.10–3.57; linear trend: p = 0.019) only in the control-diet group, but not in the two groups allocated to intervention with MeDiet ( p for interaction = 0.034). This apparent interaction suggesting that the intervention counterbalanced the detrimental cardiovascular effects of adiposity was also significant for body mass index (BMI) (p = 0.01) and waist circumference ( p = 0.043). Conclusions The MeDiet may counteract the harmful effects of increased adiposity on the risk of CVD. [ABSTRACT FROM AUTHOR]

Objective To estimate the prevalence of elevated blood pressure (EBP) in Chinese children and identify individual and family factors associated with EBP. Methods A nationwide cross-sectional study was conducted in 2010 using stratified cluster sampling. Participants' blood pressure was measured, and their parents completed a questionnaire on personal and family characteristics. Prevalence and correlates of EBP were assessed. Results Among a total of 24,333 participants, 20.2% of boys and 16.3% of girls had EBP. The prevalence of EBP increased with the ascending trend of waist circumference, Waist-to-height ratio, and body mass index. The adjusted prevalence ratios (aPRs) for obese boys and girls were 2.50 and 2.97, respectively. Fewer urban boys (16.2%) had EBP than rural boys (21.7%). Boys with a family history of hypertension were 12% more likely to have EBP. Children whose mothers received a college education tended to have lower likelihood of EBP; with an aPR was 0.85 among boys and 0.78 among girls. Conclusion EBP is common among obese students and those who have a family history of hypertension. A negative association between mothers' education levels and EBP risk in children was found. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the association between various factors and diabetes type II (DM) with a particular emphasis on indicators of central obesity, and to compare the effect of DM on disability among elder populations (≥ 50 years old) in nine countries. Data were available for 52,946 people aged ≥ 18 years who participated in the WHO Study on global AGEing and adult health and the Collaborative Research on Ageing in Europe studies conducted between 2007 and 2012. DM was defined as self-report of physician diagnosis. Height, weight, and waist circumference were measured. Disability status was assessed with the WHODAS II questionnaire. The overall prevalence of DM was 7.9% and ranged from 3.8% (Ghana) to 17.6% (Mexico). A 10 cm increase in waist circumference and waist-to-height ratio of > 0.5 were associated with a significant 1.26 (India) to 1.77 (Finland), and 1.68 (China, Spain) to 5.40 (Finland) times higher odds for DM respectively. No significant associations were observed in Mexico and South Africa. DM was associated with significantly higher disability status in all countries except Mexico in the model adjusted for demographics and smoking. The inclusion of chronic conditions associated with diabetes in the model attenuated the coefficients in varying degrees depending on the country. A considerable proportion of the studied older population had DM. Central obesity may be a key factor for the prevention of DM among older populations globally. Prevention of DM especially among the older population globally may contribute to reducing the burden of disability. [ABSTRACT FROM AUTHOR]

Background: Plasma fatty acids (FAs) and micronutrients have been associated with central obesity in adults; however, previous studies of these associations in adults have yielded mixed results. In addition, no comparable research has been conducted among youth with type 1 diabetes (T1D). Objective: We investigated the cross-sectional and longitudinal associations between plasma nutrient biomarkers and waist-to-height ratio (WHtR) in youth with T1D. Methods: These analyses included 1324 youth aged 3-20 y at T1D diagnosis with a baseline visit in the SEARCH (Search for Diabetes in Youth) Study and a subset of 1178 of these youth with a follow-up visit an average of 23 mo (range: 16-40 mo) after their baseline visit. Plasma phospholipid FAs and vitamins were measured, and estimated desaturase activities were calculated at baseline. Anthropometric measurements and diabetes-related assessments were collected at each visit. Multiple linear regression was used to examine the association between plasma nutrient biomarkers and WHtR. Results: In cross-sectional analysis, plasma palmitic acid (P = 0.004), dihomo-γ-linolenic acid (DGLA; P = 0.017) and Δ6 desaturase (D6D; P = 0.006) were positively correlated with WHtR after adjustment of confounders. Oleic acid (OA; P = 0.002), linoleic acid (LA; P = 0.015), D9 desaturase 18 (D9D-18; P = 0.027), and vitamin D (P < 0.0001) were negatively correlated with WHtR after adjustment. Weight status was an effect modifier (P < 0.05). In normal-weight youth, vitamin D (P = 0.003) was negatively associated with WHtR. In obese youth, stearic acid (P = 0.037), DGLA (P < 0.0001), and D6D (P < 0.0001) were positively associated and OA (P = 0.0008), D9D-18 (P = 0.0006), and vitamin D (P < 0.0001) were negatively associated with WHtR. In longitudinal analysis, baseline linoleic acid (P = 0.018), n-6:n-3 (ω-3:ω-6) FA ratio (P = 0.029), vitamin D (P = 0.003), and vitamin E (P < 0.0001) were negatively correlated with WHtR at follow-up only in obese participants. Conclusions: In T1D youth, plasma FAs and vitamins are associated with WHtR and are modified by weight status. These associations are particularly marked in obese youth. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to (1) investigate cardiometabolic risk markers in young women (18–30 years) with overweight/obesity, and (2) establish whether the measures of waist circumference and body mass index possess similar associations of cardiometabolic risk. Design Cross-sectional. Methods Cardiometabolic risk factors including, anthropometric, metabolic syndrome markers, biochemical, and other health/fitness indicators were assessed in women when classified as overweight/obese by waist circumference [waist circumference 91.9 ± 10.1 cm, age 22.3 ± 3.5 years, n = 38] versus control [ n = 30, waist circumference 71.4 ± 3.5 cm, age 20.1 ± 0.9 years], and when classified by body mass index [ n = 35, body mass index 32.2 ± 5.2 kg m 2 , age 22.5 ± 3.6 years] versus control [body mass index 21.7 ± 1.9 kg m 2 , age 20.1 ± 0.9 years, n = 33]. Results Compared with controls, women with overweight/obesity (classified by waist circumference or body mass index) displayed elevated body mass, systolic blood pressure and homeostasis model assessment of insulin resistance, and reduced estimated VO 2 max and weekly physical activity, with no differences in self-reported energy intake. The unadjusted odds ratio of being classified with overweight/obesity and an elevated homeostasis model assessment of insulin resistance and/or less than recommended physical activity ranged between 5.1 and 10.0. Receiver operator characteristic curves indicated waist circumference, body mass index and waist-to-height ratio cut-off points of ≥84.2 cm, ≥30.6 kg m −2 and ≥0.5, respectively, for homeostasis model assessment of insulin resistance, and ≥80.6 cm, ≥25.2 kg m −2 and ≥0.46, respectively, for less than recommended physical activity. Conclusions Waist circumference and body mass index have similar associations with cardiometabolic risk, with greater homeostasis model assessment of insulin resistance and lower physical activity, rather than differences in traditional metabolic syndrome markers, observed in young women with overweight/obesity. [ABSTRACT FROM AUTHOR]

Objective Increased aortic stiffness may be one of the mechanisms by which obesity increases cardiovascular risk independently of traditional risk factors. While body mass index (BMI) is generally used to define excess adiposity, several studies have suggested that measures of central obesity may be better predictors of cardiovascular risk. However, data comparing the association between several measures of central and general obesity with aortic stiffness in the general population are inconclusive. Methods In 1031 individuals (age 53 ± 13 years, 45% men) without manifest cardiovascular disease randomly selected from population, we tested the association between parameters of central obesity (waist circumference - WC, waist-to-hip-ratio - WHR, waist-to-height ratio - WHtR) and general obesity (BMI) with carotid-femoral pulse wave velocity (cfPWV). Results In univariate analysis, WC and WHtR were more strongly associated with cfPWV than BMI in both genders, while WHR showed a stronger association with cfPWV only in women. WHtR was more closely associated with cfPVW than WHR. This difference between obesity measures remained after multivariate adjustment. When the fully adjusted hierarchical regression was used, among central obesity measures, WHtR had the largest additive value on top of BMI, while there was no additive value of BMI on top of WHtR. Conclusion Central obesity parameters are more closely associated with aortic stiffness than BMI. Of central adiposity measures, WHtR has the strongest association with aortic stiffness beyond body mass index and cardiovascular risk factors. Our results suggest that WHtR may be the best anthropometric measure of excess adiposity in the general population. [ABSTRACT FROM AUTHOR]

Background and aims Simple, low-cost central obesity measures may help identify individuals with increased cardiometabolic disease risk, although it is unclear which measures perform best in African adults. We aimed to: 1) cross-sectionally compare the accuracy of existing waist-to-height ratio (WHtR) and waist circumference (WC) thresholds to identify individuals with hypertension, pre-diabetes, or dyslipidaemia; 2) identify optimal WC and WHtR thresholds to detect CVD risk in this African population; and 3) assess which measure best predicts 5-year CVD risk. Methods and results Black South Africans (577 men, 942 women, aged >30years) were recruited by random household selection from four North West Province communities. Demographic and anthropometric measures were taken. Recommended diagnostic thresholds (WC > 80 cm for women, >94 cm for men; WHtR > 0.5) were evaluated to predict blood pressure, fasting blood glucose, lipids, and glycated haemoglobin measured at baseline and 5 year follow up. Women were significantly more overweight than men at baseline (mean body mass index (BMI) women 27.3 ± 7.4 kg/m², men 20.9 ± 4.3 kg/m²); median WC women 81.9 cm (interquartile range 61-103), men 74.7 cm (63-87 cm), all P < 0.001). In women, both WC and WHtR significantly predicted all cardiometabolic risk factors after 5 years. In men, even after adjusting WC threshold based on ROC analysis, WHtR better predicted overall 5-year risk. Neither measure predicted hypertension in men. Conclusions The WHtR threshold of >0.5 appears to be more consistently supported and may provide a better predictor of future cardiometabolic risk in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Objective: Several studies have concluded a positive association between abdominal obesity, general obesity, and chronic diseases. However, the best anthropometric measures to predict the risk for chronic diseases should be clarified in each population. Therefore, the aim of this study was to compare the predictive power of A Body Shape Index (ABSI), body mass index (BMI), and waist-to- height ratio and Clinica Universidad de Navarra-Body Adiposity Estimator for metabolic syndrome (MetS) and cardiovascular disease (CVD) risks among Iranians in different age and sex categories. Methods: This population-based cross-sectional study conducted on 9555 individuals, ages ≥19 y. Anthropometric measures, blood pressure, and biochemical markers were measured using standard protocols. Hypertension, hyperglycemia, hypercholesterolemia, high low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol levels were considered as the CVD risks. Results: Mean (SD) of age and BMI of participants were 38.7 y (mean 15.5) and 25.7 kg/m² (mean 4.6), respectively. ABSI demonstrated the weakest correlations and lowest area under curve (AUC) for various risk factors and MetS. However, the highest odds ratio was observed for ABSI and MetS in different age and sex categories. Conclusions: Based on the AUC, we concluded that ABSI is a weak predictor for CVD risks and MetS. More studies are needed to determine the best predictor of CVD risk among the Iranian population. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To assess whether the anthropometric index used by the American Heart Association (AHA) to evaluate cardiovascular health (CVH) status, i.e., the body mass index (BMI), could also be of value in ethnic groups phenotypically different than Whites. Methods: CVH status was evaluated in 616 Ecuadorian natives/mestizos aged ≥40 years with the seven metrics proposed by the AHA. Then, the BMI was replaced by the waist-to-hip (WtoHp) and the waist-to-height (WtoHt) ratios to estimate whether these changes modify the CVH status and the presence of ≥5 ideal metrics per person. Results: Replacing the BMI for either the WtoHt or the WtoHp ratios reduces the percentage of persons with ≥5 ideal CVH metrics from 13%, to 8% (p <0.004) and to 6.8% (p <0.0003), respectively. The number of persons with a poor CVH status increased when the WtoHt ratio was used instead of the BMI (81.5% versus 69.8%, p <0.0001). Conclusions: These results may explain the paradox “better CVH status/similar stroke prevalence” previously found in Ecuadorian natives/mestizos, and suggest that the WtoHt ratio could be the best anthropometric index to be included in the set of metrics used to evaluate the CVH status in populations that are phenotypically different than Whites. [Copyright &y& Elsevier]

Abstract: Obesity is a major public health problem, and measuring adiposity accurately and predicting its future comorbidities are important issues. Therefore, we hypothesized that 4 adiposity measurements, body mass index (BMI), waist circumference (WC), waist-to-height ratio, and body fat percentage, have different physiological meanings and distinct associations with adverse health consequences. This study aimed to investigate the relationship of these 4 measurements with metabolic syndrome (MetS) components and identify the most associated factor for MetS occurrence in older, non-medicated men. Cross-sectional data from 3004 men, all 65 years of age and older, were analyzed. The correlation and association between adiposity measurements and MetS components were evaluated by Pearson correlation and multiple linear regression. Based on multivariate logistic regression, BMI and WC were significantly associated with MetS and were selected to build a combined model of receiver operating characteristic curves to increase the diagnosis accuracy for MetS. The results show that BMI is independently associated with systolic and diastolic blood pressure; WC and body fat percentage are associated with fasting plasma glucose and log transformation of triglyceride; BMI and WC are negatively associated with high-density lipoprotein cholesterol (HDL-C); and WC is a better discriminate for MetS than BMI, although the combined model (WC + BMI) is not significantly better than WC alone. Based on these results, we conclude that the 4 adiposity measurements have different clinical implications. Thus, in older men, BMI is an important determinant for blood pressure and HDL-C. Waist circumference is associated with the risk of fasting plasma glucose, HDL-C, triglyceride, and MetS occurrence. The combined model did not increase the diagnosis accuracy. [Copyright &y& Elsevier]

Objective: Chronic kidney disease (CKD) is associated with metabolic disorders, including insulin resistance (IR), mainly when associated with obesity and characterized by high abdominal adiposity (AbAd). Anthropometric measures are recommended for assessing AbAd in clinical settings, but their accuracies need to be evaluated. The aim of this study was to evaluate the precision of different anthropometric measures of AbAd in patients with CKD. We also sought to determine the AbAd association with high homeostasis model assessment index of insulin resistance (HOMA-IR) values and the cutoff point for AbAd index to predict high HOMA-IR values. Methods: A subset of clinically stable nondialyzed patients with CKD followed at a multidisciplinary outpatient clinic was enrolled in this cross-sectional study. The accuracy of the following anthropometric indices: waist circumference, waist-to-hip ratio, conicity index and waist-to-height ratio (WheiR) to assess AbAd, was evaluated using trunk fat, by dual x-ray absorptiometry (DXA), as a reference method. HOMA-IR was estimated to stratify patients in high and low HOMA-IR groups. The total area under the receiver-operating characteristic curves (AUC-ROC; sensitivity/specificity) was calculated: AbAd with high HOMA-IR values (95% confidence interval [CI]). Results: We studied 134 patients (55% males; 54% overweight/obese, body mass index ≥ 25 kg/m², age 64.9 12.5 y, estimated glomerular filtration rate 29.0 ± 12.7 mL/min). Among studied AbAd indices, WheiR was the only one to show correlation with DXA trunk fat after adjusting for confounders (P < 0.0001). Thus, WheiR was used to evaluate the association between AbAd with HOMA-IR values (r = 0.47; P < 0.0001). The cutoff point for WheiR as a predictor for high HOMA-IR values was 0.55 (AUC-ROC = 0.69 ± 0.05; 95% CI, 0.60-0.77; sensitivity/specificity, 68.9/61.9). Conclusions: WheiR is recommended as an effective and precise anthropometric index to assess AbAd and to predict high HOMA-IR values in nondialyzed patients with CKD. [ABSTRACT FROM AUTHOR]

Objectives: To determine the impact of energy density on diet quality and anthropometric proxy measures for central body fat in young Spaniards. Methods: Data were obtained from a representative national sample of 2513 young Spaniards aged 10 to 24 y. Dietary assessment was performed with a 24-h recall. Adherence to the Mediterranean diet was measured by the KIDMED index. Reduced rank regression analysis was used to identify energy-density dietary patterns. Waist circumferences and height were measured. Results: Pastries and sausages showed the strongest loading for the dietary energy density factor score (DED-FS), with fruits and vegetables at the opposite end of the scale. Multiple linear regression analysis showed a positive association (P < 0.01) of dietary energy density (DED) and the DED-FS with waist circumferences regressed on height and age (WCheight+age) and waist-to-height ratio (WHtR). The adjusted odds ratio for elevated WCheight+age and WHtR increased across quartile distribution of DED (P < 0.001) and DED-FS (P < 0.05). Diet quality characterized by the KIDMED index was negatively associated (P < 0.001) with DED and the DED-FS. Conclusions: Higher DED is a risk for increased central fat distribution and is associated with low adherence to the Mediterranean diet. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Obesity is a major risk factor for type 2 diabetes, many indexes can be used to describes obesity and predict diabetes. This research attempts to identify the best indicator of obesity to screening diabetes in Chinese population. Methods: A cross-sectional data of 8121 subjects aged 35–60 years were included in this research belongs to the Diabetes Appropriate Technology Intervention Study. Anthropometric indicators including body weight, height, waist circumferences (WC), body fat index (BFI) and visceral fat index (VFI) and blood biochemical indicators after an overnight fast [fasting blood glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triacylglycerol] were measured. BMI (body mass index) and Weight to Height Ratio was calculated. Results: Subjects with obesity had a higher risk of physician diagnosed diabetes (OR=2.50, 95% CI 1.83–3.43), new diagnosed diabetes (OR=4.23, 95% CI 2.91–6.15) and pre-diabetes (OR=1.75, 95% CI 1.31–2.34) compared to those with normal Body mass index (BMI). There was a significant trend of increased risk of all diabetes status with increased waist circumference (WC). The waist-to-height ratio (WHtR) yielded the most significant association with new diagnosed diabetes and physician diagnosed diabetes than other indices. Conclusion: Central obesity is significantly correlated with diabetes. VFI was most correlated with pre-diabetes while WHtR is an efficient screening index than BMI and WC in Chinese community diabetes screening. [Copyright &y& Elsevier]

Objectives: The prevalence of overweight and obesity continue to increase among children and adolescents worldwide. This study examined whether waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) are predictive of metabolic syndrome and elevated serum alanine aminotransferase (ALT) among adolescents and young adults in mainland China. Study design: Cross-sectional study. Methods: In total, 6997 students aged 12-24 years from nine Chinese cities participated in this study. Anthropometric and biochemical data were collected. A logistic regression model was performed to determine the association between anthropometric indicators and metabolic syndrome components and abnormal liver function. Results: This study found prevalence rates for the metabolic syndrome and elevated ALT of 1.4% and 3.1%, respectively, among adolescents and young adults in mainland China. A multivariate logistic regression model found that WHtR ≥0.50 was more strongly associated with metabolic syndrome components and elevated ALT than WC values at or above the 90th percentile (P90 or WHpR ≥P90. Odds ratios for elevated ALT were 2.03 [95% confidence interval (CI) 1.46--2.81], 4.56 (95% CI 3.07--6.78) and 13.43 (95% Cl 7.67--23.51) in adolescents and young adults with one, two and three or more components of metabolic syndrome, respectively (P < 0.001 for all). Conclusions: Higher WC and WHtR were found to be predictive of metabolic syndrome components and elevated ALT among adolescents and young adults in mainland China, and the association was stronger for WHtR. Furthermore, adolescents and young adults with more metabolic syndrome components were more likely to suffer from elevated ALT. [ABSTRACT FROM AUTHOR]

Abstract: This study examined whether physical activity (PA) and sedentary behavior mediated the relationship of neighborhood walkability with two measures of adiposity: body mass index (BMI) and waist-to-height ratio (WHTR). Twenty-four neighborhoods in Ghent, Belgium were selected, stratified by objectively assessed walkability and by socio-economic status. Participants (1200 adults aged 20–65 years) completed the International Physical Activity Questionnaire and wore an accelerometer for 7 days. Weight and height were self-reported and waist circumference was objectively measured. Accelerometer-assessed moderate-to-vigorous PA and self-reported cycling for transport mediated the associations of walkability with BMI and WHTR. Moreover, walking for transport and recreational walking significantly mediated the relationship between walkability and BMI. Sedentary behavior did not mediate associations of walkability with BMI or WHTR. These findings suggest that PA, but not sedentary behavior, is a mechanism by which walkability may affect adults’ adiposity. Planning for neighborhoods to be high in walkability could have favorable effects on physical activity and weight status. [ABSTRACT FROM AUTHOR]

Aims: To compare the associations between four anthropometric indices including waist-to-height ratio (WHtR), waist circumference (WC), waist-hip-ratio (WHR) and body mass index (BMI) and cardio-cerebrovascular events (CCBVEs) in Chinese T2DM patients.Methods: The associations of four anthropometric measures with CCBVEs and metabolic syndrome (MetS) were compared by multiple regression model in 3108 T2DM patients. CCBVEs was defined as a history of myocardial infarction, angina, angioplasty, coronary artery bypass surgery, transient ischemic attack, ischemic or hemorrhagic stroke.Results: After controlling for age, sex and diabetes duration, the prevalence of CCBVEs and MetS significantly increased across the WHtR, WC, WHR and BMI quartiles in T2DM patients, respectively. However, when controlling for these four anthropometric measurements together, although four anthropometric measures were closely associated with MetS prevalence, only WHtR quartile was significantly associated with CCBVEs prevalence (6.5%, 13.8%, 16.9% and 21.3%, p < 0.001 for trend). After adjusting for multiple confounders including four anthropometric parameters, a regression analysis revealed that only WHtR was independently and positively associated with the presence of CCBVEs (p = 0.029).Conclusions: Compared with WC, WHR and BMI, WHtR have a stronger association with CCBVEs in T2DM subjects. WHtR maybe a better indicator than other anthropometric measurements for evaluating cardiovascular risks in T2DM. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine which simple index of overweight and obesity is the best discriminator of cardiovascular risk factors. Study Design and Setting: This is a meta-analysis of published literature. MEDLINE was searched. Studies that used receiver-operating characteristics (ROC) curve analysis and published area under the ROC curves (AUC) for overweight and obesity indices with hypertension, type-2 diabetes, and/or dyslipidemia were included. The AUC for each of the four indices, with each risk factor, was pooled using a random-effects model; male and female data were analyzed separately. Results: Ten studies met the inclusion criteria. Body mass index (BMI) was the poorest discriminator for cardiovascular risk factors. Waist-to-height ratio (WHtR) was the best discriminator for hypertension, diabetes, and dyslipidemia in both sexes; its pooled AUC (95% confidence intervals) ranged from 0.67 (0.64, 0.69) to 0.73 (0.70, 0.75) and from 0.68 (0.63, 0.72) to 0.76 (0.70, 0.81) in males and females, respectively. Conclusion: Statistical evidence supports the superiority of measures of centralized obesity, especially WHtR, over BMI, for detecting cardiovascular risk factors in both men and women. [Copyright &y& Elsevier]

Abstract: Objective: Obesity is a risk factor for chronic kidney disease (CKD) and cardiovascular disease. The association between different indexes of obesity and CKD is unknown. This study evaluated the association between indexes of obesity and CKD. Methods: We reviewed 4611 participants including 2613 men and 1998 women in this community-based cross-sectional study from 2003 to 2005. CKD was defined as a glomerular filtration rate slower than 60 mL/min per 1.73 m2 by the Modification of Diet in Renal Disease formula. Indexes of obesity included body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio (WheiR). Traditional risk factors including diabetes, hypertension, smoking, and metabolic syndrome were also taken into consideration. Results: A total of 221 (4.8%) participants including 137 men and 84 women were found to have CKD. Participants with CKD were significantly older than those without (P < 0.001). In univariate logistic regression with adjustment for age, all indexes of obesity were associated with CKD (P < 0.001). In multivariate logistic regression with adjustment for age and gender, WheiR was significantly associated with CKD, independent of hypertension and diabetes (P = 0.028). The adjusted odds ratios of WheiR (every 0.1 increment) was 2.74 (95% confidence interval 1.18–6.72). Conclusion: Obesity, especially central obesity, is associated with CKD and the association is independent of hypertension, diabetes, and metabolic syndrome. In commonly used obesity indexes, WheiR is particularly associated with CKD. [Copyright &y& Elsevier]

Background: The sagittal abdominal diameter has been proposed as a useful measure by which to estimate abdominal obesity and as being more strongly related to components of the metabolic syndrome than are other anthropometric measures. Objective: The objective was to study which anthropometric measure (ie, sagittal abdominal diameter, waist circumference, waist-to-hip ratio, waist-to-height ratio, or body mass index) is the strongest correlate of components of the metabolic syndrome (ie, glucose and lipid concentrations and blood pressure) in the elderly. Design: The Hoorn Study is a population-based cohort study in older Dutch men and women. Cross-sectional data were analyzed. Age-adjusted Pearson correlations of anthropometric measures with components of the metabolic syndrome were calculated in 826 subjects (389 men, 437 women) aged 56-83 y. Analyses were performed with adjustment for age and stratification for sex and age (<65 or ⩾65 y). Results: No single anthropometric measure was consistently correlated more strongly with components of the metabolic syndrome than were the other measures in either men or women. The associations were generally stronger in younger subjects than in older subjects and in women than in men. For example, the correlation between sagittal abdominal diameter and postload glucose was 0.35 (P < 0.001) in younger and 0.14 (P = 0.051) in older men, and the correlation between waist circumference and postload glucose was 0.33 (P< 0.001) in older women and 0.14 (P = 0.062) in older men. Conclusion: The use of sagittal abdominal diameter has no advantages over simpler and more commonly used anthropometric measures such as the waist circumference in older men and women. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the effectiveness of various anthropometric indices in identifying metabolic risk among Japanese men and women (a total of approximately 17,000 persons from three observation periods), and found that waist-to-height ratio was better than other anthropometric indices as a predictor of metabolic risk. [Copyright &y& Elsevier]