To the Editor.---
The recent Pediatrics article on “Assessment of Child and Adolescent
Overweight and Obesity” (Krebs NF et al. Vol. 120 [Supplement] December
2007, pp. S193-S228) focused on defining obesity by using methods that
should be accurate, appropriate, quick, and evidence-based. Although the
authors described advantages and problems when using the body mass index,
skinfolds, and waist circumference, we were surprised that their review
made no mention of the waist/height ratio.
We consider the waist/height ratio to be a practical index that might
simplify the clinical and epidemiologic recognition of cardiometabolic
risk among young patients.1-4 In addition, since waist circumference5
and visceral abdominal fat6 are inversely related to children’s physical
activity, the waist/height ratio might also serve for the simplified and
easily comprehensible monitoring of exercise interventions among growing
children.
A longitudinal study has recently provided reason to question whether
children’s changes in body mass index (SD-score) or sum of skinfolds are
adequate to describe their changes in metabolic risk as estimated by
insulin resistance or the concentrations of circulating triglycerides, HDL
-cholesterol, and adiponectin.7
Henry S. Kahn, MD,
Giuseppina Imperatore, MD, PhD,
Yiling J. Cheng, MD, PhD
The opinions expressed in this correspondence are those of the
authors and do not necessarily represent the views of the Centers for
Disease Control and Prevention
Reference List
1. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height
ratio is the best predictor of cardiovascular disease risk factors in
Japanese schoolchildren. J Atheroscler Thromb 2002; 9:127-32.
2. Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of
BMI percentiles and waist-to-height ratio for identifying cardiovascular
risk in youth. J Pediatr 2005; 146:482-8.
3. McCarthy HD, Ashwell M. A study of central fatness using waist-to
-height ratios in UK children and adolescents over two decades supports
the simple message - `keep your waist circumference to less than half your
height'. Int J Obes 2006; 30:988-92.
4. Freedman DS, Kahn HS, Mei Z et al. Relation of body mass index
and waist-to-height ratio to cardiovascular disease risk factors in
children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 2007;
86:33-40.
5. Klein-Platat C, Oujaa M, Wagner A et al. Physical activity is
inversely related to waist circumference in 12-y-old French adolescents.
Int J Obes 2004; 29:9-14.
6. Saelens BE, Seeley RJ, van Schaick K, Donnelly LF, O'Brien KJ.
Visceral abdominal fat is correlated with whole-body fat and physical
activity among 8-y-old children at risk of obesity. Am J Clin Nutr 2007;
85:46-53.
7. Jeffery AN, Alba S, Murphy MJ et al. Behavior of insulin
resistance and its metabolic correlates in prepubertal children: A
longitudinal study (EarlyBird 32). Diabetes Care 2007; 30:2962-4.
Conflict of Interest:
None declared