Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis
Yuan Jiang, Yalan Dou, Hongyan Chen, Yi Zhang, Xiaotian Chen, Wang Yin, Myanca Rodrigues, Weili Yan
Abstract
Abstract Objective To provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used. Methods Searches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR 3 ), two (CMR 2 ), one (CMR 1 ), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95% CI s and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity. Results Fifty-three observational studies were included. The AUSROC reached 0.91 (95% CI : 0.88–0.93), 0.85 (95% CI : 0.81, 0.88) and 0.75 (95% CI : 0.71, 0.79) for CMR 3 , CMR 2 , and CMR 1 , respectively. The pooled sensitivity and specificity for CMR 3 reached 0.84 and exceeded 0.75 for CMR 2 . For CMR 1 , the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses. Conclusions WHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.