Body mass index triples overweight prevalence in 7600 children compared with waist-to-height ratio: the ALSPAC study

Abstract

Abstract Objective Waist circumference-to-height ratio (WHtR) is a highly sensitive and specific surrogate marker of excess total body adiposity and central adiposity (adiposopathy). This study examined the prevalence of body mass index (BMI) categories in relation to newly developed WHtR cut points (Agbaje WHtR cutoff) in the pediatric population. The WHtR estimated fat mass categories predictive ability to detect the risk of prediabetes and type 2 diabetes was examined in an adult population. Design A prospective birth cohort study in the UK externally validated with a nationwide survey data from the US. Methods Altogether, 7600 9-year-old children from the Avon Longitudinal Study of Parents and Children, UK birth cohort were included. Body mass index and WHtR were assessed at ages 9, 15, and 24 years. Waist circumference-to-height ratio cut points are <0.40 as low fat; 0.40 to <0.50 in males as normal fat; 0.40 to <0.51 in females as normal fat; 0.50 to <0.53 in males as high fat (adiposopathy grade 1); 0.51 to <0.54 in females as high fat; >0.53 in males as excess fat (adiposopathy grade 2), and >0.54 in females as excess fat. From the National Health and Nutrition Examination Survey (2021 to 2023 cycle), 3329 US participants with a mean (SD) age of 49 (20.3) years who had glycohemoglobin and fasting plasma glucose were included. Results Body mass index overestimated the prevalence of overweight by 2.8-fold in childhood, 2.3-fold in adolescence, and 2.6-fold in young adulthood compared with WHtR. Of 1431 children classified as BMI overweight, 25% had WHtR high fat, 11% had WHtR excess fat, and 64% had WHtR normal fat. However, of the 517 children classified as having WHtR high fat, 69.8% were BMI overweight and 24% had BMI obesity, while only 6% had normal BMI. Waist circumference-to-height ratio high fat was associated with higher odds of prediabetes [odds ratio 2.36 (95% CI, 1.10-5.10), P = .028]. Waist circumference-to-height ratio excess fat was associated with higher odds of type 2 diabetes [6.08 (2.84-13.01), P < .001]. Conclusions Waist circumference-to-height ratio can be universally adopted for preventing, diagnosing, and managing excess adiposity (adiposopathy) in pediatrics.

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