Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

doi:10.3389/fnut.2022.985319

. 2023 Jan 4:9:985319.

doi: 10.3389/fnut.2022.985319. eCollection 2022.

Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

Maysa Eslami¹, Farzad Pourghazi¹, Maryam Khazdouz², Jing Tian³, Kumars Pourrostami⁴, Zahra Esmaeili-Abdar⁵, Hanieh-Sadat Ejtahed⁶, Mostafa Qorbani^{7

8}

Affiliations

¹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
⁴ Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁵ Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁶ Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷ Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁸ Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

PMID: 36687719
PMCID: PMC9846615
DOI: 10.3389/fnut.2022.985319

Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

Maysa Eslami et al. Front Nutr. 2023.

. 2023 Jan 4:9:985319.

doi: 10.3389/fnut.2022.985319. eCollection 2022.

Authors

Maysa Eslami¹, Farzad Pourghazi¹, Maryam Khazdouz², Jing Tian³, Kumars Pourrostami⁴, Zahra Esmaeili-Abdar⁵, Hanieh-Sadat Ejtahed⁶, Mostafa Qorbani^{7

8}

Affiliations

¹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran.
³ Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
⁴ Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁵ Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁶ Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷ Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
⁸ Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

PMID: 36687719
PMCID: PMC9846615
DOI: 10.3389/fnut.2022.985319

Abstract

Introduction: Waist circumference-to-height ratio (WHtR) is a simple anthropometric index with good screening power and fast interpretation for early detection of childhood abdominal obesity. This systematic review and meta-analysis aims to determine the best cut-off value of WHtR to use in clinical setting.

Methods: Comprehensive searches were conducted in PubMed, Scopus, and Web of Science by the end of March 2021. Observational studies investigated the best WHtR cut-off to detect abdominal obesity in children and adolescents were included. Thirteen articles (n = 180,119) were included in this systematic review and eight documents were included in the meta-analysis.

Results: The overall optimal cut-off was 0.49 with pooled sensitivity, specificity and diagnostic odds ratio (DOR) of 0.93 (95% confidence interval (CI): 0.93-0.96), 0.88 (95% CI: 0.85-0.91) and 102.6 (95% CI: 50.7-207.5), respectively. The optimal WHtR cut-off to predict abdominal obesity in girls and boys were both 0.49.

Discussion: The current study shows that we could use this cut-off as a simple index for predicting abdominal obesity in children and adolescents without the need for any charts in practice.

Keywords: abdominal obesity; adolescents; central obesity; children; waist to height ratio.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**FIGURE 1**
Flow chart for study identification and selection. Based on PRISMA 2020.

**FIGURE 2**
Diagnostic test accuracy meta-analysis for overall optimal cutoff score of WHtR for detecting central obesity in children and adolescence. **(A)** Regression lines of accuracy of WHtR for children and adolescence. **(B)** The optimal cutoff score 0.49 was marked as a cross in the estimated SROC curve.

**FIGURE 3**
Forest plots for the diagnostic accuracy of overall cutoff point.

**FIGURE 4**
Diagnostic test accuracy meta-analysis for optimal cutoff score of WHtR for detecting central obesity in children and adolescence. **(A)** Regression lines of accuracy of WHtR for boys. **(B)** The optimal cutoff score 0.48 was marked as a cross in the estimated SROC curve. **(C)** Regression lines of accuracy of WHtR for girls. **(D)** The optimal cutoff score 0.49 was marked as a cross in the estimated SROC curve.

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References

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1. Mitchell L, Bel-Serrat S, Heinen M, Mehegan J, Murrin C, O’Brien S, et al. Waist circumference-to-height ratio and body mass index for obesity classification in Irish children. Acta Paediatr. (2021) 110:1541–7. 10.1111/apa.15724 - DOI - PubMed
1. Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis. Obesity Rev. (2016) 17:1258–75. - PubMed

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[1] Purnell J. Definitions, classification, and epidemiology of obesity. In Endotext [Internet]. South Dartmouth MA: MDText.com, Inc; (2018).

[2] Purnell J. Definitions, classification, and epidemiology of obesity. In Endotext [Internet]. South Dartmouth MA: MDText.com, Inc; (2018).

[3] World Health Organization. UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: levels and trends in child malnutrition: key findings of the. 2020 ed. Geneva: World health organization; (2020).

[4] World Health Organization. UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: levels and trends in child malnutrition: key findings of the. 2020 ed. Geneva: World health organization; (2020).

[5] Kilinc A, Col N, Demircioglu-Kilic B, Aydin N, Balat A, Keskin M. Waist to height ratio as a screening tool for identifying childhood obesity and associated factors. Pak J Med Sci. (2019) 35:1652–8. - PMC - PubMed

[6] Kilinc A, Col N, Demircioglu-Kilic B, Aydin N, Balat A, Keskin M. Waist to height ratio as a screening tool for identifying childhood obesity and associated factors. Pak J Med Sci. (2019) 35:1652–8. - PMC - PubMed

[7] Mitchell L, Bel-Serrat S, Heinen M, Mehegan J, Murrin C, O’Brien S, et al. Waist circumference-to-height ratio and body mass index for obesity classification in Irish children. Acta Paediatr. (2021) 110:1541–7. 10.1111/apa.15724 - DOI - PubMed

[8] Mitchell L, Bel-Serrat S, Heinen M, Mehegan J, Murrin C, O’Brien S, et al. Waist circumference-to-height ratio and body mass index for obesity classification in Irish children. Acta Paediatr. (2021) 110:1541–7. 10.1111/apa.15724 - DOI - PubMed

[9] Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis. Obesity Rev. (2016) 17:1258–75. - PubMed

[10] Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis. Obesity Rev. (2016) 17:1258–75. - PubMed

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Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

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Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: A systematic review and meta-analysis of diagnostic studies

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Conflict of interest statement

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