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. 2025 Jul 23;20(7):e0324354.
doi: 10.1371/journal.pone.0324354. eCollection 2025.

Association of weight-adjusted waist index and Albuminuria in children and adolescents: A national population-based study

Jiawen Huo  1 , Jianfeng Liu  1 , Jiying Chen  2 , Qiaolin Li  1 , Lanling Shen  1 , Juanjuan Liang  1 , Jie Jiang  1
Affiliations

Association of weight-adjusted waist index and Albuminuria in children and adolescents: A national population-based study

Jiawen Huo et al. PLoS One. .

Abstract

Background: Albuminuria is a recognized marker of early kidney damage and cardiometabolic risk in pediatric populations. While central obesity is known to contribute to renal dysfunction, the relevance of the weight-adjusted waist index (WWI), a novel indicator of central adiposity, has not been fully explored in children and adolescents.

Methods: This study included 4,000 participants aged 3-19 years from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. WWI was calculated as waist circumference divided by the square root of body weight. Albuminuria was defined as an albumin-creatinine ratio (ACR) > 30 mg/g. Multivariable logistic regression, subgroup analyses, threshold effect modeling, and receiver operating characteristic (ROC) curves were used to evaluate the association between WWI and albuminuria.

Results: Higher WWI was significantly associated with lower odds of albuminuria in the fully adjusted model (OR = 0.64; 95% CI: 0.55-0.75). This inverse relationship was strongest among adolescents (13-19 years), modest in children aged 7-12 years, and not significant in the 3-6-year group. In the youngest group, a U-shaped association was identified, with an inflection point at 11.73 cm/√kg. ROC analysis showed WWI had superior discriminatory ability (AUC = 0.628) for albuminuria compared to BMI, waist circumference, height, and weight.

Conclusion: WWI demonstrates an age-dependent and non-linear association with albuminuria in U.S. children and adolescents. These findings suggest that WWI may offer a more refined anthropometric indicator of renal risk in youth and support its potential as a screening tool in pediatric populations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of participant’s selection.
NHANES, National Health and Nutrition Examination Survey.
Fig 2
Fig 2. The nonlinear associations between weight-adjusted waist index and albuminuria.
The solid red line represents the smooth curve fit between variables. Blue bands represent the 95% of confidence interval from the fit.
Fig 3
Fig 3. Receiver operating characteristic (ROC) curves comparing the predictive performance of WWI, body mass index (BMI), waist circumference (WC), height, and weight for albuminuria.
Fig 4
Fig 4. The nonlinear associations between weight-adjusted waist index and albuminuria by different age groups.
See this image and copyright information in PMC

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References

    1. Atkins RC, Polkinghorne KR, Briganti EM, Shaw JE, Zimmet PZ, Chadban SJ. Prevalence of albuminuria in Australia: the AusDiab Kidney Study. Kidney Int Suppl. 2004;(92):S22–4. doi: 10.1111/j.1523-1755.2004.09206.x - DOI - PubMed
    1. Gansevoort RT, de Jong PE. The case for using albuminuria in staging chronic kidney disease. J Am Soc Nephrol. 2009;20(3):465–8. doi: 10.1681/ASN.2008111212 - DOI - PubMed
    1. Fuhrman DY, Schneider MF, Dell KM, Blydt-Hansen TD, Mak R, Saland JM, et al. Albuminuria, Proteinuria, and Renal Disease Progression in Children with CKD. Clin J Am Soc Nephrol. 2017;12(6):912–20. doi: 10.2215/CJN.11971116 - DOI - PMC - PubMed
    1. Rademacher ER, Sinaiko AR. Albuminuria in children. Curr Opin Nephrol Hypertens. 2009;18(3):246–51. doi: 10.1097/MNH.0b013e3283294b98 - DOI - PubMed
    1. Kalaitzidis RG, Siamopoulos KC. The role of obesity in kidney disease: recent findings and potential mechanisms. Int Urol Nephrol. 2011;43(3):771–84. doi: 10.1007/s11255-011-9974-1 - DOI - PubMed