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J Obes. 2014;2014:421658. doi: 10.1155/2014/421658. Epub 2014 Jul 14.

Cardiometabolic risk assessments by body mass index z-score or waist-to-height ratio in a multiethnic sample of sixth-graders.

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Division of Diabetes Translation, Centers for Disease Control & Prevention, CDC Mail Stop F-73, 4770 Buford Highway, Atlanta, GA 30341, USA.
The Biostatistics Center, George Washington University, Rockville, MD 20852, USA.
School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK.
Center for Obesity Research and Education, Temple University, Philadelphia, PA 19122, USA.
Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC 27599, USA.
Division of Endocrinology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
Division of Health Promotion & Sports Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
Social & Health Research Center, San Antonio, TX 78210, USA.
Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA.


Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R (2)) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R (2) attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R (2) for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.

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