An Obesity Index Derived from Waist and Hip Circumferences Well-Matched with Other Indices in Children with Obesity

Authors: Mustafa M. Donma, Orkide Donma

Abstract:

Indices derived from anthropometric measurements [waist-to-hip ratio (WHR)] or body fat mass compositions [trunk-to-leg fat ratio (TLFR)] are used for the evaluation of obesity. The best for clinical practices is still being investigated. The aim of this study is to derive an index, which best suits the purpose for the discrimination of children with normal body mass index (N-BMI) from obese (OB) children. 83 children participated in the study. Groups 1 and 2 comprised 42 children with N-BMI and 41 OB children, whose age- and sex-adjusted BMI percentile values vary between 15-85 and 95-99, respectively. The institutional ethics committee approved the study protocol. Informed consent forms were filled by the parents of the participants. Anthropometric measurements (weight, height (Ht), waist circumference (WC), hip circumference (HC), neck circumference (NC) values) were taken. BMI, WHR, (WC+HC)/2, WC/Ht, (WC/HC)/Ht, WC*NC were calculated. Bioelectrical impedance analysis was performed to obtain body’s fat compartments in terms of total fat, trunk fat, leg fat, arm fat masses. TLFR, trunk-to-appendicular fat ratio (TAFR), (trunk fat+leg fat)/2 ((TF+LF)/2), fat mass index (FMI) and diagnostic obesity notation model assessment-II (D2I) index values were calculated. Statistical analysis was performed. Significantly higher values of (WC+HC)/2, (TF+LF)/2, D2I and FMI were observed in OB group than N-BMI group. Significant correlations were found between BMI and WC, (WC+HC)/2, (TF+LF)/2, TLFR, TAFR, D2I, FMI in both groups. Similar correlations were obtained for WC. (WC+HC)/2 was correlated with TLFR, TAFR, (TF+LF)/2, D2I and FMI in N-BMI group. In OB group, the correlations were the same except those with TLFR and TAFR. These correlations were not present with WHR. Correlations were observed between TLFR as well as TAFR and BMI, WC, (WC+HC)/2, (TF+LF)/2, D2I, FMI in N-BMI group. In OB group, correlations between TLFR or TAFR and BMI, WC as well as (WC+HC)/2 were missing. None was noted with WHR. In conclusion, the only correlation valid in both groups was that exists between (TF+LF)/2 and (WC+HC)/2, which was suggested as a link between fat-based and anthropometric indices. (WC+HC)/2, but not WHR, was much more suitable as an anthropometric obesity index.

Keywords: Children, hip circumference, obesity, waist circumference.

References:

[1] A. Basit, N. Mustafa, N. Waris, S. Askari, A. Fawwad, and NDSP members, “Predicting the risk of type 2 diabetes through anthropometric indices in Pakistani adults- A sub-analysis of second national diabetes survey of Pakistan 2016-2017 (NDSP-07),” Diabetes Metab. Syndr., vol.15, no.2, pp.543-547, Mar-Apr 2021.
[2] J. Xu, L. Zhang, Q. Wu, Y. Zhou, Z. Jin, Z. Li, and Y. Zhu, “Body roundness index is a superior indicator to associate with the cardio-metabolic risk: evidence from a cross-sectional study with 17,000 Eastern-China adults,” BMC Cardiovasc. Disord., vol.21, no.1, pp.97, Feb. 2021.
[3] J. V. Chávez-Sosa, R. Rojas-Humpire, R. Gutierrez-Ajalcriña, and S. Huancahuire-Vega, “Association between lifestyles, anthropometric measurements and peripheral arterial disease in public sector health workers,” Am. J. Cardiovasc. Dis., vol.11, no.2, pp.194-202, Apr. 2021.
[4] S. N. Darko, K. A. C. Meeks, W. K. B. A. Owiredu, E. F. Laing, D. Boateng, E. Beune, J. Addo, A. de-Graft Aikins, S. Bahendeka, F. Mockenhaupt, J. Spranger, P. Agyei-Baffour, K. Klipstein-Grobusch, L. Smeeth, C. Agyemang, and E. Owusu-Dabo, “Anthropometric indices and their cut-off points in relation to type 2 diabetes among Ghanaian migrants and non-migrants: The RODAM study,” Diabetes Res. Clin. Pract., vol.173, pp.108687, Mar. 2021.
[5] B. Zhang, Y. Fan, Y. Wang, L. Zhang, C. Li, J. He, P. Guo, M. Zhang, and M. Zhang, “Comparison of bioelectrical body and visceral fat indices with anthropometric measures and optimal cutoffs in relation to hypertension by age and gender among Chinese adults,” BMC Cardiovasc. Disord., vol.21, no.1, pp.291, Jun. 2021.
[6] Q. Song, T. Huang, J. Song, X. Meng, C. Li, Y. Wang, and H. Wang, “Causal associations of body mass index and waist-to-hip ratio with cardiometabolic traits among Chinese children: A Mendelian randomization study,” Nutr. Metab. Cardiovasc. Dis., vol.30, no.9, pp.1554-1563, Aug.2020.
[7] W. Albaker, S. El-Ashker, M. A. Baraka, N. El-Tanahi, M. Ahsan, and M. Al-Hariri, “Adiposity and cardiometabolic risk assessment among university students in Saudi Arabia,” Sci. Prog., vol.104, no.1, pp.36850421998532, Jan-Mar 2021.
[8] I. Kishimoto, “Trunk-to-leg fat ratio-An emerging early marker of childhood adiposity, and future cardiometabolic risks,” Circ. J., vol.80. no.8, pp. 1707-1709, Jul. 2016.
[9] M. Donma, O. Donma, M. Aydin, M. Demirkol, B. Nalbantoglu, A. Nalbantoglu, and B. Topcu, “Gender differences in morbid obese children: Clinical significance of two diagnostic obesity notation model assessment indices,” Int. J. Med. Health Sci., vol.10, no.5, pp.310 – 316, May 2016.
[10] O. Donma, and M. Donma, “Evaluation of the weight-based and fat-based indices in relation to basal metabolic rate-to-weight ratio,” Int. J. Med. Health Sci., vol.13, no.5, pp.214-218, May 2019.
[11] A. Oliver Olid, L. Martín López, J. M. Moreno Villares, M. Á. Martínez González, V. de la O Pascual, and N. Martín Calvo, “Validation of the anthropometric data reported by parents of participants in the SENDO project,” Nutr. Hosp., 2021 Aug 25. Spanish. Epub ahead of print.
[12] H. K. Tang, C. T. C. Nguyen, and N. H. T. Vo, “Anthropometric indicators to estimate percentage of body fat: A comparison using cross-sectional data of children and adolescents in Ho Chi Minh City, Vietnam,” Indian J. Pediatr., 2021 Sep 13. Epub ahead of print.
[13] M. Mahdavi-Roshan, A. Rezazadeh, F. Joukar, M. Naghipour, S. Hassanipour, and F. Mansour- Ghanaei, “Comparison of anthropometric indices as predictors of the risk factors for cardiovascular disease in Iran: The PERSIAN Guilan Cohort Study,” Anatol. J. Cardiol., vol.25, no.2, pp.120-128, Feb. 2021.
[14] WHO World Health Organization (WHO). The WHO Child Growth Standards. 2016 June. Access: http://www.who.int/childgrowth/en/
[15] D. Pasanta, K. T. Htun, J. Pan, M. Tungjai, S. Kaewjaeng, S. Chancharunee, S. Tima, H. J. Kim, J. Kæwkhao, and S. Kothan, “Waist circumference and BMI are strongly correlated with MRI-derived fat compartments in young adults,” Life (Basel)., vol.11, no.7, pp.643, Jul. 2021.
[16] J. Luo, M. Hendryx, D. Laddu, L. S. Phillips, R. Chlebowski, E. S. LeBlanc, D. B. Allison, D. A. Nelson, Y. Li, M. C. Rosal, M. L. Stefanick, and J-A. E. Manson, “Racial and ethnic differences in anthropometric measures as risk factors for diabetes,” Diabetes Care, vol.42, pp.126–133, Jan. 2019.
[17] S. Razak, M. Justine, and V. Mohan, “Relationship between anthropometric characteristics and aerobic fitness among Malaysian men and women,” J. Exerc. Rehabil., vol.17, no.1, pp.52-58, Feb. 2021.
[18] Y. Huang, L. Gu, N. Li, F. Fang, X. Ding, Y. Wang, and Y. Peng, “The product of waist and neck circumference outperforms traditional anthropometric indices in identifying metabolic syndrome in Chinese adults with type 2 diabetes: a cross-sectional study,” Diabetol. Metab. Syndr., vol.13, no.1, pp.35, Mar. 2021.
[19] X. F. Ye, W. Dong, L. L. Tan, Z. R. Zhang, Y. L. Qiu, and J. Zhang, “Identification of the most appropriate existing anthropometric index for home-based obesity screening in children and adolescents,” Public Health., vol.189, pp.20-25, Dec. 2020.
[20] E. B. Parente, V. Harjutsalo, C. Forsblom, and P. H. Groop, “Waist-height ratio and the risk of severe diabetic eye disease in type 1 diabetes: a 15-year cohort study,” J. Clin. Endocrinol. Metab., 2021 Sep 11:dgab671. doi: 10.1210/clinem/dgab671. Epub ahead of print.
[21] S. Cho, A. Shin, J. Y. Choi, S. M. Park, D. Kang, and J. K. Lee, “Optimal cutoff values for anthropometric indices of obesity as discriminators of metabolic abnormalities in Korea: results from a Health Examinees study,” BMC Public Health., vol.21, no.1, pp.459, Mar. 2021.
[22] A. E. Malavazos, G. Capitanio, V. Milani, F. Ambrogi, I. A. Matelloni, S. Basilico, C. Dubini, F. M. Sironi, E. Stella, S. Castaldi, F. Secchi, L. Menicanti, G. Iacobellis, M. M. Corsi Romanelli, M. O. Carruba, and L. F. Morricone, “Tri-ponderal mass index vs body mass index in discriminating central obesity and hypertension in adolescents with overweight,” Nutr. Metab. Cardiovasc. Dis., vol.31, no.5, pp.1613-1621, May 2021.
[23] A. Issaka, A. J. Cameron, Y. Paradies, J. B. Kiwallo, W. K. Bosu, Y. C. N. Houehanou, C. S. Wesseh, D. S. Houinato, D. J. P. Nazoum, and C. Stevenson, “Associations between obesity indices and both type 2 diabetes and impaired fasting glucose among West African adults: Results from WHO STEPS surveys,” Nutr. Metab. Cardiovasc. Dis., vol.31, no.9, pp.2652-2660, Aug. 2021.
[24] F. L. Zhang, J. X. Ren, P. Zhang, H. Jin, Y. Qu, Y. Yu, Z. N. Guo, and Y. Yang, “Strong association of waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) with diabetes: A population-based cross-sectional study in Jilin Province, China,” J. Diabetes Res., vol.2021, pp.8812431, May 2021.
[25] G. Katamba, A. Musasizi, M. A. Kinene, A. Namaganda, and F. Muzaale, “Relationship of anthropometric indices with rate pressure product, pulse pressure and mean arterial pressure among secondary adolescents of 12-17 years,” BMC Res. Notes., vol.14, no.1, pp.101, Mar. 2021.
[26] I. Mahmoud, and N. Sulaiman, “Significance and agreement between obesity anthropometric measurements and indices in adults: a population-based study from the United Arab Emirates,” BMC Public Health, vol.21, no.1, pp.1605, Aug. 2021.
[27] Á. Martín Castellanos, P. Martín Castellanos, E. Martín, and F. J. Barca Durán, “Abdominal obesity and myocardial infarction risk - We demonstrate the anthropometric and mathematical reasons that justify the association bias of the waist-to-hip ratio,” Nutr. Hosp., vol.38, no.3, pp.502-510, Jun. 2021.