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Determinants of Waist-to-Height Ratio and Its Relation to Hypertension among School Children in India: A Multicenter Study

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To study the factors associated with waist-to-height ratio (WHtR) among school children aged 5–15 y and its association with hypertension.

Methods

In this cross-sectional study, data on background characteristics, socioeconomic status (SES), anthropometric parameters, and blood pressure were obtained from school children from three states of India. WHtR ≥ 0.5 was defined as obesity and hypertensives were defined based on Fourth Report criteria. Descriptive statistics were applied and multiple linear regression was done to identify factors associated with WHtR. A receiver operating characteristics (ROC) analysis was used to evaluate the predictive ability of WHtR to predict hypertension

Results

The mean WHtR among the 12,068 students was 0.40 (± 0.05) and it showed a U-shaped distribution with age with trough at 10 y of age for both genders. Mean WHtR was higher among residents of Manipur, among boys and hypertensives. WHtR was positively associated with weight > 30 kg, male gender, schools with high SES, Manipur and Goa region, and negatively associated with age > 10 y. The area under the ROC curve of WHtR for diagnosis of hypertension was low 0.544 (95% CI 0.532, 0.556).

Conclusion

There is a nonlinear relation between age, gender, and WHtR, which varies by geographical region and HT. This would need to be kept in mind while using it to identify obesity in children, though its discriminant value for hypertension is low.

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References

  1. World Health Organization. Childhood overweight and obesity. Avaialble at:https://www.who.int/dietphysicalactivity/childhood/en/. Accessed on 13 Nov 2020.

  2. Patil AD, Shejul S, Bhandarkar P, Kattimani A, Mudassir A, Bantwal K. A study of adolescent obesity and hypertension in urban school in Mumbai. Int J Community Med Public Health. 2018;5:790–4.

    Article  Google Scholar 

  3. Lee EY, Yoon KH. Epidemic obesity in children and adolescents: risk factors and prevention. Frontiers of medicine. 2018;12:658–66.

    Article  Google Scholar 

  4. Liang Y, Jie MI. Pubertal hypertension is a strong predictor for the risk of adult hypertension. Biomed Environ Sci. 2011;24:459–66.

    PubMed  Google Scholar 

  5. De Moraes AC, Fadoni RP, Ricardi LM, et al. Prevalence of abdominal obesity in adolescents: a systematic review. Obes Rev. 2011;12:69–77.

    Article  Google Scholar 

  6. Ranjani H, Mehreen TS, Pradeepa R, et al. Epidemiology of childhood overweight & obesity in India: A systematic review. Indian J Med Res. 2016;143:160–74.

    Article  CAS  Google Scholar 

  7. Thompson M, Dana T, Bougatsos C, Blazina I, Norris SL. Screening for hypertension in children and adolescents to prevent cardiovascular disease. Pediatrics. 2013;131:490–525.

    Article  Google Scholar 

  8. Koebnick C, Black MH, Wu J, et al. High blood pressure in overweight and obese youth: implications for screening. J Clin Hypertens (Greenwich). 2013;15:793–805.

    Article  Google Scholar 

  9. Yoo EG. Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean J Pediatr. 2016;59:425–31.

    Article  Google Scholar 

  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. Obes Rev. 2016;17:1258–75.

    Article  CAS  Google Scholar 

  11. Lee CM, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61:646–53.

    Article  Google Scholar 

  12. Panjikkaran ST. Waist to height ratio for recording the risks of overweight in schoolchildren in Kerala. Indian Pediatr. 2013;50:493–5.

    Article  Google Scholar 

  13. Kajale NA, Khadilkar AV, Chiplonkar SA, Khadilkar VV. Body fat indices for identifying risk of hypertension in Indian children. Indian Pediatr. 2014;51:555–60.

    Article  CAS  Google Scholar 

  14. Mishra PE, Shastri L, Thomas T, et al. Waist-to-height ratio as an indicator of high blood pressure in urban Indian school children. Indian Pediatr. 2015;52:773–8.

    Article  CAS  Google Scholar 

  15. Saxena A, Desai A, Narvencar K, et al. Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria–A multi site extension of RHEUMATIC study (the e-RHEUMATIC study). Int J Cardiol. 2017;249:438–42.

    Article  Google Scholar 

  16. Narang R, Saxena A, Desai A, et al. Prevalence and determinants of hypertension in apparently healthy schoolchildren in India: A multi-center study. Eur J Prev Cardiol. 2018;25:1775–84.

    Article  Google Scholar 

  17. Chung IH, Park S, Park MJ, Yoo EG. Waist-to-height ratio as an index for cardiometabolic risk in adolescents: results from the 1998–2008 KNHANES. Yonsei Med J. 2016;57:658–63.

    Article  CAS  Google Scholar 

  18. National high blood pressure education program working group on high blood pressure in children and adolescents. the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114: 555–576.

  19. Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4:627–35.

    PubMed  PubMed Central  Google Scholar 

  20. Sung RY, So HK, Choi KC, et al. Waist circumference and waist-to-height ratio of Hong Kong Chinese children. BMC Pub Health. 2008;8:324.

    Article  Google Scholar 

  21. de Pádua CI, Passos MA, Dos Santos LC, da Costa MH, Fisberg M. Waist-to-height ratio percentiles and cutoffs for obesity: a cross-sectional study in Brazilian adolescents. J Health Popul Nutr. 2014;32:411–9.

    Google Scholar 

  22. Rerksuppaphol S, Rerksuppaphol L. Waist circumference, waist-to-height ratio and body mass index of Thai children: secular changes and updated reference standards. J Clin Diagn Res. 2014;8:PC05–9.

  23. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediat. 2011;11:105.

    Article  Google Scholar 

  24. Xiong F, Garnett SP, Cowell CT, et al. Waist circumference and waist-to-height ratio in Han Chinese children living in Chongqing, south-west China. Pub Health Nutr. 2011;14:20–6.

    Article  CAS  Google Scholar 

  25. Kuriyan R, Thomas T, Lokesh DP, et al. Waist circumference and waist for height percentiles in urban South Indian children aged 3–16 years. Indian Pediatr. 2011;48:765–71.

    Article  Google Scholar 

  26. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56:303–7.

    Article  Google Scholar 

  27. Ejtahed HS, Kelishadi R, Qorbani M, et al. Utility of waist circumference-to-height ratio as a screening tool for generalized and central obesity among Iranian children and adolescents: The CASPIAN-V study. Pediatr Diabetes. 2019;20:530–7.

    PubMed  Google Scholar 

  28. Ma C, Wang R, Liu Y, et al. Performance of obesity indices for screening elevated blood pressure in pediatric population: Systematic review and meta-analysis. Medicine. 2016;95:1–7.

    Article  Google Scholar 

  29. Kuciene R, Dulskiene V. Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: a cross-sectional study. Sci Rep. 2019;9:9493.

    Article  Google Scholar 

  30. Mirmiran P, Rezaei M, Asghari G, Mehrabi Y, Azizi F. Association of metabolic syndrome with body fat percent, anthropometric indices in 10 to 18 year old adolescents. Iran J Public Health. 2014;43:193–201.

    PubMed  PubMed Central  Google Scholar 

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Funding

The study was funded by restricted research grant from Medtronics Foundation, USA (through Public Health Foundation of India (PHFI), (grant number: F087) and Indian Council of Medical Research, India (grant number: 5/4/1–14/09-NCD-II). The sponsors had no role in the design of the study; collection, analysis, or interpretation of the data; or writing of the manuscript and in the decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India

    Ankita Kankaria

  2. Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Rajiv Narang, Anita Saxena & Sivasubramanian Ramakrishnan

  3. Endocrinology Unit, Department of Medicine, Goa Medical College, Bambolim, Goa, India

    Ankush Desai

  4. Department of Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India

    Rajendra S. Thangjam

  5. Department of Community Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Anand Krishnan

Authors
  1. Ankita Kankaria
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  2. Rajiv Narang
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  3. Anita Saxena
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  4. Sivasubramanian Ramakrishnan
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  5. Ankush Desai
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  6. Rajendra S. Thangjam
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  7. Anand Krishnan
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Correspondence to Anita Saxena.

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Ethics Committee Approval

The ethical approval was obtained from the Institute Ethics Committee at all three sites.

Informed Consent

It was obtained from each school principal as well as the parents

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Kankaria, A., Narang, R., Saxena, A. et al. Determinants of Waist-to-Height Ratio and Its Relation to Hypertension among School Children in India: A Multicenter Study. Indian J Pediatr 89, 546–552 (2022). https://doi.org/10.1007/s12098-021-03879-2

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  • DOI: https://doi.org/10.1007/s12098-021-03879-2

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