European Journal of Nutrition

, Volume 52, Issue 1, pp 247–253 | Cite as

A composite score combining waist circumference and body mass index more accurately predicts body fat percentage in 6- to 13-year-old children

  • I. Aeberli
  • M. Gut-Knabenhans
  • R. S. Kusche-Ammann
  • L. Molinari
  • M. B. Zimmermann
Original Contribution

Abstract

Purpose

Body mass index (BMI) and waist circumference (WC) are widely used to predict % body fat (BF) and classify degrees of pediatric adiposity. However, both measures have limitations. The aim of this study was to evaluate whether a combination of WC and BMI would more accurately predict %BF than either alone.

Methods

In a nationally representative sample of 2,303 6- to 13-year-old Swiss children, weight, height, and WC were measured, and %BF was determined from multiple skinfold thicknesses. Regression and receiver operating characteristic (ROC) curves were used to evaluate the combination of WC and BMI in predicting %BF against WC or BMI alone. An optimized composite score (CS) was generated.

Results

A quadratic polynomial combination of WC and BMI led to a better prediction of %BF (r2 = 0.68) compared with the two measures alone (r2 = 0.58–0.62). The areas under the ROC curve for the CS [0.6 * WC-SDS + 0.4 * BMI-SDS] ranged from 0.962 ± 0.0053 (overweight girls) to 0.982 ± 0.0046 (obese boys) and were somewhat greater than the AUCs for either BMI or WC alone. At a given specificity, the sensitivity of the prediction of overweight and obesity based on the CS was higher than that based on either WC or BMI alone, although the improvement was small.

Conclusion

Both BMI and WC are good predictors of %BF in primary school children. However, a composite score incorporating both measures increased sensitivity at a constant specificity as compared to the individual measures. It may therefore be a useful tool for clinical and epidemiological studies of pediatric adiposity.

Keywords

Waist circumference Body fat Body mass index Overweight Children 

Notes

Acknowledgments

We would like to thank all children and teachers at the participating schools for their support. This study was supported by the Swiss Federal Office of Public Health.

References

  1. 1.
    Aeberli I, Amman RS, Knabenhans M, Molinari L, Zimmermann MB (2010) Decrease in the prevalence of paediatric adiposity in Switzerland from 2002–2007. Public Health Nutr 13:806–811. doi:1368980009991558 CrossRefGoogle Scholar
  2. 2.
    Aeberli I, Gut-Knabenhans M, Kusche-Ammann RS, Molinari L, Zimmermann MB (2011) Waist circumference and waist-to-height ratio percentiles in a nationally representative sample of 6–13 year old children in Switzerland. Swiss Med Wkly 141:w13227. doi:10.4414/smw.2011.13227 Google Scholar
  3. 3.
    Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj 320:1240–1243CrossRefGoogle Scholar
  4. 4.
    Cowin I, Emmett P (2000) Cholesterol and triglyceride concentrations, birthweight and central obesity in pre-school children. ALSPAC study team. Avon longitudinal study of pregnancy and childhood. Int J Obes Relat Metab Disord 24:330–339CrossRefGoogle Scholar
  5. 5.
    Davison AC, Hinkley DV (1997) Bootstrap methods and their application. Cambridge University Press, CambridgeGoogle Scholar
  6. 6.
    Deurenberg P, Pieters JJ, Hautvast JG (1990) The assessment of the body fat percentage by skinfold thickness measurements in childhood and young adolescence. Br J Nutr 63:293–303CrossRefGoogle Scholar
  7. 7.
    Flodmark CE, Sveger T, Nilsson-Ehle P (1994) Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12–14 year-old children. Acta Paediatr 83:941–945CrossRefGoogle Scholar
  8. 8.
    Freedman DS, Serdula MK, Srinivasan SR, Berenson GS (1999) Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa heart study. Am J Clin Nutr 69:308–317Google Scholar
  9. 9.
    Freedman DS, Sherry B (2009) The Validity of BMI as an indicator of body fatness and risk among children. Pediatrics 124:S23–S34. doi:10.1542/peds.2008-3586E CrossRefGoogle Scholar
  10. 10.
    Gibson RS (1993) Nutritional assessment: a laboratory manual. Oxford University Press, OxfordGoogle Scholar
  11. 11.
    Gibson RS (2005) Principles of nutritional assessment. Oxford University Press, New YorkGoogle Scholar
  12. 12.
    Goran MI, Gower BA (1999) Relation between visceral fat and disease risk in children and adolescents. Am J Clin Nutr 70:149S–156SGoogle Scholar
  13. 13.
    Gutin B, Litaker M, Islam S, Manos T, Smith C, Treiber F (1996) Body-composition measurement in 9–11 year-old children by dual-energy X-ray absorptiometry, skinfold-thickness measurements, and bioimpedance analysis. Am j Clin Nutr 63:287–292Google Scholar
  14. 14.
    Hammond J, Rona RJ, Chinn S (1994) Estimation in community surveys of total-body fat of children using bioelectrical-impedance or skinfold thickness measurements. Eur J Clin Nutr 48:164–171Google Scholar
  15. 15.
    Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. Jama 291:2847–2850CrossRefGoogle Scholar
  16. 16.
    Janssen I, Heymsfield SB, Allison DB, Kotler DP, Ross R (2002) Body mass index and waist circumference independently contribute to the prediction of non abdominal, abdominal subcutaneous, and visceral fat. Am J Clin Nutr 75:683–688Google Scholar
  17. 17.
    Lean ME, Han TS, Morrison CE (1995) Waist circumference as a measure for indicating need for weight management. Bmj 311:158–161CrossRefGoogle Scholar
  18. 18.
    McCarthy HD (2006) Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference. Proc Nutr Soc 65:385–392Google Scholar
  19. 19.
    Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, Wei R, Grummer-Strawn LM, Curtin LR, Roche AF, Johnson CL (2002) Centers for disease control and prevention 2000 growth charts for the United States: improvements to the 1977 national center for health statistics version. Pediatrics 109:45–60CrossRefGoogle Scholar
  20. 20.
    Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ (1994) Waist circumference and abdominal sagittal diameter—best simple anthropometric indexes of abdominal visceral adipose-tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 73:460–468CrossRefGoogle Scholar
  21. 21.
    Reilly JJ (2010) Assessment of obesity in children and adolescents: synthesis of recent systematic reviews and clinical guidelines. J Hum Nutr Diet 23:205–211. doi:10.1111/j.1365-277X.2010.01054.x CrossRefGoogle Scholar
  22. 22.
    Reilly JJ, Kelly J, Wilson DC (2010) Accuracy of simple clinical and epidemiological definitions of childhood obesity: systematic review and evidence appraisal. Obes Rev 11:645–655. doi:10.1111/j.1467-789X.2009.00709.x CrossRefGoogle Scholar
  23. 23.
    Sardinha LB, Going SB, Teixeira PJ, Lohman TG (1999) Receiver operating characteristic analysis of body mass index, triceps skinfold thickness, and arm girth for obesity screening in children and adolescents. Am j Clin Nutr 70:1090–1095Google Scholar
  24. 24.
    Schaefer F, Georgi M, Zieger A, Scharer K (1994) Usefulness of bioelectric impedance and skinfold measurements in predicting fat-free mass derived from total body potassium in children. Pediatr Res 35:617–624CrossRefGoogle Scholar
  25. 25.
    Seidell JC (1999) Obesity: a growing problem. Acta Paediatr Suppl 88:46–50CrossRefGoogle Scholar
  26. 26.
    WHO (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO expert committeeGoogle Scholar
  27. 27.
    Zimmermann MB, Gubeli C, Puntener C, Molinari L (2004) Detection of overweight and obesity in a national sample of 6–12 year-old Swiss children: accuracy and validity of reference values for body mass index from the US centers for disease control and prevention and the international obesity task force. Am J Clin Nutr 79:838–843Google Scholar
  28. 28.
    Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, Wong G, Bennett P, Shaw J, Caprio S (2007) The metabolic syndrome in children and adolescents. Lancet 369:2059–2061CrossRefGoogle Scholar
  29. 29.
    Zweig MH, Campbell G (1993) Receiver-operating characteristic (roc) plots—a fundamental evaluation tool in clinical medicine. Clin Chem 39:561–577Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • I. Aeberli
    • 1
    • 2
  • M. Gut-Knabenhans
    • 1
  • R. S. Kusche-Ammann
    • 1
  • L. Molinari
    • 3
  • M. B. Zimmermann
    • 1
    • 4
  1. 1.Institute of Food, Nutrition and Health, Human Nutrition LaboratoryETH ZurichZürichSwitzerland
  2. 2.Division for Endocrinology and DiabetesUniversity Hospital ZurichZurichSwitzerland
  3. 3.Child Development CenterUniversity Children’s HospitalZurichSwitzerland
  4. 4.Wageningen UniversityWageningenThe Netherlands

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