Elsevier

The Journal of Pediatrics

Volume 149, Issue 6, December 2006, Pages 809-816
The Journal of Pediatrics

Original article
Waist circumference, blood pressure, and lipid components of the metabolic syndrome

https://doi.org/10.1016/j.jpeds.2006.08.075Get rights and content

Objectives

To examine whether waist circumference (WC) predicts blood pressure (BP) and lipid components of the metabolic syndrome independent of body mass index (BMI) percentile in youths.

Study design

The study group comprised 70 African-American youths and 97 Caucasian youths. Outcome measures included BP, lipid profile, and abdominal adipose tissue (AT).

Results

Both BMI percentile and WC were significantly (P < .05) associated with daytime and nighttime systolic and diastolic BP, triglycerides (TG), high-density lipoprotein (HDL), and TG/HDL ratio independent of race. In African-Americans and Caucasians, WC remained a significant (P < .05) correlate of daytime (r = .50 and .59, respectively) and nighttime (r = .49 and .62, respectively) systolic BP, and in Caucasians, TG, HDL, TG/HDL, and very-low-density lipoprotein after controlling for BMI percentile. After accounting for age, sex, and race, the addition of WC to BMI percentile increased the variance (R2) in systolic BP by 15% (P < .05). The inclusion of WC with BMI percentile explained an additional 3% and 7% of the variance in TG and HDL, respectively (P < .05).

Conclusions

The prediction of childhood obesity-related health risks is significantly improved by the inclusion of WC in addition to BMI percentile. This observation supports the notion that WC should be included in the evaluation of childhood obesity along with BMI percentile to identify those at increased health risks due to excess abdominal fat.

Section snippets

Subjects

Subjects consisted of healthy African-American (n = 70) and Caucasian (n = 97) youths who participated in various body composition and metabolic studies, some of whom have been reported previously.12, 13, 14 Study participants were recruited through the general media. The investigation was approved by the institutional review board. Parental informed consent and child assent were obtained from all subjects. All subjects were in good health on the basis of clinical history, physical examination,

Results

The subject characteristics are given in Table I. BMI percentile and WC were significantly (P < .05) associated with daytime and nighttime BP and with markers of dyslipidemia independent of race. In African-Americans and Caucasians, WC remained a significant (P < .05) correlate of daytime (r = .50 and .59) and nighttime (r = .49 and .62) systolic BP after controlling for BMI percentile. These relationships remained significant (P < .05) after further adjustment of height. In Caucasians alone,

Discussion

A growing body of evidence demonstrates that WC is an independent predictor of cardiovascular disease and insulin resistance in youths. Savva et al18 demonstrated that in European boys and girls, WC is a better predictor of BP, HDL, and LDL than BMI. We recently demonstrated that WC alone is a strong predictor of in vivo insulin sensitivity measured by the euglycemic clamp in African-American and Caucasian youths.12 In the Bogalusa Heart Study, central or abdominal fat deposition as assessed by

References (40)

  • L.O. Ohlson et al.

    The influence of body fat distribution on the incidence of diabetes mellitus: 13.5 years of follow-up of the participants in the study of men born in 1913

    Diabetes

    (1985)
  • K.M. Rexrode et al.

    Abdominal adiposity and coronary heart disease in women

    JAMA

    (1998)
  • Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report

    Obes Res

    (1998)
  • I. Janssen et al.

    Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines

    Arch Intern Med

    (2002)
  • S. Zhu et al.

    Combination of BMI and waist circumference for identifying cardiovascular risk factors in whites

    Obes Res

    (2004)
  • C.I. Ardern et al.

    Discrimination of health risk by combined body mass index and waist circumference

    Obes Res

    (2003)
  • P. Bjorntorp

    “Portal” adipose tissue as a generator of risk factors for cardiovascular disease and diabetes

    Arteriosclerosis

    (1990)
  • R.J. Kuczmarski et al.

    2000 CDC growth charts for the United States: methods and development

    Vital Health Stat

    (2002)
  • S.A. Arslanian et al.

    Hyperinsulinemia in African-American children: decreased insulin clearance and increased insulin secretion and its relationship to insulin sensitivity

    Diabetes

    (2002)
  • F. Bacha et al.

    Obesity, regional fat distribution, and syndrome X in obese black versus white adolescents: race differential in diabetogenic and atherogenic risk factors

    J Clin Endocrinol Metab

    (2003)
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    Supported by the US Public Health Service (grants RO1-HD-27503, K24-HD-01357, and MO1-RR-00084), the General Clinical Research Center of Children’s Hospital of Pittsburgh, and Eli Lilly and Company.

    None of the authors has any conflict of interest to declare.

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