Waist-to-height ratio, waist circumference and BMI as indicators of percentage fat mass and cardiometabolic risk factors in children aged 3-7 years

Clin Nutr. 2014 Apr;33(2):311-5. doi: 10.1016/j.clnu.2013.05.010. Epub 2013 May 23.


Objective: To assess whether waist-to-height-ratio (WHtR) is a better estimate of body fat percentage (BF%) and a better indicator of cardiometabolic risk factors than BMI or waist circumference (WC) in young children.

Methods: WHtR, WC and BMI were measured by trained staff according to standardized procedures. (2)H2O and (2)H2(18)O isotope dilution were used to assess BF% in 61 children (3-7 years) from the general population, and bioelectrical impedance (Horlick equation) was used to assess BF% in 75 overweight/obese children (3-5 years). Cardiometabolic risk factors, including diastolic and systolic blood pressure, HOMA2-IR, leptin, adiponectin, triglycerides, total cholesterol, HDL- and LDL-cholesterol, TNFα and IL-6 were determined in the overweight/obese children.

Results: In the children from the general population, after adjustments for age and gender, BMI had the highest explained variance for BF% compared to WC and WHtR (R(2) = 0.32, 0.31 and 0.23, respectively). In the overweight/obese children, BMI and WC had a higher explained variance for BF% compared to WHtR (R(2) = 0.68, 0.70 and 0.50, respectively). In the overweight/obese children, WHtR, WC and BMI were all significantly positively correlated with systolic blood pressure (r = 0.23, 0.30, 0.36, respectively), HOMA2-IR (r = 0.53, 0.62, 0.63, respectively), leptin (r = 0.70, 0.77, 0.78, respectively) and triglycerides (r = 0.33, 0.36, 0.24, respectively), but not consistently with other parameters.

Conclusion: In young children, WHtR is not superior to WC or BMI in estimating BF%, nor is WHtR better correlated with cardiometabolic risk factors than WC or BMI in overweight/obese children. These data do not support the use of WHtR in young children.

Keywords: Anthropometry; Blood pressure; Body composition; Cholesterol; Insulin; Lipid.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiponectin / blood
  • Adiposity*
  • Blood Pressure / physiology
  • Body Height*
  • Body Mass Index*
  • Cardiovascular Diseases / epidemiology*
  • Child
  • Child, Preschool
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Cross-Sectional Studies
  • Electric Impedance
  • Female
  • Humans
  • Interleukin-6 / blood
  • Leptin / blood
  • Linear Models
  • Male
  • Overweight / blood
  • Overweight / complications
  • Pediatric Obesity / blood
  • Pediatric Obesity / complications
  • Risk Assessment
  • Risk Factors
  • Triglycerides / blood
  • Tumor Necrosis Factor-alpha / blood
  • Waist Circumference*


  • Adiponectin
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Interleukin-6
  • Leptin
  • Triglycerides
  • Tumor Necrosis Factor-alpha