Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development

J Clin Endocrinol Metab. 2013 Aug;98(8):3384-93. doi: 10.1210/jc.2013-1389. Epub 2013 Jun 17.


Context: The predictive value of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WtHR) to define cardiometabolic risk is unclear in childhood obesity.

Objective: [corrected] The associations between BMI, WtHR, or WC and cardiometabolic risk markers were analyzed in a multicenter data collection of obese youth.

Design and subjects: BMI, WtHR, and WC were retrospectively evaluated in 1278 patients (11-18 years, 53% boys) from the German/Austrian/Swiss Adiposity Patients Registry.

Main outcome measures: Parameters were correlated with homeostasis model assessment for insulin resistance, fasting insulin, blood pressure, transaminases, lipids and uric acid, applying adjusted regression models, with age group, pubertal stage and gender as covariates.

Results: Homeostasis model assessment for insulin resistance and fasting insulin were most strongly correlated with BMI, independent of age group or gender. Lipids, transaminases, and uric acid were most strongly correlated with WC with stronger associations for boys. Correlations between BMI and WC as well as metabolic markers and systolic blood pressure showed only minor differences. The pattern of relationship changed during the course of pubertal development with the strongest associations for pubertal children. None of the parameters showed a dependency on WtHR that was superior to BMI or WC.

Conclusions: There is only small additional benefit in using WC measurements for routine pediatric care in addition to BMI for predicting metabolic risk. For all parameters, the relationship is strongest during midpuberty, emphasizing that among obese pubertal adolescents, anthropometric measures (BMI and WC) best predict cardiometabolic comorbidities. WtHR does not seem to be superior to BMI or WC in predicting metabolic or cardiovascular risk related to childhood obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Body Height*
  • Body Mass Index*
  • Cardiovascular Diseases / etiology*
  • Child
  • Female
  • Humans
  • Insulin Resistance
  • Male
  • Obesity / complications*
  • Puberty*
  • Retrospective Studies
  • Risk
  • Uric Acid / blood
  • Waist Circumference*
  • gamma-Glutamyltransferase / metabolism


  • Uric Acid
  • gamma-Glutamyltransferase