Cardio-metabolic risk screening among adolescents: understanding the utility of body mass index, waist circumference and waist to height ratio

Pediatr Obes. 2015 Oct;10(5):329-37. doi: 10.1111/ijpo.267. Epub 2014 Dec 17.


Background: Few studies have assessed how well body mass index (BMI), waist circumference (WC), or waist to height ratio (WtHR) perform in identifying cardio-metabolic risk among youth.

Objective: The objective of this study was to evaluate the utility of BMI and WC percentiles and WtHR to distinguish adolescents with and without cardio-metabolic risk.

Methods: A cross-sectional analysis of data from 6097 adolescents aged 10-13 years who participated in the HEALTHY study was conducted. Receiver operating characteristic curves determined the discriminatory ability of BMI and WC percentiles and WtHR.

Results: The discriminatory ability of BMI percentile was good (area under the curve [AUC] ≥ 0.80) for elevated insulin and clustering of ≥3 risk factors, with optimal cut-points of 96 and 95, respectively. BMI percentile performed poor to fair (AUC = 0.57-0.75) in identifying youth with the majority of individual risk factors examined (elevated glucose, total cholesterol, low-density lipoprotein, blood pressure, triglycerides and high-density lipoprotein). WC percentile and WtHR performed similarly to BMI percentile.

Conclusions: The current definition of obesity among US children performs well at identifying adolescents with elevated insulin and a clustering of ≥3 cardio-metabolic risk factors. Evidence does not support WC percentile or WtHR as superior screening tools compared with BMI percentile for identifying cardio-metabolic risk.

Keywords: Adolescents; cardiovascular risk; screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Area Under Curve
  • Blood Pressure / physiology
  • Body Mass Index
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / prevention & control*
  • Child
  • Cholesterol
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lipoproteins, HDL
  • Lipoproteins, LDL
  • Male
  • Pediatric Obesity / blood
  • Pediatric Obesity / diagnosis*
  • Pediatric Obesity / prevention & control
  • ROC Curve
  • Reference Values
  • Risk Assessment
  • Risk Factors
  • Triglycerides / blood
  • Waist Circumference
  • Waist-Height Ratio


  • Lipoproteins, HDL
  • Lipoproteins, LDL
  • Triglycerides
  • Cholesterol