USE OF HEIGHT AND GENDER BASED WAIST CIRCUMFERENCE CHARTS IN PEDIATRIC OBESITY MANAGEMENT

Objective: Evaluate the incorporation of waist circumference in the risk stratification of pediatric patients being evaluated for obesity. Study Design: Two representative samples of US children and adolescents ages 6 to 18 years from the National Health and Nutrition Examination Survey collected from 2001 to 2008 were used in these analyses. Age and gender specific waist circumference percentiles and elevated percent body fat were calculated for each participant; abnormal high density lipoprotein cholesterol, total cholesterol, glucose, and liver enzymes were calculated for participants ages 12 and older. The 2001-04 sample was used to develop cut points for the waist circumference percentiles by evaluating sensitivity and specificity. A reclassification system was designed that adds waist circumference to BMI to estimate an anthropometric risk profile. This reclassification system was validated using the 2005-08 sample. Validation was confirmed using area under the receiver operating curve statistics (AUC) and net reclassification improvement (NRI). Results: Waist circumference cut points were determined to be the 80th percentile for boys and 75th for girls to detect excess adiposity; 65th for boys and 60th for girls to detect any abnormal lab value. Reclassification according to the cut points for excess adiposity resulted in a minimal increase in AUC from 0.915 to 0.918 for boys and decrease in AUC from 0.878 to 0.873 for girls. NRI however demonstrated a 0.213 improvement in classification for boys and 0.182 improved classification for girls in the detection of excess adiposity with statistical significance (P-Value < 0.001 for both). Neither AUC nor NRI showed any significant improvement in the detection of abnormal lab values. Conclusion: The addition of waist circumference to BMI significantly improved the detection of children with excess adiposity compared to BMI alone, but not the presence of lab abnormalities.

Grantor dc:publisher

Wake Forest University

Year dc:date.issued

2011

Author dc:creator

• Ross, Michael

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/10339/36420

OAI identifier oai:identifier

oai:wakespace.lib.wfu.edu:10339/36420