Association of the Waist-to-Height Ratio with Cardiovascular Risk Factors in Children and Adolescents: The Three Cities Heart Study

Objectives: To determine the best anthropometric index in relation tocardiovascular disease risk factors among children and adolescents.Methods: This cross-sectional school-based study was conductedamong a random sample of 3179 students, aged 6 to 18 years, in threelarge cities in Brazil.Results: The prevalence of overweight and obesity was 10% and 5%,respectively. In relation to the students in the lower quartile (Q1) of thedistribution of subscapular skinfold, the students in the upper quartile(Q4) presented a 2.0 times higher risk (odds ratio) of having elevatedtotal cholesterol levels. Overweight and obese students had a 3.3 timeshigher risk of having elevated systolic blood pressure, and a 1.9 timeshigher risk of elevated diastolic blood pressure than other students.The less active students presented a 1.58 times higher risk of havingwaist-to-height ratio (WHtR) above the upper tertile (Q3). WHtR meanvalues was 0.46 (SE 0.00) presented the largest area under the curve(AUC) [0.613 (CI995%:0.578-0.647)] for high total cholesterol levels,[0.546 (CI995%: 0.515-0.578)] for low HDL-C levels, and [0.614(CI95%: 0.577-0.651)] for high LDL-C levels, while body mass indexpresented the largest AUC [0.669 (CI95%: 0.64-0.699)] for increaseddiastolic blood pressure followed by the waist circumference for increasedsystolic blood pressure [0.761 (CI95%: 0.735-0.787)].Conclusions: WHtR is considered as a simple and accurate anthropometricparameter that identifies youth with cardiovascular risk factors.In this study, WHtR above 0.44 was indicative of risk factors inchildren and adolescents. These findings can be applied in future preventivestrategies against CVDs, and screening programs.