Waist-to-Height Ratio Associated Cardiometabolic Risk Phenotype in Children with Overweight/Obesity

Abstract

Abstract Background Higher childhood overweight/obesity has been associated with an elevated risk of insulin resistance and cardiometabolic disorders. Waist-to-height ratio (WHtR) may be a simple screening tool to identify children at risk for cardiometabolic associated obesity. This study investigated whether being in the upper tertile for WHtR predicted the odds of insulin resistance, elevated liver enzyme concentrations, and cardiometabolic risk factor measures using cross-sectional data from the Family Weight Management Study randomized controlled trial. Methods Included was baseline data (n = 360, 7–12 years, mean Body Mass Index ≥ 85th percentile for age and sex). WHtR were grouped into tertiles by sex, male: ≤0.55(T1), > 0.55-≤0.59(T2), > 0.59(T3); female: ≤0.56(T1),>0.56-≤0.6(T2), > 0.6(T3). The Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used to categorize participants as insulin-resistant (HOMA-IR ≥ 2.6) and insulin-sensitive (HOMA-IR < 2.6). Liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were categorized as normal vs. elevated (AST of < 36.0 µkat/L or ≥ 36.0 µkat/L; ALT of < 30.0 µkat/L or ≥ 30.0 µkat/L). We examined differences in baseline cardiometabolic risk factors by WHtR tertiles and sex-specific multivariable logistic regression models to predict IR and elevation of liver enzymes. Results Study participants had a mean WHtR of 0.59 ([SD: 0.06)]). Irrespective of sex, children in WHtR T3 had higher BMIz scores, blood pressure, triglycerides, 2-hr glucose, fasting, 2-hr insulin and lower HDL-C concentrations compared to those in T2 and T1. After adjusting for covariates, the odds of elevated IR (using HOMA-IR > 2.6) were over 5fold higher among children in T3 versus T1 (males) and T2 and T3 versus T1 (females). The odds of elevated ALT values (≥ 30) were 2.9 fold higher among female children in T3 compared to T1. Conclusion WHtR may be a practical screening tool in pediatric populations with overweight/obesity to identify children at risk of IR and cardiometabolically unhealthy phenotypes in public health settings.