Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study

Background: Several investigators have concluded that the waist-to-height ratio is more strongly associated with cardiovascular disease risk factors than is the body mass index (BMI; in kg/m(2)). Objectives: We examined the relation of the BMI-for-age z score and waist-to-height ratio to risk factors (lipids, fasting insulin, and blood pressures). We also compared the abilities of these 2 indexes to identify children with adverse risk factors. Design: Children aged 5-17 y (n = 2498) in the Bogalusa Heart Study were evaluated. Results: As assessed by the ability of the 2 indexes to 1) account for the variability in each risk factor and 2) correctly identify children with adverse values, the predictive abilities of the BMI-for-age z score and waist-to-height ratio were similar. Waist-to-height ratio was slightly better (0.01-0.02 higher R-2 values, P < 0.05) in predicting concentrations of total-to-HDL cholesterol ratio and LDL cholesterol, but BMI was slightly better in identifying children with high systolic blood pressure (0.03 higher R-2, P < 0.05) in predicting measures of fasting insulin and systolic and diastolic blood pressures. On the basis of an overall index of the 6 risk factors, no difference was observed in the predictive abilities of BMI-for-age and waist-to-height ratio, with areas under the curves of 0.85 and 0.86 (P = 0.30) and multiple R-2 values of 0.320 and 0.318 (P = 0.79). This similarity likely results from thehigh intercorrelation (R-2 = 0.78) between the 2 indexes. Conclusions: BMI-for-age and waist-to-height ratio do not differ in their abilities to identify children with adverse risk factors. Although waist-to-height ratio may be preferred because of its simplicity, additional longitudinal data are needed to examine its relation to disease.