LMS Tables for Waist-circumference and Waist-height Ratio Z-scores in Children Aged 5-19 Y in NHANES III: Association with Cardio-metabolic Risks

Overview

Journal Pediatr Res

Specialties Biology
Pediatrics

Date 2015 Sep 3

PMID 26331767

Citations 98

Authors

Atul K Sharma

Daniel L Metzger

Carrie Daymont

Stasia Hadjiyannakis

Celia J Rodd

Affiliations

Soon will be listed here.

Abstract

Background: In adults, anthropometric measures of central adiposity, such as waist-height ratio (WHtR) and waist circumference (WC), are more strongly associated with cardio-metabolic risks than BMI.

Methods: To provide similar quantitative tools for North American children, we created smoothed centile charts and LMS tables for WHtR and WC based on data from the US National Health and Nutrition Survey, cycle III (NHANES III, N = 11,930 aged 2-24 y 1988-1994).

Results: Applying these reference charts to subsequent NHANES survey cycles, 1999-2012) demonstrated a significant mean increase in both Z-scores of approximately 0.30 SD. In measuring the strength of the association between anthropometric measures and cardio-metabolic risk factors, a unit change in Z-scores for WHtR, WC, and BMI significantly increased the odds of an adverse outcome in all cases (1.18-2.03, P < 0.0001). Z-scores for both measures of central adiposity were significantly more strongly associated with cardio-metabolic comorbidities than BMI-Z.

Conclusion: Since Z-scores permit standardized comparisons across ages and genders, they are useful measures of central adiposity in both clinical or research settings. By providing LMS tables for children and adolescents based on North American reference data, we hope to provide quantitative tools for the study of obesity and its complications.

Citing Articles

Trajectories of adherence to an obesogenic dietary pattern and changes in diet quality, food intake, and adiposity during adolescence.

Martinez-Gomez J, Bodega P, Santos-Beneit G, de Cos-Gandoy A, Beneito-Dura M, de Miguel M Nutr J. 2025; 24(1):35.

PMID: 40055723 PMC: 11887375. DOI: 10.1186/s12937-025-01102-y.

Ultraprocessed Food Consumption and Obesity Development in Canadian Children.

Chen Z, Mousavi S, Mandhane P, Simons E, Turvey S, Moraes T JAMA Netw Open. 2025; 8(1):e2457341.

PMID: 39888617 PMC: 11786234. DOI: 10.1001/jamanetworkopen.2024.57341.

Indicators of Glucose Metabolism in Children and Adolescents Characterized as Having "Metabolically Healthy" and "Metabolically Unhealthy" Obesity.

Baltogianni M, Dermitzaki N, Giapros V, Balomenou F, Kosmeri C, Ladomenou F Children (Basel). 2025; 12(1.

PMID: 39857881 PMC: 11763677. DOI: 10.3390/children12010050.

Impact of Early Nutritional Intervention During Cancer Treatment on Dietary Intakes and Cardiometabolic Health in Children and Adolescents.

Delorme J, Dima A, Belanger V, Napartuk M, Bouchard I, Meloche C Cancers (Basel). 2025; 17(1.

PMID: 39796783 PMC: 11719478. DOI: 10.3390/cancers17010157.

Satellite-Based and Street-View Green Space and Adiposity in US Children.

Yi L, Harnois-Leblanc S, Rifas-Shiman S, Suel E, Pescador Jimenez M, Lin P JAMA Netw Open. 2024; 7(12):e2449113.

PMID: 39636637 PMC: 11621986. DOI: 10.1001/jamanetworkopen.2024.49113.

References

Daniels S, Greer F . Lipid screening and cardiovascular health in childhood. Pediatrics. 2008; 122(1):198-208. DOI: 10.1542/peds.2008-1349. View

Rodd C, Metzger D, Sharma A . Extending World Health Organization weight-for-age reference curves to older children. BMC Pediatr. 2014; 14:32. PMC: 3922078. DOI: 10.1186/1471-2431-14-32. View

Katzmarzyk P, Srinivasan S, Chen W, Malina R, Bouchard C, Berenson G . Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics. 2004; 114(2):e198-205. DOI: 10.1542/peds.114.2.e198. View

McCarthy H, Ellis S, Cole T . Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference. BMJ. 2003; 326(7390):624. PMC: 151972. DOI: 10.1136/bmj.326.7390.624. View

Jayawardana R, Ranasinghe P, Sheriff M, Matthews D, Katulanda P . Waist to height ratio: a better anthropometric marker of diabetes and cardio-metabolic risks in South Asian adults. Diabetes Res Clin Pract. 2013; 99(3):292-9. DOI: 10.1016/j.diabres.2012.12.013. View

Katzmarzyk P . Waist circumference percentiles for Canadian youth 11-18y of age. Eur J Clin Nutr. 2004; 58(7):1011-5. DOI: 10.1038/sj.ejcn.1601924. View

Khoury M, Manlhiot C, McCrindle B . Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol. 2013; 62(8):742-51. DOI: 10.1016/j.jacc.2013.01.026. View

Li C, Ford E, Mokdad A, Cook S . Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics. 2006; 118(5):e1390-8. DOI: 10.1542/peds.2006-1062. View

Rolland-Cachera M . Childhood obesity: current definitions and recommendations for their use. Int J Pediatr Obes. 2011; 6(5-6):325-31. DOI: 10.3109/17477166.2011.607458. View

10.

Kahn H, Imperatore G, Cheng Y . A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr. 2005; 146(4):482-8. DOI: 10.1016/j.jpeds.2004.12.028. View

11.

Garnett S, Baur L, Srinivasan S, Lee J, Cowell C . Body mass index and waist circumference in midchildhood and adverse cardiovascular disease risk clustering in adolescence. Am J Clin Nutr. 2007; 86(3):549-55. DOI: 10.1093/ajcn/86.3.549. View

12.

Mokha J, Srinivasan S, DasMahapatra P, Fernandez C, Chen W, Xu J . Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr. 2010; 10:73. PMC: 2964659. DOI: 10.1186/1471-2431-10-73. View

13.

Patry-Parisien J, Shields M, Bryan S . Comparison of waist circumference using the World Health Organization and National Institutes of Health protocols. Health Rep. 2012; 23(3):53-60. View

14.

Rigby R, Stasinopoulos D . Smooth centile curves for skew and kurtotic data modelled using the Box-Cox power exponential distribution. Stat Med. 2004; 23(19):3053-76. DOI: 10.1002/sim.1861. View

15.

de Onis M, Onyango A, Borghi E, Siyam A, Nishida C, Siekmann J . Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007; 85(9):660-7. PMC: 2636412. DOI: 10.2471/blt.07.043497. View

16.

Fernandez J, Redden D, Pietrobelli A, Allison D . Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004; 145(4):439-44. DOI: 10.1016/j.jpeds.2004.06.044. View

17.

McCarthy H, Jarrett K, Crawley H . The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr. 2001; 55(10):902-7. DOI: 10.1038/sj.ejcn.1601240. View

18.

Ashwell M, Gunn P, Gibson S . Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2011; 13(3):275-86. DOI: 10.1111/j.1467-789X.2011.00952.x. View

19.

Kuczmarski R, Ogden C, Guo S, Grummer-Strawn L, Flegal K, Mei Z . 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11. 2002; (246):1-190. View

20.

Xi B, Mi J, Zhao M, Zhang T, Jia C, Li J . Trends in abdominal obesity among U.S. children and adolescents. Pediatrics. 2014; 134(2):e334-9. DOI: 10.1542/peds.2014-0970. View