Waist Height Ratio As a Marker of Obesity and Insulin Resistance in Adolescents

Presentation Number: THR-544
Date of Presentation: March 5th, 2015

V. Sri Nagesh*1, Rakesh Kumar Sahay2, Neelaveni Kudugunti3, Vishnu Vardhan Rao.M4, Aditya Vikram B5, Sridhar Bathula6, Syed Mustafa Hashmi3, Sana Hyder3, Sania Jiwani3 and Hari Mohan R3
1CARE Out Patient Centre, CARE Hospital, Hyderabad, 2Osmania Medical College, Hyderabad, 3Osmania Medical College, 4National Institute of Nutrition, 5Gandhi Medical College, 6Kakatiya Medical College


Background: Recent studies have shown that pediatric obesity is on the rise, especially in the developing countries, possibly due to a sea change in lifestyle. While multiple studies have shown a rising trend in pediatric obesity, especially in the developing countries, studies dealing with the ultimate metabolic consequences of pediatric obesity and the means of accurately predicting these consequences are limited. Also, most studies have only focused on body mass index (BMI), and not evaluated waist height ratio (WHtR), which is a better tracking marker of central obesity, especially in adolescents.

Objective: To study the utility of WHtR as a marker of insulin resistance, especially the relevance of its association with lifestyle factors, other anthropometric markers like Body Mass Index and Waist Circumference and the strength of its association with biochemical markers of insulin resistance like HOMA-IR, fasting insulin; markers of cardiovascular risk like hs-CRP. Also, to validate the presently used cutoffs (≥0.5) and validate its utility in populations studies.

Methods: 96 children of both sexes  in the 11-16 yr age group were evaluated for lifestyle factors conducive to obesity, like frequent meat and snack consumption, greater screen time and eating meals while watching television, lesser physical activity and lesser access to parks and playgrounds; body mass index (BMI), WC, WHtR, triceps skin fold thickness and fat percentage measured and fasting samples drawn for fasting insulin, glucose, lipids, adiponectin, hs-CRP; & HOMA-IR was also calculated.

Results: Waist Height Ratio showed significant association with lifestyle factors, other anthropometric markers and biochemical markers,(p< 0.05), except for adiponectin. 40 children out of the total 96 had a BMI< 85th centile, among whom, 8 children had raised WHtR and greater incidence of frequent snack consumption, family history of obesity and increased fat percentage (p< 0.05). When the entire study group was divided into tertiles, the tertile with WHtR - 0.49-0.53 had HOMA-IR and hs-CRP values similar to cut-offs determined in previous studies.

Conclusions: WHtR performed as well as BMI and WC in assessing obesity and insulin resistance in children. Children with normal BMI and high WHtRcan still have increased central obesity & consequent metabolic risks. The presently used WHtR cutoff ≥0.5  for central obesity, correlates well with insulin resistance and future cardiovascular risk. WHtR has the potential to become “the anthropometric marker” to define insulin resistance and cardio-vascular risk in future community studies.


Nothing to Disclose: VSN, RKS, NK, VVR, AVB, SB, SMH, SH, SJ, HMR