Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Communication
  • Published:

Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls

European Journal of Clinical Nutrition volume 57, pages 566–572 (2003)Cite this article

Abstract

Objectives: (a) to explore the relationship between waist circumference and certain cardiovascular risk factors in a group of girls; and (b) to assess the clinical relevance of waist circumference in identifying girls with higher cardiovascular risk across puberty.

Subjects and methods: One-hundred and fifty-five overweight or obese girls aged 5–16 y were recruited. Overweight and obesity were defined on the basis of BMI, according to Cole.

Results: Waist circumference was significantly correlated with plasma insulin (r=0.43; P<0.001), systolic blood pressure (r=0.22; P=0.007) and IRHOMA (r=0.40; P<0.001). A multivariate linear correlation analysis showed that, when adjusted for age and Tanner stage, waist circumference was significantly associated with plasma insulin (r2=0.23; P<0.01), IRHOMA (r2=0.17; P<0.02), systolic and diastolic blood pressure (r2=0.20; P=0.006 and r2=0.32; P<0.001, respectively). A logistic regression analysis, using IRHOMA as the dependent variable, showed that waist circumference was a significant independent risk factor of insulin resistance (IRHOMA≥2.6) in this group of girls (OR 1.10; 95% CI 1.03–1.18; P=0.003), independently of their age and Tanner stage.

Conclusions: Waist circumference of these girls was independently associated with certain cardiovascular risk factors, in particular insulin resistance and diastolic blood pressure, independently of age and Tanner stage. Thus suggesting that waist circumference may be reasonably included in clinical practice as a simple tool that may help to identify sub-groups of obese girls at higher metabolic risk across puberty.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Amiel, SA, Sherwin, RS, Simonson, DC, Lauritano, AA & Tamborlane, WV (1986). Impaired insulin action in puberty. N. Engl. J. Med., 315, 215–219.

    Article  CAS  PubMed  Google Scholar 

  • Bonora, E, Targher, G, Alberiche, M, Bonadonna, RC, Saggiani, F, Zenere, MB, Monauni, T & Muggeo, M (2000). Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 23, 57–63.

    Article  CAS  PubMed  Google Scholar 

  • Caprio, S, Bronson, M, Sherwin, RS, Rife, F & Tamborlane, WV (1996a). Co-existence of severe insulin resistance and hyperinsulinaemia in pre-adolescent obese children. Diabetologia, 39, 1489–1497.

    Article  CAS  PubMed  Google Scholar 

  • Caprio, S, Hyman, LD, McCarthy, S, Lange, R, Bronson, M & Tamborlane, WV (1996). Fat distribution and cardiovascular risk factors in obese adolescent girls: importance of the intraabdominal fat depot. Am. J. Clin. Nutr., 64, 12–17.

    Article  CAS  PubMed  Google Scholar 

  • Cole, TJ, Bellizzi, MC, Flegal, KM & Dietz, WH (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey. Br. Med. J., 320, 1240–1243.

    Article  CAS  Google Scholar 

  • Cook, JS, Hoffman, RP, Stene, MA & Hansen, JR (1993). Effects of maturational stage on insulin sensitivity during puberty. J. Clin. Endocrinol. Metab., 80, 172–178.

    Google Scholar 

  • Daniels, SR, Khoury, PR & Morrison, JA (1977). The utility of body mass index as a measure of body fatness in children and adolescents: difference by race and gender. Pediatrics, 99, 804–807.

    Article  Google Scholar 

  • Deeg, R & Ziegenhorn, J (1983). Kinetic enzymatic method of automated determination of total cholesterol in serum. Clin. Chem., 29, 1798–1802.

    CAS  PubMed  Google Scholar 

  • de Ridder, CM, de Boer, RW, Seidell, JC, Nieuwenhoff, CM, Jeneson, JA, Bakker, CJ, Zonderland, ML & Erich, WB (1992). Body fat distribution in pubertal girls quantified by magnetic resonance imaging. Int. J. Obes. Relat. Metab. Disord., 16, 443–449.

    CAS  PubMed  Google Scholar 

  • Dietz, WH & Bellizzi, MC (1999). Introduction: the use of body mass index to assess obesity in children. Am. J. Clin. Nutr., 70, 123S–125S.

    Article  CAS  PubMed  Google Scholar 

  • Ellis, KJ, Abrams, SA & Wong, WW (1999). Monitoring childhood obesity: assessment of the weight/height2 index. Am. J. Epidemiol., 150, 939–946.

    Article  CAS  PubMed  Google Scholar 

  • Fagot-Campagna, A, Narayan, KM & Imperatore, G (2001). Type 2 diabetes in children. Br. Med. J., 322, 377–378.

    Article  CAS  Google Scholar 

  • Forbes, GB (1987). Human Body Composition. Growth, Aging, Nutrition, and Activity, New York: Springer

    Google Scholar 

  • Franklin, MF (1999). Comparison of weight and height relations in boys from 4 countries. Am. J. Clin. Nutr., 70, (Suppl) 157S–162S.

    Article  CAS  PubMed  Google Scholar 

  • Freedman, DS, Serdula, MK, Srinivasan, SR & Berenson, GS (1999). Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am. J. Clin. Nutr., 69, 308–317.

    Article  CAS  PubMed  Google Scholar 

  • Friedewald, WT, Levy, R & Fredrickson, DS (1972). Estimation of the concentration of low density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge. Clin. Chem., 18, 499–502.

    CAS  PubMed  Google Scholar 

  • Goran, MI, Kaskoun, M & Shuman, WP (1995). Intra-abdominal adipose tissue in young children. Int. J. Obes. Relat. Metab. Disord., 19, 279–283.

    CAS  PubMed  Google Scholar 

  • Goran, MI, Driscoll, P & Jhonson, R et al (1996). Cross-calibration of body-composition techniques against dual-energy X-ray absorptimetry in young children. Am. J. Clin. Nutr., 63, 299–305.

    Article  CAS  PubMed  Google Scholar 

  • Kanai, H, Matsuzawa, Y, Kotani, K, Keno, Y, Kobatake, T, Nagai, Y, Fujioka, S, Tokunaga, K & Tarui, S (1990). Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension, 16, 484–490.

    Article  CAS  PubMed  Google Scholar 

  • Larsson, B, Svardsudd, K, Welin, L, Wilhelmsen, L, Bjorntorp, P & Tibblin, G (1984). Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. Br. Med. J. (Clin. Res. Edn)., 288, 1401–1404.

    Article  CAS  Google Scholar 

  • Lean, MEJ, Han, TS & Seidell, JC (1998). Impairment of health and quality of life in people with large waist circumference. Lancet, 351, 853–856.

    Article  CAS  PubMed  Google Scholar 

  • Lillioja, S, Mott, DM, Spraul, M, Ferraro, R, Foley, JE, Ravussin, E, Knowler, WC, Bennett, PH & Bogardus, C (1993). Insulin resistance and insulin secretory dysfunction as precursors of non-insulin-dependent diabetes mellitus. Prospective studies of Pima Indians. N. Engl. J. Med., 329, 1988–1992.

    Article  CAS  PubMed  Google Scholar 

  • Lindsay, RS, Hanson, RL & Roumain, J et al (2001). Body mass index as a measure of adiposity in children and adolescents: relationship to adiposity by dual energy x-ray absorptiometry and to cardiovascular risk factors. J. Clin. Endocrinol. Metab., 86, 4061–4067.

    Article  CAS  PubMed  Google Scholar 

  • Lohman, TG (1986). Applicability of body composition techniques and constants for children and youth. Exerc. Sport. Sci. Rev., 14, 325–357.

    Article  CAS  PubMed  Google Scholar 

  • Maffeis, C, Pietrobelli, A, Grezzani, A, Provera, S & Tato, L (2001). Waist circumference and cardiovascular risk factors in prepubertal children. Obes. Res., 9, 179–187.

    Article  CAS  PubMed  Google Scholar 

  • Moran, A, Jacobs, DR, Steinberger, J, Hong, CP, Prineas, R, Luepker, R & Sinaiko, AR (1999). Insulin resistance during puberty. Results from clamp studies in 357 children. Diabetes, 48, 2039–2044.

    Article  CAS  PubMed  Google Scholar 

  • Must, A, Jacques, PF, Dallal, GE, Bajema, CJ & Dietz, WH (1992). Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N. Engl. J. Med., 327, 1350–1355.

    Article  CAS  PubMed  Google Scholar 

  • Nagele, U, Hagele, EO & Sauer, G et al (1984). Reagent for the enzymatic determination of serum total triacylglycerols with improved lipolytic efficiency. J. Clin. Chem. Clin. Biochem., 26, 1775–1779.

    Google Scholar 

  • Pietrobelli, A, Faith, MS & Allison, DB et al (1998). Body mass index as a measure of adiposity among children and adolescents: a validation study. J. Pediatr., 32, 204–210.

    Article  Google Scholar 

  • Pi-Sunyer, FX (1991). Health implications of obesity. Am. J. Clin. Nutr., 53, 1595S–1603S.

    Article  CAS  PubMed  Google Scholar 

  • Rankinen, T, Kim, SY, Perusse, L, Despres, JP & Bouchard, C (1999). The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int. J. Obes. Relat. Metab. Disord., 23, 801–809.

    Article  CAS  PubMed  Google Scholar 

  • Stumvoll, M, Mitrakou, A, Pimenta, W, Jenssen, T, Yki-Jarvinen, H, Van Haeften, T, Renn, W & Gerich, J (2000). Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care, 23, 295–301.

    Article  CAS  PubMed  Google Scholar 

  • Tanner, JM (1962). Growth at Adolescence, 2nd edn. Blackwell: Oxford

    Google Scholar 

  • Troiano, RP & Flegal, KM (1998). Overweight children and adolescents: description, epidemiology and demographics. Pediatrics, 101, 497–504.

    CAS  PubMed  Google Scholar 

  • WHO (1998). Preventing and managing the global epidemic, Report of a WHO Consultation on Obesity. Geneva, 3–5 June 1997 Geneva: World Health Organization

Download references

Author information

Authors and Affiliations

  1. Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology, Italy

    C Maffeis, N Corciulo, C Livieri, I Rabbone, G Trifirò, A Falorni, L Guerraggio, P Peverelli, G Cuccarolo, G Bergamaschi, M Di Pietro & A Grezzani

Authors
  1. C Maffeis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N Corciulo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Livieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I Rabbone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Trifirò
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Falorni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. L Guerraggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P Peverelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G Cuccarolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G Bergamaschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M Di Pietro
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. A Grezzani
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Guarantor: Claudio Maffels, MO.

Contributors: Serone Ptlarma SpA, Via Casilina, 125 00 176, Roma, Italia.

Corresponding author

Correspondence to C Maffeis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maffeis, C., Corciulo, N., Livieri, C. et al. Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls. Eur J Clin Nutr 57, 566–572 (2003). https://doi.org/10.1038/sj.ejcn.1601573

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601573

Keywords

This article is cited by

Search

Advanced search

Quick links