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Pediatrics

Alternative waist-to-height ratios associated with risk biomarkers in youth with diabetes: comparative models in the SEARCH for Diabetes in Youth Study

International Journal of Obesity volume 43, pages 1940–1950 (2019)Cite this article

Subjects

Abstract

Background/objectives

The waist-to-height ratio (WHtR) estimates cardiometabolic risk in youth without need for growth charts by sex and age. Questions remain about whether waist circumference measured per protocol of the National Health and Nutrition Examination Survey (WNHAHtR) or World Health Organization (WWHOHtR) can better predict blood pressures and lipid parameters in youth.

Participants/methods

WHtR was measured under both anthropometric protocols among participants in the SEARCH Study, who were recently diagnosed with diabetes (ages 5–19 years; N = 2 773). Biomarkers were documented concurrently with baseline anthropometry and again ~7 years later (ages 10–30 years; N = 1 712). For prediction of continuous biomarker outcomes, baseline WNHAHtR or WWHOHtR entered semiparametric regression models employing restricted cubic splines. To predict binary biomarkers (high-risk group defined as the most adverse quartile) linear WNHAHtR or WWHOHtR terms entered logistic models. Model covariates included demographic characteristics, pertinent medication use, and (for prospective predictions) the follow-up time since baseline. We used measures of model fit, including the adjusted-R2 and the area under the receiver operator curves (AUC) to compare WNHAHtR and WWHOHtR.

Results

For the concurrent biomarkers, the proportion of variation in each outcome explained by full regression models ranged from 23 to 46%; for the prospective biomarkers, the proportions varied from 11 to 30%. Nonlinear relationships were recognized with the lipid outcomes, both at baseline and at follow-up. In full logistic models, the AUCs ranged from 0.75 (diastolic pressure) to 0.85 (systolic pressure) at baseline, and from 0.69 (triglycerides) to 0.78 (systolic pressure) at the prospective follow-up. To predict baseline elevations of the triglycerides/HDL cholesterol ratio, the AUC was 0.816 for WWHOHtR compared with 0.810 for WNHAHtR (p = 0.003), but otherwise comparisons between alternative WHtR protocols were not significantly different.

Conclusions

Among youth with recently diagnosed diabetes, measurements of WHtR by either waist circumference protocol similarly helped estimate current and prospective cardiometabolic risk biomarkers.

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Acknowledgements

The SEARCH for Diabetes in Youth Study is indebted to the many youth and their families, and their health care providers, whose participation made this study possible. SEARCH 3/4: The authors wish to acknowledge the involvement of the Kaiser Permanente Southern California’s Clinical Research Center (funded by Kaiser Foundation Health Plan and supported in part by the Southern California Permanente Medical Group; the South Carolina Clinical & Translational Research Institute, at the Medical University of South Carolina, NIH/National Center for Advancing Translational Sciences (NCATS) grant number UL1 TR000062, UL1 Tr001450; Seattle Children’s Hospital and the University of Washington, NIH/NCATS grant number UL1 TR00423; University of Colorado Pediatric Clinical and Translational Research Center, NIH/NCATS grant Number UL1 TR000154; the Barbara Davis Center at the University of Colorado at Denver (DERC NIH grant number P30 DK57516); the University of Cincinnati, NIH/NCATS grant number UL1 TR000077, UL1 TR001425; and the Children with Medical Handicaps program managed by the Ohio Department of Health. This study includes data provided by the Ohio Department of Health, which should not be considered an endorsement of this study or its conclusions. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases.

Funding

Grant Support (SEARCH 3): SEARCH for Diabetes in Youth is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Grant Support (SEARCH 4): The SEARCH for Diabetes in Youth Cohort Study (1UC4DK108173) is funded by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases and supported by the Centers for Disease Control and Prevention. The Population Based Registry of Diabetes in Youth Study (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139) is funded by the Centers for Disease Control and Prevention and supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Sites (SEARCH 3/4): Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171).

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Authors and Affiliations

  1. Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Henry S. Kahn & Sharon Saydah

  2. Department of Biostatistics, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jasmin Divers

  3. Biostatistics and Design Program, Oregon Health and Science University, Portland, OR, USA

    Nora F. Fino

  4. Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Dana Dabelea

  5. Department of Public Health, East Carolina University, Greenville, NC, USA

    Ronny Bell

  6. Department of General Pediatrics, Seattle Children’s Hospital, Seattle, WA, USA

    Lenna L. Liu

  7. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Victor W. Zhong

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  1. Henry S. Kahn
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Contributions

HSK conceived this work and drafted the initial paper. JD contributed substantially to the research design and directed the statistical analyses. NFF organized data and assisted with analyses. All authors participated in the acquisition of data, interpretation of the results, and review of the final paper. HSK confirms he had full access to the data in the study and final responsibility for the decision to submit for publication.

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Correspondence to Sharon Saydah.

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Kahn, H.S., Divers, J., Fino, N.F. et al. Alternative waist-to-height ratios associated with risk biomarkers in youth with diabetes: comparative models in the SEARCH for Diabetes in Youth Study. Int J Obes 43, 1940–1950 (2019). https://doi.org/10.1038/s41366-019-0354-8

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