To investigate the performance of weight/heightn in discriminating obesity-related cardio-metabolic risks, and compare their performance with BMI in Chinese and American children.
57,201 Chinese children aged 7–18 and 10,441 American children aged 12–18 with complete record of sex, age, height, weight, and waist circumference were included. Analyses and comparisons of BMI, weight/height2.5, and weight/height3 were predominantly discussed, while BMI z score, converted by BMI based on 2007 WHO growth standard, was set as the reference. Log-binomial regression models and areas under receiver-operating characteristic curves were used to examine their abilities on identifying cardio-metabolic risks, including elevated blood pressure, impaired fasting glucose, and dyslipidemia. Misclassification rates of each index were calculated.
Weight/height3 is relatively stable during childhood in both populations. Odds ratio of weight/height3 in discriminating cardio-metabolic risks ranged from 1.09 (95% CI: 1.04, 1.14) to 1.23 (95% CI: 1.22, 1.25) and 1.06 (95% CI: 1.04, 1.08,) to 1.17 (95% CI: 1.15, 1.20) in Chinese and American participants, respectively. When 85th and 95th percentiles were set as thresholds for each sex, weight/height3 showed similar accuracy to BMI percentiles, and were more precise than BMI z scores. Misclassification rates of weight/height3 ranged from 19.1% (95% CI: 18.8%, 19.5%) to 34.7% (95% CI: 34.0%, 35.4%) compared to BMI z score, which ranged from 26.3% (95% CI: 26.0%, 26.7%) to 36.8% (95% CI: 36.0%, 37.5%) in Chinese participants. Results were similar in American participants. Combined use of weight/height3 and waist-to-height ratio did not change the classification accuracy.
Conclusions and relevance
Tri-ponderal mass index (TMI) performed superior to BMI z scores and similar to BMI percentiles in Chinese and American participants. TMI is stable in adolescents, and could be a more efficient indicator for screening obesity-related cardio-metabolic risks in routine health screening compared with BMI.
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The authors greatly appreciated the Educational Administration Leaderships and primary and middle school health nurses who worked hard on data collection. The present research was supported by funding of National Natural Science Foundation of China (No. 81673192) and the funding of Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002). JM, YS, and ZZ were co-investigators and designer of the original study, XW carried out the initial data analysis, BD. and LA supervised the procedure. All authors were involved in writing the manuscript and had final approval of the submitted and published versions. XW took full responsibility for the whole work.
This work was supported by the funding of National Natural Science Foundation of China (No. 81673192) awarded to JM and the funding of Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002) awarded to BD. These funding sources had no role in the design of this study and did not have any role during its execution, analyses, interpretation of the data, or decision to submit results.
Conflict of interest
The authors declare that they have no conflict of interest.
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