Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents

Quadros, Teresa Maria Bianchini de; Gordia, Alex Pinheiro; Silva, Rosane Carla Rosendo da; Silva, Luciana Rodrigues

doi:10.1016/j.jped.2014.11.006

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ORIGINAL ARTICLES • J. Pediatr. (Rio J.) 91 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.jped.2014.11.006 copy

Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents^☆ ☆ Please cite this article as: Quadros TM, Gordia AP, Silva RC, Silva LR. Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents. J Pediatr (Rio J). 2015;91:455-63. ^☆ ☆ Study conducted at Centro de Formação de Professores, Universidade Federal do Recôncavo da Bahia (UFRB), Amargosa, BA, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To analyze the predictive capacity of anthropometric indicators and their cut-off values for dyslipidemia screening in children and adolescents.

METHODS:

This was a cross-sectional study involving 1139 children and adolescents, of both sexes, aged 6-18 years. Body weight, height, waist circumference, subscapular, and triceps skinfold thickness were measured. The body mass index and waist-to-height ratio were calculated. Children and adolescents exhibiting at least one of the following lipid alterations were defined as having dyslipidemia: elevated total cholesterol, low high-density lipoprotein, elevated low-density lipoprotein, and high triglyceride concentration. A receiver operating characteristic curve was constructed and the area under the curve, sensitivity, and specificity was calculated for the parameters analyzed.

RESULTS:

The prevalence of dyslipidemia was 62.1%. The waist-to-height ratio, waist circumference, subscapular, body mass index, and triceps skinfold thickness, in this order, presented the largest number of significant accuracies, ranging from 0.59 to 0.78. The associations of the anthropometric indicators with dyslipidemia were stronger among adolescents than among children. Significant differences between accuracies of the anthropometric indicators were only observed by the end of adolescence; the accuracy of waist-to-height ratio was higher than that of subscapular (p = 0.048) for females, and the accuracy of waist circumference was higher than that of subscapular (p = 0.029) and body mass index (p = 0.012) for males. In general, the cut-off values of the anthropometric predictors of dyslipidemia increased with age, except for waist-to-height ratio. Sensitivity and specificity varied substantially between anthropometric indicators, ranging from 75.6 to 53.5 and from 75.0 to 50.0, respectively.

CONCLUSIONS:

The anthropometric indicators studied had little utility as screening tools for dyslipidemia, especially in children.

Keywords:
Dyslipidemia; Body mass index; Abdominal circumference; Skinfold thickness; Child; Adolescent

Variable	n	% (95% CI)
Sex
Male	506	44.4 (41.4–46.7)
Female	633	55.6 (53.0–58.1)

Age range
Children (6–9 years)	363	31.9 (29.2–34.2)
Adolescents (10–18 years)	776	68.1 (65.2–70.3)

Study place
Urban area	864	75.9 (73.4–77.9)
Rural area	275	24.1 (21.5–26.2)

School type
Public	1044	91.7 (90.0–93.0)
Private	95	8.3 (6.8–9.7)

Maternal schooling
<4 years	264	24.5 (21.9–26.7)
4–8 years	389	36.2 (33.4–38.7)
>8 years	423	39.3 (36.5–41.7)

Monthly household income ^a
<1 minimum wage	614	57.2 (54.3–59.7)
≥1 minimum wage	459	42.8 (39.7–45.1)

Socioeconomic class
A and B (high)	141	12.4 (10.6–14.0)
C (middle)	550	48.4 (45.3–50.8)
D and E (low)	446	39.2 (36.2–41.6)

Excess weight (overweight and obese)	181	15.9 (13.9–18.1)

Dyslipidemia
Elevated total cholesterol	259	23.1 (20.8–25.0)
Low HDL-C	465	41.5 (38.6–44.0)
Elevated LDL-C	50	4.5 (3.2–5.5)
Elevated triglycerides	139	12.4 (10.6–14.0)

	n	Total cholesterol (mg/dL)^a	HDL-C (mg/dL)^a	LDL-C (mg/dL)^a	Triglycerides (mg/dL)^b
Sex
Male	506	146.6 (29.3)	47.1 (11.4)	82.4 (24.0)	77 (60, 104)
Female	633	151.1 (30.2)	47.1 (10.7)	85.4 (25.4)	82 (65, 111)
p ^c		0.501	0.296	0.336	0.006

Age group (years)
6–7	155	155.9 (30.1)	50.2 (10.8)	88.9 (26.4)	80 (62, 106)
8–9	208	148.9 (28.5)	47.8 (10.7)	83.7 (23.7)	75 (60, 107)
10–12	314	149.5 (31.7)	48.1 (11.2)	84.0 (25.5)	77 (63, 105)
13–15	285	157.1 (29.7)	45.6 (10.5)	82.8 (24.9)	85 (64, 114)
16–18	177	145.9 (27.7)	44.4 (11.0)	82.5 (23.1)	84 (65, 108)
p ^d		0.002	0.001	0.022	0.009

Total	1139	149.1 (29.9)	47.1 (11.0)	84.1 (24.8)	80 (63, 108)

Age group (years)	Anthropometric indicator	Males	Females
		AUC (95% CI)	AUC (95% CI)
6–7	BMI (kg/m²)	0.61 (0.49–0.72)	0.61 (0.49–0.72)
	WC (cm)	0.64 (0.52–0.75)^a	0.64 (0.52–0.75)^a
	WHtR	0.66 (0.55–0.77)^a	0.65 (0.53–0.76)^a
	SSF (mm)	0.55 (0.43–0.66)	0.63 (0.51–0.74)^a
	TSF (mm)	0.56 (0.44–0.67)	0.55 (0.43–0.66)

8–9	BMI (kg/m²)	0.52 (0.42–0.63)	0.57 (0.47–0.66)
	WC (cm)	0.52 (0.41–0.62)	0.57 (0.47–0.66)
	WHtR	0.57 (0.46–0.67)	0.58 (0.48–0.67)
	SSF (mm)	0.49 (0.38–0.59)	0.56 (0.46–0.65)
	TSF (mm)	0.50 (0.39–0.61)	0.54 (0.44–0.64)

10–12	BMI (kg/m²)	0.58 (0.49–0.66)	0.57 (0.48–0.65)
	WC (cm)	0.57 (0.49–0.65)	0.59 (0.51–0.67)^a
	WHtR	0.61 (0.52–0.68)^a	0.59 (0.51–0.67)^a
	SSF (mm)	0.62 (0.53–0.69)^a	0.56 (0.48–0.64)
	TSF (mm)	0.60 (0.53–0.69)^a	0.57 (0.49–0.65)

13–15	BMI (kg/m²)	0.65 (0.55–0.74)^a	0.54 (0.46–0.62)
	WC (cm)	0.64 (0.54–0.73)^a	0.53 (0.46–0.61)
	WHtR	0.65 (0.55–0.73)^a	0.59 (0.51–0.66)^a
	SSF (mm)	0.63 (0.54–0.72)^a	0.54 (0.46–0.62)
	TSF (mm)	0.60 (0.51–0.70)^a	0.54 (0.46–0.61)

16–18	BMI (kg/m²)	0.63 (0.50–0.74)^a,b	0.70 (0.60–0.78)^a
	WC (cm)	0.78 (0.65–0.87)^a,b	0.68 (0.59–0.78)^a
	WHtR	0.68 (0.55–0.79)^a	0.70 (0.60–0.78)^a,c
	SSF (mm)	0.64 (0.51–0.75)^a,b	0.62 (0.53–0.71)^a,c
	TSF (mm)	0.62 (0.49–0.74)	0.58 (0.48–0.67)

Age group (years)	Anthropometric indicator	Males			Females
		Cut-off	Sensitivity (%)	Specificity (%)	Cut-off	Sensitivity (%)	Specificity (%)
6–7	BMI (kg/m²)	–	–	–	–	–	–
	WC (cm)	54.2	62.8	58.8	54.3	62.2	55.2
	WHtR	0.45	53.5	67.6	0.45	60.0	58.6
	SSF (mm)	–	–	–	5.7	60.0	69.0
	TSF (mm)	–	–	–	–	–	–

8–9	BMI (kg/m²)	–	–	–	–	–	–
	WC (cm)	–	–	–	–	–	–
	WHtR	–	–	–	–	–	–
	SSF (mm)	–	–	–	–	–	–
	TSF (mm)	–	–	–	–	–	–

10–12	BMI (kg/m²)	–	–	–	–	–	–
	WC (cm)	–	–	–	64.6	57.4	56.7
	WHtR	0.43	65.6	51.7	0.44	57.4	53.3
	SSF (mm)	5.8	55.9	53.3	–	–	–
	TSF (mm)	8.4	58.1	53.3	–	–	–

13–15	BMI (kg/m²)	18.1	67.6	63.4	–	–	–
	WC (cm)	68.4	60.6	58.5	–	–	–
	WHtR	0.42	64.8	56.1	0.45	58.1	59.3
	SSF (mm)	6.2	62.0	61.0	–	–	–
	TSF (mm)	7.9	56.3	53.7	–	–	–

16–18	BMI (kg/m²)	19.7	64.4	50.0	19.7	73.7	61.1
	WC (cm)	70.5	75.6	65.0	71.8	65.8	55.6
	WHtR	0.42	60.0	75.0	0.45	67.1	50.0
	SSF (mm)	7.5	64.4	55.0	11.4	67.1	58.3
	TSF (mm)	–	–	–	–	–	–

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[1] *Corresponding author. E-mails: tetemb@gmail.com,tetemb@ufrb.edu.br(T.M.B. de Quadros).