Background: BMI to screen children for cardiometabolic risk has numerous drawbacks. Hypertriglyceridemic-waist (HW) phenotype is recognized as an effective screening tool to identify adults but role in children is not known.
Objective and hypotheses: To evaluate HW-phenotype as an alternative for BMI in recognizing children (518 years) at risk for cardiometabolic risk factors.
Method: Retrospective review of case records of children evaluated for cardiometabolic risks in the Paediatric Endocrine Clinic of a developing country. Children with waist circumference ≥90th percentile and serum triglyceride levels >100 mg/dl considered to have abnormal HW-phenotype.
Results: Records of 40 children (mean age 10.0±3.3 years; 27 males; mean BMISDS 2.8±0.6) reviewed. 87.5, 50, and 40% subjects had abnormal waist, elevated triglycerides, and abnormal HW-phenotype respectively. Children with abnormal HW-phenotype had higher total cholesterol (166.7±38.1 vs 161.2±33.4 mg/dl; P<0.05), higher LDL levels (105.7±38.1 vs 102.9±30.4 mg/dl; P<0.05), and lower HDL levels (41.3±17.1 vs 45.0±14.1 mg/dl; P>0.05). Low HDL was more frequently observed in children with abnormal HW-phenotype (46.7 vs 30.8%; P<0.05). Comparison of BMI, waist circumference alone, and HW-phenotype revealed that BMI has highest sensitivity and HW phenotype has highest specificity to recognize cardiometabolic risk factors (Table 1).
|BMISDS >+2||HW phenotype||WC >90th percentile|
|Sen (%)||Sp (%)||Sen (%)||Sp (%)||Sen (%)||Sp (%)|
|TCa >170 mg/dl||92.3||13.4||37.5||58.3||75||4.1|
|LDLb >110 mg/dl||91.6||13.0||40||62.5||73.3||4.1|
|HDLc <35 mg/dl||80||8||58.3||70.3||83.3||11.1|
|Insulin >15 mIU/ml||100||5||50||64||88.8||25|
|Blood sugar >110 mg/dl||83.3||9.5||42.8||68.1||79||12.3|
Conclusion: Though HW phenotype is more specific, BMI remains the gold standard to screen children for metabolic risk factors.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology