Body Mass Index, Waist Circumference, and Clustering of Cardiovascular Disease Risk Factors in a Biracial Sample of Children and Adolescents

Objective. To derive optimal body mass index (BMI) and waist circumference thresholds for children and adolescents, to predict risk factor clustering. Design. Cross-sectional receiver operating characteristic curve analysis. Setting. The Bogalusa Heart Study, a community-based study of cardiovascular disease risk factors in early life. Participants. A total of 2597 black and white children and adolescents, 5 to 18 years of age, who were examined between 1992 and 1994. Main Outcome Measures. The presence or absence of ≥3 age-adjusted risk factors (low high-density lipoprotein cholesterol level, high low-density lipoprotein cholesterol level, high triglyceride level, high glucose level, high insulin level, and high blood pressure) was predicted from age-adjusted BMI and waist circumference values. Results. The areas under the receiver operating characteristic curves were significantly different from 0.5 for both BMI and waist circumference for all gender/race groups, ranging from 0.73 to 0.82. The optimal BMI thresholds were at the 53rd and 50th percentiles for white and black male subjects, respectively, and at the 57th and 51st percentiles for white and black female subjects, respectively. Similarly, the optimal waist circumference thresholds were at the 56th and 50th percentiles for white and black male subjects, respectively, and at the 57th and 52nd percentiles for white and black female subjects, respectively. The sensitivity and specificity at the thresholds were similar for all gender/race groups, ranging from 67% to 75%. Conclusions. The use of BMI and waist circumference for the prediction of risk factor clustering among children and adolescents has significant clinical utility. In this sample, race and gender differences in the optimal thresholds were minimal.