Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y

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Abstract
Background: A central fat pattern has adverse health implications in both children and adults. Because adiposity tracks from childhood into adulthood, the ability of simple anthropometric techniques to correctly measure truncal adiposity in childhood needs to be assessed. Objectives: We sought to assess the validity of waist circumference, waist-to-hip ratio (WHR), and the conicity index as indicators of trunk fat mass in children and adolescents. Design: Trunk fat mass (kg) was measured with dual-energy X-ray absorptiometry in 278 girls and 302 boys aged 3–19 y. Receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for the ROCs were calculated to compare the relative abilities of the anthropometric measures to correctly identify children with high trunk fat mass (z score for our study population of ≥1). Results: The 80th percentile for waist circumference correctly identified 89% of girls and 87% of boys with high trunk fat mass (sensitivity) and 94% of girls and 92% of boys with low trunk fat mass (specificity). Waist circumference performed significantly better as an index of trunk fat mass than did WHR or the conicity index, as shown by the AUCs in girls and boys, respectively: waist circumference AUCs = 0.97 and 0.97, conicity index AUCs = 0.80 and 0.81, and WHR AUCs = 0.73 and 0.71. Our cutoffs for high trunk fat mass and high waist circumference are provided for both sexes for each year of age. Conclusion: Waist circumference provides a simple yet effective measure of truncal adiposity in children and adolescents.