Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma

IMPACT FACTOR 2018: 1.239

CiteScore 2018: 1.22

SCImago Journal Rank (SJR) 2018: 0.507
Source Normalized Impact per Paper (SNIP) 2018: 0.562

See all formats and pricing
More options …
Volume 29, Issue 5


Waist-to-height ratio as a marker of low-grade inflammation in obese children and adolescents

Carolina Caminiti / Marisa Armeno / Carmen S. Mazza
Published Online: 2016-02-17 | DOI: https://doi.org/10.1515/jpem-2014-0526


Background: The epidemic of childhood obesity is associated with early atherosclerosis. Several reports have related this event to low-grade inflammation described in obesity. CRP and IL6 are markers that correlate with adiposity. The waist-to-height ratio (WtHR) is an anthropometric marker associated with insulin resistance and inflammation. The objective of this study was to assess the correlation between WtHR, metabolic complications and pro-inflammatory factors in obese children and adolescents.

Methods: Weight, height, waist circumference, glycemia, insulin, CRP, TNF-α and IL-6 were measured in the baseline sample in 280 patients 6–19 years of age with overweight or obesity (OW/OB) and 112 normal-weight controls. Logistic regression was performed using WtHR as an independent variable. p>0.05 STATA11.

Results: Mean WtHR was 0.6±0.06 in OW/OB and 0.43±0.02 in controls (p<0.01). WtHR was increased in 93% of the OW/OB vs. 2% of the controls. In the OW/OB inflammatory markers were significantly increased (p<0.01) compared to the controls (CRP 2.2 vs. 0.8; Il-6 2.9 vs. 2.1; and TNF-α 6.2 vs. 5.5). In the WtHR>0.5, insulin resistence and inflammatory markers were significantly increased (p<0.01) compared to the WtHR<0.5 (HOMA 3.4 vs. 1.4; CRP 2.3 vs. 0.6; Il-6 2.9 vs. 2.1; and TNF-α 6.4 vs. 5.55). In logistic regression, a significant independent association was found between WtHR with CRP (OR1.47), IL6 (OR1.60) and TNF-α (OR1.79).

Conclusions: Obese children and adolescents have high inflammatory markers that may increase cardiovascular risk. WtHR is associated with low-grade inflammation and may be considered a relevant anthropometric marker in the clinical practice.

Keywords: inflammation; pediatric obesity; waist-to-height ratio


  • 1.

    WHO. Obesity: preventing and managing the global epidemic. WHO: Geneva, Switzerland, Report of a WHO consultation. Report No: 894. 2000.Google Scholar

  • 2.

    World Health Organization. Global strategy for non-communicable disease prevention and control (draft). Geneva, Switzerland: World Health Organization, 1997. (Publication no. WHO/NCD/GS/97.1).Google Scholar

  • 3.

    Khan BB, Flier JS. Obesity and insulin resistance. J Clin Invest 2000;106:473–81.Google Scholar

  • 4.

    Klein S, Burke LE, Bray GA. Clinical implications of obesity with specific focus on cardiovascular disease, a statement for professionals from the American Heart Association Council of Nutrition, Physical Activity, and Metabolism endorsed by the American College of Cardiology foundation. Circulation 2004;110:2952–67.Google Scholar

  • 5.

    Atkinson RL. Guidelines for the initiation of obesity treatment. J Nutr Biochem 1998;9:546–52.Google Scholar

  • 6.

    Flynn MA, Mc Neil DA, Maloff B. Reducing obesity and related chronic disease risk in children and youth, a synthesis of evidence with best practice recommendations. Obes Rev 2006;7:7–66.Google Scholar

  • 7.

    Caballero E, Bousquet-Santos K, Robles-Osorio L, Montagnani V, Soodini G, et al. Overweight latino children and adolescents have marked endothelial dysfunction and subclinical vascular inflammation in association with excess body fat and insulin resistance. Diabetes Care 2008;31:576–82.Google Scholar

  • 8.

    Dowd JB, Zajacova A, Aiello A. Predictors of inflammation in US children aged 3–16 years. Am J Prev Med 2010;39:314–20.Google Scholar

  • 9.

    Skinner AC, Steiner MJ, Henderson FW, Perrin EM. Multiple markers of inflammation and weight status: cross sectional analyses throughout childhood. Pediatrics 2010;125: e801–9.CrossrefGoogle Scholar

  • 10.

    Norris AL, Steinberger J, Steffen LM, Metzig AM, Schwarzenberg SJ, et al. Circulating oxidized LDL and inflammation in extreme pediatric obesity. Obesity 2011;19:1415–9.Google Scholar

  • 11.

    Oliver SR, Sosa JS, Milne GL, Pontello AM, Borntrager HL, et al. Increased oxidative stress and altered substrate metabolism in obese children. Int J Pediatr Obes 2010;5:436–44.Google Scholar

  • 12.

    Sniger K, Eng DS, Lumeng CN, Cebremariam A, Lee JM. The relationship between body fat mass percentiles and inflammation in children. Obesity (Silver Spring) 2014;22:1332–6.Google Scholar

  • 13.

    Jarvisalo MJ, Harmoinen A,Hakanen M, Paakkunainen U, Viikari J, et al. Elevated serum C-reactive protein levels and early arterial changes in healthy children. Arterioscl Throm Vasc Biol 2002;22:1323–8.Google Scholar

  • 14.

    Qi L, Zhang C, van Dam RM, Hu FB. Interleukin-6 genetic variability and adiposity: associations in two prospective cohorts and systematic review in 26,944 individuals. J Clin Endocrinol Metab 2007;92:3618–25.Google Scholar

  • 15.

    Roth CL, Kratz M, Ralston M, Reinehr T. Changes in adipose-derived inflammatory cytokines and chemokines after successful lifestyle intervention in obese children. Metabolism 2011;60:445–52.Google Scholar

  • 16.

    Kristiansen OP, Mandrup-Poulsen T. Interleukin-6 and diabetes: the good, the bad, or the indifferent? Diabetes 2005;54(Suppl 2): S114–24.Google Scholar

  • 17.

    Carey AL, Steinberg GR, Macaulay SL, Thomas WG, Holmes AG, et al. Interleukin-6 increases insulin-stimulated glucose disposal in humans and glucose uptake and fatty acid oxidation in vitro via AMP-activated protein kinase. Diabetes 2006;55: 2688–97.Google Scholar

  • 18.

    Qi L, van Dam RM, Meigs JB, Manson JE, Hunter D, et al. Genetic variation in IL6 gene and type 2 diabetes: tagging-SNP haplotype analysis in large-scale case-control study and meta-analysis. Hum Mol Genet 2006;15:1914–20.Google Scholar

  • 19.

    Marsland AL, McCaffery JM, Muldoon MF, Manuck SB. Systemic inflammation and the metabolic syndrome among middle-aged community volunteers. Metabolism 2010;59:1801–8.Google Scholar

  • 20.

    Hotamisligil GS, Shargill NS, Spiegelman BM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science 1993;259:87–91.Google Scholar

  • 21.

    Khoury M, Manlhiot C, McCrindle BW. Role of the waist/height ratio in the cardiometabolic risk assessment of children classified by body mass index. J Am Coll Cardiol 2013;62:742–51.Google Scholar

  • 22.

    Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010;10:73.Google Scholar

  • 23.

    Freedman DS, Kahn HS, Mei Z, Grummer-strawn LM, Dietz WH, et al. Relation of body mass index and waist to height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Int J Clin Nutr 2007;86: 33–40.Google Scholar

  • 24.

    Carvalho Vidigal F, Daez de Lima Rosado LE, Paixao Rosado G, de Cassia Lanes Ribeiro R, do Camo Castro, et al. Predictive ability of the anthropometric and body composition indicators for detecting changes in inflammatory markers. Nutr Hosp 2013;28:1639–45.Google Scholar

  • 25.

    Olza J, Aguilera CM, Gil-Campos M, Leis R, Buneo G, et al. Waist-to-height-ratio, inflammation and CVD risk in obese children. Public Health Nutr 2014;17:2378–85.Google Scholar

  • 26.

    Guías para la evaluación del crecimiento fisico. Comité Nacional de Crecimiento y Desarrollo. Sociedad Argentina de Pediatría 2013.

  • 27.

    National high blood pressure education program working group on high blood pressure in children and adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114:555.Google Scholar

  • 28.

    Taylor RW, Jones IE, Williams SM,Goulding A. 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. Am J Clin Nutr 2000;72:490–5.Google Scholar

  • 29.

    Update on the task force (1987) on high blood pressure in children and adolescents: a working group from the National High Blood Pressure Education Program. Pediatrics 1996;98:649–58.Google Scholar

  • 30.

    Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23.Google Scholar

  • 31.

    Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303.Google Scholar

  • 32.

    Haffner S, Miettinen H, Stern M. The homeostasis model in the san antonio heart study. Diabetes Care 1997;20:1087–92.Google Scholar

  • 33.

    Reaven GM, Chen YD, Hollenbeck CB, Sheu WH, Ostrega D, et al. Plasma insulin, C-peptide, and proinsulin concentrations in obese and nonobese individuals with varying degrees of glucose tolerance. J Clin Endocrinol Metab 1993;76:44–8.Google Scholar

  • 34.

    Guntsche Z, Guntsche EM, Saravi FD, Gonzalez LM, Lopez Avellaneda C, et al. Umbilical waist-to-hight ratio and trunk fat mass index (DXA) as markers of central adiposity and insulin resistance in Argentinean children with a family history of metabolic syndrome. J Pediatr Endocrinol Metab 2010;23:245–56.Google Scholar

  • 35.

    August G, Caprio S, Fennoy I, Freemark M, Kaufman F, et al. Prevention and treatment of pediatric obesity: an endocrine society clinical practice guideline based on expert opinion. J Clin endocrinol Metab 2008;93:4576–99.Google Scholar

  • 36.

    Magnussen C, Koskinen J, Chen W, Thomson R, Schmidt M, et al. Pediatric metabolic syndrome predicts adulthood metabolic syndrome, suclinical atherosclerosis, and type 2 diabetes mellitus – but is no bettr than body mass index alone: the Bogalusa Heart Study and the cardiovascular risk in young finns study. Circulation 2010;122:1604–11.Google Scholar

  • 37.

    Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, et al. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes 2014;15:(Suppl 20):4–17.Google Scholar

  • 38.

    Viikari JS, Raitakari OT, Simell O. Nutritional influences on lipids and future atherosclerosis beginning prenatally and during childhood. Curr Opin Lipidol 2002;13:11–8.Google Scholar

  • 39.

    Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006;83:461–5.Google Scholar

  • 40.

    Dandona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 2004;25:4–7.Google Scholar

  • 41.

    Xu H, Barnes GT, Yang Q, Tan G, Yang D, et al. Chronic inflammation in fat plays a crucial role in the development of obesity-related insulin resistance. J Clin Invest 2003;112:1821–30.Google Scholar

  • 42.

    Das UN. Is obesity an inflammatory condition? Nutrition 2001;17:953–66.Google Scholar

  • 43.

    Trayhurn P, Wood IS. Signalling role of adipose tissue: adipokines and inflammation in obesity. Biochem Soc Trans 2005;33:1078–81.Google Scholar

  • 44.

    Taylor R, Williams SM, Grant AM, Ferguson E, Taylor BJ, et al. Waist circumference as a measure of trunk fat mass in children aged 3 to 5 years. Int J Ped Obes 2008;3:226–33.Google Scholar

  • 45.

    Johnson ST, Kuk JL, Mackenzie KA, Huang T, Rosychuk RJ, et al. Metabolic risk varies according to waist circumference measurement site in overweight boys and girls. J Pediatr 2010;156:247–52.Google Scholar

  • 46.

    González Jiménez E, Aguilar Cordero MJ, García López PA, Schmidt Río-Valle J, García García CJ. Analysis of the nutritional state and body composition of school children in Granada (Spain). Nutr Hosp 2012;27:1496–504.Google Scholar

  • 47.

    Savva SC, Lamnisos D, Kapatos AG. Predicting cardiometabolic risk: waist to height ratio or BMI. A meta-analysis. Diabetes Metab Syndr Obes 2013;6:403–19.Google Scholar

  • 48.

    Mazza CS, Ozuna B, Krochik AG, Araujo MB. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in obese Argentinean children and adolescents. J Pediatr Endocrinol Metab 2005;18:491–8.Google Scholar

  • 49.

    Armeno ML, Krochik AG, Mazza CS. Evaluation of two dietary treatments in obese hyperinsulinemic adolescents. J Pediatr Endocrinol Metab 2011;24:715–22.Google Scholar

  • 50.

    Reyes M, Gahagan S, Diaz E, Blanco E, Leiva L, et al. Relationship of adiposity and insulin resistance mediated by inflammation in a group of overweight and obese Chilean adolescents. Nutrition J 2011;10:4.Google Scholar

  • 51.

    Person TA, Mensah GA, Alexander RW, Anderson JL, Cannon PO, et al. Markers of inflammation and cardiovascular disease, application to clinical and public health practice, a statement for healthcare professionals for the Center of Disease Control and Prevention and the American Health Association. Circulation 2003;107:499–511.Google Scholar

  • 52.

    Festa A, D’Agostino R Jr, Howard G, Mykkanen L, Tracy RP, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome, the insulin resistance atherosclerosis study (IRAS). Circulation 2000;102:42–7.Google Scholar

  • 53.

    Mc Laughlin T, Abbasi F, Lamendola C, Liang L, Reaven G, et al. Differentiation between obesity and insulin resistance in the association with C-reactive protein. Circulation 2002;106: 2908–12.Google Scholar

  • 54.

    Aguirre V, Werner ED, Giraud J, Lee YH, Shoelson SE, et al. Phosphorylation of Ser307 in insulin receptor substrate-1 blocks interactions with the insulin receptor and inhibits insulin action. J Biol Chem 2002;277:1531–7.Google Scholar

  • 55.

    Prins JB, Nielser CU, Winterford CM, Bright NA, Siddle K, et al. Tumor necrosis factor-alpha induces apoptosis of human adipose cells. Diabetes 1997;46:1939–44.Google Scholar

  • 56.

    Mauras N, Delgiorno C, Kollman C, Bird K, Morgan M, et al. Obesity without established comorbidities of the metabolic syndrome is associated with a proinflammatory and prothrombotic state, even before the onset of puberty in children. J Clin Endocr Metab 2010;95:1060–8.Google Scholar

  • 57.

    Aygun AD, Gungor S, Ustundag B, Gurgoze MK, Sen Y. Proinflammatory cytokines and leptin are increased in serum of prepubertal obese children. Mediators Inflamm 2005;3: 180–3.Google Scholar

  • 58.

    Bacha F, Gungor N, Lee S, Arslanian SA. In vivo insulin sensitivity and secretion in obese youth: what are the differences between normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes? Diabetes Care 2009;32:100–5.Google Scholar

  • 59.

    Hermsdorff HH, Zulet MA, Puchau B, Martinez A. Central adiposity rather than total adiposity measurements are specifically involved in the inflammatory status from healthy young adults. Inflammation 2011;34:3.Google Scholar

  • 60.

    González M, del Mar Bibiloni M, Pons A, Llompart I, Tur JA. Inflammatory markers and metabolic syndrome among adolescents. Eur J Clin Nutr 2012;66:1141–5.Google Scholar

  • 61.

    Del Mar Bibiloni M, Maffeis C, Llompart I, Pons A, Tur JA. Dietary factors associated with subclinical inflammation among girls. Eur J Clin Nutr. 2013;67:1264–70.Google Scholar

  • 62.

    Stelzer I, Zelzer S, Raggam RB, Prüller F, Truschnig-Wilders M, et al. Link between leptin and interleukin-6 levels in the initial phase of obesity related inflammation. Transl Res 2012;159:118–24.Google Scholar

  • 63.

    Pirkola J,Vaarasmaki M, Ala-Korpela M, Bloigu A, Canoy D, et al. Low grade, systemic inflammation in adolescents: association with early-life factors, gender and lifestyle. Am J Epidemiol 2010;171:72–82.Google Scholar

  • 64.

    Jung C, Fisher N, Fritzenwagner M, Figulla HR. Anthropometric indices as predictors of the metabolic syndrome and its components in adolescents. Ped Inter 2010;52: 402–9.Google Scholar

About the article

Corresponding author: Carolina Caminiti, Hospital J. P. Garrahan, Nutrition Department, Combate de los Pozos 1881, CP1245 CABA, Buenos Aires, Argentina, E-mail:

Received: 2015-10-26

Accepted: 2015-12-07

Published Online: 2016-02-17

Published in Print: 2016-05-01

Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 29, Issue 5, Pages 543–551, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2014-0526.

Export Citation

©2016 by De Gruyter.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Carolina da Silva Peres, Roberta Pratti Gava, Igor Renan Zen, Julio Cesar Molina Correa, Gabriela Fleury Seixas, Carla Cristiane Silva, Cassia Cilene Dezan Garbelini, and Solange de Paula Ramos
Apunts. Medicina de l'Esport, 2019
Xian-pei Heng, Xiu-jun Li, Liang Li, Liu-qing Yang, Zi-ta Wang, and Su-ping Huang
Chinese Journal of Integrative Medicine, 2018
Jennifer W. Bea, Janet Funk, Megan Hetherington-Rauth, Betsy C. Wertheim, Lucia Mosquiera, Ravina Thuraisingam, Vinson Lee, Robert Blew, Timothy Lohman, Denise J. Roe, and Scott Going
Obesity, 2018, Volume 26, Number 10, Page 1594
Vincent J. Palmieri, Melissa H. Henshaw, Janet Carter, and Shahryar M. Chowdhury
Acta Paediatrica, 2017
Edmar Lacerda Mendes, Alynne Christian Ribeiro Andaki, Ciro José Brito, Juliano Magalhães Guedes, Maria Paula Maia Santos, and Jorge Mota
Annals of Human Biology, 2017, Volume 44, Number 4, Page 303

Comments (0)

Please log in or register to comment.
Log in