Performance of waist-to-height ratio as a screening tool for identifying cardiometabolic risk in children: a meta-analysis

Abstract

Objective: To provide the latest evidence of performance and robustness of waist-to-height ratio (WHtR) in discriminating clusters of cardiometabolic risk factors (CMRs) and promote WHtR in routine primary health care practice in children, a meta-analysis was used.Methods: Searches was performed in eight databases from inception to July 03, 2020. Inclusion criteria were: (1) observational study, (2) children and adolescents, (3) provided WHtR measurements, (4) had CMRs as outcomes, and (5) diagnostic studies. Exclusion criteria were: (1) non-original articles, (2) unable to extract 2 × 2 contingency tables, (3) not in English or Chinese language, (4) populations comprising clinical patients, or (5) duplicate articles. WHtR cutoff points, 2 × 2 contingency tables were extracted from published reports. Outcomes included: CMR clusters of at least three CMRs (CMR₃), two (CMR₂), one (CMR₁), and CMR components. Bivariate mixed-effects models were performed to estimate the summarised area under the curves (AUSROC) with 95%CIs and related indexes. We conducted subgroup analyses by sex and East Asian ethnicity.Results: Fifty-three observational studies were included. The AUSROC reached 0.91 (95%CI: 0.88–0.93), 0.85 (95%CI: 0.81, 0.88) and 0.75 (95%CI: 0.71, 0.79) for CMR₃, CMR₂, and CMR₁, respectively. The pooled sensitivity and specificity for CMR₃reached 0.84 and exceeded 0.75 for CMR₂. For CMR₁, the sensitivity achieved 0.55 with 0.84 for specificity. We had similar findings for our subgroup and sensitivity analyses.Conclusions: WHtR shows good and robust performance in identifying CMRs clustering across racial populations, suggesting its promising utility in public health practice globally.