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Predictive Utility of Anthropometric Based Cut-offs in Assessing Excess Adiposity among Preschool Children in a Multiethnic Population



Objective: Screening for childhood obesity is a necessary step in developing appropriate and effective interventions.  We evaluated the diagnostic performance of various recommended international anthropometric cut-offs based on body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR),  triceps skinfold (TSF) and mid-upper arm circumference (MUAC) in predicting excess adiposity (body fat ≥ 25%) in a random sample of Trinidadian preschoolers.

Methods: After obtaining written parental consent, weight, height, WC, triceps and MUAC were measured in 596 children using standard procedures.  These were used to calculate BMI-for-age, WHtR, TSF-for-age z-scores and MUAC-for-age z-scores.  Percentage body fat was measured using a Tanita-531 foot-to-foot bioelectrical impedance analyser.  Sensitivities, specificities and area under the receiver-operating curve (AUC) analysis and predictive values were then computed.

Results: The prevalence of excess adiposity was 12.2% and 5.1% among males and females respectively.  Sensitivities for the various cut-offs ranged from 20.0%‒75.0% and 57.1 ‒ 96.9% among males and females respectively. WHO-BMI recommended cut-offs and those based on MUAC z-scores had significantly higher sensitivities in females than males. Triceps skinfold z-scores had significantly lower sensitivities compared to those based on BMI and WHtR among males.  Similarly, specificities ranged from 81.3%‒99.9% and 79.8%‒99.9% among males and females, respectively. In girls, cut-offs based on TSF z-scores had a higher likelihood ratio than cut-offs from CDC, IOTF and WHtR.  Diagnostic performance was not associated with ethnicity.

Conclusion: Our results suggest that diagnostic performance was associated with gender and the cut-offs used, however it was not associated with ethnicity.

30 Sep, 2015
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e-Published: 15 Mar, 2016


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