Diagnostic test accuracy of waist-to-height ratio as a screening tool for cardiovascular risk in children and adolescents: a meta-analysis

Abstract

Context

Waist-to-height ratio (WHtR) is a controversial evaluation index of cardiovascular risk factors (CVRFs) in children and adolescents.

Objective

To assess the accuracy of WHtR as a measure to screen for clusters of at least one CVRF (CVRF₁), two CVRFs (CVRF₂), and three CVRFs (CVRF₃) in different ages, sexes, regions and cut-offs.

Methods

The PubMed, Web of Science, EBSCOhost, Springer, Taylor & Francis Online, Wiley Online Library, Wanfang, and CNKI databases were searched for eligible publications up to June 2021. The QUADAS-2 checklist was used to assess the methodology of the included studies.

Results

Twenty-two studies that evaluated 85281 children and adolescents aged 5–19 years were included in the meta-analysis. The AUSROC values were 0.56 (95% CI: 0.54–0.57), 0.82 (95% CI: 0.81–0.83), and 0.89 (95% CI: 0.89–0.90) for CVRF₁, CVRF₂, and CVRF₃, respectively. Higher AUSROC values were found for adolescents (12–19 years), that is, 0.91 (95% CI: 0.88–0.93), 0.90 (95% CI: 0.87–0.92) for males, and 0.91 (95% CI: 0.90–0.91) for a cut-off of ≥ 0.51 in the identification of CVRF₃.

Conclusion

WHtR can be used as an accurate screening tool for CVRF₃ and CVRF₂ in children and adolescents, and it is recommended to select different cut-offs according to different ages, sexes, and regions.

Keywords:

• Cardiovascular risk
• diagnosis
• receiver-operating characteristic curve
• waist-to-height ratio
• children

Acknowledgements

The authors thank the National Social Science Foundation of China for the financial support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Social Science Foundation of China [Grant 19XTY011].