Predictive value of WHO vs. IAP BMI charts for identification of metabolic risk in Indian children and adolescents

Chirantap Oza; Vaman Khadilkar; Ketan Gondhalekar; Neha Kajale; Anuradha Khadilkar

doi:10.1515/jpem-2021-0411

Article

Predictive value of WHO vs. IAP BMI charts for identification of metabolic risk in Indian children and adolescents

Chirantap Oza , Vaman Khadilkar , Ketan Gondhalekar , Neha Kajale and Anuradha Khadilkar

Published/Copyright: September 6, 2021

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 12

Abstract

Objectives

Owing to increase in prevalence of obesity and metabolic syndrome in Indian children and adolescents, this study is conducted to assess the predictive value of IAP 2015 and WHO 2007 BMI for age cut-offs in identifying metabolic risk in Indian children.

Methods

Cross-sectional multicentric school-based study on 9–18-year-old healthy children (n=1,418) randomly selected from three states of India.

Results

WHO 2007 and IAP 2015 charts classified 222 (15.7%) and 271 (19.1%) as overweight/obese, respectively. A total of 192 (13.5%) subjects had metabolic risk. Of these 47 (25%) and 36 (18.75%) were classified as having normal body mass index (BMI) by WHO and IAP, respectively. In identifying metabolic risk, IAP 2015 and WHO 2007 charts showed a sensitivity of 81.3 and 75%, negative predictive value 96.5% as against 94.8%, positive predictive value 57.5 and 64.8%, and specificity of 89.7 and 91.6%, respectively.

Conclusions

Owing to obesity epidemic and high metabolic risk in Indians, IAP 2015 charts (as against the WHO 2007 references) which had a higher sensitivity in identifying metabolic risk may be more suitable in Indian children and adolescents.

Keywords: BMI; growth charts; IAP; metabolic risk; obesity; WHO

Corresponding author: Dr Anuradha Khadilkar, Deputy Director and Consultant Pediatrician, Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune 411001, India; and Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India, Phone: +91 0206057004, E-mail: anuradhavkhadilkar@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The local Institutional Review Board have approved the study. (Ethical committee, Jehangir Clinical Development Center Pvt Ltd, ECR/352/Inst/MH/2013 dated June 21, 2016).

References

1. Weiss, R, Dziura, J, Burgert, TS, Tamborlane, WV, Taksali, SE, Yeckel, CW, et al.. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362–74. https://doi.org/10.1056/nejmoa031049.Search in Google Scholar

2. Global status report on non-communicable diseases WHO 2010. Available from: http://www.who.int/nmh/publications/ncd_report2010/en/.Search in Google Scholar

3. Singh, R, Bhansali, A, Sialy, R, Aggarwal, A. Prevalence of metabolic syndrome in adolescents from a north Indian population. Diabet Med 2007;24:195–9. https://doi.org/10.1111/j.1464-5491.2007.02066.x.Search in Google Scholar

4. World Health Organization. Global strategy on diet, physical activity and health: obesity and overweight; 2004. Available from: http://www.who.int/.Search in Google Scholar

5. Ranjani, H, Mehreen, TS, Pradeepa, R, Anjana, RM, Garg, R, Anand, K, et al.. Epidemiology of childhood overweight & obesity in India: a systematic review. Indian J Med Res 2016;143:160. https://doi.org/10.4103/0971-5916.180203.Search in Google Scholar

6. Khadilkar, V, Yadav, S, Agrawal, KK, Tamboli, S, Banerjee, M, Cherian, A, et al.. Revised IAP growth charts for height, weight and body mass index for 5-to 18-year-old Indian children. Indian Pediatr 2015;52:47–55. https://doi.org/10.1007/s13312-015-0566-5.Search in Google Scholar

7. de Onis, M, Onyango, AW, Borghi, E, Siyam, A, Nishida, C, Siekmann, J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7. https://doi.org/10.2471/blt.07.043497.Search in Google Scholar

8. Mckeigue, PM, Shah, B, Marmot, MG. Relationship of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet 1991;337:382–6. https://doi.org/10.1016/0140-6736(91)91164-p.Search in Google Scholar

9. Khadilkar, AV, Lohiya, N, Mistry, S, Chiplonkar, S, Khadilkar, V, Kajale, N, et al.. Random blood glucose concentrations and their association with body mass index in Indian school children. Indian J Endocrinol Metab 2019;23:529–35. https://doi.org/10.4103/ijem.IJEM_536_19.Search in Google Scholar PubMed PubMed Central

10. IDF consensus definition of metabolic syndrome in children and adolescents, Last update: 05/04/2017. Available from: https://www.idf.org/e-library/consensus-statements/61-idf-consensus-definition-of-metabolic-syndrome-in-children-and-adolescents.Search in Google Scholar

11. Saudek, CD, Herman, WH, Sacks, DB, Bergenstal, RM, Edelman, D, Davidson, MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008;93:2447–53. https://doi.org/10.1210/jc.2007-2174.Search in Google Scholar PubMed

12. Gupta, N, Goel, K, Shah, P, Misra, A. Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr Rev 2012;33:48–70. https://doi.org/10.1210/er.2010-0028.Search in Google Scholar PubMed

13. Agarwal, KN, Saxena, A, Bansal, AK, Agarwal, DK. Physical growth assessment in adolescence. Indian Pediatr 2001;38:1217–35.Search in Google Scholar

14. Stigler, MH, Arora, M, Dhavan, P, Tripathy, V, Shrivastav, R, Reddy, KS, et al.. Measuring obesity among school-aged youth in India: a comparison of three growth references. Indian Pediatr 2011;48:105–10.https://doi.org/10.1007/s13312-011-0041-x.Search in Google Scholar PubMed

15. Cole, TJ, Freeman, JV, Preece, MA. Body mass index reference curves for the UK, 1990. Arch Dis Child 1995;73:25–9. https://doi.org/10.1136/adc.73.1.25.Search in Google Scholar PubMed PubMed Central

16. Group of China Obesity Task Force. Body mass index reference norm for screening overweight and obesity in Chinese children and adolescents. Chin J Epidemiol 2004;25:97–102. (in Chinese).Search in Google Scholar

17. Kuczmarski, RJ, Ogden, CL, Grummer-Strawn, LM, Flegal, KM, Guo, SS, Wei, R, et al.. CDC growth charts: United States. Adv Data 2000;314:1–27.Search in Google Scholar

18. Wang, Y, Wang, JQ. A comparison of international references for the assessment of child and adolescent overweight and obesity in different populations. Eur J Clin Nutr 2002;56:973–82. https://doi.org/10.1038/sj.ejcn.1601415.Search in Google Scholar PubMed

19. Palaniappan, LP, Wong, EC, Shin, JJ, Fortmann, SP, Lauderdale, DS. Asian Americans have greater prevalence of metabolic syndrome despite lower body mass index. Int J Obes (Lond). 2011;35:393–400. https://doi.org/10.1038/ijo.2010.152.Search in Google Scholar PubMed PubMed Central

20. Stommel, M, Schoenborn, CA. Variations in BMI and prevalence of health risks in diverse racial and ethnic populations. Obesity 2010;18:1821–6.https://doi.org/10.1038/oby.2009.472.Search in Google Scholar PubMed

21. Khadilkar, VV, Khadilkar, AV, Borade, AB, Chiplonkar, SA. Body mass index cut-offs for screening for childhood overweight and obesity in Indian children. Indian Pediatr 2012;49:29–34.https://doi.org/10.1007/s13312-012-0011-y.Search in Google Scholar PubMed

22. Reilly, JJ, Dorosty, AR, Emmett, PM. Avon Longitudinal Study of Pregnancy and Childhood Study Team. Identification of the obese child: adequacy of the body mass index for clinical practice and epidemiology. Int J Obes Relat Metab Disord 2000;24:1623–7. https://doi.org/10.1038/sj.ijo.0801436.Search in Google Scholar PubMed

23. Anzolin, CC, Silva, DA, Zanuto, EF, Cayres, SU, Codogno, JS, Costa Junior, P, et al.. Accuracy of different cutoff points of body mass index to identify overweight according to body fat values estimated by DEXA. J Pediatr (Rio J) 2017;93:58–63. https://doi.org/10.1016/j.jped.2016.04.010.Search in Google Scholar PubMed

24. Neovius, MG, Linné, YM, Barkeling, BS, Rossner, SO. Sensitivity and specificity of classification systems for fatness in adolescents. Am J Clin Nutr 2004;80:597–603. https://doi.org/10.1093/ajcn/80.3.597.Search in Google Scholar PubMed

25. Bowen, ME, Xuan, L, Lingvay, I, Halm, EA. Random blood glucose: a robust risk factor for type 2 diabetes. J Clin Endocrinol Metab 2015;100:1503–10. https://doi.org/10.1210/jc.2014-4116.Search in Google Scholar PubMed PubMed Central

26. Rolka, DB, Narayan, KM, Thompson, TJ, Goldman, D, Lindenmayer, J, Alich, K, et al.. Performance of recommended screening tests for undiagnosed diabetes and dysglycemia. Diabetes Care 2001;24:1899–903. https://doi.org/10.2337/diacare.24.11.1899.Search in Google Scholar PubMed

27. Khadilkar, A, Ekbote, V, Chiplonkar, S, Khadilkar, V, Kajale, N, Kulkarni, S, et al.. Waist circumference percentiles in 2-18 year old Indian children. J Pediatr 2014;164:1358–62.e2.https://doi.org/10.1016/j.jpeds.2014.02.018.Search in Google Scholar PubMed

Received: 2021-06-17

Accepted: 2021-08-12

Published Online: 2021-09-06

Published in Print: 2021-12-20

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jpem-2021-0411

Keywords for this article

BMI; growth charts; IAP; metabolic risk; obesity; WHO