Body Mass Index and Waist-to-Height Ratio in Children Ages 6-17: A Comparison of the United States and India Open Access

Narula, Trishna Harneet (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/xd07gt25z?locale=pt-BR%2A
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Abstract

BACKGROUND. In recent years, childhood overweight and obesity has become a global epidemic. While childhood obesity is a greater burden in the United States than India, the rate of non-communicable diseases (NCDs) is higher in India. Increasing evidence illustrates that central obesity, or excess abdominal fat, more closely predicts risk of NCDs than obesity in general. While body mass index (BMI), the standard measure of overweight and obesity, does not account for location of body fat, waist-to-height ratio (WHtR) had been found an effective measure of central obesity. The current study aims to determine the prevalence of overweight/obesity through BMI and central obesity through WHtR in children from the US and from India, and to compare levels of WHtR within BMI categories in both populations.

METHODS. A secondary analysis of existing data from the National Health and Nutrition Examination Survey administered by the Centers for Disease Control & Prevention (N=1414) and a survey collected by the All India Institute of Medical Sciences in New Delhi (N=1640) was used to examine pediatric populations ages 6-17 in the US and India, respectively.

RESULTS. The age-adjusted prevalence of overweight/obesity (BMI ≥ 25 kg/m2), was 15.3% (95% confidence interval [CI]: 13.5, 17.2%) in US children and 8.4% (95% CI: 7.1, 9.8%) in Indian children. The age-adjusted prevalence of central obesity (WHtR ≥ 0.5) was 27.6% (95% CI: 25.3, 29.9%) in US children and 18.4% (95% CI: 16.5, 20.2%) in Indian children. Mean WHtR in obese children (BMI ≥ 30 kg/m2) was 0.650 ± 0.059 (standard error) in the US and 0.607 ± 0.083 in India. At the 95% confidence level, the prevalence of overweight/obesity (p < 0.0001) and central obesity (p < 0.0001) were both found significantly higher in children from the US than those from India.

DISCUSSION. Findings indicate central obesity is more prevalent among US than Indian children, both overall and within BMI categories, inconsistent with previous research among adults. Future research should target the 18-and-above population in each country to determine in what age demographic the trend reverses and consider other measures of central obesity such as waist-to-hip ratio.

Table of Contents

BACKGROUND... 1

The Burden of Childhood Overweight, Obesity, and Non-Communicable Disease...1 Definition & Measures of Obesity...2 Central Obesity...3 METHODS...6 Research Questions...6 Study Design...6 Description of US Data...7 Description of India Data...8 Data Analysis...9 RESULTS...12 Descriptive Statistics...12 Age-Adjusted Prevalence of Overweight/Obesity & Central Obesity in US & India...12 Levels of Central Obesity within BMI Categories...13 Chi-Square Test Results...15 DISCUSSION...16 Summary of Findings: Prevalence of Overweight/Obesity & Central Obesity...16 Summary of Findings: Levels of Central Obesity within BMI Categories...17 Discussion of Findings...17 Limitations...18 FUTURE DIRECTIONS... 20 REFERENCES... 21 TABLES... 26 Table 1: Age-adjusted prevalence of overweight/obesity and central obesity among children aged 6-17 years in US and India...26 Table 2: Age-adjusted prevalence of overweight/obesity and central obesity among children aged 6-11 and 12-17 years in US and India...26 Table 3: Prevalence of central obesity within BMI groups among children aged 6-17 years in US and India...27 FIGURES... 28 Figure 1: Mean waist-to-height ratio within BMI groups among children aged 6-17 years in US and India...28 Figure 2a: Mean waist-to-height ratio within BMI groups among male and female children aged 6-17 years in US...29 Figure 2b: Mean waist-to-height ratio within BMI groups among male and female children aged 6-17 years in India...29 APPENDICES... 30 Appendix A: IRB Non-Human Subjects Determination Letter...30

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