Waist-To-Height Ratio, Lean Mass and Fat Mass in Preschool Children


  • Thais Costa Machado Department of Maternal and Child Health, School of Public Health (Faculdade de Saúde Pública- FSP), University of São Paulo (Universidade de São Paulo- USP), São Paulo, SP, Brazil
  • Viviane G. Nascimento Department of Maternal and Child Health, FSP/USP. Lecturer at Paulista University (Universidade Paulista- UNIP), São Paulo, SP, Brazil;
  • Ciro João Bertoli Lecturer, Department of Medicine, University of Taubaté (Universidade de Taubaté - UNITAU), Taubaté, SP, Brazil;
  • Luiz Carlos de Abreu Faculdade de Medicina do ABC. Departamento de Saúde da Coletividade. Disciplina de Metodologia Científica.
  • Claudio Leone Full Professor, Department of Maternal and Child Health, FSP/USP, São Paulo, SP, Brazil




body composition, preschool children, obesity, waist circumference.


Introduction: Abdominal fat and the proportion of lean body mass have both been independently considered as risk factors leading to insulin resistance and to an increased risk of developing chronic diseases later in life. Objective: To analyse the relationship between the waist-to-height ratio (WHtR) and other body composition indicators in children aged 2-6 years at public childcare centres. Methods: This study consisted of a random, probabilistic cluster sampling of 9 of the 59 existing childcare centres (Taubaté-SP, Brazil), resulting in the evaluation of 950 preschool children. The body mass index z-score (zBMI) and internationally accepted cut-off points were used to evaluate their nutritional status. The z-score for the arm muscle area (zAMA) and arm fat area (zAFA) and the WHtR were used to evaluate their body composition. Analyses were performed using the parameters of central tendency, dispersion, proportions and correlations, adopting a significance level of 5%. Results: The data indicated a direct correlation between the WHtR and zBMI (rP= 0.78), zAMA (rP= 0.52), zAFA (rP= 0.66) and the percentage of AFA (rP=0.54), with p <0.0001. There was an inverse correlation between the WHtR and the percentage of AMA (rP= -0.54), with p <0.0001. Conclusion: In preschool children, as the WHtR increases, the amounts of both lean body mass and body fat mass also increase. However, an increase in the waist circumference is accompanied by a disproportionately greater increase in fat mass compared to lean mass, which could indicate an additional risk factor for future chronic diseases.




Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sciences Nutr. 2005;56:303-7.

Baker PT, Hunt EE, Sen T. The growth and interrelations of skinfolds and brachial tissues in man. Am J Phys Anthropol. 1958;16:39-58.

Boeke CE, Oken E, Kleinman KP, Rifas-Shiman SL, Taveras EM, Gillman MW. Correlations among adiposity measures in school-aged children. BMC Pediatr. 2013;13(1):99.

Cândido APC, Freitas SN, Machado-Coelho GLL. Anthropometric measurements and obesity diagnosis in schoolchildren. Acta Pædiatrica. 2011;100:e120-e4.

Chen B, Li H. Waist circumference as an indicator of high blood pressure in preschool obese children. Asia Pac J Clin Nutr. 2011;20:557-62.

Chiarelli F, Marcovecchio ML. Insulin resistance and obesity in childhood. Eur J Endocrinol. 2008;159:S67-S74.

Chowdhury SD, Ghosh T. The upper arm muscle and fat area of Santal children: an evaluation of nutritional status. Acta Pædiatrica. 2009;98:103-6.

Freedman DS, Kahn HS, Mei Z, Grummer-Strawn Dietz WH, LM, Srinivasan SR, Berenson GS. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 2007;86:33-40.

Frisancho AR. Anthropometric standards: an interactive nutritional reference of body size and body composition for children and adults. Michigan: The University of Michigan Press, 2008.

Ibáñez L, Ong K, Dunger DB, de Zegher F: Early development of adiposity and insulin resistance after catch-up weight gain in small-for-gestational-age children. J Clin Endocrinol Metab. 2006;91:2153-8. Epub 2006 Mar 14.

Jelliffe EFP, Jelliffe DB. The arm circumference as a public health index of protein-calorie malnutrition of early childhood. J Trop Pediatr. 1969;15:179-88.

Kuba VM, Leone C, Damiani D. Is waist-to-height ratio a useful indicator of cardio-metabolic risk in 6-10-year-old children? BMC Pediatrics 2013;13:91.

Lee CMY, Huxley RR, Wildman RP, Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol. 2008;61:646-53.

Maffeis C, Banzato C, Talamini G, Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology. Waist-to-Height Ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr. 2008;152:207-13.

McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message – ‘keep your waist circumference to less than half your height’. Int J Obes Relat Metab Disord. 2006;30:988-92.

Ministério da Saúde. Departamento de atenção básica. Sistema de Vigilância Alimentar e Nutricional. [Ministry of Health. Department of Primary Care. Food and Nutrition Surveillance System]. 2009. Available at: http://nutricao.saude.gov.brsisvan.php?conteudo=curvas_cresc_oms [2010 Jan 20]

Mokha JS, Srinivasan SR, DasMahapatra P, Fernandez C, Chen W, Xu J, Berenson GS. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: The Bogalusa Heart Study. BMC Pediatrics. 2010;10:73.

Moreno LA, Pineda I, Rodríguez G, Fleta J, Sarría A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr. 2002;91:1307-12.

Murphy MJ, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. Does lean rather than fat mass provide the link between birth weight, BMI, and metabolic risk? EarlyBird 23. Pediatric Diabetes. 2006;7:211-4.

Onis M de, Onyango AW, Van den Broeck J, Chumlea WC, Martorell R. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull 2004;25:S27-36.

Onis M de, Lobstein T. Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes. 2010;5:458-60. Epub 2010 Mar 17.

Phillips DIW. Relation of fetal growth to adult muscle mass and glucose tolerance. Diabet Med 1995;12:686-90.

Ralt D. The muscle – fat duel or why obese children are taller? BMC Pediatr. 2006;13:33.

Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, Georgiou C, Kafatos A. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass índex. Int J Obes Relat Metab Disord. 2000;24:1453-8.

Singhal A, Wells J, Cole TJ, Fewtrell M, Lucas A: Programming of lean body mass: a link between birth weight, obesity, and cardiovascular disease? Am J Clin Nutr. 2003;77:726-30.

Taylor RW, Williams SM, Grant AM, Taylor BJ, Goulding A. Predictive ability of waist-to-height in relation to adiposity in children is not improved with age and sex-specific values. Obesity (Silver Spring). 2011;19:1062-8. Epub 2010 Sep 30.

Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697-738.

World Health Organization. Physical status: the use and interpretation of anthropometry. Geneva: WHO; 1995.

World Health Organization. Obesity: preventing and managing the global epidemic. Geneva; 2000 (WHO – Technical Report Series, 894).

World Health Organization. Child growth standards based on length/height, weight and age. Acta Paediatr. 2006;450:S76-85.

World Health Organization. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85:660-7.

Ylihärsilä H, Kajantie E, Osmond C, Forsén T, Barker DJP, Eriksson JG: Birth size, adult body composition and muscle strength in later life. Int J Obes (Lond) 2007;31:1392-9. Epub 2007 Mar 13.

Monteiro CBM, Almeida Junior AD, Wajnzstejn R. Project

Management in Health and Medical Research. Journal of

Human Growth and Development. 2014; 24(3): 239-242. DOI:


Atrash HK, Carpentier R. The evolving role of

public health in the delivery of health care. Rev

Journal of Human Growth and Development.. 2012; 22(3): 396-9.







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