{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T04:27:21Z","timestamp":1792988841134,"version":"4.5.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Horten municipality"},{"DOI":"10.13039\/100031564","name":"Kristiania University College","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100031564","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Norwegian Order of Odd Fellow Research Fund"},{"name":"Oslofjord Regional Research Fund"},{"name":"the Norwegian Fund for Post-Graduate Training in Physiotherapy"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Understanding the relationship between central adiposity and health outcomes in children is crucial for early prevention of non-communicable diseases (NCDs). Waist-to-height ratio (WHtR) has emerged as a key anthropometric measure for predicting cardiovascular and metabolic health risks.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The objective of this study was to investigate whether WHtR is associated with cardiovascular and metabolic risk markers, including HbA1c, CRP, lipid profiles, blood pressure, ferritin, and iron levels, in healthy children aged 6\u201312 years. The study further aimed to assess WHtR\u2019s potential as a screening tool for identification of cardiometabolic risk.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>An association between WHtR and unfavorable lipid profiles, with elevated total cholesterol and non-HDL cholesterol levels, alongside decreased HDL levels in the highest WHtR quartile, were displayed, suggesting increased cardiovascular risk. Similarly, the combination of high erythrocyte count, low hematocrit (HCT), high ferritin, and low iron, combined with high CRP may imply chronic inflammation due to adiposities. Elevated systolic and diastolic blood pressure values further underscore this cohort\u2019s cardiovascular risks associated with central adiposity.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>WHtR\u2019s ability to predict metabolic and cardiovascular risk factors highlights its potential as a simple, non-invasive screening tool in pediatric healthcare. Implementing WHtR in routine health assessments could provide an accessible and cost-effective method for early identification of at-risk children, enabling timely interventions to improve long-term health outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>Clinical Trial.gov. Identifier: NCT02495714. Registered 20 June 2015. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/register.clinicaltrials.gov\/prs\/app\/action\/LogoutUser?uid=U0002ORK&amp;ts=13&amp;sid=S0005MCN&amp;cx=pc85td\" xlink:type=\"simple\">https:\/\/register.clinicaltrials.gov\/prs\/app\/action\/LogoutUser?uid=U0002ORK&amp;ts=13&amp;sid=S0005MCN&amp;cx=pc85td<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0326772","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T17:28:05Z","timestamp":1752082085000},"page":"e0326772","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Waist-to-Height Ratio as a predictor of cardiovascular and metabolic health in a pediatric population"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7450-2925","authenticated-orcid":true,"given":"Per Morten","family":"Fredriksen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asgeir","family":"Mamen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandu","family":"Goswami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Lindberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"issue":"1","key":"pone.0326772.ref001","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1038\/ejcn.2009.70","article-title":"Appropriateness of waist circumference and waist-to-hip ratio cutoffs for different ethnic groups","volume":"64","author":"SA Lear","year":"2010","journal-title":"Eur J Clin Nutr"},{"issue":"7","key":"pone.0326772.ref002","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1016\/j.jclinepi.2007.08.012","article-title":"Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis","volume":"61","author":"CMY Lee","year":"2008","journal-title":"J Clin Epidemiol"},{"issue":"9","key":"pone.0326772.ref003","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1056\/NEJMoa0908359","article-title":"Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults","volume":"362","author":"E Selvin","year":"2010","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0326772.ref004","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1001\/jama.291.6.711","article-title":"Body iron stores in relation to risk of type 2 diabetes in apparently healthy women","volume":"291","author":"R Jiang","year":"2004","journal-title":"JAMA"},{"issue":"3","key":"pone.0326772.ref005","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1001\/jama.286.3.327","article-title":"C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus","volume":"286","author":"AD Pradhan","year":"2001","journal-title":"JAMA"},{"issue":"17","key":"pone.0326772.ref006","doi-asserted-by":"crossref","first-page":"2735","DOI":"10.1161\/CIRCULATIONAHA.105.169404","article-title":"Diagnosis and management of the metabolic syndrome: an American Heart Association\/National Heart, Lung, and Blood Institute Scientific Statement","volume":"112","author":"SM Grundy","year":"2005","journal-title":"Circulation"},{"key":"pone.0326772.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/EP171764.APPGL","article-title":"American association of clinical endocrinologists and American college of endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease","volume":"23","author":"PS Jellinger","year":"2017","journal-title":"Endocr Pract"},{"issue":"6","key":"pone.0326772.ref008","doi-asserted-by":"crossref","DOI":"10.1161\/HYP.0000000000000228","article-title":"Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association","volume":"80","author":"B Falkner","year":"2023","journal-title":"Hypertension"},{"issue":"23","key":"pone.0326772.ref009","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1056\/NEJMoa031049","article-title":"Obesity and the metabolic syndrome in children and adolescents","volume":"350","author":"R Weiss","year":"2004","journal-title":"New England J Med"},{"issue":"3","key":"pone.0326772.ref010","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010159","article-title":"Waist-to-height ratio as an indicator of \u201cearly health risk\u201d: simpler and more predictive than using a \u201cmatrix\u201d based on BMI and waist circumference","volume":"6","author":"M Ashwell","year":"2016","journal-title":"BMJ Open"},{"issue":"11","key":"pone.0326772.ref011","first-page":"1118","article-title":"Assessment of anthropometric indices for optimal cut-offs for obesity screening in a South African Adolescent Population","volume":"10","author":"GA Engwa","year":"2021","journal-title":"Biology (Basel)"},{"issue":"1","key":"pone.0326772.ref012","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1186\/s12889-017-4282-z","article-title":"The health Oriented pedagogical project (HOPP) - a controlled longitudinal school-based physical activity intervention program","volume":"17","author":"PM Fredriksen","year":"2017","journal-title":"BMC Public Health"},{"key":"pone.0326772.ref013","author":"NOKLUS","year":"2021"},{"issue":"15","key":"pone.0326772.ref014","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1002\/sim.3107","article-title":"Scaling regression inputs by dividing by two standard deviations","volume":"27","author":"A Gelman","year":"2008","journal-title":"Stat Med"},{"key":"pone.0326772.ref015","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1403494818769852","article-title":"Development of weight and height in Norwegian children: The Health Oriented Pedagogical Project (HOPP)","volume":"46","author":"A Sk\u00e5r","year":"2018","journal-title":"Scand J Public Health"},{"issue":"2","key":"pone.0326772.ref016","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.blre.2013.12.003","article-title":"The sex difference in haemoglobin levels in adults - mechanisms, causes, and consequences","volume":"28","author":"WG Murphy","year":"2014","journal-title":"Blood Rev"},{"issue":"1","key":"pone.0326772.ref017","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1542\/peds.2008-1349","article-title":"Lipid screening and cardiovascular health in childhood","volume":"122","author":"Committee on Nutrition","year":"2008","journal-title":"Pediatrics"},{"issue":"3","key":"pone.0326772.ref018","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.jacl.2018.02.021","article-title":"Sex differences in cholesterol levels from birth to 19 years of age may lead to increased cholesterol burden in females with FH","volume":"12","author":"KB Holven","year":"2018","journal-title":"J Clin Lipidol"},{"issue":"1","key":"pone.0326772.ref019","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1093\/emph\/eoab041","article-title":"Early life, life course and gender influences on levels of C-reactive protein among migrant Bangladeshis in the UK","volume":"10","author":"K Begum","year":"2021","journal-title":"Evol Med Public Health"},{"issue":"9","key":"pone.0326772.ref020","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1038\/ajh.2008.228","article-title":"Gender-related differences in the relationships between blood pressure, age, and body size in prepubertal children","volume":"21","author":"G Barba","year":"2008","journal-title":"Am J Hypertens"},{"issue":"2","key":"pone.0326772.ref021","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.clnu.2021.12.013","article-title":"Iron status in early childhood is modified by diet, sex and growth: Secondary analysis of a randomized controlled vitamin D trial","volume":"41","author":"EM Holmlund-Suila","year":"2022","journal-title":"Clin Nutr"},{"issue":"10","key":"pone.0326772.ref022","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1056\/NEJMra041809","article-title":"Anemia of chronic disease","volume":"352","author":"G Weiss","year":"2005","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0326772.ref023","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1093\/ije\/dyh105","article-title":"Socioeconomic position in childhood and cardiovascular risk factors in older Spanish people","volume":"33","author":"E Regidor","year":"2004","journal-title":"Int J Epidemiol"},{"issue":"1","key":"pone.0326772.ref024","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1186\/s12916-023-03169-y","article-title":"Establishing international optimal cut-offs of waist-to-height ratio for predicting cardiometabolic risk in children and adolescents aged 6\u201318 years","volume":"21","author":"X Zong","year":"2023","journal-title":"BMC Med"},{"key":"pone.0326772.ref025","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/1403494818770129","article-title":"Anthropometric measures as fitness indicators in primary school children: The Health Oriented Pedagogical Project (HOPP)","volume":"46","author":"A Mamen","year":"2018","journal-title":"Scand J Public Health"},{"issue":"4","key":"pone.0326772.ref026","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.2337\/db06-1656","article-title":"Visceral fat adipokine secretion is associated with systemic inflammation in obese humans","volume":"56","author":"L Fontana","year":"2007","journal-title":"Diabetes"},{"issue":"12","key":"pone.0326772.ref027","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1172\/JCI200318921","article-title":"C-reactive protein: a critical update","volume":"111","author":"MB Pepys","year":"2003","journal-title":"J Clin Invest"},{"key":"pone.0326772.ref028","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.ifset.2018.04.015","article-title":"Iron bioavailability from food fortification to precision nutrition. A review","volume":"51","author":"R Blanco-Rojo","year":"2019","journal-title":"Innovative Food Sci Emerging Technol"},{"issue":"4","key":"pone.0326772.ref029","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.hoc.2014.04.005","article-title":"Anemia of inflammation","volume":"28","author":"E Nemeth","year":"2014","journal-title":"Hematol Oncol Clin North Am"},{"issue":"9","key":"pone.0326772.ref030","article-title":"Hepcidin and iron homeostasis","volume":"1823","author":"T Ganz","year":"2012","journal-title":"Biochim Biophys Acta"},{"key":"pone.0326772.ref031","doi-asserted-by":"crossref","DOI":"10.1017\/S0029665120005911","article-title":"Excessive adiposity is associated with an inflammation induced elevation in serum hepcidin, serum ferritin and increased risk of iron overload","volume":"79","author":"AM Heslin","year":"2020","journal-title":"Proc Nutrition Soc"},{"issue":"19","key":"pone.0326772.ref032","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1182\/blood.2021013472","article-title":"The role of iron in chronic inflammatory diseases: from mechanisms to treatment options in anemia of inflammation","volume":"140","author":"O Marques","year":"2022","journal-title":"Blood"},{"key":"pone.0326772.ref033","author":"WHO"},{"issue":"1","key":"pone.0326772.ref034","first-page":"39","article-title":"Association of the Waist-to-Height Ratio with cardiovascular risk factors in children and adolescents: the three cities heart study","volume":"1","author":"RC Ribeiro","year":"2010","journal-title":"Int J Prev Med"},{"issue":"11","key":"pone.0326772.ref035","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1093\/aje\/kws172","article-title":"Comparisons of the strength of associations with future type 2 diabetes risk among anthropometric obesity indicators, including waist-to-height ratio: a meta-analysis","volume":"176","author":"S Kodama","year":"2012","journal-title":"Am J Epidemiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326772","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T17:28:11Z","timestamp":1752082091000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326772"}},"subtitle":[],"editor":[{"given":"Aleksandra","family":"Klisic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":35,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0326772","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}