ORIGINAL COMMUNICATION Waist circumference as a predictor of cardiovascular and metabolic risk factors in obese girls C Maffeis 1 *, N Corciulo 1 , C Livieri 1 , I Rabbone 1 , G Trifiro` 1 , A Falorni 1 , L Guerraggio, P Peverelli 1 , G Cuccarolo 1 , G Bergamaschi 1 , M Di Pietro 1 and A Grezzani 1 1 Childhood Obesity Group of the Italian Society of Pediatric Endocrinology and Diabetology, Italy Objectives: (a) to explore the relationship between waist circumference and certain cardiovascular risk factors in a group of girls; and (b) to assess the clinical relevance of waist circumference in identifying girls with higher cardiovascular risk across puberty. Subjects and methods: One-hundred and fifty-five overweight or obese girls aged 5 – 16 y were recruited. Overweight and obesity were defined on the basis of BMI, according to Cole. Results: Waist circumference was significantly correlated with plasma insulin (r ¼ 0.43; P < 0.001), systolic blood pressure (r ¼ 0.22; P ¼ 0.007) and IR HOMA (r ¼ 0.40; P < 0.001). A multivariate linear correlation analysis showed that, when adjusted for age and Tanner stage, waist circumference was significantly associated with plasma insulin (r 2 ¼ 0.23; P < 0.01), IR HOMA (r 2 ¼ 0.17; P < 0.02), systolic and diastolic blood pressure (r 2 ¼ 0.20; P ¼ 0.006 and r 2 ¼ 0.32; P < 0.001, respectively). A logistic regression analysis, using IR HOMA as the dependent variable, showed that waist circumference was a significant independent risk factor of insulin resistance (IR HOMA 5 2.6) in this group of girls (OR 1.10; 95% CI 1.03 – 1.18; P ¼ 0.003), independently of their age and Tanner stage. Conclusions: Waist circumference of these girls was independently associated with certain cardiovascular risk factors, in particular insulin resistance and diastolic blood pressure, independently of age and Tanner stage. Thus suggesting that waist circumference may be reasonably included in clinical practice as a simple tool that may help to identify sub-groups of obese girls at higher metabolic risk across puberty. European Journal of Clinical Nutrition (2003) 57, 566 – 572. doi:10.1038=sj.ejcn.1601573 Keywords: child; obesity; cardiovascular risk factors; waist circumference Introduction Obesity is a social emergency in industrialised countries (WHO, 1998). In particular, the progressive increase in the prevalence of childhood obesity is cause for concern due to the association of obesity with morbidity also in children and for the high persistency of obesity into adulthood (Must et al, 1992; Troiano & Flegal, 1998). Evidence that the duration of obesity and the persistency of metabolic and cardiovascular risk factors associated with obesity increase morbidity in adulthood suggests the need for early diagnosis of obesity as well as simple and sensitive indexes of meta- bolic and cardiovascular risks in obese individuals early in life (Dietz & Bellizzi, 1999). Simple anthropometric measures, such as body mass index (BMI) and waist circumference, have been used to investigate the association between adiposity and cardiovas- cular risk factors in adults (Lean et al, 1998). Recently, studies on children seem to confirm the usefulness of waist circum- ference as an appropriate index of metabolic and cardiovas- cular risk also in the pre-puberty years (Freedman et al, 1999; Maffeis et al, 2001). However, few data are available for the period during puberty. Puberty affects cardiovascular and metabolic risk factors differently in males and females by the combined effects of hormones, changes of body compo- sition and body fat distribution, and psycho-behavioural *Correspondence: C Maffeis, Department of Pediatrics, University of Verona, Polyclinic, 37134 Verona, Italy. E-mail: claudio.maffeis@univr.it Guarantor: Claudio Maffels, MO. Contributors: Serone Ptlarma SpA, Via Casilina, 125 00 176, Roma, Italia. Received 6 March 2002; revised 18 June 2002; accepted 19 June 2002 European Journal of Clinical Nutrition (2003) 57, 566–572 ß 2003 Nature Publishing Group All rights reserved 0954–3007/03 $25.00 www.nature.com/ejcn