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Journal of Obesity
Volume 2016, Article ID 2740538, 7 pages
Research Article

Establishing Waist-to-Height Ratio Standards from Criterion-Referenced BMI Using ROC Curves in Low-Income Children

1Department of Health, Kinesiology, and Recreation, University of Utah, 250 S. 1850 E., HPER North, RM 241, Salt Lake City, UT 84112, USA
2School of Community Health Sciences, University of Nevada, Reno, 1664 North Virginia Street, Reno, NV 89557, USA
3College of Physical Activity and Sport Sciences, West Virginia University, P.O. Box 6116, 375 Birch St., Morgantown, WV 26505-6116, USA

Received 15 May 2016; Revised 6 October 2016; Accepted 16 October 2016

Academic Editor: Li Ming Wen

Copyright © 2016 Ryan D. Burns et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The purpose of this study was to establish health-related waist-to-height ratio (WHtR) cut-points associating with FITNESSGRAM’s body mass index (BMI) criterion-referenced standards in low-income children. A secondary aim was to examine the classification agreement between the derived WHtR cut-points and various cardiometabolic blood markers using current recommendations. Participants were 219 children from low-income schools (mean age = 10.5 ± 0.6 years). Waist circumference, height, weight, and cardiometabolic blood markers were collected in a fasting state before school hours. Receiver operating characteristic (ROC) curves were used to determine WHtR cut-points that associated with a child meeting FITNESSGRAM’s age- and sex-specific criterion-referenced standards for BMI. The derived WHtR cut-point was 0.50 (AUC = 0.89, ; sensitivity = 0.86, specificity = 0.82, and accuracy = 84.3%). Classification agreement using the derived WHtR cut-point with various blood marker standards was statistically significant but considered weak to fair (kappa 0.14–0.34, agreement = 59%–67%, and ). The WHtR cut-point of 0.50 can be used with strong accuracy to distinguish low-income children who met FITNESSGRAM’s criterion-referenced standards for body composition; however, the evidence was weaker for its use in distinguishing low-income children meeting specific cardiometabolic blood marker recommendations.