Arm Circumference-to-Height Ratio as a Situational Alternative to BMI Percentile in Assessing Obesity and Cardiometabolic Risk in Adolescents

Table 2

Weighted percent for unhealthy levels of cardiometabolic risk variables within levels of general obesity measures, N = 12,268.

Gender	Predictor	Categories	Overall CR	TC	LDL-C	HDL-C	TG	SBP	DBP	HbA1C	FPG
All adolescents	Conventional cutoffs of BMI percentile	Healthy	63.7	27.6	15.6	25.6	24.8	9.3	3.0	3.5	14.5
		Overweight	75.2	34.6	23.2	43.6	36.5	17.0	2.8	3.5	16.9
		Obese	84.8	40.4	26.7	56.1	49.3	22.9	5.3	4.5	21.9
		Severe obese	89.3	41.7	35.2	71.3	59.8	31.7	4.4	12.9	30.2
	CR cutoffs of BMI percentile	Low risk	61.7	29.9	17.1	23.8	24.8	7.5	3.0	3.2	11.7
		High risk	80.8	33.2	22.7	50.5	41.5	21.9	3.7	5.6	24.1
	CR cutoffs of arm-to-height ratio	Low risk	61.5	28.8	16.0	24.2	25.1	7.4	2.9	3.3	13.1
		High risk	81.0	34.7	24.2	50.2	41.1	22.3	3.9	5.6	22.2
Females	Conventional cutoffs of BMI percentile	Healthy	59.4	32.6	17.2	19.6	24.9	4.5	3.0	2.6	9.2
		Overweight	67.3	35.7	21.9	35.9	33.3	8.7	2.3	3.4	8.0
		Obese	80.1	41.7	25.1	45.0	42.0	10.0	5.1	4.8	13.8
		Severe obese	86.2	39.5	30.1	63.3	49.8	23.5	3.0	10.5	20.4
	CR cutoffs of BMI percentile	Low risk	60.8	33.2	18.5	22.6	26.2	5.3	2.8	2.8	9.3
		High risk	80.6	40.3	25.2	49.8	43.8	14.3	4.3	6.5	15.1
	CR cutoffs of arm-to-height ratio	Low risk	60.7	32.8	18.3	22.2	26.8	5.2	2.9	2.7	9.7
		High risk	78.7	40.6	25.2	47.5	39.7	13.3	3.8	6.0	13.0
Males	Conventional cutoffs of BMI percentile	Healthy	67.9	22.9	14.0	31.4	24.8	14.0	3.0	4.4	19.7
		Overweight	82.8	33.5	24.5	50.7	39.6	24.8	3.3	3.5	25.3
		Obese	89.1	39.3	28.3	65.9	56.0	33.9	5.5	4.3	29.4
		Severe obese	91.9	43.7	39.6	78.2	68.1	38.8	5.5	14.9	38.4
	CR cutoffs of BMI percentile	Low risk	63.5	22.6	14.1	26.3	21.9	12.3	3.5	4.3	16.6
		High risk	80.9	31.1	22.0	50.7	40.8	24.1	3.6	5.4	26.7
	CR cutoffs of arm-to-height ratio	Low risk	63.2	21.1	11.8	28.0	22.1	11.5	3.0	4.2	19.3
		High risk	81.8	32.5	23.9	51.1	41.6	25.4	3.9	5.5	25.4

CR = cardiometabolic risk; TC = total cholesterol; LDL-C = low-density lipoprotein cholesterol; HDL-C = high-density lipoprotein cholesterol; TG = triglycerides; SBP = systolic blood pressure; DBP = diastolic blood pressure; HbA1c = glycated hemoglobin; FPG = fasting plasma glucose. Overall CR indicates unhealthy level on any of the eight CR variables. Unhealthy level of each CR variable includes both borderline-risk and high-risk levels, defined according to National Heart, Lung, and Blood Institute Expert Panel Report 2012, American Academy of Pediatrics, and American Diabetes Association. Conventionally, BMI < 85^th percentile was considered healthy; ≥85^th to <95^th percentile, overweight; ≥95^th percentile to <120% of 95^th percentile, obese; ≥120% of 95^th percentile or BMI > 35 regardless of age was severe obese. For CR, BMI ≥ 94^th percentile in females and BMI ≥ 64^th percentile in males, at a given age, as well as arm-to-height ≥ 0.19 in females and arm-to-height ≥ 0.16 in males, regardless of age, were considered high-risk. Sample weights were utilized across the eight survey cycles as per survey guidelines. Combined weights were calculated for participants whose data were collected in mobile examination centers; separate weights were applied for participants in the fasting subsample who provided measures of FPG, LDL-C, and TG.