Journal of Obesity

Research Article

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

Table 3

Characteristics of overall and specific cardiometabolic risk classifications, using measures of general obesity, ages 12–18, N = 12,268.


CR	Predictor	Sensitivity	Specificity	PPV	NPV	True +	False +	True −	False −	Total	Accuracy (%)	J

Overall all adolescents	BMI ≥ 85^th percentile	42.78	77.73	82.16	36.17	1511	328	1145	2021	5005	53.07	20.51
	CR cutoffs, BMI percentile	51.08	70.67	80.68	37.59	1774	432	1041	1758	5005	56.24	21.75
	CR cutoffs, arm-to-height	52.01	70.67	80.96	38.05	1837	432	1041	1695	5005	57.50	22.68

Overall female	BMI ≥ 85^th percentile	43.88	74.85	76.97	41.05	685	205	610	876	2376	54.50	18.73
	CR cutoffs, BMI percentile	27.80	88.22	81.89	38.95	434	96	719	1127	2376	48.53	16.02
	CR cutoffs, arm-to-height	30.17	84.05	78.37	38.59	471	130	685	1090	2376	48.65	14.22

Overall male	BMI ≥ 85^th percentile	41.91	81.31	87.04	31.85	826	123	535	1145	2629	51.77	23.22
	CR cutoffs, BMI percentile	67.99	48.94	79.95	33.79	1340	336	322	631	2629	63.22	16.93
	CR cutoffs, arm-to-height	69.30	54.1	81.89	37.04	1366	302	356	605	2629	65.50	23.40

TC	BMI ≥ 85^th percentile	45.33	66.02	39.15	71.46	1646	2558	4969	1985	11158	59.28	11.35
	CR cutoffs, BMI percentile	45.47	61.68	36.41	70.10	1651	2884	4643	1980	11158	56.41	7.15
	CR cutoffs, arm-to-height	41.86	66.60	37.68	70.37	1520	2514	5013	2111	11158	58.55	8.46

LDL-C	BMI ≥ 85^th percentile	49.85	66.59	26.69	84.47	505	1387	2764	508	5164	63.30	16.44
	CR cutoffs, BMI percentile	49.85	62.25	24.37	83.57	505	1567	2584	508	5164	59.82	12.10
	CR cutoffs, arm-to-height	46.69	66.59	25.43	83.66	473	1387	2764	540	5164	62.68	13.28

HDL-C	BMI ≥ 85^th percentile	55.62	71.54	50.12	75.82	2107	2097	5272	1681	11157	66.14	27.17
	CR cutoffs, BMI percentile	59.64	69.13	49.82	76.91	2259	2275	5094	1529	11157	65.90	28.76
	CR cutoffs, arm-to-height	54.80	73.43	51.46	75.97	2076	1958	5411	1712	11157	67.11	28.23

TG	BMI ≥ 85^th percentile	53.16	70.74	45.12	76.95	882	1073	2594	777	5326	65.26	23.90
	CR cutoffs, BMI percentile	54.97	66.65	42.72	76.59	912	1223	2444	747	5326	63.01	21.62
	CR cutoffs, arm-to-height	50.63	70.55	43.75	75.95	840	1080	2587	819	5326	64.34	21.18

SBP	BMI ≥ 85^th percentile	58.18	66.48	23.48	89.99	1046	3409	6760	752	11967	65.23	24.65
	CR cutoffs, BMI percentile	67.19	64.54	25.09	91.75	1208	3606	6563	590	11967	64.94	31.73
	CR cutoffs, arm-to-height	62.24	69.01	26.21	91.18	1119	3151	7018	679	11967	68.00	31.25

DBP	BMI ≥ 85^th percentile	39.49	62.95	3.53	96.81	156	4266	7247	239	11908	62.17	2.44
	CR cutoffs, BMI percentile	43.80	60.04	3.62	96.89	173	4601	6912	222	11908	59.50	3.83
	CR cutoffs, arm-to-height	41.77	64.65	3.90	97.00	165	4070	7443	230	11908	63.89	6.42

HbA1C	BMI ≥ 85^th percentile	51.32	63.22	7.30	95.83	310	3934	6762	294	11300	62.58	14.54
	CR cutoffs, BMI percentile	57.45	60.42	7.58	96.18	347	4233	6463	257	11300	60.27	17.87
	CR cutoffs, arm-to-height	51.82	64.86	7.69	95.97	313	3759	6937	291	11300	64.16	16.68

FPG	BMI ≥ 85^th percentile	45.45	65.18	20.54	85.79	405	1567	2933	486	5391	61.92	10.63
	CR cutoffs, BMI percentile	56.00	63.31	23.21	87.90	499	1651	2849	392	5391	62.10	19.32
	CR cutoffs, arm-to-height	49.16	66.76	22.65	86.90	438	1496	3004	453	5391	63.85	15.91

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. 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. PPV = positive predictive value; NPV = negative predictive value; true + = number of true positives; false + = number of false positives; true − = number of true negatives; false − = number of false negatives; accuracy = percent of (true positives + true negatives); J = sensitivity + specificity − 100 (i.e., Youden’s Index). Conventionally, BMI ≥ 85^th percentile (overweight) was considered high risk. 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.