Glycated hemoglobin HbA1c, waist circumference, and waist-to-height ratio in overweight and obese adolescents

Main Article Content

Elysa Nur Safrida
Neti Nurani
Madarina Julia


Background Central obesity has been associated with a high risk of insulin resistance. Waist circumference and waist-to-height ratio are anthropometric indices for determining central obesity and have been associated with increased blood pressure, cholesterol, and insulin levels. In adults, fat distribution around the waist is a valid predictor of glycated hemoglobin (HbA1c)levels, and is currently recommended by experts as a diagnostic tool for diabetes. Central obesity measurement has advantages over fasting blood glucose and oral glucose tolerance tests, as it is simple and inexpensive to perform.

Objective To assess for correlations between HbA1c level and waist circumference as well as waist-to-height ratio and to assess factors potentially associated with HbA1c levels in overweight and obese adolescents.

Methods This cross-sectional study was done in four junior high schools in Yogyakarta, which were obtained by cluster sampling. Overweight and obese students who were generally healthy were included in the study. Subjects underwent waist circumference and waist-to-height ratio measurements, as well as blood tests for HbA1clevels.

Results Sixty-seven children participated in the study, with 48 girls (71.6%) and 19 boys (28.4%). Waist circumference and HbA1c levels were not significantly associated (r=0.178; P=0.15). However, waist-to-height ratio and HbA1c levels had a weak positive correlation (r=0.21; P=0.04). Linear regression analysis revealed that waist-to-height ratio had a significant association with HbA1c level (P=0.02), but age, sex, and nutritional status did not.

Conclusion Waist-to-height ratio is correlated with HbA1c levels in overweight and obese adolescents.

Article Details

How to Cite
Safrida E, Nurani N, Julia M. Glycated hemoglobin HbA1c, waist circumference, and waist-to-height ratio in overweight and obese adolescents. PI [Internet]. 28Apr.2017 [cited 24Apr.2019];57(2):57-2. Available from:


1. Rocchini AP. Childhood obesity and a diabetes epidemic. N Engl J Med. 2002;346:854-5.
2. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 1999. Report No.: 894. p.32-3.
3. Kementrian Kesehatan RI. Riset Kesehatan Dasar (RISKESDAS). Laporan nasional badan penelitian dan pengembangan kesehatan. Jakarta: Kementrian Kesehatan RI; 2010. p. 20.
4. Ryha NH. Hubungan antara lingkar pinggang dan rasio lingkar pinggang-panggul dengan resistensi insulin pada remaja putri obes di Yogyakarta [thesis]. Universitas Gadjah Mada; 2009.
5. Velloso LA, Araujo EP, de Souza CT. Diet-induced inflammation of the hypothalamus in obesity. Neuroimmunomodulation. 2008;15:189-93.
6. von Kries R, Koletzko B, Sauerwald T, von Mutius E, Barnert D, Gnmert V, et al. Breastfeeding and obesity: cross sectional study. BMJ. 1999;319:147-50.
7. Thevenod F. Pathophysiology of diabetes mellitus type 2: roles of obesity insulinresistance and 3-cell dysfunction. In: Masur K, Thevenod F, Zanker K, editors. Diabetes and Cancer. Front Diabetes ed. Basel: Karger; 2008.p.1-18
8. International Expert Committee. Report on the role of the A1c assay in the diagnosis of diabetes. Diabetes Care. 2009;32:1327-34.
9. Nowicka P, Santoro N, Liu H, Lartaud D, Shaw MM, Goldberg R, et al. Utility of hemoglobin A1c for diagnosing prediabetes and diabetes in obese children and adolescents. Diabetes Care. 2011;34:1306-11.
10. Malonda AA, Tangklilisan HA. Comparison of metabolic syndrome criteria in obese and overweight children. Paediatr Indones. 2010;50:295-9.
11. Freedman DS, Kahn HS, Mei Z, Grummer-Strawn LM, Dietz WH, Srinivasan S, et al. Relation of body mass index and waist-to-height ratio to cardiovascular disease risk factors in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 2007;86:33-40.
12. Wu HY, Chen LL, Zheng J, Liao YF, Zhou M. Simple anthropometric indices in relation to cardiovascular risk factors in Chinese type 2 diabetic patients. Clin J Physiol. 2007;50:135-42.
13. Aerbeli I, Gut-Knabenhans I, Kusche-Amman RS, Molinari L, Zimmermann MB. Waist circumference and waist to height ratio percentiles in a nationally representative sample of 6-13 year old children in Switzerland. Swiss Med Wkly. 2011;141:w13227.
14. Mokha JS, Srinivasan SR, Dasmahapatra P, Fernandez C, Chen W, Xu J, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr. 2010;10:73.
15. Martin LF, Hunter SM. How can we do better? Obesity Research. 2012;2:398-9.
16. Adam JMF. Obesitas dan sindroma metabolik. Bandung: FK Universitas Padjajaran; 2006.
17. Motswagole BS, Kruger HS, Faber M, van Rooyen JM, de Ridder JH. The sensitivity of waist-to-height ratio in identifying children with high blood pressure. Cardiovasc J Afr. 2011;22:208-11.
18. Mahdiah. Prevalensi obesitas dan hubungan konsumsi fast food dengan kejadian obesitas pada remaja SLTP kota dan desa di Daerah Istimewa Yogyakarta [thesis]. Yogyakarta: Universitas Gadjah Mada; 2004.
19. Saydah S, Bullard KM, Imperatore G, Geiss L, Gregg EW. Cardiometabolic risk factors among US adolescents and young adults and risk of early mortality. Pediatrics. 2013;131:e679-86.
20. Asdie AM. Patogenesis dan terapi diabetes mellitus tipe 2. Yogyakarta: Penerbit Medika FK UGM; 2003.
21. Hannon TS, Rao G, Arslanian SA. Childhood obesity and type 2 diabetes mellitus. Pediatrics. 2005;116:473-80.
22. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697-738.
23. Hirschler V, Aranda C, Calcagno ML, Maccalini G, Jadzinsky M. Can waist circumference identify children with the metabolic syndrome? Arch Pediatr Adolesc Med. 2005;159:750-4.
24. Nasir BM, Aziz AA, Abdullah MR, Norhayati MN. Waist height ratio compared to body mass index and waist circumference in relation to glycemic control in Malay type 2 diabetes mellitus patients, Hospital Universiti Sains Malaysia. Intl J Collab Res Internal Med Public Health. 2012;4:406-15.
25. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation ofcircumferences and skinfold thickness to lipid and insulin concentrations inchildren and adolescents: TheBogalusa Heart Study.Am J Clin Nutr. 1999;69:308-17.
26. Eldeirawi K, Lipton RB. Predictors of hemoglobin A1c in a national sample of nondiabetic children: the Third National Health and Nutrition Examination Survey, 1988-1994. Am J Epidemiol. 2003;157:624-32.
27. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23:247-69.
28. Kusumaningrum E, Prawirohartono EP. Hubungan antara obesitas sentral dengan kadar glukosa darah puasa anak usia 10-12 tahun [thesis]. Yogyakarta: Universitas Gadjah Mada; 2011.
29. Horchani I, Mehdi O, Meriem O, Ibtissem O, Khiati K, Abdallah NB. Waist to height ratio as a new marker of metabolic syndrome in type 2 diabetic patients. Endocr Abstr. 2016;41
30. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatr. 2011;11:105.
31. Astuti LMD, Prawirohartono EP, Noormanto, Julia M. Obesitas sentral berhubungan dengan toleransi glukosa terganggu pada remaja perempuan. IJCN. 2016;8:1-6.
32. Dehgan M, Akhtar-Danesh N, Merchant AT. Childhood obesity, prevalence and prevention. Nutr J. 2005;4:24.