Tri-ponderal mass index vs. body mass index to determine obesity and central obesity in adolescents
Abstract
Background Tri-ponderal mass index (TMI) is as accurate as body mass index (BMI) in predicting body fat in children and adolescents. Despite TMI simplicity, there have been few studies comparing the sensitivity and specificity of TMI and BMI in determining obesity and central obesity in adolescents.
Objective To compare the sensitivity and specificity of TMI and BMI in determining general obesity and central obesity in adolescents.
Methods This cross-sectional study was conducted in Surakarta. Healthy school children aged 12 to 17 years underwent TMI, BMI, and waist circumference measurements in 2016, 2017, 2019. Tri-ponderal mass index was calculated as the weight divided by the height in metres cubed (kg/m3). General obesity was defined by the International Obesity Task Force (IOTF) classification of overweight-obese. The BMI-WHO overweight/obesity was defined as over the 85th percentile of the BMI SDS (WHO growth reference). Central obesity was defined as waist-to-height ratio (WtHR) ? 0.5. The sensitivity and specificity of TMI and BMI were calculated.
Results A total of 1,173 children and adolescents (837 girls, 336 boys) aged 12-17 years were recruited into this study. The overall prevalences of obesity by BMI-WHO, TMI, BMI-IOTF, and WtHR were 22.68%, 14.92%, 20.55%, and 32.74%, respectively. The sensitivity of BMI-WHO vs. TMI for general obesity was 100.00% vs. 77.71%, respectively (girls) and 100.00% vs. 59.52%, respectively (boys). The specificity was 98.24% vs. 99.56%, respectively (girls) and 98.84% vs. 100%, respectively (boys). The sensitivity of BMI-WHO vs. TMI for central obesity was 58.77% vs 48.82%, respectively (girls), and 47.40% vs 27.75%, respectively (boys). The specificity was 92.81% vs. 96.49%, respectively (girls), and 90.80% vs 98.77%, respectively (boys).
Conclusion Tri-ponderal mass index consistently showed higher specificity and lower sensitivity than BMI in assessing general and central obesity.
References
2. Kansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: a review. Front Pediatr. 2021;8:581461. DOI: https://doi.org/10.3389/fped.2020.581461
3. Zhang YX, Chen J, Liu XH. Screening of central obesity among normal-weight children and adolescents in Shandong, China. Br J Nutr. 2021;126:950-5. DOI: https://doi.org/10.1017/S0007114520004882
4. Hassapidou M, Tzotzas T, Makri E, Pagkalos I, Kaklamanos I, Kapantais E, et al. Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010. BMC Public Health. 2017;17:126. DOI: https://doi.org/10.1186/s12889-017-4061-x
5. Gul Siraz U, Hatipoglu N, Mazicioglu MM, Ozturk A, Cicek B, Kurtoglu S. Triponderal mass index is as strong as body mass index in the determination of obesity and adiposity. Nutrition. 2023;105:111846. DOI: https://doi.org/10.1016/j.nut.2022.111846
6. Eslami M, Pourghazi F, Khazdouz M, Tian J, Pourrostami K, Esmaeili-Abdar Z, et al. Optimal cut-off value of waist circumference-to-height ratio to predict central obesity in children and adolescents: a systematic review and meta-analysis of diagnostic studies. Front Nutr. 2023;9:985319. DOI: https://doi.org/10.3389/fnut.2022.985319
7. Malavazos AE, Capitanio G, Milani V, Ambrogi F, Matelloni IA, Basilico S, et al. Tri-ponderal mass index vs body mass index in discriminating central obesity and hypertension in adolescents with overweight. Nutr Metab Cardiovasc Dis. 2021;31:1613-21. DOI: https://doi.org/10.1016/j.numecd.2021.02.013
8. Peterson CM, Su H, Thomas DM, Heo M, Golnabi AH, Pietrobelli A, et al. Tri-ponderal mass index vs body mass index in estimating body fat during adolescence. JAMA Pediatr. 2017;171:629-36. DOI: https://doi.org/10.1001/jamapediatrics.2017.0460
9. Sun J, Yang R, Zhao M, Bovet P, Xi B. Tri-ponderal mass index as a screening tool for identifying body fat and cardiovascular risk factors in children and adolescents: a systematic review. Front Endocrinol (Lausanne). 2021;12:694681. DOI: https://doi.org/10.3389/fendo.2021.694681
10. Niu Y, Zhang Y, Sheng J, Lu W, Li J, Mao X, Cai W, Tang Q, Shen X, & Feng Y. Tri-ponderal mass index as a screening tool for obesity prediction in children aged 6–9 years. Frontiers in Endocrinology. 2023;14. DOI: https://doi.org/10.3389/fendo.2023.1277125.
11. Shim Y. The relationship between tri-ponderal mass index and metabolic syndrome and its components in youth aged 10–20 years. Sci Rep. 2019;9:14462. DOI: https://doi.org/10.1038/s41598-019-50987-3
12. Park H & Shim Y. Distribution of Tri-Ponderal Mass Index and its Relation to Body Mass Index in Children and Adolescents Aged 10 to 20 Years. The Journal of Clinical Endocrinology and Metabolism. 2020;105,e826-e834. DOI: https://doi.org/10.1210/clinem/dgaa030.
13. Ramírez?Vélez R, Correa-Bautista J, Carrillo H., González-Jiménez, E., Schmidt-RioValle, J., Correa-Rodríguez, M., García-Hermoso, A., & González-Ruíz, K. Tri-Ponderal Mass Index vs. Fat Mass/Height3 as a Screening Tool for Metabolic Syndrome Prediction in Colombian Children and Young People. Nutrients. 2018;10. DOI: https://doi.org/10.3390/nu10040412.
14. Xijie Wang et al. "Use of Tri-Ponderal Mass Index in Predicting Late Adolescent Overweight and Obesity in Children Aged 7–18." Frontiers in Nutrition. 2020;9. DOI: https://doi.org/10.3389/fnut.2022.785863.
15. Matsuo, A., Lopes, W., Locatelli, J., Simões, C., Oliveira, G., & Nardo, N. Tri-ponderal mass index as a tool for insulin resistance prediction in overweight adolescents: A cross-sectional study. Nutrition. 2020;74,110744. DOI: https://doi.org/10.1016/j.nut.2020.110744.
16. Sims ED, Wang KW, Fleming A, Johnston DL, Zelcer SM, Rassekh SR, et al. Tri-ponderal mass index in survivors of childhood brain tumors: a cross-sectional study. Sci Rep. 2018;8:16336. DOI: https://doi.org/10.1038/s41598-018-34602-5
17. Rachma UP, Moelyo AG, Aryani I. Influence of Body Mass Index, Waist Circumference, and Physical Activity on Age of Menarche in Female Adolescent. J Matern Child Health. 2021;06(04):400-408. DOI: https://doi.org/10.26911/thejmch.2021.06.04.02
18. Ariesta D, Moelyo AG. Perbedaan Antara Rasio Lingkar Pinggang-Tinggi Badan (RLPTB) dan Indeks Massa Tubuh (IMT) dalam Menentukan Status Obesitas Anak Sekolah Menengah Pertama (SMP). UNS-F.Kedokteran, Prodi Studi Kedokteran. 2017. DOI: https://digilib.uns.ac.id/dokumen/detail/71281/
19. Moelyo A, Candrarukmi D, & Rachma U. Using the National Indonesian Growth Chart to assess short stature and obesity in urban schoolchildren in Surakarta, Indonesia: comparisons to the WHO 2007 and CDC 2000 Growth Charts. Paediatrica Indonesiana. 2022; 62(3), 180-5. DOI: https://doi.org/10.14238/pi62.3.2022.180-5
20. WHO. Global Health Observatory (GHO) data repository. Prevalence of overweight among children and adolescents, BMI > +1 standard deviations above the median, crude. (crude estimate) (%) (Noncommunicable diseases). Estimates by country, among children aged 5-19 years. DOI: http://apps.who.int/gho/data/view.main.BMIPLUS1C05-19v
21. Yoo EG. Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean J Pediatr. 2016;59(11):425-431. DOI:10.3345/kjp.2016.59.11.425
22. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ.2000;320(7244): 1240. DOI: https://doi.org/10.1136/bmj.320.7244.1240
23. Ashley-Martin J, Ensenauer R, Maguire B, Kuhle S. Predicting cardiometabolic markers in children using tri-ponderal mass index: a cross-sectional study. Arch Dis Child. 2019;104:577-82. DOI: https://doi.org/10.1136/archdischild-2018-316028
24. Neves FS, Alvim R de O, Zaniqueli D, Pani VO, Martins CR, Peçanha MA de S, et al. Tri-ponderal mass index is useful for screening children and adolescents with insulin resistance. Rev Paul Pediatr. 2020;38:e2019066. DOI: https://doi.org/10.1590/1984-0462/2020/38/2019066
25. Sulistiadi W, Kusuma D, Amir V, Tjandrarini DH, Nurjana MA. Growing up unequal: disparities of childhood overweight and obesity in Indonesia’s 514 districts. Healthcare. 2023;11:1322. DOI: https://doi.org/10.3390/healthcare11091322
26. Oktaviani S, Mizutani M, Nishide R, Tanimura S. Factors associated with overweight/obesity of children aged 6–12 years in Indonesia. BMC Pediatr. 2023;23:484. DOI: https://doi.org/10.1186/s12887-023-04321-6
27. Grigorakis DA, Georgoulis M, Psarra G, Tambalis KD, Panagiotakos DB, Sidossis LS. Prevalence and lifestyle determinants of central obesity in children. Eur J Nutr. 2016;55:1923-31. DOI: https://doi.org/10.1007/s00394-015-1008-9
28. Kilinc A, Col N, Demircioglu-Kilic B, Aydin N, Balat A, Keskin M. Waist to height ratio as a screening tool for identifying childhood obesity and associated factors. Pak J Med Sci. 2019;35:1652-8. DOI: https://doi.org/10.12669/pjms.35.6.748
29. Garcés MJ, Hernández J, Queipo G, Klünder-Klünder M, Bustos M, Herrera A, et al. Novel gender-specific visceral adiposity index for Mexican pediatric population. Rev Médica del Hosp Gen México. 2014;77:153-9. DOI: https://doi.org/10.1016/j.hgmx.2014.10.002
30. Räisänen L, Lommi S, Engberg E, Kolho KL, Viljakainen H. Central obesity in school-aged children increases the likelihood of developing paediatric autoimmune diseases. Pediatr Obes. 2022;17:e12857. DOI: https://doi.org/10.1111/ijpo.12857
31. Mancuso P. The role of adipokines in chronic inflammation. Immunotargets Ther. 2016;5:47-56. DOI: https://doi.org/10.2147/ITT.S73223
32. Travers RL, Motta AC, Betts JA, Bouloumié A, Thompson D. The impact of adiposity on adipose tissue-resident lymphocyte activation in humans. Int J Obes. 2015;39:762-9. DOI: https://doi.org/10.1038/ijo.2014.195
33. Tebar W, Vanderlei L, Scarabottolo C, Zanuto E, Ciccotti Saraiva BT, Tebar F, et al. Abdominal obesity: Prevalence,sociodemographic and lifestyle-associated factors in adolescents. J Hum Growth Dev. 2017;27:56-63. DOI: https://doi.org/10.7322/jhgd.127653
34. Ghasemirad M, Ketabi L, Fayyazishishavan E, Hojati A, Maleki ZH, Gerami MH, et al. The association between screen use and central obesity among children and adolescents: a systematic review and meta-analysis. J Health Popul Nutr. 2023;42:51. DOI: https://doi.org/10.1186/s41043-023-00391-5
Copyright (c) 2024 Annang Giri Moelyo, Hanum Ferdian
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Accepted 2024-11-21
Published 2024-11-21
