Comments on “Overweight status, abdominal circumference, physical activity, and functional constipation in children”

The article entitled “Overweight status, abdominal circumference, physical activity, and functional constipation in children” by Dias et al.¹ assessed the prevalence of functional constipation and its relationship with food intake, overweight status, and physical activity in children. First, in the scientific context, we need to use technical terms, e.g., “circumference” is wrong; measurements of body surfaces are called “perimeters”; “height” must be “stature”; and “weight” should be “body mass” (note that the concept of BMI is body [mass] index, not body [weight] index)². Besides, the authors used the abdomen perimeter divided by stature; however, this mathematical measurement is wrong because the literature recommends the waist perimeter (waist-to-stature ratio)³.

The use of the waist perimeter to assess the risk of metabolic diseases⁴,⁵ is also used to measure the waist–hip ratio⁶,⁷. However, the waist–hip ratio uses two variables (the waist and hip) that change during body mass loss. Furthermore, the waist–hip ratio disregards body proportionality. For example, patients with smaller stature (e.g., 150 cm) have waist areas with smaller perimeters compared to taller patients (e.g., 185 cm). This must be considered in the clinical assessment, as body proportionality is supported by Cube law⁸. Therefore, I recommend that researchers and clinicians to use the waist-to-stature ratio³. The cutoff point is <0.50 (i.e., the waist perimeter must be less than 50% of the patients’ stature)⁹–¹².

• Funding: This study was partially supported by the Coordination for the Improvement of Higher Education Personnel (CAPES, BR – code 001). However, the funding source had no involvement in the study design, collection, analysis, interpretation of data, and writing of the report, nor in the decision to submit the article for publication.

REFERENCES

• ¹
  Dias FC, Boilesen SN, Tahan S, Melli L, Morais MB. Overweight status, abdominal circumference, physical activity, and functional constipation in children. Rev Assoc Med Bras (1992). 2023;69(3):386-91. https://doi.org/10.1590/1806-9282.20220845
  » https://doi.org/10.1590/1806-9282.20220845
• ²
  Pontes-Silva A. May skeletal muscle index predict mortality in individuals with cirrhosis? J Clin Exp Hepatol. 2023;13(1):190. https://doi.org/10.1016/j.jceh.2022.07.250
  » https://doi.org/10.1016/j.jceh.2022.07.250
• ³
  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(2):247-69. https://doi.org/10.1017/S0954422410000144
  » https://doi.org/10.1017/S0954422410000144
• ⁴
  You Q, Jiang Q, Li D, Wang T, Wang S, Cao S. Waist circumference, waist-hip ratio, body fat rate, total body fat mass and risk of low back pain: a systematic review and meta-analysis. Eur Spine J. 2022;31(1):123-35. https://doi.org/10.1007/s00586-021-06994-y
  » https://doi.org/10.1007/s00586-021-06994-y
• ⁵
  Lam BC, Koh GC, Chen C, Wong MT, Fallows SJ. Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) as predictors of cardiovascular disease risk factors in an adult population in Singapore. PLoS One. 2015;10(4):e0122985. https://doi.org/10.1371/journal.pone.0122985
  » https://doi.org/10.1371/journal.pone.0122985
• ⁶
  Cao Q, Yu S, Xiong W, Li Y, Li H, Li J, et al. Waist-hip ratio as a predictor of myocardial infarction risk: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(30):e11639. https://doi.org/10.1097/MD.0000000000011639
  » https://doi.org/10.1097/MD.0000000000011639
• ⁷
  Qin J, Chen Y, Guo S, You Y, Xu Y, Wu J, et al. Effect of Tai Chi on quality of life, body mass index, and waist-hip ratio in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2021;11:543627. https://doi.org/10.3389/fendo.2020.543627
  » https://doi.org/10.3389/fendo.2020.543627
• ⁸
  Froese R. Cube law, condition factor and weight-length relationships: history, meta-analysis and recommendations. J Appl Ichthyol. 2006;22(4):241-53. https://doi.org/10.1111/j.1439-0426.2006.00805.x
  » https://doi.org/10.1111/j.1439-0426.2006.00805.x
• ⁹
  Corrêa MM, Thumé E, Oliveira ER, Tomasi E. Performance of the waist-to-height ratio in identifying obesity and predicting non-communicable diseases in the elderly population: a systematic literature review. Arch Gerontol Geriatr. 2016;65:174-82. https://doi.org/10.1016/j.archger.2016.03.021
  » https://doi.org/10.1016/j.archger.2016.03.021
• ¹⁰
  Ashwell M, Gunn P, Gibson S. Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis. Obes Rev. 2012;13(3):275-86. https://doi.org/10.1111/j.1467-789X.2011.00952.x
  » https://doi.org/10.1111/j.1467-789X.2011.00952.x
• ¹¹
  Mak KK, Ho SY, Lo WS, Thomas NG, McManus AM, Lam TH. The use of waist-to-stature ratio to identify underweight and overweight in adolescents. Int J Pediatr Obes. 2010;5(5):390-5. https://doi.org/10.3109/17477161003728451
  » https://doi.org/10.3109/17477161003728451
• ¹²
  Ho SY, Lam TH, Janus ED, Hong Kong Cardiovascular Risk Factor Prevalence Study Steering Committee. Waist to stature ratio is more strongly associated with cardiovascular risk factors than other simple anthropometric indices. Ann Epidemiol. 2003;13(10):683-91. https://doi.org/10.1016/s1047-2797(03)00067-x
  » https://doi.org/10.1016/s1047-2797(03)00067-x

Publication Dates

• Publication in this collection
  29 May 2023
• Date of issue
  2023

History

• Received
  07 Mar 2023
• Accepted
  16 Mar 2023