MÁLAGA, Spain — Children with a gradually increasing waist-to-height ratio trajectory (a marker of central obesity) during the first decade of life show signs of increased cardiometabolic and cardiovascular disease (CVD) risk at age 10 years, according to data from Denmark.
Children who showed this gradual rise in central obesity from birth were more likely to demonstrate signs of cardiometabolic and CVD risk by age 10 years. These signs include elevated blood pressure and higher levels of biomarkers linked to metabolic dysfunction, such as triglycerides, homeostatic model assessment of insulin resistance (HOMA-IR), glycoprotein acetyls, and high-sensitivity C-reactive protein.
“Central obesity in childhood matters, and the waist-to-height ratio offers a simple and effective marker that may help early identification of cardiometabolic and CVD risk,” said lead researcher David Horner, MD, PhD, of Herlev and Gentofte Hospital in Copenhagen. “Anything that can prevent this trajectory of central obesity development may prove beneficial and impact outcomes.
“These data reinforce the importance of monitoring central obesity in routine care, not only tracking weight, but also measures of central obesity as part of standard assessments,” he added.
Horner presented the findings at the European Congress on Obesity (ECO) 2025.
Practical and Predictive
The waist-to-height ratio may offer a more accurate and practical assessment of cardiometabolic and CVD risk in children than body mass index (BMI) does, Horner argued.
“BMI works well for population assessments of overweight and obesity, but it can be flawed at the individual level,” he said. “An athlete who is 185 cm tall and weighs 120 kg may have a BMI of 35 but looks very different from someone else with the same BMI who is living with obesity.”
In this study, Horner explored the trajectories of waist-to-height ratios from birth to 10 years for associations with increased cardiometabolic and CVD risk.
Data were drawn from the prospective longitudinal COPSAC2010 mother-child cohort. A total of 736 mothers were recruited in 2010 and have been followed longitudinally for 13 years.
Children were assessed at 14 time points between age 0 and 10 years for waist circumference and height. At 10 years, children underwent a cardiometabolic risk assessment comprising a composite z-score of high-density lipoprotein (HDL), triglycerides, glucose, height-adjusted blood pressure, and HOMA-IR. CVD risk was determined using metabolomic biomarkers by extrapolating from a study that used an adult cohort.
Horner compared waist-to-height trajectories with cardiometabolic and CVD risk.
Cardiometabolic Risk
Horner identified three distinct waist-to-height ratio trajectories from birth to age 10 years: a stable reference group (66%), a high-falling group (18%), and a slow-rising group (15%). The reference group showed a flat line, signifying no variation in waist-to-height trajectory over time. The high-falling group started with a slightly higher ratio at birth, rose until around age 2.5 years, and then dropped slowly to about the level of the reference group.
Horner calculated that in the slow-rising group, cardiometabolic risk, as determined by the z-score, was 0.79 (P < .0001), and the CVD risk score was 0.53 (P < .0001), compared with the reference group. These findings are significant, he said.
Across the cardiometabolic risk outcomes, these overall findings were reflected in four of the five metabolic measures: high blood pressure (P = .005), high triglycerides (P = .026), high HOMA-IR (P <.0001), and low HDL (P < .001). Inflammatory markers and apolipoprotein (ApoB) level were also elevated in this group.
Compared with the reference group, the high-falling group (18%) had significantly lower A1c levels (beta = -0.90; P = .003) and slightly higher ApoB levels (beta = 0.03; P = .032).
Practical Implications
“Despite our detailed trajectory analysis, we found, in fact, that children’s level of central obesity [at age 10 years] is as good a predictor of their heart and metabolic health as knowing their trajectory,” said Horner. The “earlier pattern of gradual fat gain as seen in the slow-rising group was no longer linked to higher risk on its own,” he added. “But it’s important to understand when and how fat accumulates in childhood, because this may be a window of opportunity to intervene.”
Regarding measurement, he added, “It’s the amount of central fat at the time of assessment [here, age 10 years], not necessarily the pattern of gain over time, that seems to play the biggest role in determining their present-day risk for heart and metabolic problems.”
Commenting for Medscape Medical News, session co-moderator Andrew Agbaje, MD, a pediatric clinical epidemiologist at the University of Eastern Finland in Joensuu, welcomed the study’s findings. “We know waist-to-height ratio has potential to replace the BMI, because it is cheaply and universally available and it doesn’t vary by ethnic group, nor with age, and distinguishes between fat mass and muscle mass.
“The danger of obesity is specific for fat mass. This study shows the validity of waist-to-height [ratio] in children and, given that its value in prediction of fatty liver, type 2 diabetes, heart failure, and bone fracture is so much better than BMI, this is a very good study. If we have this tool in early childhood, we can predict those at true cardiometabolic risk.”
The study was conducted without outside funding. Horner and Agbaje reported having no relevant financial relationships.