SciELO - Scientific Electronic Library Online

vol.38 número4Llegar al peso ideal o estar metabólicamente sano. ¿Cuál debe ser nuestro verdadero objetivo?Vitamina D y su importancia en la infección por SARS-CoV-2 índice de autoresíndice de materiabúsqueda de artículos
Home Pagelista alfabética de revistas  

Servicios Personalizados




Links relacionados

  • En proceso de indezaciónCitado por Google
  • No hay articulos similaresSimilares en SciELO
  • En proceso de indezaciónSimilares en Google


Nutrición Hospitalaria

versión On-line ISSN 1699-5198versión impresa ISSN 0212-1611

Nutr. Hosp. vol.38 no.4 Madrid jul./ago. 2021  Epub 20-Sep-2021 


Waist-to-height ratio and body mass index as indicators of obesity in children from Montenegro

Índice cintura-estatura e índice de masa corporal como indicadores de obesidad en niños de Montenegro

Marija Bubanja1  , Marina Vukotic1  , Georgi Georgiev2  , Zoran Milosevic3 

1Faculty for Sport and Physical Education. University of Montenegro. Podgorica, Montenegro

2Faculty of Sport and Physical Education. University of Novi Sad. Novi Sad, Serbia

3Faculty for Physical Education. University St. Cyril and Methodius. Skopje, Republic of Macedonia

Dear Editor-in-Chief,

During the recent decade there has been a noticeable increase in obesity among children and adolescents. The number of obese individuals aged five to 19 years has increased ten times globally – from 11 million in 1975 to 124 million in 2016. Researchers have determined that there were an additional 213 million respondents who were overweight in 2016, but they were below the obesity threshold (1). Obesity during childhood and adolescence, especially in the abdominal area, might be associated with adverse health issues later in adulthood, such as elevated serum triglycerides and low-density lipoprotein cholesterol (LDL-C), and a reduction in high-density lipoprotein cholesterol (HDL-C) (2). Body mass index (BMI) is commonly used to identify overweight and obesity in children, adolescents, and adults (3). Despite its standardized use, BMI tends to be a less precise indicator for determining obesity among children because it does not provide indications about adipose tissue distribution (4). Also, some authors argue that BMI cannot be applied to the population of the western Balkans due to a specific body composition that can stimulate a disproportionate BMI to increase at the expense of muscle and bone components. Therefore, it requires creating special standards for overweight and obesity prevention for the population in this region (5). On the other hand, Browning et al. (6) believe that the waist-to-height ratio (WtHR) is a better predictor of diabetes and cardiovascular disease (CVD) than BMI because it is a simple and accurate index that does not depend on age, and which has been highly applicable in the screening of overweight and obesity in children and adolescents (7). Therefore, the aim of this study was to determine the percentage of central obesity among younger school-aged children from the northern region in Montenegro, based on the waist-to-height ratio (WtHR), and then compare those results with body mass index (BMI) values. This study was conducted in a sample of 400 respondents, children aged 9 and 10 years (180 boys and 220 girls). Body height, body weight, and waist circumference were measured to assess anthropometric characteristics, while central obesity (WtHR > 0.5) and BMI were calculated by the standard formula (6,8). Testing was conducted in March 2021. According to the results of this study, the central obesity rate among boys from the northern region of Montenegro, based on the WtHR index, is 10.4 %, while it is slightly lower among girls – 7.6 %. However, according to the BMI, obesity among boys is far higher – 19.4 %, and among girls it is 7.8 %. In terms of girls, obesity does not represent a high percentage, and both indices show similar results. On the other hand, BMI shows an extremly high obesity percentage among boys compared to the WtHR index, which shows significantly lower percentage values. As a result, the assumption that BMI criteria should be adjusted for different regions and races, including the Montenegrin population, is justified, as previous research has established that the population of the western Balkans has a specific body composition (5).The results display a difference in central obesity between sexes, which could be explained by a mechanism detected in the second half of the 20th century (9), which shows that boys are under a stronger environmental influence than girls in both skeletal maturation rate and linear growth.


1. Bjelica D, Popovic S. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016:a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet 2017;390:2627-42. DOI:10.1016/S0140-6736(17)32129-3 [ Links ]

2. Koskinen J, Magnussen CG, Sinaiko A, Woo J, Urbina E, Jacobs DR, et al. Childhood age and associations between childhood metabolic syndrome and adult risk for metabolic syndrome, type 2 diabetes mellitus and carotid intima media thickness:The International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2017;6(8):e005632. DOI:10.1161/JAHA.117.005632 [ Links ]

3. Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr 2002;76(3):653-8. DOI:10.1093/ajcn/76.3.653 [ Links ]

4. McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr 2001;55(10):902-7. DOI:10.1038/sj.ejcn.1601240 [ Links ]

5. Starc G, Popovic S, Djordjic V, Ostojic S, Music-Milanovic S, Kujindzic E, et al. Differences in body height between the contemporary Western Balkan children and the WHO growth references core sample. Anthropological Notebooks;2019. Available from: ]

6. Browning LM, Hisich SD, Ashwell M. A suprematic review of waistto- height ratio as a screening tool for the prediction of cardiovascular disease and diabetes:0.5 could be a suitable boundary value. Nutr Res Rev 2010;23(2):247-69. DOI:10.1017/S0954422410000144 [ Links ]

7. Yan W, Bingxian H, Hua Y, Jianghong D, Jun C, Dongliang G, et al. Waist-to-height ratio is an accurate and easier index for evaluating obesity in children and adolescents. Obesity 2007;15(3):748-52. DOI:10.1038/oby.2007.601 [ Links ]

8. World Health Organization. WHO AnthroPlus for Personal Computers Manual Software for assessing growth of the world's children and adolescents. Department of Nutrition for Health and Development, Geneva, Switzerland;2007. Available from: ]

9. Stinson S. Sex differences in environmental sensitivity during growth and development. Am J Phys Anthropol 1985;28(6):123-47. DOI:10.1002/ajpa.1330280507 [ Links ]

Conflicts of interest:

the authors declare no conflicts of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License