Body mass index as a surrogate measure of cardiovascular risk factor clustering in fifth-grade children: results from the coronary artery risk detection in the Appalachian Communities Project.

BACKGROUND: Obesity, an increasing problem in children in the United States and abroad, has been associated with risk factors for cardiovascular disease (CVD). Consequently, there is a need to determine body mass index (BMI) cut-off values for recommending comprehensive assessment and intervention for high-risk children. The objective of this study was to use results from a large-scale cross-sectional screening project, the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC), to derive BMI cut-off values that predict clustering of CVD risk factors. Design. 29 436 fifth grade West Virginia students in the United States participated in a comprehensive risk factor screening between 1997 and 2006.

METHODS: Screening included the calculation of BMI, resting blood pressure, presence or absence of acanthosis nigricans, and a fasting lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). Factor analysis and receiver operating characteristic curves were used to examine BMI as a predictor for CVD risk factor clustering.

RESULTS: BMI at the 95th percentile or higher were shown to be specific and sensitive predictors when three or more CVD risk factor clusters were present.

CONCLUSION: These findings suggest that BMI, a cost-effective assessment tool, can be used to identify CVD risk-factor clustering at the 95th percentile.