Cardiorespiratory fitness and abdominal strength tests for screening obesity risk by the waist-to-height ratio in youth
DOI:
https://doi.org/10.47197/retos.v83.119574Keywords:
Anthropometrics, physical fitness, cutoff point, nutritional statusAbstract
Introduction: Obesity in children and adolescents is a relevant public health problem, and screening with acceptable accuracy using physical fitness tests supports their use as a health assessment tool.
Aim: This study aimed to identify cutoff points for physical fitness tests for screening obesity risk by the waist-to-height ratio in youth.
Methods: This study is a secondary analysis of the PROESP-Br database, selecting subjects with anthropometric variables and physical fitness tests for flexibility, cardiorespiratory fitness, and abdominal strength. The final sample consisted of 4645 children and adolescents aged between 6 and 17 years. For data analysis, we used the ROC curves.
Results: The study presents significant results for abdominal strength and 6-minute run tests in both age groups (6-12 and 13-17 years), allowing cutoff points to be established with the ROC curve. For the 6-12-year-old group, the 6-minute run (area under the curve AUC > 0.662) optimal cutoff point was 852.5 m, and for abdominal strength (AUC >0.678), the cutoff point was 26 per minute. For the 13-17-year-old group, the 6-minute run (AUC >0.668) cutoff point was 880.50 m, and for abdominal strength (AUC >0.661), it was 30 per minute. Flexibility was the only test that did not present significant results in either of the groups.
Discussion: The findings were consistent with previous research supporting the use of physical fitness tests for screening obesity risk in youth, and these results stood out for incorporating the waist-to-height ratio as the reference criterion.
Conclusion: The 6-minute run test and abdominal strength test showed sufficient accuracy for screening obesity risk in youth aged 6–12 and 13–17 years.
References
Alves de Almeida, D. (2025). Relationship between anthropometric values and physical fitness in children and adolescents. Sustainability and Sports Science Journal, 3(3), 150–157. https://doi.org/10.55860/WDQH9830
Arafa, A., Yasui, Y., Kokubo, Y., Kato, Y., Matsumoto, C., Teramoto, M., Nosaka, S., & Kogirima, M. (2024). Lifestyle Behaviors of Childhood and Adolescence: Contributing Factors, Health Consequences, and Potential Interventions. American Journal of Lifestyle Medicine. https://doi.org/10.1177/15598276241245941
Ashwell, M., & Gibson, S. (2016). Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference. BMJ Open, 6(3), e010159. https://doi.org/10.1136/bmjopen-2015-010159
Ashwell, M., Gunn, P., & Gibson, S. (2012). Waist‐to‐height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta‐analysis. Obesity Reviews, 13(3), 275–286. https://doi.org/10.1111/j.1467-789X.2011.00952.x
Ashwell, M., & Hsieh, S. D. (2005). Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International Journal of Food Sciences and Nutrition, 56(5), 303–307. https://doi.org/10.1080/09637480500195066
Aune, D., Sen, A., Prasad, M., Norat, T., Janszky, I., Tonstad, S., Romundstad, P., & Vatten, L. J. (2016). BMI and all cause mortality: systematic review and non-linear dose-response meta-analysis of 230 cohort studies with 3.74 million deaths among 30.3 million participants. BMJ, i2156. https://doi.org/10.1136/bmj.i2156
Browning, L. M., Hsieh, S. D., & Ashwell, M. (2010). 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. Nutrition Research Reviews, 23(2), 247–269. https://doi.org/10.1017/S0954422410000144
Burns, R., Hannon, J. C., Brusseau, T. A., Shultz, B., & Eisenman, P. (2013). Indices of Abdominal Adiposity and Cardiorespiratory Fitness Test Performance in Middle-School Students. Journal of Obesity, 2013, 1–8. https://doi.org/10.1155/2013/912460
Buss, J. (2014). Limitations of Body Mass Index to Assess Body Fat. Workplace Health & Safety, 62(6), 264–264. https://doi.org/10.1177/216507991406200608
Campos Rodríguez, A. Y., Romero García, J. A., Hall-López, J. A., & Ochoa Martínez, P. Y. (2020). Panorama del sobrepeso y la obesidad en escolares de Latinoamérica (Overview of overweight and obesity in Latin American schools). Retos, (39). https://doi.org/10.47197/retos.v0i39.78426
Castro‐Piñero, J., Girela‐Rejón, M. J., González‐Montesinos, J. L., Mora, J., Conde‐Caveda, J., Sjöström, M., & Ruiz, J. R. (2013). Percentile values for flexibility tests in youths aged 6 to 17 years: Influence of weight status. European Journal of Sport Science, 13(2), 139–148. https://doi.org/10.1080/17461391.2011.606833
Dong, J., Song, P., Zhang, Z., & Zhang, J. (2024). Curvilinear association between waist-to-height ratio and cardiorespiratory fitness: a cross-sectional study based on nationwide data from Chinese children and adolescents. BMC Sports Science, Medicine and Rehabilitation, 16(1), 73. https://doi.org/10.1186/s13102-024-00868-8
Eslami, M., Pourghazi, F., Khazdouz, M., Tian, J., Pourrostami, K., Esmaeili-Abdar, Z., Ejtahed, H.-S., & Qorbani, M. (2023). 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. Frontiers in Nutrition, 9. https://doi.org/10.3389/fnut.2022.985319
Forkert, E. C. O., Rendo-Urteaga, T., Nascimento-Ferreira, M. V., de Moraes, A. C. F., Moreno, L. A., & de Carvalho, H. B. (2016). Abdominal obesity and cardiometabolic risk in children and adolescents, are we aware of their relevance? Nutrire, 41(1), 15. https://doi.org/10.1186/s41110-016-0017-7
Gilleard, W., & Smith, T. (2007). Effect of obesity on posture and hip joint moments during a standing task, and trunk forward flexion motion. International Journal of Obesity, 31(2), 267–271. https://doi.org/10.1038/sj.ijo.0803430
Hernández-Jaña, S., Forte Freitas Junior, I., Jorquera-Aguilera, C., & Rodríguez-Rodríguez, F. (2025). Utilidad del índice de masa triponderal para determinar el porcentaje de grasa corporal en niños y niñas chilenos de 9 a 14 años. Journal of Movement & Health, 22(2). https://doi.org/10.5027/jmh-Vol22-Issue2(2025)art247
Hsu, C.-Y., Chen, L.-S., Chang, I.-J., Fang, W.-C., Huang, S.-W., Lin, R.-H., Ueng, S. W.-N., & Chuang, H.-H. (2021). Can Anthropometry and Body Composition Explain Physical Fitness Levels in School-Aged Children? Children, 8(6), 460. https://doi.org/10.3390/children8060460
Jones, M. A., Hitchen, P. J., & Stratton, G. (2000). The importance of considering biological maturity when assessing physical fitness measures in girls and boys aged 10 to 16 years. Annals of Human Biology, 27(1), 57–65. https://doi.org/10.1080/030144600282389
Kasović, M., Štefan, L., Petrić, V., Štemberger, V., & Blažević, I. (2022). Defining Optimal Cut-Points for Cardiorespiratory Fitness Associated With Overweight/Obesity in Children: A School-Based Study. Frontiers in Physiology, 13. https://doi.org/10.3389/fphys.2022.784787
Kılınç, A., Çöl, N., Demircioğlu-Kılıç, B., Aydin, N., Balat, A., & Keskin, M. (2019). Waist to height ratio as a screening tool for identifying childhood obesity and associated factors. Pakistan Journal of Medical Sciences, 35(6). https://doi.org/10.12669/pjms.35.6.748
Latorre Román, P. A., Salazar, C. M., Montilla, J. A. P., Cabrera-Linares, J. C., Andrade-Lara, K. E., Fuentes, A. R., & Silva, J. M. E. (2025). Reference Values in the 6-Minute Walk Test in Chilean Children Aged 3–10 Years and Relationship With Cardiometabolic Risk. Pediatric Exercise Science, 37(1), 54–61. https://doi.org/10.1123/pes.2023-0127
Lloyd, R. S., Oliver, J. L., Faigenbaum, A. D., Myer, G. D., & De Ste Croix, M. B. A. (2014). Chronological Age vs. Biological Maturation. Journal of Strength and Conditioning Research, 28(5), 1454–1464. https://doi.org/10.1519/JSC.0000000000000391
Malina, R. M. (2014). Top 10 Research Questions Related to Growth and Maturation of Relevance to Physical Activity, Performance, and Fitness. Research Quarterly for Exercise and Sport, 85(2), 157–173. https://doi.org/10.1080/02701367.2014.897592
Marques, A., Henriques-Neto, D., Peralta, M., Martins, J., Gomes, F., Popovic, S., Masanovic, B., Demetriou, Y., Schlund, A., & Ihle, A. (2021). Field-Based Health-Related Physical Fitness Tests in Children and Adolescents: A Systematic Review. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.640028
Megchún Hernández, M., Espinosa Raya, J., García Parra, E., Gómez Pliego, R., Castellanos Pérez, M., & Briones Aranda, A. (2022). Comparative analysis of anthropometric indicators for diagnosing obesity and predicting cardiometabolic risk in Mexican adolescents. Nutrición Hospitalaria. https://doi.org/10.20960/nh.03897
Millard-Stafford, M., Becasen, J. S., Beets, M. W., Nihiser, A. J., Lee, S. M., & Fulton, J. E. (2013). Is Physical Fitness Associated With Health in Overweight and Obese Youth? A Systematic Review. Kinesiology Review, 2(4), 233–247. https://doi.org/10.1123/krj.2.4.233
Moore, S. A., Mckay, H. A., Macdonald, H., Nettlefold, L., Baxter-Jones, A. D. G., Cameron, N., & Brasher, P. M. A. (2015). Enhancing a Somatic Maturity Prediction Model. Medicine & Science in Sports & Exercise, 47(8), 1755–1764. https://doi.org/10.1249/MSS.0000000000000588
Nevill, A. M., Duncan, M. J., & Myers, T. (2022). BMI is dead; long live waist-circumference indices: But which index should we choose to predict cardio-metabolic risk? Nutrition, Metabolism and Cardiovascular Diseases, 32(7), 1642–1650. https://doi.org/10.1016/j.numecd.2022.04.003
Nuttall, F. Q. (2015). Body Mass Index. Nutrition Today, 50(3), 117–128. https://doi.org/10.1097/NT.0000000000000092
Pelegrini, A., Silva, D. A. S., de Lima Silva, J. M. F., Grigollo, L., & Petroski, E. L. (2015). Anthropometric indicators of obesity in the prediction of high body fat in adolescents. Revista Paulista de Pediatria (English Edition), 33(1), 56–62. https://doi.org/10.1016/S2359-3482(15)30031-2
Piqueras, P., Ballester, A., Durá-Gil, J. V., Martinez-Hervas, S., Redón, J., & Real, J. T. (2021). Anthropometric Indicators as a Tool for Diagnosis of Obesity and Other Health Risk Factors: A Literature Review. In Frontiers in Psychology (Vol. 12). Frontiers Media S.A. https://doi.org/10.3389/fpsyg.2021.631179
Quiroga-Torres, E., Delgado-López, V., & Ramos-Padilla, P. (2022). Diagnostic value of anthropometric indicators for overweight and obesity. Introduction. Archivos Latinoamericanos de Nutricion, 72(1), 23–30. https://doi.org/10.37527/2022.72.1.003
Ramesh, N., Kumar, P., Sweta, S., Prasad, A., & Tiwari, L. K. (2024). Correlation of anthropometric measurements with body mass index and estimation of the proportion of metabolic syndrome among overweight and obese children: a hospital-based cross-sectional study. BMJ Paediatrics Open, 8(1), e002354. https://doi.org/10.1136/bmjpo-2023-002354
Reis Gaya, A., Gaya, A., Pedretti, A., & Mello, J. (2021). PROJETO ESPORTE BRASIL Manual de medidas, testes e avaliações Versão 2021.
Ruiz, J. R., Cavero-Redondo, I., Ortega, F. B., Welk, G. J., Andersen, L. B., & Martinez-Vizcaino, V. (2016). Cardiorespiratory fitness cut points to avoid cardiovascular disease risk in children and adolescents; what level of fitness should raise a red flag? A systematic review and meta-analysis. British Journal of Sports Medicine, 50(23), 1451–1458. https://doi.org/10.1136/bjsports-2015-095903
Savva, S., Tornaritis, M., Savva, M., Kourides, Y., Panagi, A., Silikiotou, N., Georgiou, C., & Kafatos, A. (2000). Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. International Journal of Obesity, 24(11), 1453–1458. https://doi.org/10.1038/sj.ijo.0801401
Silva, D. A. S., Lang, J. J., Petroski, E. L., Mello, J. B., Gaya, A. C. A., & Tremblay, M. S. (2020). Association between 9-minute walk/run test and obesity among children and adolescents: evidence for criterion-referenced cut-points. PeerJ, 8, e8651. https://doi.org/10.7717/peerj.8651
Thompson, H. R., Pavlovic, A., D’Agostino, E., Napier, M. D., Konty, K., & Day, S. E. (2021). The association between student body mass index and tests of flexibility assessed by the FITNESSGRAM®: New York City public school students, 2017–18. PLOS ONE, 16(12), e0262083. https://doi.org/10.1371/journal.pone.0262083
Tomkinson, G. R., Carver, K. D., Atkinson, F., Daniell, N. D., Lewis, L. K., Fitzgerald, J. S., Lang, J. J., & Ortega, F. B. (2018). European normative values for physical fitness in children and adolescents aged 9–17 years: results from 2 779 165 Eurofit performances representing 30 countries. British Journal of Sports Medicine, 52(22), 1445–1456. https://doi.org/10.1136/bjsports-2017-098253
Ukegbu, T. E., Wylie-Rosett, J., Groisman-Perelstein, A. E., Diamantis, P. M., Rieder, J., Ginsberg, M., Lichtenstein, A. H., Matthan, N. R., & Shankar, V. (2023). Waist-to-height ratio associated cardiometabolic risk phenotype in children with overweight/obesity. BMC Public Health, 23(1), 1549. https://doi.org/10.1186/s12889-023-16418-9
Wu, Y., Li, D., & Vermund, S. H. (2024). Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity. International Journal of Environmental Research and Public Health, 21(6), 757. https://doi.org/10.3390/ijerph21060757
Yan, W., Bingxian, H., Hua, Y., Jianghong, D., Jun, C., Dongliang, G., Yujian, Z., Ling, L., Yanying, G., Kaiti, X., Xiaohai, F., & Da, M. (2007). Waist‐to‐Height Ratio is an Accurate and Easier Index for Evaluating Obesity in Children and Adolescents. Obesity, 15(3), 748–752. https://doi.org/10.1038/oby.2007.601
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