Vol.1, No.3, 171-181 (2011)
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJPM/
Open Journal of Preventive Medicine
Simple anthropometric measurements to predict
dyslipidemias in Mexican school-age children: a
cross-sectional study
Maria del Carmen Caamaño1,2, Olga Patricia García1, María del Rocío Arellano1,
Karina de la Torre-Carbot1, Jorge L. Rosado1,2*
1School of Natural Sciences, Universidad Autónoma de Querétaro, Querétaro, Mexico;
*Corresponding Author: jlrosado@prodigy.net.mx
2Disease and Development Center for Chronic Diseases, Querétaro, Mexico.
Received 8 September 2011; revised 14 October 2011; accepted 27 October 2011.
Objective: The purpose of this study was to i-
dentify the best predictors of dyslipidemias in
Mexican obese children using different anthro-
pometric and body composition measurements.
Methods: In an observational, cross-sectional
study, 905 children from 5 schools were meas-
ured for weight, height, waist and hip circum-
ference, and triceps and subscapular skinfolds.
A fasting blood sample was taken from a ran-
dom sub-sample of 306 children to determine
lipid profile. Abnormal total cholesterol, LDL,
HDL, triglycerides, total cholesterol to HDL ratio,
and LDL to HDL ratio, were determined. Logistic
regressions and ROC analysis were carried out
to determine the best anthropometric predictors
of these risk factors. Results: Prevalence of ele-
vated total cholesterol, triglycerides and LDL
cholesterol was 14%, 56% and 58%, respectively.
In logistic regressions, BMI and triceps skinfold
had the highest odds ratios to predict elevated
total cholesterol (1.05, 95% CI: 0.97 - 1.14; 1.07,
1.01 - 1.13, respectively), triglycerides (1.19, 1.11
- 1.27; 1.12, 1.08 - 1.17, respectively), LDL cho-
lesterol (1.11, 1.04 - 1.18; 1.09, 1.05 - 1.14, re-
spectively), total cholesterol to HDL ratio (1.06,
1.00-1.14; 1.07,1.03-1.12, respectively) and LDL
to HDL ratio risk (1.08,1.01-1.15; 1.07, 1.03-1.12,
respectively). After BMI and triceps skinfold,
subscapular skinfold also predicted dyslipide-
mias, except for low HDL; both skinfolds had a
narrower odds ratio confidence interval than
BMI. In ROC analysis, subscapular skinfold was
the best predictor of elevated triglycerides with
an AUC 0.7. Conclusion: Anthropometric
measurements are not strongly associated with
dyslipidemias in Mexican children. However,
since triceps and subscapular skinfolds were be-
tter predictors than other anthropometry meas-
ures, they may be a simple way to predict dys-
lipidemias in Mexican children.
Keywords: Cardiovascular Risk; Dyslipidemia;
Lipids; Anthropometry and Children
Obesity is a major public health problem in Mexican
children [1,2]. About 26% of children between 5 to 12
years of age are overweight or obese, and this age group
had the highest rates of obesity increase in the past 10
years. The high prevalence of obesity in Mexican popu-
lation is associated with the increased incidence in
chronic diseases observed in recent years [3,4]. An ex-
cess in body fat is associated with insulin resistance and
metabolic syndrome which results in a greater probabil-
ity of developing type 2 diabetes and hyperlipidemia
[5,6]. Dyslipidemia and the consequent cardiovascular
(CV) diseases constitute the first cause of mortality in
Mexican adults [7]. In children, obesity produces an in-
crease in the prevalence of CV risk factors such as high
concentration of total cholesterol, tryglicerides or low
concentrations of HDL [8-11].
Anthropometric measures are useful and practical
methods for screening and surveillance of childhood o-
besity [12]. The most widely used are weight and height
which are used to determine Body Mass Index (BMI),
waist and hip circumferences, and skinfolds measure-
ments [13-16]. Some studies have recommended to iden-
tify children with dyslipidemia by measuring BMI or
waist circumference (WC) [11,15,17-19]. However, other
studies have suggested that different anthropometry and
body composition measurements, such as skinfold mea-
M. del C. Caamaño et al. / Open Journal of Preventive Medicine 1 (20 11) 171-181
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surements and waist-to-height ratio (WHtR), could pre-
dict better the risk for CV diseases [10,20,21].
It has been observed that dyslipidemias, such as low
high-density lipoprotein cholesterol (HDL), elevated low-
density lipoprotein cholesterol (LDL) and triglycerides
(TG) are associated with body fat, even in the absence of
elevated body weight [17,22]. In addition, fat distribu-
tion may differ according to gender or ethnicity, thus
these variables may affect the relationship between obe-
sity and dyslipidemias [17,23].
The objective of this study was to identify the best
predictors of abnormal lipoproteins and triglycerides in
obese children from elementary schools in Queretaro,
Mexico, using different anthropometric measurements.
2.1. Subjects and Place of the Study
Children aged 6 to 12 y from 5 elementary schools in
the city of Querétaro, Mexico, participated in the study.
Parents of all children from 1st to 6th grade received oral
and written information about the study and those that
accepted to participate signed a consent form. The study
was performed in accordance with the Helsinki Declara-
tion, and the study protocol was approved by the Internal
Committee of Human Research of the University of
From 905 children that participated, 17% were over-
weight and 18% were obese [24], according to the WHO
cut off criteria [25] (according to international cut-off
points (IOTF) [26]: 21% were overweight and 13% were
obese) [24]. A sub-sample was selected to include ap-
proximately the same proportion of children with over-
weight or obesity than with normal weight to participate
in the present study. Three hundred and six children par-
ticipated in a cross-sectional study. A calculation of 300
children was established to detect a significant Area
Under the Curve (AUC) of 0.6 to predict dyslipidemias
from each anthropometry measurement compared with
0.5 considering a type I error of 0.05 and a type II error
of 0.20. An AUC value of 0.5 means that the prediction
is equal to chance, and AUC value of 1 means perfect
prediction. This sample size was calculated with Med-
Calc software V. (Mariakerke, Belgium).
2.2 Measurements
2.2.1. Anthropometry
Anthropometry and body composition were measured
in all children by trained and standardized staff. Parents
of enrolled children received written notification with
the date of their measurements and were instructed that
their children not to eat anything for the previous 12
hours. Measurements were taken on school ground, in a
room specifically assigned by school authorities and
conditioned for this study. Anthropometry included
weight, height, waist, hip circumference, and subscapu-
lar and triceps skinfolds. A fasting blood sample was
taken to measure plasma lipids concentration.
Anthropometric measurements were performed in du-
plicate by trained nutritionists following standard pro-
cedures [27]. Children were weighed in light clothes,
without sweater or jacket and without shoes using an
electronic scale (SECA, Erecta 844, Hamburg, Germany)
to the nearest 1 g. Height was measured using portable
stadimeters (SECA, Bodymeter 208, Germany) with an
accuracy of 0.1 cm. Waist and hip circumference were
measured to the nearest 0.1 cm using flexible bands
(SECA). Children’s triceps and subscapular skinfolds
thickness were measured on the child’s right side fol-
lowing standard procedures to the nearest 1 mm with a
Lange caliper (Beta Technology, Inc, Cambridge, MD).
BMI for age was calculated according to the World
Health Organization growth curves references [28]: chil-
dren were identified as overweight when their BMI-for-
age Z-score was >1SD and as obese when BMI-for-age
Z-score was > 2SD. Waist to height ratios (WHtR) were
also calculated.
2.2.2. Lipid Profile
Fasting blood samples were centrifuged at 1800 -
2000 rpm during 15 minutes and plasma was separated
and stored at –20˚C until subsequent analysis. Total
cholesterol, HDL-cholesterol and triglycerides, were
measured by enzymatic/colorimetric methods using a
commercial kit (Sera-Pak Kit Bayer Diagnostics,
France). LDL was calculated with Friedwald’s equation
According to the National Cholesterol Education Pro-
gram (1992), the cut off values to determine children at
risk of a CV disease are: total cholesterol > 170 mg/dL,
HDL < 35 mg/dL, LDL > 110 mg/dL. High triglycerides
is considered with blood concentrations > 130 mg/dL for
children above 10 y and > 100 mg/dL for children aged
10 years or less. Also, total cholesterol to HDL ratio
>3.5 and LDL to HDL ratio >2.2 were considered risk
factors [30,31].
2.3. Statistical Analysis
Descriptive analysis included central tendency meas-
urements and abnormal lipids or triglycerides prevalence.
Logistic regressions were performed to determine the
odds ratio as a measure to predict the probability to pre-
sent a dyslipidemia according with the cut-off previously
described for total cholesterol, LDL, HDL, triglycerides,
total cholesterol to HDL ratio, and LDL to HDL ratio
M. del C. Caamaño et al. / Open Journal of Preventive Medicine 1 (20 11) 171-181
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based on continuous anthropometry variables adjusting
for age. The Receiver Operating Characteristics (ROC)
analysis was carried out to evaluate the accuracy of di-
agnosis of children with a dyslipidemia according to
each anthropometry measurements. The AUC was used
as a measure of overall performance to predict dyslipi-
demias from each anthropometry measurement. A sig-
nificant p value means that the AUC is significantly dif-
ferent from 0.5. All analyses were also performed strati-
fying by gender. The software used for statistical analy-
sis was SPSS v 18.0 (Chicago Il)
Demographic characteristics of subjects included in
the study are described in Table 1. Boys had higher
WHR and WHtR than girls, and girls had a larger hip
circumference. Plasma lipids concentration is described
in Table 2. High total cholesterol concentration was
found in 13.5% of the children. Fifty six percent of the
studied children presented high TG concentrations; a
higher proportion of girls (66%) compared with boys
(49%) presented high TG concentration. Fifty eight per-
cent of children presented elevated LDL concentrations,
while 24.8% showed total cholesterol to HDL ratio > 3.5
and 64.8% showed a LDL to HDL ratio > 2.2. Obese
children had significantly higher LDL, total cholesterol
and triglycerides than normal weight and overweight
In logistics regression, all dyslipidemias, except for
low HDL cholesterol, were associated with one or more
anthropometric measures. BMI and triceps skinfold had
the highest odds ratios to predict elevated lipids or
triglycerides concentration. Odds ratio for BMI and tri-
ceps skinfold, respectively were: for high total choles-
terol: 1.05, (95%CI) 0.97 - 1.14; 1.07, 1.01 - 1.13, for
high triglycerides: 1.19, 1.11 - 1.27; 1.12, 1.08 - 1.17,
for high LDL cholesterol: 1.11, 1.04 - 1.18; 1.09, 1.05 -
1.14, for high total cholesterol to HDL ratio: 1.06, 1.00 -
1.14; 1.07, 1.03 - 1.12 and for LDL to HDL ratio: 1.08,
1.01 - 1.15; 1.07, 1.03 - 1.12. After BMI and triceps
skinfold the next best predictor of plasma lipids was
subscapular skinfold. The odds ratio confidence inter-
val for both skinfolds was narrower than BMI’s (Figure
1). When stratifying logistics regressions by gender, less
anthropometric measures could predict dyslipidemias a-
mong boys, but the results were similar to overall results.
Table 1. Anthropometry characteristics of children that participated in the study.
Anthropometry measurements All Boys Girls Normal weight Overweight Obese
N 306 161 145 94 74 137
Age (y) 9.3 ± 1.6 9.3 ± 1.6 9.4 ± 1.6 9.5 ± 1.6 9.4 ± 1.6 9.3 ± 1.6
Boys (%) 52.6 100 0 54.3 47.3 54.0
Girls (%) 47.4 0 100 45.7 52.7 46.0
BMI Zscore<1 (%) 30.8 31.9 29.7 100 0 0
BMI Zscore>1 (%) 24.3 21.9 26.9 0 100 0
BMI Zscore>2 (%) 44.9 46.2 43.4 0 0 100
BMI (Kg/m2) 20.9 ± 4.1 20.6 ± 4.1 21.1 ± 4.1 16.5 ± 1.6 a 20.0 ± 1.6 b 24.3 ± 3.0 c
BMIfor age (Z score) 1.6 ± 1.3 1.7 ± 1.4 1.5 ± 1.2 0.0 ± 0.7 a 1.6 ± 0.3 b 2.7 ± 0.6 c
Triceps skinfold (mm) 19.0 ± 6.1 18.5 ± 6.4 19.5 ± 5.7 12.8 ± 3.6 a 18.1 ± 3.9 b 23.6 ± 4.2 c
Subescapular skinfold (mm) 14.5 ± 6.8 13.9 ± 6.9 15.1 ± 6.8 7.7 ± 2.6 a 12.7 ± 3.6 b 19.9 ± 5.4 c
Waist circumference (cm) 70.3 ± 11.2 70.8 ± 11.5 69.8 ± 10.8 59.5 ± 5.7 a 67.6 ± 6.1 b 79.0 ± 8.6 c
Hip circumference (cm) 80.0 ± 10.1 78.8 ± 9.8 a 81.4 ± 10.4 b 71.7 ± 6.8 a 78.3 ± 7.1 b 86.5 ± 8.9 c
Waist to hip ratio 0.9 ± 0.1 0.9 ± 0.1 a 0.9 ± 0.1 b 0.8 ± 0.0 a 0.9 ± 0.0 b 0.9 ± 0.1 c
Skinfolds sum (mm) 33.4 ± 12.4 32.4 ± 12.7 34.6 ± 12.0 20.4 ± 5.9 a 30.8 ± 6.7 b 43.5 ± 8.6 c
Waist to height ratio 51.6 ± 6.9 52.4 ± 7.1 a 50.8 ± 6.7 b 43.8 ± 3.0 a 49.9 ± 3.1 b 57.6 ± 4.0 c
Values are means ± SD or %; a,b,cDifferent letters represent significant difference between groups (p < 0.05 in ANOVA).
M. del C. Caamaño et al. / Open Journal of Preventive Medicine 1 (20 11) 171-181
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Table 2. Lipids concentration in school-age children.
concentration All Boys Girls Normal Overweight Obesity
Total cholesterol
(mg/dL) (306) 136.4 ± 31.1(161) 138.1 ± 30.3(145) 134.5 ± 31.9(94) 131.1 ± 28.1 a(74) 128.3 ± 30.5 a (137) 144.2 ± 31.8b
(mg/dL) (301) 118.7 ± 48.8(157) 111.6 ± 46.6a(144) 126.4 ± 50.1b(93) 103.6 ± 48.6 a(74) 114.4 ± 45.5 a (133) 131.6 ± 47.8b
HDL Cholesterol
(mg/dL) (302) 48.2 ± 10.7(159) 49.1 ± 10.5 (143) 47.1 ± 10.9 (93) 48.4 ± 8.7 (74) 47.8 ± 11.7 (134) 48.3 ± 11.5
LDL Cholesterol
(mg/dL) (296) 118.2 ± 33.3(156) 117.6 ± 31.3(140) 118.8 ± 35.5(93) 114.2 ± 34.9 a(74) 109.5 ± 35.1 a (128) 126.0 ± 29.4b
Total cholesterol
to HDL ratio (300) 2.9 ± 0.8 (157) 2.9 ± 0.8 (143) 3.0 ± 0.9 (92) 2.8 ± 0.7 a (73) 2.8 ± 0.9 a (134) 3.1 ± 0.9b
LDL cholesterol to
HDL ratio (293) 2.6 ± 0.9 (153) 2.5 ± 0.9 (140) 2.6 ± 0.9 (91) 2.4 ± 0.8 a (73) 2.4 ± 1.0 a (128) 2.8 ± 0.9b
Values are (n) mean ± SD; a,bDifferent letters represent significance level of p < 0.05 i n ANOVA among gender or BMI category explain.
Among girls, all types of dyslipidemias were predicted
by some anthropometric measures; skinfolds had similar
odds ratio than BMI but narrower confidence intervals.
HDL cholesterol was better predicted only in girls by
BMI percentile and WC (Figures 2-3).
The ROC analysis showed that the only indicator of
dyslipidemia that was fairly well predicted by an an-
thropometric measurement with an AUC 70 was high
TG by subscapular skinfold (Table 3). Among boys, the
best predicted dyslipidemias were high TG by the WHR
and high LDL cholesterol by the triceps skinfold; among
girls, only high TG values were well predicted by sub-
scapular skinfold with the highest AUC value followed
by BMI, WHtR, WC and the sum of both skinfolds.
The prevalence of obesity in school-age Mexican
children is high, similar to some developed countries [32]
and is one of the highest in the world [1]. As found in
other studies in obese children with similar age groups
[8,33], the most prevalent dyslipidemia in the present
study was high concentration of TG, followed by high
concentrations of LDL cholesterol.
In the population studied, dyslipidemias are not con-
sistently present in obese children and non-obese chil-
dren may present abnormal lipids concentration, which
makes difficult to identify children at risk. For this rea-
son the AUC values from ROC curves to predict abnor-
mal lipids and triglycerides concentration from most
anthropometric measurements were slightly lower than
those reported from obese children in other populations.
For instance, in Argentinean school-age children AUC
values to predict low HDL and high triglycerides were
0.87, 0.83, and 0.84 for BMI, WC and WHtR, respect-
tively [34] and in Chinese adolescents the AUC to pre-
dict clustering of risk factors from BMI in girls and boys
were 0.85 and 0.76, and from WC were 0.82 and 0.78,
respectively. The highest AUC value found in the pre-
sent study was 0.72, an acceptable value to predict high
triglycerides from subscapular skinfold. The highest
AUC values from anthropometric measures, BMI, WC
or WHtR, that have been recognized as good predictors
of CV disease in other studies [19,35] differed from boys
to girls and overall were lower than skinfolds to predict
high triglycerides.
Body mass index had the highest odds ratio in logis-
tics regression, which means that the higher the BMI, the
higher the risk to have elevated lipids or triglycerides.
However the confidence interval for these odds ratio was
much wider than other anthropometry measurements that
had a similar odds ratio, which means that there is a
higher variability of the association between BMI and
lipids and TG concentrations than there is with other
anthropometric measurements. That may be the reason
why in ROC curves, triceps and subscapular skinfolds
seemed to diagnose similarly or even better than BMI,
WC, or WHtR.
Although different anthropometry measurements have
been evaluated to predict body fat or dyslipidemias, few
studies have compared skinfolds thickness with BMI or
waist measurements to identify children at risk of a CV
disease. Results from similar studies are controversial;
some studies have found similar results than the ones
found in the present study. Teixeira et al. [10] concluded
that trunk skinfolds predict CV disease as well as DXA
body fat variables did in Portuguese pre-adolescents.
Maffeis et al. [36] found that subscapular and triceps
skinfolds, as well as WC, may be helpful in identifying
prepubertal children with an adverse blood-lipids profile
and hypertension.
In contrast, some studies have recommended different
M. del C. Caamaño et al. / Open Journal of Preventive Medicine 1 (20 11) 171-181
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Figure 1. Odds ratio (±95%CI) of different anthropometry measurements to predict dyslipidemias from logistic regressions adjusted
for age.
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Figure 2. Odds ratio (± 95%CI) of different anthropometry measurements to predict dyslipidemias from logistic regressions adjusted
for age in boys.
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Figure 3. Odds ratio (±95% CI) of different anthropometry measurements to predict dyslipidemias from logistic regressions adjusted
for age in girls.
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Table 3. Area under the curve from Receiving Operating Characteristics (ROC) to predict dyslipidemia from anthropometry measurements.
Values are areas under the curve in the receivers operating characteristics analysis (95% CI) 1The cut offs considered at risk are: Total Cholesterol >170 mg/dL, triglycerides < 130 mg/dL in children >10y; triglyc-
erides<110 in children 10 y, LDL cholesterol >110 mg/dL, HDL cholesterol < 35 mg/dL, VLDL cholesterol < Total cholesterol to HDL ratio > 3.5 and LDL to HDL ratio > 2.2 Different to 0.50 * p < 0.05, **p <
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measurements than skinfolds to adequately predict dys-
lipidemias. Geiss et al. [11] concluded that height-to-
weight indices, such as BMI, in prepubescent German
children, are best predictors of CV risk factors. Feedman
et al. [37] also reported that WHtR is better than skin-
folds to predict adult CV risk in a bi-racial sample of
American children; although, in the same study, the pre-
diction from the sum of skinfolds thickness did not differ
much from WHtR’s.
We are thankful to the schools that kindly agreed to participate in
this study. We would like to thank Juana Ramirez Anguiano, Paola
García Juarez and Abigail Dominguez Chavero for their dedicated
work, and to Elba Suaste for her special touch when taking blood from
children and her assistance with laboratory work.
No conflicts of interest are stated, the study was partially funded by
Conacyt Mexico
The different predictors found among studies may be
related to ethnicity, gender and age which can affect the
relationship between the ratio of subcutaneous fat to
total body fat [12,38,39] and consequently anthropome-
try predictors of dyslipidemias may differ according to
such demographic characteristics [40-42]. For in- stance,
in the present study high LDL cholesterol was better
predicted in boys than in girls, probably because differ-
ences of fat deposition between boys and girls. Similarly
the distinct ethnic characteristics of our sample may re-
sult in a different fat deposition distribution which could
have led to a better prediction of dyslipidemias with tri-
ceps and subscapular skinfolds.
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than other anthropometry measures, they may be a sim-
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