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Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: a cross-sectional study
  1. Joyce Ying Hui Tee1,
  2. Wan Ying Gan1,
  3. Poh Ying Lim2
  1. 1 Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
  2. 2 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
  1. Correspondence to Dr Wan Ying Gan; wanying{at}


Objective To compare the performance of different anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and a body shape index to predict high blood pressure (BP) in adolescents using the 90th and 95th percentiles as two different thresholds.

Design Cross-sectional study.

Setting Probability proportionate to size was used to randomly select two schools in Selangor state, Malaysia.

Participants A total of 513 adolescents (58.9% women and 41.1% men) aged 12–16 years were recruited.

Primary and secondary outcome measures Weight, height, WC and BP of the adolescents were measured. The predictive power of anthropometric indices was analysed by sex using the receiver operating characteristic curve.

Results BMI and WHtR were the indices with higher areas under the curve (AUCs), yet the optimal cut-offs to predict high BP using the 95th percentile were higher than the threshold for overweight/obesity. Most indices showed poor sensitivity under the suggested cut-offs. In contrast, the optimal BMI and WHtR cut-offs to predict high BP using the 90th percentile were lower (men: BMI-for-age=0.79, WHtR=0.46; women: BMI-for-age=0.92, WHtR=0.45). BMI showed the highest AUC in both sexes but had poor sensitivity among women. WHtR presented good sensitivity and specificity in both sexes.

Conclusions These findings suggested that WHtR might be a useful indicator for screening high blood pressure risk in the routine primary-level health services for adolescents. Future studies are warranted to involve a larger sample size to confirm these findings.

  • hypertension
  • body mass index
  • waist circumference
  • waist-to-height ratio
  • Malaysian adolescents

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  • Contributors All authors contributed to the study design, revising and improving the manuscript. JYHT carried out data collection, data analysis, data interpretation and drafted the manuscript. WYG and PYL contributed to data interpretation and provided a critical review of the manuscript.

  • Funding This study was supported by Putra Grant—Postgraduate Initiative (GP-IPS) from the Universiti Putra Malaysia, grant number GP/IPS/2017/9519900.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Ethics Committee for Research Involving Human Subject of Universiti Putra Malaysia (Reference No. FPSK(EXP16) P186).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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