Comparison of Body Mass Index Percentiles to Detect Metabolic Syndrome Using the Korean, United States Centers for Disease Control and Prevention, and World Health Organization References in Korean Children Aged 10-16 Years.

BACKGROUND: Few studies have compared the local and international body mass index (BMI) reference sets for their relationship with metabolic syndrome (MetS) in children. This study aimed to compare the BMI percentiles using Korean, United States Centers for Disease Control and Prevention (US-CDC), and World Health Organization (WHO) charts for their ability to detect MetS in Korean children and examine their associations with the severity of MetS.

METHODS: Among 3094 children (1653 boys, age: 10-16 years) from the Korean National Health and Examination Survey 2011-2016, age and sex-specific BMI percentiles using the three charts (Korean, US-CDC, and WHO charts) were determined. MetS severity score was derived using age and sex-specific z-scores of individual MetS components.

RESULTS: The prevalence of MetS by the International Diabetes Federation criteria was 1.9%. Bland-Altman plots showed positive linear relationships between the differences in BMI percentiles and their means derived from the Korean chart and other charts (US-CDC or WHO charts). BMI percentiles were positively associated with MetS (odds ratio 1.27-1.36) and MetS severity scores (regression coefficient 0.025-0.026). Area under the receiver operating characteristics curve values for identifying MetS ranged from 0.927 (WHO chart) to 0.953 (Korean chart) at the 84.6-89.2 BMI percentiles.

CONCLUSION: The 2017 Korean BMI reference chart has a better discriminatory ability to identify clustered MetS components compared to the 2000 US-CDC chart and the 2007 WHO chart in Korean children aged 10-16 years.