Abstract
<jats:p>Visceral adiposity drives atherosclerosis and ectopic fat deposition, including hepatic steatosis, and is a major determinant of cardiometabolic risk in pediatric obesity. In adolescents, both BMI and WC are linked to cardiometabolic comorbidities, though their predictive accuracy differs. BMI is widely used due to its simplicity, low cost, and standardized reference values, but it cannot distinguish fat from lean mass, provides no information on fat distribution, and may misclassify children during rapid growth or puberty. Its association with metabolic risk also varies by sex, ethnicity, and developmental stage, limiting its value as a standalone indicator. Measures of central adiposity, including WC and waist-to-height ratio (WHtR), have gained increasing attention because they better capture visceral fat burden and show stronger associations with early metabolic dysfunction. Both WC and BMI are positively associated with elevated blood pressure and triglyceride concentrations and inversely associated with high-density lipoprotein cholesterol. Evidence shows that WC correlates more strongly than BMI with atherogenic lipid profiles, insulin resistance, alanine aminotransferase, and serum uric acid levels. Despite these advantages, the routine use of WC in pediatric practice is limited by the lack of standardized measurement protocols and universally accepted reference charts. Emerging evidence indicates that combining BMI and WC improves risk stratification compared with BMI alone. A two-step approach—using BMI for initial screening followed by WC or WHtR to assess central adiposity—may better identify high-risk children. Future research should integrate anthropometry with advanced imaging, molecular biomarkers, and AI-based models to enhance precision in cardiometabolic risk prediction.</jats:p>