Predicting cardiometabolic markers in children using tri-ponderal mass index: A cross-sectional study

Jillian Ashley-Martin, Regina Ensenauer, Bryan Maguire, Stefan Kuhle

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective To model the development of the tri-ponderal mass index (TMI, kg/m 3) throughout childhood and adolescence and to compare the utility of the TMI with that of the body mass index (BMI, kg/m 2) to predict cardiometabolic risk in a population-based sample of Canadian children and youth. Methods We used data from the Canadian Health Measures Survey to model TMI from 6 to 19 years of age. Percentile curves were developed using the LMS method. Logistic regression was used to predict abnormal levels of cardiometabolic markers; predictive accuracy was assessed using the area under the ROC curve (AUC). Results Mean TMI was relatively stable from ages 6 to 19 years for both sexes, but variability increased with age. There was no notable difference in AUC values for prediction models based on BMI z-score compared with TMI for any of the outcomes. For both BMI z-score and TMI, prediction accuracy was good for homeostasis model assessment insulin resistance and having ≥3 abnormal tests (AUC>0.80), fair for C-reactive protein and poor for the remainder of the outcomes. Conclusions The use of a single sex-specific TMI cut-off for overweight or obesity is hampered by the increasing variability of the measure with age. Weight-for-height indices likely have only limited ability to predict cardiometabolic marker levels, and changing the scaling power of height is unlikely to improve predictive accuracy.

Original languageEnglish
Pages (from-to)577-582
Number of pages6
JournalArchives of Disease in Childhood
Issue number6
StatePublished - Jun 1 2019
Externally publishedYes


  • epidemiology
  • growth
  • metabolic
  • obesity
  • statistics


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