Letter to the Editor
Reference values of waist circumference and waist/hip ratio in children and adolescents of Mérida, Venezuela
Valores de referencia de la circunferencia de la cintura e índice de la cintura/cadera en escolares y adolescentes de Mérida, Venezuela
Guillermo Lagos-Grisales, Vicente Cediel-Collazos, Alfonso J. Rodriguez-Morales
Corresponding author
Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
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Rodriguez-Morales" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Lagos-Grisales" ] 1 => array:2 [ "nombre" => "Vicente" "apellidos" => "Cediel-Collazos" ] 2 => array:4 [ "nombre" => "Alfonso J." "apellidos" => "Rodriguez-Morales" "email" => array:2 [ 0 => "ajrodriguezm_md@hotmail.com" 1 => "ajrodriguezmmd@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Valores de referencia de la circunferencia de la cintura e índice de la cintura/cadera en escolares y adolescentes de Mérida, Venezuela</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Mederico et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> reporting the search for regional reference values for waist circumference and waist/hip ratio in children and adolescents of the city of Mérida, Venezuela, and comparing them with international references. While we agree on the importance of studies of this type,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> we think it is worthwhile to review and discuss some methodological, statistical, and conceptual aspects regarding the internal and external validity of their findings and their implications at national and international level.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It should first be noted that the study title refers to reference values from a Venezuelan state (the main territorial unit of the country) and compares them to international and national references. This may confuse readers, because the abstract already speaks about “regional” reference values, when they were actually collected in a state, rather than a region (which would encompass several states). In Venezuela, this may be mistaken for the Andes region, including the states of Mérida, Táchira, and Trujillo.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On the other hand, for those who do not know the geography of the Venezuelan state of Mérida, the title would suggest that a representative sample of that state was studied when, in fact, only children and adolescents aged 9–18 years from one of the 23 municipalities of the state (Municipio Libertador) were passively studied (because this was not a study actively searching for subjects on a home by home basis). Since none of the other municipalities are represented in the study, it should not be considered that the values are generalizable to the rest of the state by calling them regional values, especially given that there are great differences in socioeconomic conditions. The 2001 census of the municipality estimated that 18.1% of the population lived in poverty (2.3% in extreme poverty) but, for example, in the municipality Justo Briceño in the same state of Mérida the corresponding figures for the same year were 69.3% and 35.9% (3.9 and 15 times higher) respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Moreover, the study did not even include the whole metropolitan area of the state, which comprises, in addition to Municipio Libertador where Mérida is located, the municipalities of Campo Elías, Santos Marquina, and Sucre, with a total population of 504,666 inhabitants according to data from the 2011 census of the National Statistic Institute of Venezuela. As these other municipalities were not included, the study only focused on Mérida, which has a total population of 330,821 inhabitants according to the same census.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Both the title and other parts of the study are confusing because mention is made of schoolchildren and adolescents, when the population assessed was aged 9–18 years and the population of “school age”, which is how it should be called, starts at 5 or 6 years depending on the classification being used, but never at 9 years.</p><p id="par0025" class="elsevierStylePara elsevierViewall">From the statistical and epidemiological viewpoint, we wonder whether the authors are justified in calling a reference sample one that was not selected at random, with every subject aged 9–18 years living in the city of Mérida having the same chance of being selected. Was probabilistic sampling used? Although the authors state that “The sample was selected using proportional stratified, multistage random sampling that guaranteed adequate participation by sex, public or private institution (socioeconomic level), and geographical location”, they do not detail the methods used to estimate sample size, random error, beta error, <span class="elsevierStyleItalic">a priori</span> power, and <span class="elsevierStyleItalic">post hoc</span> power. The type of study conducted is not clearly defined in either the abstract or the Material and Methods section.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The total population aged 9–18 years in the city of Mérida is 32,650. What criteria were used to select the 927 participants? How was the conclusion that the eight public schools and five private schools selected were a representative sample of the population reached? There is no specific reference to the randomization of such units, but of subjects. Similarly, a study conducted in Colombia in 2011 in the municipality of Pereira, located in the department (the equivalent to a Venezuelan state) of Risaralda, which was not intended to generate reference values, but to ascertain the prevalence of overall, acute, and chronic malnutrition in a population of 69,875 children less than 10 years of age, assessed a representative sample of 1516 subjects selected at random.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">While we agree that childhood obesity is an increasing problem, the statement in the study introduction that “The prevalence of childhood obesity has tripled since the 1970s and it is now considered to be one of the most serious public health challenges of the <span class="elsevierStyleSmallCaps">21</span>st century” is not supported by any of the multiple references which could have been cited on a subject of increasing interest in the international literature.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> A comment should be made on the references cited in the article. For example, after stating that “the use of WC is currently recommended for the diagnosis of central obesity in children”, the authors refer to an article published in 1996.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Research studies of interest on large populations (1,066,864 adolescents of both sexes) have recently been conducted in Venezuela.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">From the anthropological viewpoint, we would also like to express our disagreement with the term “races” used in the article. We think that there are no different human races,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and do not agree either with the statement that “Genetic (sexual maturation and race) and environmental factors are involved in body fat increase and, particularly, in fat distribution.” The variables given in brackets are not genetic factors, but maybe rather the presence of thrifty or other genes. Sexual maturity does not depend on genetic factors alone. The article states that differences have been found between “Hispanics, Caucasians, and Blacks”, but the first group corresponds to a region of the world, while the other two refer to skin colors.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on all of the foregoing, caution is required with regard to the perspectives, implications, and scope of research studies which may have methodological and conceptual limitations and regarding which we need to verify whether the primary objective has actually been met and the study results can in fact be reliably used for such a complex task as the generating of anthropometric reference values for the population, which is undoubtedly a clear need for countries not having such data, such as Colombia and many other Latin American countries. National reference values are only currently available for Venezuela, Cuba, Brazil, and Argentina.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lagos-Grisales G, Cediel-Collazos V, Rodriguez-Morales AJ. Valores de referencia de la circunferencia de la cintura e índice de la cintura/cadera en escolares y adolescentes de Mérida, Venezuela. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 2 | 8 |
| 2024 October | 17 | 8 | 25 |
| 2024 September | 10 | 12 | 22 |
| 2024 August | 12 | 5 | 17 |
| 2024 July | 15 | 8 | 23 |
| 2024 June | 7 | 7 | 14 |
| 2024 May | 8 | 5 | 13 |
| 2024 April | 16 | 19 | 35 |
| 2024 March | 17 | 10 | 27 |
| 2024 February | 13 | 10 | 23 |
| 2024 January | 10 | 4 | 14 |
| 2023 December | 13 | 11 | 24 |
| 2023 November | 26 | 7 | 33 |
| 2023 October | 21 | 8 | 29 |
| 2023 September | 2 | 2 | 4 |
| 2023 August | 8 | 5 | 13 |
| 2023 July | 11 | 6 | 17 |
| 2023 June | 10 | 3 | 13 |
| 2023 May | 6 | 7 | 13 |
| 2023 April | 19 | 11 | 30 |
| 2023 March | 20 | 4 | 24 |
| 2023 February | 26 | 3 | 29 |
| 2023 January | 27 | 4 | 31 |
| 2022 December | 22 | 8 | 30 |
| 2022 November | 22 | 7 | 29 |
| 2022 October | 27 | 5 | 32 |
| 2022 September | 20 | 28 | 48 |
| 2022 August | 16 | 15 | 31 |
| 2022 July | 14 | 7 | 21 |
| 2022 June | 11 | 6 | 17 |
| 2022 May | 16 | 4 | 20 |
| 2022 April | 13 | 11 | 24 |
| 2022 March | 21 | 5 | 26 |
| 2022 February | 12 | 7 | 19 |
| 2022 January | 19 | 5 | 24 |
| 2021 December | 12 | 10 | 22 |
| 2021 November | 11 | 9 | 20 |
| 2021 October | 38 | 11 | 49 |
| 2021 September | 31 | 12 | 43 |
| 2021 August | 16 | 4 | 20 |
| 2021 July | 23 | 8 | 31 |
| 2021 June | 22 | 7 | 29 |
| 2021 May | 28 | 9 | 37 |
| 2021 April | 35 | 18 | 53 |
| 2021 March | 43 | 3 | 46 |
| 2021 February | 25 | 12 | 37 |
| 2021 January | 26 | 12 | 38 |
| 2020 December | 22 | 9 | 31 |
| 2020 November | 25 | 14 | 39 |
| 2020 October | 24 | 8 | 32 |
| 2020 September | 16 | 7 | 23 |
| 2020 August | 10 | 2 | 12 |
| 2020 July | 13 | 5 | 18 |
| 2020 June | 16 | 12 | 28 |
| 2020 May | 21 | 7 | 28 |
| 2020 April | 22 | 5 | 27 |
| 2020 March | 20 | 12 | 32 |
| 2020 February | 22 | 14 | 36 |
| 2020 January | 24 | 10 | 34 |
| 2019 December | 30 | 6 | 36 |
| 2019 November | 12 | 9 | 21 |
| 2019 October | 12 | 1 | 13 |
| 2019 September | 25 | 10 | 35 |
| 2019 August | 7 | 3 | 10 |
| 2019 July | 8 | 13 | 21 |
| 2019 June | 34 | 41 | 75 |
| 2019 May | 97 | 68 | 165 |
| 2019 April | 31 | 13 | 44 |
| 2019 March | 11 | 10 | 21 |
| 2019 February | 18 | 7 | 25 |
| 2019 January | 12 | 2 | 14 |
| 2018 December | 16 | 8 | 24 |
| 2018 November | 16 | 1 | 17 |
| 2018 October | 14 | 7 | 21 |
| 2018 September | 7 | 7 | 14 |
| 2018 August | 14 | 0 | 14 |
| 2018 July | 7 | 6 | 13 |
| 2018 June | 8 | 3 | 11 |
| 2018 May | 13 | 1 | 14 |
| 2018 April | 11 | 2 | 13 |
| 2018 March | 23 | 2 | 25 |
| 2018 February | 16 | 0 | 16 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 15 | 0 | 15 |
| 2017 November | 14 | 0 | 14 |
| 2017 October | 18 | 2 | 20 |
| 2017 September | 14 | 9 | 23 |
| 2017 August | 21 | 3 | 24 |
| 2017 July | 4 | 2 | 6 |
| 2017 June | 15 | 7 | 22 |
| 2017 May | 26 | 16 | 42 |
| 2017 April | 25 | 12 | 37 |
| 2017 March | 42 | 10 | 52 |
| 2017 February | 41 | 2 | 43 |
| 2017 January | 9 | 1 | 10 |
| 2016 December | 26 | 6 | 32 |
| 2016 November | 21 | 4 | 25 |
| 2016 October | 47 | 5 | 52 |
| 2016 September | 32 | 3 | 35 |
| 2016 August | 20 | 1 | 21 |
| 2016 July | 23 | 2 | 25 |
| 2016 June | 34 | 5 | 39 |
| 2016 May | 26 | 12 | 38 |
| 2016 April | 25 | 10 | 35 |
| 2016 March | 37 | 18 | 55 |
| 2016 February | 25 | 19 | 44 |
| 2016 January | 26 | 18 | 44 |
| 2015 December | 20 | 10 | 30 |
| 2015 November | 15 | 7 | 22 |
| 2015 October | 0 | 1 | 1 |
| 2014 March | 0 | 1 | 1 |
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