Association of weight-adjusted waist index and Albuminuria in children and adolescents: A national population-based study

Abstract

Background Albuminuria is a recognized marker of early kidney damage and cardiometabolic risk in pediatric populations. While central obesity is known to contribute to renal dysfunction, the relevance of the weight-adjusted waist index (WWI), a novel indicator of central adiposity, has not been fully explored in children and adolescents. Methods This study included 4,000 participants aged 3–19 years from the National Health and Nutrition Examination Survey (NHANES) 2017–2020. WWI was calculated as waist circumference divided by the square root of body weight. Albuminuria was defined as an albumin-creatinine ratio (ACR) > 30 mg/g. Multivariable logistic regression, subgroup analyses, threshold effect modeling, and receiver operating characteristic (ROC) curves were used to evaluate the association between WWI and albuminuria. Results Higher WWI was significantly associated with lower odds of albuminuria in the fully adjusted model (OR = 0.64; 95% CI: 0.55–0.75). This inverse relationship was strongest among adolescents (13–19 years), modest in children aged 7–12 years, and not significant in the 3–6-year group. In the youngest group, a U-shaped association was identified, with an inflection point at 11.73 cm/√kg. ROC analysis showed WWI had superior discriminatory ability (AUC = 0.628) for albuminuria compared to BMI, waist circumference, height, and weight. Conclusion WWI demonstrates an age-dependent and non-linear association with albuminuria in U.S. children and adolescents. These findings suggest that WWI may offer a more refined anthropometric indicator of renal risk in youth and support its potential as a screening tool in pediatric populations.