Background: Body-mass index (BMI), waist circumference (WC), and, recently, waist-to-height ratio (WHtR) have been proposed as clinical indexes to identify children at cardiometabolic risk. The aim was to identify the usefulness of WHtR cutoffs, WC, and BMI as predictors of metabolic syndrome in Mexican children, according to BMI z-scores, and the severity of obesity to cardiometabolic risk factors and metabolic syndrome.

Methods: This was a cross-sectional study of 214 overweight/obese and 47 normal-weight Mexican children 6–12 years old. Children were divided in groups according to BMI z-scores. Anthropometric and biochemical measurements were determined. Receiver-operating characteristic (ROC) curves and areas under the curves were calculated to compare the abilities of the anthropometric measurements to predict metabolic syndrome.

Results: The overall prevalence of metabolic syndrome was 23.3%, ranging from 11.0% in the overweight group to 73.9% in the severely obese one. Children with metabolic syndrome had significantly higher WHtR, WC, BMI, percentage of body fat, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure, and lower high-density lipoprotein cholesterol (HDL-C). A WHtR cutoff point of 0.59 from the ROC curve was identified as strong predictor of metabolic syndrome in our population, whereas a cutoff of 0.5 showed very poor specificity (22.7%). WC predicted metabolic syndrome as well.

Conclusion: Cutoff values for WHtR make a difference in predicting metabolic syndrome. A cutoff of 0.59 for WHtR strongly predicted metabolic syndrome; it might be a simpler to use screening tools and counters for short people. Further studies are required to determine the cutoff points for an accurate prediction, because there are few in children and none in Mexico.