18 Further research is required, however, to validate these thresholds in adults with CP. In agreement with previous

research,15 WHR was associated with a number of cardiometabolic risk factors. The relative predictive power of WHR, however, was not as high as that of WC. The predictive power of WHR in adults with CP may be influenced by its association with gross motor function. This association was a result of the inverse relationship between hip circumference and GMFCS level—an expected relationship considering the positive correlation between hip circumference, gluteal muscle, and total leg muscle mass.30 Although some amount of muscle atrophy is present in all adults with CP, gluteal and total leg muscle mass particularly Mdm2 inhibitor atrophy in nonambulatory adults.31 As well as being associated with gross motor function, WHR is more difficult to assess and a less reliable measure than WC in the general population.32 Difficulty with obtaining hip circumference measurements from nonambulatory participants or participants with significant contractures may also increase the potential for error when measuring WHR in adults with CP. In contrast, WC is a simple and feasible measure to take on ambulatory Dabrafenib in vivo and nonambulatory adults in a clinical setting. This study

has a number of limitations. Primarily, the cross-sectional design of the study does not allow causality to be inferred. In addition, the studied sample was relatively small and may have influenced the estimate of cardiometabolic risk. There is currently no CP register in the Republic of Ireland, and the majority of rehabilitative services are provided only until age 18 years. Despite every effort being made to recruit adults with CP for this study, the low response rate may have resulted in selection bias. In particular, adults with an interest in health promotion may have been more likely to participate. Because information was not available on adults who did not respond to the recruitment efforts, comparisons oxyclozanide cannot be made between responders and nonresponders. However, it should be noted that the sample

size is similar to other studies of adults with CP. In addition, the small sample size did not allow for adjustment for gender when conducting ROC curve analysis. Only WC and WHR, however, are known to be associated with gender, and it is unlikely that performing separate analyses would change the order of the outcome. The results of the ROC curve analysis were also supported by the results of the regression analysis, which was adjusted for gender. Although an attempt was made to detect differences in cardiometabolic outcomes between ambulatory and nonambulatory adults, it is also possible that the sample size was not adequate to detect between-group differences. The results of this study indicate that relatively young adults with CP have clustering of cardiometabolic risk factors.