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. 2020 Apr 1;105(4):e1569-e1583.
doi: 10.1210/clinem/dgz195.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years

Bo Xi  1 , Xin'nan Zong  2 , Roya Kelishadi  3 , Mieczysław Litwin  4 , Young Mi Hong  5 , Bee Koon Poh  6 , Lyn M Steffen  7 , Sonya V Galcheva  8 , Isabelle Herter-Aeberli  9 , Tadeusz Nawarycz  10 , Małgorzata Krzywińska-Wiewiorowska  11 , Anuradha Khadilkar  12 , Michael D Schmidt  13 , Hannelore Neuhauser  14 , Anja Schienkiewitz  15 , Zbigniew Kułaga  16 , Hae Soon Kim  5 , Barbara Stawińska-Witoszyńska  11 , Mohammad Esmaeil Motlagh  17 , Abd Talib Ruzita  6 , Violeta M Iotova  8 , Aneta Grajda  16 , Mohd Noor Ismail  18 , Alicja Krzyżaniak  11 , Ramin Heshmat  19 , Velin Stratev  20 , Agnieszka Różdżyńska-Świątkowska  21 , Gelayol Ardalan  3 , Mostafa Qorbani  22 , Anna Świąder-Leśniak  21 , Lidia Ostrowska-Nawarycz  10 , Yoto Yotov  23 , Veena Ekbote  12 , Vaman Khadilkar  12 , Alison J Venn  24 , Terence Dwyer  24   25 , Min Zhao  26 , Costan G Magnussen  24   27 , Pascal Bovet  28
Affiliations

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years

Bo Xi et al. J Clin Endocrinol Metab. .

Abstract

Context: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents.

Objective: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk.

Design and setting: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years).

Main outcome measure: WC measured based on recommendation by the World Health Organization.

Results: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls).

Conclusion: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

Keywords: central obesity; children and adolescents; cutoff points; waist circumference.

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Figures

Figure 1.
Figure 1.
Flow chart of the study design and analysis.
Figure 2.
Figure 2.
Comparisons of the 90th percentile (P90) curves of waist circumference (WC) by age and sex among samples excluding children and adolescents with obesity, overweight, or underweight, based on pooled data from 8 countries. Notes: Sample 1 indicates the P90 of WC based on the whole population; Sample 2 indicates the P90 of WC based on the population excluding obese children; Sample 3 indicates the P90 of WC based on the population excluding obese and overweight children; Sample 4 indicates the P90 of WC based on the population excluding obese, overweight, and underweight children.
Figure 3.
Figure 3.
Comparisons of the 75th and 90th percentile values of waist circumference (WC) after exclusion of children and adolescents with underweight, overweight or obesity compared to corresponding percentiles of normal-weight European children in the IDEFICS study
See this image and copyright information in PMC

Comment in

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