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. 2020 May-Jun;114(3):530-537.
doi: 10.36660/abc.20190043.

Waist Circumference Percentiles and Cut-Off Values for Obesity in a Large Sample of Students from 6 To 10 Years Old Of The São Paulo State, Brazil

[Article in English, Portuguese]
José Luiz F Santos  1 , Valentin P Valério  1 , Rafael N Fernandes  1 , Ligia Duarte  1 , Antonio C Assumpção  1 , Jayme Guerreiro  1 , Antonio L Sickler  1 , Álvaro A R Lemos  1 , Jayro G Goulart Filho  1 , Luiz Antonio Machado Cesar  2 , Ibraim Masciarelli Pinto  3 , Carlos Magalhães  4 , Maria Fernanda Hussid  4 , Cleber Camacho  4 , Alvaro Avezum  1 , Carine T Sangaleti  5 , Fernanda Marciano Consolim-Colombo  6
Affiliations

Waist Circumference Percentiles and Cut-Off Values for Obesity in a Large Sample of Students from 6 To 10 Years Old Of The São Paulo State, Brazil

[Article in English, Portuguese]
José Luiz F Santos et al. Arq Bras Cardiol. 2020 May-Jun.

Abstract
in English, Portuguese

Backgroud: The prevalence of obesity has systematically been increased in the population, including children and adolescents, around the world.

Objectives: To describe reference percentile curves for waist circumference (WC) in Brazilian children and provide cut-off values of WC to identify children at risk for obesity.

Methods: A multicenter, prospective, cross-sectional study was performed with children aged from 6 to 10 years old, enrolled in public and private elementary schools from 13 cities of the São Paulo State. Height, weight, and WC were measured in duplicate in 22,000 children (11,199 boys). To establish the WC best cut-off value for obesity diagnosis, ROC curves with children classified as normal weight and obese were calculated, according to BMI curves, stratified by gender and age, and the Youden Index was utilized as the maximum potential effectiveness of this biomarker. A p < 0.05 was considered statistically significant.

Results: WC values increased with age in both boys and girls. The prevalence of obesity in each age group varied from 17% (6 years old) to 21.6% (9 years old) among boys, and from 14.1% (7 years old) to 17.3 % (9 years old) among girls. ROC analyses have shown the 75th percentile as a cut-off for obesity risk, and the diagnosis of obesity is classified on the 85th percentile or more.

Conclusion: Age and gender specific reference curves of WC for Brazilian children and cut-off values for obesity risk may be used for national screening and interventional studies to reduce the obesity burden in Brazil. (Arq Bras Cardiol. 2020; 114(3):530-537).

Fundamento: A prevalência da obesidade vem aumentando sistematicamente na população, inclusive nas crianças e adolescentes, ao redor do mundo.

Objetivos: Descrever curvas percentílicas de referência para a circunferência abdominal (CA) nas crianças brasileiras e fornecer pontos de corte da CA para identificar crianças com risco de obesidade.

Métodos: Um estudo multicêntrico, prospectivo, tranversal foi realizado em crianças com idades entre 6 e 10 anos, matriculadas no ensino fundamental de escolas públicas e particulares de 13 cidades do estado de São Paulo. A estatura, o peso e a CA foram medidos em duplicata em 22.000 crianças (11.199 meninos). Para estabelecer o melhor ponto de corte da CA para o diagnóstico da obesidade, foram calculadas curvas ROC com crianças classificadas como com peso normal e obesas, de acordo com as curvas do IMC, estratificadas por gênero e idade, e o índice Youden foi utilizado como a eficácia potencial máxima desse biomarcador. Valores de p < 0,05 foram considerados estatisticamente significativos.

Resultados: Os valores da CA aumentaram com a idade, tanto nos meninos quanto nas meninas. A prevalência de obesidade em cada grupo variou de 17% (6 anos de idade) a 21,6 % (9 anos de idade), dentre os meninos, e de 14,1% (7 anos de idade) a 17,3 % (9 anos de idade), dentre as meninas. As análises ROC mostraram o percentil 75 como ponto de corte para o risco de obesidade, e o diagnóstico de obesidade está classificado no percentil 85 ou acima.

Conclusão: Curvas de referência da CA específicas para idade e sexo em crianças brasileiras e pontos de corte para o risco de obesidade podem ser usados em triagem nacional e estudos intervencionais para reduzir a carga da obesidade no Brasil. (Arq Bras Cardiol. 2020; 114(3):530-537).

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Conflict of interest statement

Potencial conflito de interesses

Declaro não haver conflito de interesses pertinentes.

Figures

Figura 1
Figura 1. – Curvas percentílicas da CA de crianças brasileiras (6–10 anos de idade). Meninos (A); meninas (B).
Figura 2
Figura 2. – Comparação entre as curvas da CA (percentil 50) nas crianças de 13 países diferentes. A: Comparação entre meninos de 6 a 10 anos; B: Comparação entre meninas de 6 a 10 anos. C: Comparação entre as curvas da CA (percentil 50) de meninos (C) e meninas (D) das diferentes regiões brasileiras estudadas.
Figure 1
Figure 1. – WC percentile curves for Brazilian children (aged 6–10 years). Boys (A) Girls (B).
Figure 2
Figure 2. – Comparison of children 50th WC percentiles curves between 13 different countries. A: Comparison between 6-10 years old boys; B: Comparison between 6-1- years old girls. C: Comparison between boys (C) and girls (D) WC 50th percentiles curves from different Brazilian studies.
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