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

Bo Xi; Xin'nan Zong; Roya Kelishadi; Mieczysław Litwin; Young Mi Hong; Bee Koon Poh; Lyn M Steffen; Sonya V Galcheva; Isabelle Herter-Aeberli; Tadeusz Nawarycz; Małgorzata Krzywińska-Wiewiorowska; Anuradha Khadilkar; Michael D Schmidt; Hannelore Neuhauser; Anja Schienkiewitz; Zbigniew Kułaga; Hae Soon Kim; Barbara Stawińska-Witoszyńska; Mohammad Esmaeil Motlagh; Abd Talib Ruzita; Violeta M Iotova; Aneta Grajda; Mohd Noor Ismail; Alicja Krzyżaniak; Ramin Heshmat; Velin Stratev; Agnieszka Różdżyńska-Świątkowska; Gelayol Ardalan; Mostafa Qorbani; Anna Świąder-Leśniak; Lidia Ostrowska-Nawarycz; Yoto Yotov; Veena Ekbote; Vaman Khadilkar; Alison J Venn; Terence Dwyer; Min Zhao; Costan G Magnussen; Pascal Bovet

doi:10.1210/clinem/dgz195

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

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

Authors

Bo Xi¹, Xin'nan Zong², Roya Kelishadi³, Mieczysław Litwin⁴, Young Mi Hong⁵, Bee Koon Poh⁶, Lyn M Steffen⁷, Sonya V Galcheva⁸, Isabelle Herter-Aeberli⁹, Tadeusz Nawarycz¹⁰, Małgorzata Krzywińska-Wiewiorowska¹¹, Anuradha Khadilkar¹², Michael D Schmidt¹³, Hannelore Neuhauser¹⁴, Anja Schienkiewitz¹⁵, Zbigniew Kułaga¹⁶, Hae Soon Kim⁵, Barbara Stawińska-Witoszyńska¹¹, Mohammad Esmaeil Motlagh¹⁷, Abd Talib Ruzita⁶, Violeta M Iotova⁸, Aneta Grajda¹⁶, Mohd Noor Ismail¹⁸, Alicja Krzyżaniak¹¹, Ramin Heshmat¹⁹, Velin Stratev²⁰, Agnieszka Różdżyńska-Świątkowska²¹, Gelayol Ardalan³, Mostafa Qorbani²², Anna Świąder-Leśniak²¹, Lidia Ostrowska-Nawarycz¹⁰, Yoto Yotov²³, Veena Ekbote¹², Vaman Khadilkar¹², Alison J Venn²⁴, Terence Dwyer^{24

25}, Min Zhao²⁶, Costan G Magnussen^{24

27}, Pascal Bovet²⁸

Affiliations

¹ Department of Epidemiology, School of Public Health, Shandong University, Jinan, China.
² Department of Growth and Development, Capital Institute of Pediatrics, Beijing, China.
³ Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
⁴ Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
⁵ Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea.
⁶ Nutritional Sciences Programme and Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
⁷ Division of Epidemiology and Community Health, University of Minnesotas School of Public Health, Minneapolis, USA.
⁸ Department of Pediatrics, Varna Medical University, Varna, Bulgaria.
⁹ Institute of Food, Nutrition and Health, Human Nutrition Laboratory, ETH Zurich, Zürich, Switzerland.
¹⁰ Department of Biophysics, Chair of Experimental and Clinical Physiology, Medical University of Lodz, Lodz, Poland.
¹¹ Department of Epidemiology and Hygiene, Chair of Social Medicine, Poznan University of Medical Sciences, Poznan, Poland.
¹² Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
¹³ Department of Kinesiology, University of Georgia, Athens, Georgia, USA.
¹⁴ Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany and DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
¹⁵ Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
¹⁶ Department of Public Health, The Children's Memorial Health Institute, Warsaw, Poland.
¹⁷ Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
¹⁸ Faculty of Social Sciences and Leisure Management, Taylor's University, Subang Jaya, Selangor, Malaysia.
¹⁹ Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
²⁰ Department of Internal Medicine, Varna Medical University, Varna, Bulgaria.
²¹ Department of Anthropometry, The Children's Memorial Health Institute, Warsaw, Poland.
²² Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
²³ Department of cardiology, Medical University Varna, Varna, Bulgaria.
²⁴ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
²⁵ George Institute for Global Health, Oxford Martin School and Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
²⁶ Departments of Nutrition and Food Hygiene, School of Public Health, Shandong University, Jinan, China.
²⁷ Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
²⁸ Department of Epidemiology and Health Services, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

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.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Area Under Curve
Body Height*
Body Mass Index*
Child
Child, Preschool
Cross-Sectional Studies
Female
Follow-Up Studies
Humans
Iran / epidemiology
Malaysia / epidemiology
Male
Obesity, Abdominal / epidemiology*
Obesity, Abdominal / physiopathology
Overweight / epidemiology*
Overweight / physiopathology
Pediatric Obesity / epidemiology*
Pediatric Obesity / physiopathology
Poland / epidemiology
Prognosis
Sex Factors
Switzerland / epidemiology
Waist Circumference*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding