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

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.

Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011–2018 NHANES

“…The BMI percentiles were then dichotomized as ≥95th percentile (obesity) and <95th percentile. Based on the international sex- and age-specific waist circumference percentile reference [ 28 ], participants aged 6 years and older were categorized into ≥95 percentile (central obesity) and <95th percentile. Dual-energy X-ray absorptiometry (DXA) whole-body scans were administered to participants aged 8 years and older using Hologic Discovery model A densitometers (Hologic, Inc.; Bedford, MA, USA).…”

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“…Left ventricular geometry pattern. To define the LV geometry pattern, we measured the myocardial mass index by M-mode echocardiography using the Devereux formula and normalized to height 2,7 , as well as the relative wall thickness (RWT) defined as LV wall thickness + septal thickness relative to the internal dimensions of the LV. The LVH was diagnosed by cutoff value utilized in adults (51 g/m) corresponding to the 97.5 th percentile in children (9).…”

Population-based waist circumference reference values in Japanese children (0–6 years): comparisons with Dutch, Swedish and Turkish preschool children

“…The international WC cutoffs were developed to screen central obesity in children and adolescents aged 6-18 years, using the pooled data on WC of children and adolescents from eight countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles and Switzerland) [32]. The age-and sex-specific 90th centile WC cutoffs were calculated in children and adolescents with normal weight (excluding youth with obesity, overweight or underweight) by linking the centile with cardiovascular risk.…”