International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years

Bo Xi; Xinnan 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

Bo Xi, Xinnan 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 RuzitaVioleta 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

Epidemiology & Community Health

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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.

Original language	English (US)
Pages (from-to)	E1569-E1583
Journal	Journal of Clinical Endocrinology and Metabolism
Volume	105
Issue number	4
DOIs	https://doi.org/10.1210/clinem/dgz195
State	Published - Apr 1 2020

Bibliographical note

Funding Information:
This work was supported, in part, by National Natural Science Foundation of China (81673195); National Institutes of Health (NIH) (grants R01-HD30880, DK056350, R24-HD050924, and R01-HD38700); a Fellowship Grant of ?Medical Science Fund? of Varna Medical University; a Fellowship Grant from Government of India; the Swiss Federal Office of Public Health; Isfahan University of Medical Sciences; a Ministry of Science, Ministry of Science, Technology and Innovation ScienceFund research grant (06-01-02-SF0314); Nestle Products (Malaysia) Sdn. Bhd. (NN-002-2007); a grant funded by European Economic Area (E015/ P01/2007/01/85-PL 0080); a grant from the National Centre for Research and Development in Poland (NR13000206). The study funders had no role in the study design, data collection, analysis or interpretation, or writing of the paper or in the decision to submit the paper for publication.

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© Endocrine Society 2019. All rights reserved.

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Xi, B., Zong, X., Kelishadi, R., Litwin, M., Hong, Y. M., Poh, B. K., Steffen, L. M., Galcheva, S. V., Herter-Aeberli, I., Nawarycz, T., Krzywińska-Wiewiorowska, M., Khadilkar, A., Schmidt, M. D., Neuhauser, H., Schienkiewitz, A., Kułaga, Z., Kim, H. S., Stawińska-Witoszyńska, B., Motlagh, M. E., ... Bovet, P. (2020). International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. Journal of Clinical Endocrinology and Metabolism, 105(4), E1569-E1583. https://doi.org/10.1210/clinem/dgz195

International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. / Xi, Bo; Zong, Xinnan; Kelishadi, Roya; Litwin, Mieczysław; Hong, Young Mi; Poh, Bee Koon; Steffen, Lyn M.; Galcheva, Sonya V.; Herter-Aeberli, Isabelle; Nawarycz, Tadeusz; Krzywińska-Wiewiorowska, Małgorzata; Khadilkar, Anuradha; Schmidt, Michael D.; Neuhauser, Hannelore; Schienkiewitz, Anja; Kułaga, Zbigniew; Kim, Hae Soon; Stawińska-Witoszyńska, Barbara; Motlagh, Mohammad Esmaeil; Ruzita, Abd Talib; Iotova, Violeta M.; Grajda, Aneta; Ismail, Mohd Noor; Krzyżaniak, Alicja; Heshmat, Ramin; Stratev, Velin; Różdżyńska-Świątkowska, Agnieszka; Ardalan, Gelayol; Qorbani, Mostafa; Świąder-Leśniak, Anna; Ostrowska-Nawarycz, Lidia; Yotov, Yoto; Ekbote, Veena; Khadilkar, Vaman; Venn, Alison J.; Dwyer, Terence; Zhao, Min; Magnussen, Costan G.; Bovet, Pascal.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 105, No. 4, 01.04.2020, p. E1569-E1583.

Research output: Contribution to journal › Article › peer-review

Xi, B, Zong, X, Kelishadi, R, Litwin, M, Hong, YM, Poh, BK, Steffen, LM, Galcheva, SV, Herter-Aeberli, I, Nawarycz, T, Krzywińska-Wiewiorowska, M, Khadilkar, A, Schmidt, MD, Neuhauser, H, Schienkiewitz, A, Kułaga, Z, Kim, HS, Stawińska-Witoszyńska, B, Motlagh, ME, Ruzita, AT, Iotova, VM, Grajda, A, Ismail, MN, Krzyżaniak, A, Heshmat, R, Stratev, V, Różdżyńska-Świątkowska, A, Ardalan, G, Qorbani, M, Świąder-Leśniak, A, Ostrowska-Nawarycz, L, Yotov, Y, Ekbote, V, Khadilkar, V, Venn, AJ, Dwyer, T, Zhao, M, Magnussen, CG & Bovet, P 2020, 'International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years', Journal of Clinical Endocrinology and Metabolism, vol. 105, no. 4, pp. E1569-E1583. https://doi.org/10.1210/clinem/dgz195

Xi, Bo ; Zong, Xinnan ; Kelishadi, Roya ; Litwin, Mieczysław ; Hong, Young Mi ; Poh, Bee Koon ; Steffen, Lyn M. ; Galcheva, Sonya V. ; Herter-Aeberli, Isabelle ; Nawarycz, Tadeusz ; Krzywińska-Wiewiorowska, Małgorzata ; Khadilkar, Anuradha ; Schmidt, Michael D. ; Neuhauser, Hannelore ; Schienkiewitz, Anja ; Kułaga, Zbigniew ; Kim, Hae Soon ; Stawińska-Witoszyńska, Barbara ; Motlagh, Mohammad Esmaeil ; Ruzita, Abd Talib ; Iotova, Violeta M. ; Grajda, Aneta ; Ismail, Mohd Noor ; Krzyżaniak, Alicja ; Heshmat, Ramin ; Stratev, Velin ; Różdżyńska-Świątkowska, Agnieszka ; Ardalan, Gelayol ; Qorbani, Mostafa ; Świąder-Leśniak, Anna ; Ostrowska-Nawarycz, Lidia ; Yotov, Yoto ; Ekbote, Veena ; Khadilkar, Vaman ; Venn, Alison J. ; Dwyer, Terence ; Zhao, Min ; Magnussen, Costan G. ; Bovet, Pascal. / International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. In: Journal of Clinical Endocrinology and Metabolism. 2020 ; Vol. 105, No. 4. pp. E1569-E1583.

@article{3dfbf7d8ebc149b28a0913c6be9065b4,

title = "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.",

author = "Bo Xi and Xinnan Zong and Roya Kelishadi and Mieczys{\l}aw Litwin and Hong, {Young Mi} and Poh, {Bee Koon} and Steffen, {Lyn M.} and Galcheva, {Sonya V.} and Isabelle Herter-Aeberli and Tadeusz Nawarycz and Ma{\l}gorzata Krzywi{\'n}ska-Wiewiorowska and Anuradha Khadilkar and Schmidt, {Michael D.} and Hannelore Neuhauser and Anja Schienkiewitz and Zbigniew Ku{\l}aga and Kim, {Hae Soon} and Barbara Stawi{\'n}ska-Witoszy{\'n}ska and Motlagh, {Mohammad Esmaeil} and Ruzita, {Abd Talib} and Iotova, {Violeta M.} and Aneta Grajda and Ismail, {Mohd Noor} and Alicja Krzy{\.z}aniak and Ramin Heshmat and Velin Stratev and Agnieszka R{\'o}{\.z}d{\.z}y{\'n}ska-{\'S}wi{\c a}tkowska and Gelayol Ardalan and Mostafa Qorbani and Anna {\'S}wi{\c a}der-Le{\'s}niak and Lidia Ostrowska-Nawarycz and Yoto Yotov and Veena Ekbote and Vaman Khadilkar and Venn, {Alison J.} and Terence Dwyer and Min Zhao and Magnussen, {Costan G.} and Pascal Bovet",

note = "Funding Information: This work was supported, in part, by National Natural Science Foundation of China (81673195); National Institutes of Health (NIH) (grants R01-HD30880, DK056350, R24-HD050924, and R01-HD38700); a Fellowship Grant of ?Medical Science Fund? of Varna Medical University; a Fellowship Grant from Government of India; the Swiss Federal Office of Public Health; Isfahan University of Medical Sciences; a Ministry of Science, Ministry of Science, Technology and Innovation ScienceFund research grant (06-01-02-SF0314); Nestle Products (Malaysia) Sdn. Bhd. (NN-002-2007); a grant funded by European Economic Area (E015/ P01/2007/01/85-PL 0080); a grant from the National Centre for Research and Development in Poland (NR13000206). The study funders had no role in the study design, data collection, analysis or interpretation, or writing of the paper or in the decision to submit the paper for publication. Publisher Copyright: {\textcopyright} Endocrine Society 2019. All rights reserved.",

year = "2020",

month = apr,

day = "1",

doi = "10.1210/clinem/dgz195",

language = "English (US)",

volume = "105",

pages = "E1569--E1583",

journal = "Journal of Clinical Endocrinology and Metabolism",

issn = "0021-972X",

publisher = "The Endocrine Society",

number = "4",

}

TY - JOUR

T1 - International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years

AU - Xi, Bo

AU - Zong, Xinnan

AU - Kelishadi, Roya

AU - Litwin, Mieczysław

AU - Hong, Young Mi

AU - Poh, Bee Koon

AU - Steffen, Lyn M.

AU - Galcheva, Sonya V.

AU - Herter-Aeberli, Isabelle

AU - Nawarycz, Tadeusz

AU - Krzywińska-Wiewiorowska, Małgorzata

AU - Khadilkar, Anuradha

AU - Schmidt, Michael D.

AU - Neuhauser, Hannelore

AU - Schienkiewitz, Anja

AU - Kułaga, Zbigniew

AU - Kim, Hae Soon

AU - Stawińska-Witoszyńska, Barbara

AU - Motlagh, Mohammad Esmaeil

AU - Ruzita, Abd Talib

AU - Iotova, Violeta M.

AU - Grajda, Aneta

AU - Ismail, Mohd Noor

AU - Krzyżaniak, Alicja

AU - Heshmat, Ramin

AU - Stratev, Velin

AU - Różdżyńska-Świątkowska, Agnieszka

AU - Ardalan, Gelayol

AU - Qorbani, Mostafa

AU - Świąder-Leśniak, Anna

AU - Ostrowska-Nawarycz, Lidia

AU - Yotov, Yoto

AU - Ekbote, Veena

AU - Khadilkar, Vaman

AU - Venn, Alison J.

AU - Dwyer, Terence

AU - Zhao, Min

AU - Magnussen, Costan G.

AU - Bovet, Pascal

N1 - Funding Information: This work was supported, in part, by National Natural Science Foundation of China (81673195); National Institutes of Health (NIH) (grants R01-HD30880, DK056350, R24-HD050924, and R01-HD38700); a Fellowship Grant of ?Medical Science Fund? of Varna Medical University; a Fellowship Grant from Government of India; the Swiss Federal Office of Public Health; Isfahan University of Medical Sciences; a Ministry of Science, Ministry of Science, Technology and Innovation ScienceFund research grant (06-01-02-SF0314); Nestle Products (Malaysia) Sdn. Bhd. (NN-002-2007); a grant funded by European Economic Area (E015/ P01/2007/01/85-PL 0080); a grant from the National Centre for Research and Development in Poland (NR13000206). The study funders had no role in the study design, data collection, analysis or interpretation, or writing of the paper or in the decision to submit the paper for publication. Publisher Copyright: © Endocrine Society 2019. All rights reserved.

PY - 2020/4/1

Y1 - 2020/4/1

N2 - 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.

AB - 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.

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ER -

International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years

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