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.
Bibliographical noteFunding 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.
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't