Waist Circumference Percentile Curves Research Articles

Reference Values for Waist Circumference and Waist-Height Ratio in Korean Children and Adolescents.

BackgroundAbdominal obesity, which is a strong indicator of cardiometabolic risk, is widely evaluated using waist circumference (WC) and waist–height ratio (WHtR). In Korea, the reference values for WC for children and adolescents were published in 2007 and need to be revised. Moreover, there is no reference for WHtR. The aim of this study was to establish new reference values for WC and WHtR in Korean children and adolescents.MethodsData of 20,033 subjects from the Korea National Health and Nutrition Examination Survey (2007–2019) were used. Tables for reference values and the graphs of smoothed percentile curves of WC and WHtR for children and adolescents aged 2–18 years by sex were generated using the LMS method and locally estimated scatterplot smoothing regression analysis after removing extreme values.ResultsSex-specific reference tables and percentile curves for WC and WHtR were developed. In the new WC curves, the 10th, 50th, and 90th percentile lines were lower than the corresponding lines of the 2007 reference for both sexes. The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years in both sexes. In the logistic regression analysis, the WC and WHtR z-scores showed higher odds ratios for predicting cardiometabolic risk factors than the body mass index z-score.ConclusionNew WC and WHtR reference values for Korean children and adolescents aged 2–18 years were developed using the latest statistical methods. These references will help monitor and track WC and WHtR for evaluating abdominal obesity among at-risk children and adolescents in Korea.

Waist Circumference of the Elderly over 65 Years Old in China Increased Gradually from 1993 to 2015: A Cohort Study

ObjectiveThis study aimed to analyze the temporal trends and characteristics associated with waist circumference (WC) among elderly Chinese people. MethodsWe used data from 3,096 adults ≥ 65 years who participated in the China Health and Nutrition Survey (CHNS), an ongoing cohort study, between 1993 and 2015. We used longitudinal quantile regression models to explore the temporal trends and characteristics associated with WC. ResultsWC increased gradually among the elderly Chinese population during the survey. The WC curves shifted to the right with wider distributions and lower peaks in men and women. All WC percentile curves shifted upward with similar growth rates in the 25th, 50th, and 75th percentiles. The WC means increased from 78 cm to 86 cm during the 22 years of our study. WC significantly increased with age and body mass index and decreased with physical activity (PA). These associations were stronger in the higher percentiles than in the lower percentiles. ConclusionsWC is rising among Chinese adults ≥ 65 years. Factors affecting WC in elderly people may have different effects on different percentiles of the WC distribution, and PA was the most important protective factor in the higher percentiles of the WC distribution. Thus, different interventional strategies are needed.

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.

ResumoFundamento 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)

Percentile Curves for Body-Mass Index, Waist Circumference, Waist-To-Height Ratio and Waist-To-Height Ratio(Exp) in Croatian Adolescents.

Purpose: The main purpose of the present study was to establish percentile curves for body-mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and WHtR(exp) in adolescents. Methods: In this cross-sectional study, we recruited 1036 secondary-school students aged 15 to 18 years from eight randomly selected schools (55.3% girls). BMI, WC, WHtR and WHtR(exp) were calculated using standardized measuring protocol. The sex- and age-specific smoothed percentile curves with 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentile for each anthropometric measure were constructed using Cole’s LMS method. Results: In boys, both BMI and WC percentile curves increased by age, yet the 95th percentile curve for WHtR and WHtR(exp) decreased by age. In girls, the 95th percentile curve for BMI remained unchanged through the age of 15 to 18 years, yet the 90th and 95th percentile curves for WC and WHtR decreased by age. Conclusion: This is the first study in Croatia to establish combined BMI, WC, WHtR and WHtR(exp) percentile curves and add some new insight on anthropometric measures in 15- to 18-year-old adolescents.

Waist circumference percentile curves as a screening tool to predict cardiovascular risk factors and metabolic syndrome risk in Brazilian children.

The goals of this study were to develop reference values for waist circumference (WC) in Brazilian children between 6-10 years old and to evaluate the WC performance in predicting cardiovascular risk factors and metabolic syndrome (MetS) in children. This is a population-based epidemiological cross-sectional study, in which 1,397 children participated, with a 6-10 years old probability sampling and from public and private schools in the city of Uberaba, Minas Gerais State, Brazil. WC was measured at the waist narrowest point (WC1) and at the umbilicus level (WC2). Blood samples and blood pressure were collected to determine the MetS diagnosis. There was a significant effect of age (p = 0.001), anatomical point (WC1 vs. WC2, p = 0.001) and sex-anatomical point interaction (p = 0.016) for WC. Smoothed sex- and age-specific 5th, 10th, 25th, 50th, 75th, 90th and 95th percentile curves of WC1 and WC2 were designed by the LMS method. WC was accurate to predict MetS, for all ages [area under the ROC curve (AUC) > 0.79 and p < 0.05], regardless of sex. This study presented percentile curves for WC at two anatomical points in a representative sample of Brazilian children. Furthermore, WC was shown to be a strong predictor of cardiovascular risk factors and MetS in children.

Waist circumference percentile in children from municipalities of developed and developing countries

Abstract Aims: to design reference percentile curves of waist circumference (WC) in children aged 6-10 from municipalities of developed (Portugal) and developing (Brazil) countries and to compare these results with other international references. Methods: this cross-sectional study enrolled a 6-10-year-old probability sampling. Univariate analysis of covariance adjusted by height was carried out to test the main effects of age, sex, countries, and interactions. WC percentile curves were performed with the LMS Chart Maker. Results: The sample comprised 6,475 children. Portuguese children presented a curvilinear increase in WC curves and Brazilian WC curves have shown a linear increase with age both for boys and girls. Overweight and obesity prevalence was 15.9 % and 4.7 % for Portuguese children and 12.9 % 4.5% for Brazilian children, respectively. There was a main effect (p<0.0001) for age and countries, and an interaction effect for sex*age (p=0.001) and countries*age (p<0.0001). Portuguese boys and girls have shown higher values for the 50th, 75th, and 95th percentiles than Brazilian boys and girls. Conclusions: WC reference percentile curves were drawn for 6-10-year-old Portuguese and Brazilian children. Portuguese children have higher WC values than Brazilian children and other children from developed countries.

BMI, Waist Circumference Reference Values for Chinese School-Aged Children and Adolescents.

Background: Childhood obesity has become one of the most serious public health challenges in the 21st century in most developing countries. The percentile curve tool is useful for monitoring and screening obesity at population level, however, in China, no official recommendations on childhood body mass index (BMI) and waist circumference (WC) reference percentiles have been made in practice. Aims: to construct the percentile reference values for BMI and WC, and then to calculate the prevalence of overall and abdominal obesity for Chinese children and adolescents. Methods: A total of 5062 anthropometric records for children and adolescents aged from 7 to 18 years (2679 boys and 2383 girls) were included for analysis. The participants were recruited as part of the national representative “China Health and Nutrition Survey” (CHNS). Age, gender, weight, height, and WC were assessed. Smoothed BMI and WC percentile curves and values for the 3rd, 5th, 10th, 15th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were constructed by using the Lambda-Mu-Sigma (LMS) method. The prevalence estimates of the overall and abdominal obesity were calculated by using the cut-offs from our CHNS study and the previous “Chinese National Survey on Students’ Constitution and Health” (CNSSCH) study, respectively. The difference between prevalence estimates was tested by a McNemar test, and the agreement between these prevalence estimates was calculated by using the Cohen’s kappa coefficient. Results: The prevalence values of overall obesity based on the cut-offs from CHNS and CNSSCH studies were at an almost perfect agreement level in boys (κ = 0.93). However, among girls, the overall obesity prevalence differed between the studies (p < 0.001) and the agreement was weaker (κ = 0.76). The abdominal obesity prevalence estimates were significant different according to the two systems both in boys and girls, although the agreement reached to 0.88, which represented an almost perfect agreement level. Conclusions: This study provided new BMI and WC percentile curves and reference values for Chinese children and adolescents aged 7–18 years, which can be adopted in future researches. Large longitudinal study is still needed to reveal the childhood growth pattern and validate the inconsistence between different percentile studies.

Waist circumference percentiles for Singaporean children and adolescents aged 6–17 years

Population-specific waist circumference (WC) percentiles are crucial for screening children at higher obesity-related metabolic risk. This study aimed to develop age- and gender-specific WC percentile curves for Singaporean children and adolescents. 3029 participants (boys, 1506; girls, 1523) from different population strata of Singapore were recruited. Stature, weight and WC were measured and BMI calculated. Smoothed WC percentile curves and cut-offs for the 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th were constructed using the Cole's LMS method. WC and BMI increased with age in both sexes and boys had higher WC than girls at every age. Comparison of 50th and 90th percentiles with other populations showed distinct difference in WC curve patterns and values of Singaporean children. We present the first working WC percentile curves and age- and gender-specific cut-offs of Singaporean children and adolescents. These cut-offs and curves can serve as valuable reference for screening and identify children at a higher metabolic risk, for international comparisons and to better understand secular trends in paediatric obesity.

Central obesity in Yemeni children: A population based cross-sectional study

To establish percentile curves and to explore prevalence and correlates of central obesity among Yemeni children in a population based cross-sectional study. A representative sample of 3114 Yemeni children (1564 boys, 1550 girls) aged 6-19 years participating in the HYpertension and Diabetes in Yemen study was studied. Data collection was conducted at home by survey teams composed of two investigators of both genders. Study questionnaire included questions about demographics, lifestyle, and medical history. Anthropometric measurements included body weight, height, waist circumference (WC) and hip circumferences. Waist to hip ratio (WHR) and waist-to-height ratio (WHtR) were then calculated. Age and gender specific smoothed percentiles of WC, WHR, and WHtR were obtained using lambda-mu-sigma parameters (LMS method). The independent predictors of central obesity defined as (1) WC percentile ≥ 90(th); (2) WHtR ≥ 0.5; or (3) WC percentile ≥ 90(th) and WHtR ≥ 0.5, were identified at multivariate logistic regression analysis adjusted for age, gender, urban/rural location, years of school education, sedentary/active life-style. Percentile curves for WC, WHR and WHtR are presented. Average WC increased with age for both genders. Boys had a higher WC than girls until early adolescence and thereafter girls had higher values than boys. WHR decreased both in boys and girls until early adolescence. Thereafter while in boys it plateaued in girls it continued to decrease. Mean WHtR decreased until early adolescence with no gender related differences and thereafter increased more in girls than in boys towards adult age. Prevalence of central obesity largely varied according to the definition used which was 10.9% for WC ≥ 90(th) percentile, 18.3% for WHtR ≥ 0.5, and 8.6% when fulfilling both criteria. At adjusted logistic regression WC ≥ 90(th) percentiles and WHtR ≥ 0.5 were less prevalent in rural than in urban areas (OR = 0.52, 95%CI: 0.41-0.67 and 0.66, 0.54-0.79 respectively), being more prevalent in children with sedentary lifestyle rather than an active one (1.52, 95%CI: 1.17-1.98 and 1.42, 95%CI: 1.14-1.75, respectively). Yemeni children central obesity indices percentile curves are presented. Central obesity prevalence varied according to the definition used and was more prevalent in urban sedentary subjects.

Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years

BackgroundCentral obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years.MethodsA population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05.ResultsFirst ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC.ConclusionsComprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obese and strong predictors included higher grade, urban area with high SES and higher parental education. These findings support the need for developing a National strategy for childhood obesity and implementing targeted interventions, prioritizing the higher social class and involving communities.

Waist circumference percentile curves for Malaysian children and adolescents aged 6.0–16.9 years

The prevalence of obesity is increasing rapidly and abdominal obesity especially is known to be a risk factor for metabolic syndrome and other non-communicable diseases. Waist circumference percentile curves are useful tools which can help to identify abdominal obesity among the childhood and adolescent populations. To develop age- and sex-specific waist circumference (WC) percentile curves for multi-ethnic Malaysian children and adolescents aged 6.0-16.9 years. Subjects and methods. A total of 16,203 participants comprising 8,093 boys and 8,110 girls recruited from all regions of Malaysia were involved in this study. Height, weight, WC were measured and BMI calculated. Smoothed WC percentile curves and values for the 3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th percentiles were constructed using the LMS Method. WC was found to increase with age in both sexes, but boys had higher WC values at every age and percentile. Z-scores generated using the UK reference data shows that Chinese children had the highest WC compared to Malays, Indians and other ethnicities. Comparisons with other studies indicate that at the 50th percentile, Malaysian curves did not differ from the UK, Hong Kong and Turkish curves, but at the 90th percentile, Malaysian curves were higher compared with other countries, starting at 10 years of age. The 90th percentile was adopted as the cut-off point to indicate abdominal obesity in Malaysian children and adolescents. These curves represent the first WC percentiles reported for Malaysian children, and they can serve as a reference for future studies.

Nationally representative waist circumference percentiles in German adolescents aged 11.0–18.0 years

The aim of this study was to develop age- and sex-specific percentile curves for waist circumference (WC) in German adolescents. A cross-sectional population-based study (German Health Interview and Examination Survey for Children and Adolescents [KiGGS]) was carried out in a large nationally representative sample of 3 345 males and 3 221 females aged 11.0 to 18.0 years from May 2003 to May 2006. Smoothed percentile curves of WC were derived by the LMS method. Girls had lower WC values than boys at any age and percentile. WC increased with age in both boys and girls. The curves show a fairly linear pattern for males, but for females they begin to level off after the age of 13 years. The presented WC percentile curves are based on a representative sample of adolescents living in Germany and standardized measurements. We propose their use for clinical practice to monitor abdominal obesity in adolescents, although there is a need for future studies correlating cut-offs with health outcomes. The German curves could contribute to the feasibility of combining representative data from several countries to establish an international reference for WC.

Percentile distributions of waist circumference for 7–19‐year‐old Polish children and adolescents

The aim of the study was to develop waist circumference (WC) percentiles in Polish children and youth and to compare these with the results obtained in other countries. The study comprised a random group of 5663 Polish children aged 7-18 years. Smoothed WC percentile curves were computed using the LMS method. The curves displaying the values of the 50th (WC(50)) and the 90th (WC(90)) percentile were then compared with the results of similar studies carried out in children from the UK, Spain, Germany, Turkey, Cyprus, Canada and the USA. WC increased with age in both boys and girls and in all observed age periods the boys were seen to dominate. For 18-year-old Polish boys and girls the values of WC(90) were 86.5 and 78.2, respectively, and were lower than the current criteria developed by the International Diabetes Federation. Both WC(50) and WC(90) were higher in Polish boys and girls compared with their counterparts in the UK, Turkey and Canada and significantly lower than in children from the USA, Cyprus and Spain. The percentile curves for Polish children and youth, which were developed here for the first time, are base curves that can be applied in analysing trends as well as making comparisons with results of similar studies performed in other countries.

Waist circumference percentile curves for Bulgarian children and adolescents aged 6–18 years

Waist circumference (WC) is a simple, easily available anthropometric measurement, giving relevant information about fat distribution and reflecting the degree of central adiposity in children. It appears to be the main risk factor for the progress of the metabolic syndrome. Our aim was to develop age- and sex-specific WC percentile curves for Bulgarian children/adolescents and to compare them with those from other countries. A representative cross-sectional study of 3,810 healthy Bulgarian children/adolescents (2,052 males) aged 6-18 years, conducted in 2006/07. Body weight, height and WC were measured and body mass index (BMI) was calculated. Sex- and age-specific WC percentile curves were constructed using the LMS method. WC increased with age in both sexes (P<0.0001), with higher values in boys at every age and percentile point. This difference became significant from age 11 years onwards (P<0.05). The boys' values continued to increase steeply after this age, while in girls we found a constant continuing increase until the age of 15. Thereafter WC began to decrease and level off. The WC percentile values in Bulgarian children were lower than in US children, higher than in British and Turkish children, and similar to those of their Cypriot peers. For the first time, WC percentile curves were constructed for Bulgarian children/adolescents. A unique standardized method for WC measurement in children is needed for more acceptable international comparisons.

Waist circumference percentile curves for Bulgarian children and adolescents aged 6-18 years

Waist circumference percentile curves for Bulgarian children and adolescents aged 6-18 years

Waist circumference and waist-to-height ratio of Hong Kong Chinese children.

BackgroundCentral body fat is a better predictor than overall body fat for cardiovascular (CV) risk factors in both adults and children. Waist circumference (WC) has been used as a proxy measure of central body fat. Children at high CV risk may be identified by WC measurements. Waist-to-height ratio (WHTR) has been proposed as an alternative, conveniently age-independent measure of CV risk although WHTR percentiles have not been reported. We aim to provide age- and sex-specific reference values for WC and WHTR in Hong Kong Chinese children.MethodsCross sectional study in a large representative sample of 14,842 children aged 6 to 18 years in 2005/6. Sex-specific descriptive statistics for whole-year age groups and smoothed percentile curves of WC and WHTR were derived and presented.ResultsWC increased with age, although less after age 14 years in girls. WHTR decreased with age (particularly up to age 14). WHTR correlated less closely than WC with BMI (r = 0.65, 0.59 cf. 0.93, 0.91, for boys and girls respectively).ConclusionReference values and percentile curves for WC and WHRT of Chinese children and adolescents are provided. Both WC and WHTR are age dependent. Since the use of WHRT does not obviate the need for age-related reference standards, simple WC measurement is a more convenient method for central fat estimation than WHRT.

Waist circumference percentiles for 7- to 17-year-old Turkish children and adolescents

Abdominal obesity is associated with risk of cardiovascular disease and type 2 diabetes mellitus. Waist circumference as a measure of obesity may be clinically useful as a predictor of metabolic syndrome in children. To develop age- and sex-specific reference values for waist circumference we evaluated the data obtained from Turkish children and adolescents. Waist circumference measurements from 4,770 healthy schoolchildren were obtained. Smoothed percentile curves were produced by the LMS method. The median curves of Turkish children were compared with four other countries: Australia, the UK, USA (Bogalusa) and Japan. Smoothed percentile curves and values for the 3rd, 5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th and 97th percentiles were calculated for boys and girls. We found that waist circumference increased with age both in boys and girls. The 50th percentile waist circumference curve of Turkish children was over the British and Japanese but lower than the Bogalusa children and adolescents. This study presents data and smoothed percentile curves for waist circumference of healthy Turkish children aged 7-17 years. The differences in waist circumference of different countries can be explained by lifestyles and cultural characteristics. These data can be added to the existing international reference values for waist circumference of children and adolescents.

The development of waist circumference percentiles in British children aged 5.0-16.9 y.

To develop waist circumference percentile curves for British children and to compare these curves with those from other countries. Cross-sectional study. School-aged population. A representative sample of school children from the geographical regions of Great Britain, approximately in proportion to their age distribution. The sample population consisted of 8355 children (3585 males, 4770 females) with ages ranging between 5.0 and 16.9 y. Waist circumferences were measured with a flexible non-elastic tape and waist circumference percentiles were constructed and smoothed using the LMS method. Smoothed waist circumference percentile curves. Mean waist circumference increased with age in both boys and girls. For girls, curves began to plateau after the age of 13 y whereas, for boys, waist percentile curves continued to increase more sharply after this age. However, these curves mainly reflect the patterns of waist circumference in Caucasian children. These curves represent the first waist circumference percentiles for British children and could be used provisionally for both clinical and possibly epidemiological use, although they should be validated against equivalent longitudinal data. This project has been sponsored by UNL Diversity and Development Fund.