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

Research output: Contribution to journalArticlepeer-review

71 Scopus citations


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 languageEnglish
Pages (from-to)E1569-E1583
JournalJournal of Clinical Endocrinology and Metabolism
Issue number4
StatePublished - 1 Apr 2020

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© Endocrine Society 2019. All rights reserved.


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