Abstract
Background
Waist circumference (WC) is a sensitive marker for abdominal obesity in the pediatric age group. However, WC is influenced by age, sex, ethnicity and body mass index (BMI), causing difficulties in the selection of the most appropriate cut-off value. Considering the lack of reference values in Germany, we developed age- and gender-specific WC smoothed reference curves in German children, and compared them with reference curves obtained from different countries.
Methods
A representative sample of 3531 German children (1788 boys, 1743 girls) aged 3–11 years participating in the Prevention Education Program (PEP) Family Heart Study was studied. WC was measured according to the recommendations of the World Health Organization, then age- and sex-specific WC reference curves were constructed and smoothed using the LMS method and SPSS 14.0 for statistical analysis.
Results
WC increased with age in both boys and girls. Boys had higher values of WC than girls at every age and percentile level. 4.1% of the boys and 2.8% of the girls had WC values >97th percentile as compared to 6.3% of the boys and 4.9% of the girls with >97th percentile of BMI (severe obesity). 3.1% of the boys and 2% of the girls had both risk factors. Because 85.3% of the boys and 87.3% of the girls with WC<90th percentile had normal weight, this cut-off point might be appropriate for defining high WC.
Conclusions
These first WC reference curves of German children can be added to the existing international curves for children; comparison of different populations demonstrated that the German values are in the middle range of the curves obtained in different countries. Our findings about significant differences between the reference curves obtained in various regions emphasize the necessity of developing population-specific percentiles, and to use them in clinical and epidemiological studies among children.
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References
Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473–482.
Lobstein T, Baur L, Uauy R, IASO International Obesity TaskForce. Obesity in children and young people: a crisis in public health. Obes Rev 2004;5Suppl 1:4–104.
Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295:1549–1555.
Reilly JJ, Methven E, McDowell ZC, Hacking B, Alexander D, Stewart L, et al. Health consequences of obesity. Arch Dis Child 2003;88:748–752.
Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101(3 Pt 2):518–525.
Li C, Ford ES, Mokdad AH, Cook S. Recent trends in waist circumference and waist-height ratio among US children and adolescents. Pediatrics 2006;118:e1390–e1398.
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999;103(6 Pt 1):1175–1182.
Maffeis C, Grezzani A, Pietrobelli A, Provera S, Tatò L. Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 2001;9:179–187.
Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 2004;114:e198–e205.
Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 2000;24:1453–1458.
Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr 2000;72:490–495.
McCarthy HD, Ellis SM, Cole TJ. Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ 2003;326:624.
Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, Fox KR, et al. Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int J Obes (Lond) 2006;30:23–30.
Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 1992;11:1305–1319.
Martinez E, Devesa M, Bacallao J, Amador M. Percentiles of the waist-hip ratio in Cuban scholars aged 4.5 to 20.5 years. Int J Obes Relat Metab Disord 1994;18:557–560.
Zannolli R, Morgese G. Waist percentiles: a simple test for atherogenic disease? Acta Paediatr 1996;85:1368–1369.
Barba G, Troiano E, Russo P, Strazzullo P, Siani A. Body mass, fat distribution and blood pressure in Southern Italian children: results of the ARCA project. Nutr Metab Cardiovasc Dis 2006;16:239–248.
Moreno LA, Fleta J, Mur L, Rodríquez G, Sarría A, Bueno M. Waist circumference values in Spanish children—gender related differences. Eur J Clin Nutr 1999;53:429–433.
McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0–16.9 y. Eur J Clin Nutr 2001;55:902–907.
Savva SC, Kourides Y, Tornaritis M, Epiphaniou-Savva M, Tafouna P, Kafatos A. Reference growth curves for cypriot children 6 to 17 years of age. Obes Res 2001;9:754–762.
Katzmarzyk PT. Waist circumference percentiles for Canadian youth 11–18y of age. Eur J Clin Nutr 2004;58:1011–1015.
Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 2004; 145:439–444.
Eisenmann JC. Waist circumference percentiles for 7- to 15-year-old Australian children. Acta Paediatr 2005;94: 1182–1185.
Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM. Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr 2005;164:216–222.
Inokuchi M, Matsuo N, Anzo M, Takayama JI, Hasegawa T. Age-dependent percentile for waist circumference for Japanese children based on the 1992–1994 cross-sectional national survey data. Eur J Pediatr 2007;166:655–661.
Sung RY, Yu CC, Choi KC, McManus A, Li AM, Xu SL, et al. Waist circumference and body mass index in Chinese children: cutoff values for predicting cardiovascular risk factors. Int J Obes (Lond) 2007;31:550–558.
Kelishadi R, Gouya MM, Ardalan G, Hosseini M, Motaghian M, Delavari A, et al. First reference curves of waist and hip circumferences in an Asian population of youths: CASPIAN study. J Trop Pediatr 2007;53:158–164.
Hatipoglu N, Ozturk A, Mazicioglu MM, Kurtoglu S, Seyhan S, Lokoglu F. Waist circumference percentiles for 7- to 17-year-old Turkish children and adolescents. Eur J Pediatr 2008;167:383–389.
Gómez-Díaz RA, Martínez-Hernández AJ, Aguilar-Salinas CA, Violante R, Alarcón ML, Villarruel MJ, et al. Percentile distribution of the waist circumference among Mexican preadolescents of a primary school in Mexico City. Diabetes Obes Metab 2005;7:716–721.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240–1243.
Schwandt P, Geiss HC, Ritter MM, Ublacker C, Parhofer KG, Otto C, et al. The Prevention Education Program (PEP). A prospective study of the efficacy of family-oriented lifestyle modification: design and baseline data. J Clin Epidemiol 1999;52:791–800.
Lean MEJ, Han Thang S, Deurenberg P. Predicting body composition by densitometry from simple anthropometric measurements. Am J Clin Nutr 1996;63:4–14.
Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45–60.
Brambilla P, Lissau I, Flodmark CE, Moreno LA, Widhalm K, Wabitsch M, et al. Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome. Int J Obes (Lond) 2007;31:591–600.
Al-Shaer MH, Abusabha H. The impact of ethnicity on the lifetime risk of the metabolic syndrome and diabetes mellitus. Am J Cardiol 2005;95:819–820.
Banerjee D, Misra A. Does using ethnic specific criteria improve the usefulness of the term metabolic syndrome? Controversies and suggestions. Int J Obes (Lond) 2007;31:1340–1349.
Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, Heymsfield SB, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003;77:379–384.
de Ferranti SD, Gauvreau K, Ludwig DS, Neufeld EJ, Newburger JW, Rifai N. Prevalence of the metabolic syndrome in American adolescents: findings from the Third National Health and Nutrition Examination Survey. Circulation 2004;110:2494–2497.
Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 2004;114:e198–e205.
Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002;91:1307–1312.
Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH. Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 2003;157:821–827.
Janssen I, Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, et al. Combined influence of body mass index and waist circumference on coronary artery disease risk factors among children and adolescents. Pediatrics 2005;115:1623–1630.
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Schwandt, P., Kelishadi, R. & Haas, GM. First reference curves of waist circumference for German children in comparison to international values: the PEP Family Heart Study. World J Pediatr 4, 259–266 (2008). https://doi.org/10.1007/s12519-008-0048-0
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DOI: https://doi.org/10.1007/s12519-008-0048-0