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Original article

Vol. 141 No. 2526 (2011)

Waist circumference and waist-to-height ratio percentiles in a nationally representative sample of 6–13 year old children in Switzerland

  • M Gut-Knabenhans
  • RS Kusche-Ammann
  • MB Zimmermann
DOI
https://doi.org/10.4414/smw.2011.13227
Cite this as:
Swiss Med Wkly. 2011;141:w13227
Published
20.06.2011

Summary

OBJECTIVES:Central obesity, measured as waist circumference (WC), is an important risk factor for cardiovascular disease and diabetes already in children. The ratio of waist circumference to height (WHtR) is a further indicator for body shape. International reference values, however, do not exist for any of the two measures and neither do references specific to Switzerland. The aim of this study therefore was to develop WC and WHtR percentiles from a nationally representative sample of Swiss children.

METHODS:In a nationally representative sample of 2,303 6 to 13 year old children in Switzerland weight, height and WC were measured and body fat % (%BF) was determined from multiple skinfold-thickness measurements. WC, WHtR and % BF percentiles were calculated using the LMS-Method of Cole and Green.

RESULTS:WC increases almost linearly over the age range of 6 to 13 years for both boys and girls. Generally, girls show slightly lower WC than boys, but in the higher percentiles (85th, 90th and 95th) they reach the same or even slightly higher values around 10 years of age. At the 85th percentile for boys and the 90th percentile for girls, WHtR remains constant over the entire age range. Above these levels the ratio increases and below it decreases with age. Percentiles for %BF in boys increase constantly up to an age of 11.5 years, after which they plateau. For girls, the plateau can be seen earlier, around 10.5 years, but at 12.5 years another increase begins.

CONCLUSION:These first WC and WHtR percentiles may be useful for clinical and epidemiological use in Switzerland until official, validated references become available. An advantage in using WHtR seems to be that it is not age dependent at certain levels and it may therefore be possible to use a single cut-off value for all children.

References

  1. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics. 1998;101:518–25.
  2. Weiss R, Caprio S. The metabolic consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab. 2005;19:405–19.
  3. Pouliot MC, Despres JP, Lemieux S, et al. Waist Circumference and Abdominal Sagittal Diameter - Best Simple Anthropometric Indexes of Abdominal Visceral Adipose-Tissue Accumulation and Related Cardiovascular Risk in Men and Women. Am J Cardiol. 1994;73:460–8.
  4. Lean ME, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ. 1995;311:158–61.
  5. Goran MI, Gower BA. Relation between visceral fat and disease risk in children and adolescents. Am J Clin Nutr. 1999;70:149S–156S.
  6. Cowin I, Emmett P. Cholesterol and triglyceride concentrations, birthweight and central obesity in pre-school children. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Int J Obes Relat Metab Disord. 2000;24:330–9.
  7. Flodmark CE, Sveger T, Nilsson-Ehle P. Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12-14-year-old children. Acta Paediatr. 1994;83:941–5.
  8. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 1999;69:308–17.
  9. Zimmet P, Alberti G, Kaufman F, et al. The metabolic syndrome in children and adolescents. Lancet. 2007;369:2059–61.
  10. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.
  11. Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60.
  12. Zimmermann MB, Gubeli C, Puntener C, Molinari L. Detection of overweight and obesity in a national sample of 6-12-y-old Swiss children: accuracy and validity of reference values for body mass index from the US Centers for Disease Control and Prevention and the International Obesity Task Force. Am J Clin Nutr. 2004;79:838–43.
  13. McCarthy HD. Body fat measurements in children as predictors for the metabolic syndrome: focus on waist circumference. Proc Nutr Soc. 2006;65:385–92.
  14. Browning L, Hsieh S, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value Nutrition Research Reviews 2010;23:247–69.
  15. Ashwell M, Cole TJ, Dixon AK. Ratio of waist circumference to height is strong predictor of intra-abdominal fat. BMJ. 1996;313:559–60.
  16. Hsieh SD, Yoshinaga H. Waist/height ratio as a simple and useful predictor of coronary heart disease risk factors in women. Intern Med. 1995;34:1147–52.
  17. Hara M, Saitou E, Iwata F, Okada T, Harada K. Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb. 2002;9:127–32.
  18. Kahn HS, Imperatore G, Cheng YJ. A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth. J Pediatr. 2005;146:482–8.
  19. WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee 1995.
  20. Gibson RS. Principles of Nutritional Assessment. 2. ed. New York: Oxford University Press, 2005.
  21. Gibson RS. Nutritional Assessment: A Laboratory Manual. Oxford: Oxford University Press, 1993.
  22. Deurenberg P, Pieters JJ, Hautvast JG. The assessment of the body fat percentage by skinfold thickness measurements in childhood and young adolescence. Br J Nutr. 1990;63:293–303.
  23. Cole TJ, Green PJ. Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med. 1992;11:1305–19.
  24. Royston P, Wright EM. Goodness-of-fit statistics for age-specific reference intervals. Statistics in Medicine. 2000;19:2943–62.
  25. van Buuren S, Fredriks M. Worm plot: a simple diagnostic device for modelling growth reference curves. Statistics in Medicine. 2001;20:1259–77.
  26. Aeberli I, Ammann RS, Knabenhans M, Molinari L, Zimmermann MB. Decrease in the prevalence of paediatric adiposity in Switzerland from 2002 to 2007. Public Health Nutrition. 2010;13:806–11.
  27. 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.
  28. 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;55:902–7.
  29. 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 Journal of Pediatrics. 2008;4:257–64.
  30. Zannolli R, Morgese G. Waist percentiles: a simple test for atherogenic disease? Acta Paediatr. 1996;85:1368–9.
  31. Moreno LA, Fleta J, Mur L, Sarria A, Bueno M. Fat distribution in obese and nonobese children and adolescents. J Pediatr Gastroenterol Nutr. 1998;27:176–80.
  32. 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. 2007.
  33. Eisenmann JC. Waist circumference percentiles for 7- to 15-year-old Australian children. Acta Paediatr. 2005;94:1182–5.
  34. 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;72:490–5.
  35. Fernandez 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;145:439–44.
  36. Katzmarzyk PT. Waist circumference percentiles for Canadian youth 11–18 y of age. Eur J Clin Nutr. 2004;58:1011–5.
  37. 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;164:216–22.
  38. Galcheva SV, Iotova VM, Yotov YT, Grozdeva KP, Stratev VK, Tzaneva VI. Waist circumference percentile curves for Bulgarian children and adolescents aged 6–18 years. International J Pediatr Obesity. 2009;4:381–8.
  39. Savva SC, Tornaritis M, Savva ME, 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;24:1453–8.
  40. Gomez-Diaz RA, Martinez-Hernandez AJ, Aguilar-Salinas CA, et al. Percentile distribution of the waist circumference among Mexican pre-adolescents of a primary school in Mexico City. Diabetes Obes Metab. 2005;7:716–21.
  41. Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr. 2005;56:303–7.
  42. Crosbie A, Eichner J, Moore W. Body mass index screening and volunteer bias. Annals of Epidemiology. 2008;18:602–4.
  43. Peneau S, Salanave B, Maillard-Teyssier L, et al. Prevalence of overweight in 6- to 15-year-old children in central/western France from 1996 to 2006: trends toward stabilization. Int J Obes. (Lond) 2009.