Letter to the Editor from Zhang: “International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years”
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The widespread prevalence of obesity in children and adolescents, with its attendant health risks, has become an important public health concern (1). Waist circumference (WC) and related indicators (indicating abdominal fat accumulation) may better predict the risk of cardiovascular disease (2). As of yet, international WC cutoffs to define central obesity in children and adolescents have not been proposed (3); waist-to-height ratio (WHtR), by contrast, has gained increasing interest as a measure of central obesity, independent of sex and age, with the simple public health message: “keep your waist circumference to less than half your height” (4). Fortunately, a set of international age- and sex-specific WC cutoffs, based on data from 8 countries (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland), have just been established by Xi et al in 2020 (5). Based on a large sample, we examined the profiles of central obesity among children and adolescents by both WC cutoffs and WHtR. Data were obtained from a survey on students’ constitution and health in Shandong, China. A total of 42 296 children and adolescents (21 218 boys and 21 078 girls) aged 7–18 years were included in the analysis (the age- and sex-specific sample size was 1669–1901). Using WC cutoffs, the total prevalence of central obesity was 27.37% (95% confidence interval [CI]: 26.77–27.97%) for boys and 16.80% (95% CI: 16.30–17.30%) for girls. Using WHtR ≥ 0.5, the total prevalence of central obesity was 15.97% (95% CI: 15.48–16.46%) for boys and 7.63% (95% CI: 7.27–7.99%) for girls. A wide disparity in the results of the 2 criteria was observed, and a significant difference was observed in all age groups (P < 0.01). We speculate that the 0.5 threshold of WHtR may be a bit high for children and adolescents. Further research is needed to find which approach (the current WC cutoffs or WHtR ≥ 0.5) should be prioritized as a recommendation in practice.
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Because children and adolescents continue to grow physically, the normal values of WC and WHtR differ according to sex and age, necessitating sex- and age-specific reference values.
“Because children and adolescents continue to grow physically, the normal values of WC and WHtR differ according to sex and age, necessitating sex- and age-specific reference values.16,17”
From Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents (2022) · cites this paper as [17]
The letter describes international age- and sex-specific WC cutoffs for children and adolescents. It describes WHtR, by contrast, as a measure of central obesity independent of sex and age, so it does not support the claim that WHtR also necessitates sex- and age-specific reference values. (LLM, conf=0.88)
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Research works printed but not linked: 5
- Karnik S, Kanekar A. Childhood obesity: a global public health crisis. Int J Prev Med. 2012;3(1):1-7.
- van Dijk SB, Takken T, Prinsen EC, Wittink H. Different an- thropometric adiposity measures and their association with car- diovascular disease risk factors: a meta-analysis. Neth Heart J. 2012;20(5):208-218.
- de Moraes AC, Fadoni RP, Ricardi LM, et al. Prevalence of ab- dominal obesity in adolescents: a systematic review. Obes Rev. 2011;12(2):69-77.
- Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of car- diovascular disease and diabetes: 0•5 could be a suitable global boundary value. Nutr Res Rev. 2010;23(2):247-269.
- Xi B, Zong X, Kelishadi R, et al. International waist circum- ference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. J Clin Endocrinol Metab. 2020;105(4):1569-1583. Downloaded from academic.oup.com/jcem/article/105/12/e4977/5913409 by guest on 18 August 2026
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Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents
Lee, J., Kang, S.-C., Kwon, O., Hwang, S.-S., Moon, J. S., & Kim, J. (2022) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes22033 · Cited by 33 · see citing works
- Authors
- Zhang, Y.-X.
- Affiliations
- Shandong University (CN)
- Corresponding author
- Zhang, Ying-Xiu
- ORCID
- Zhang, Ying-Xiu
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2020-09-30
- Volume
- 105
- Issue
- 12
- Pages
- e4977-e4977
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W3090631982
- Cited by
- 16
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 3 · 2023: 4 · 2022: 1 · 2020: 2
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- abdominal obesity, waist circumference, waist-to-height ratio, cut-off values, children and adolescents, abdominal fat, obesity prevalence, sex differences, age-specific thresholds, cardiovascular risk, Shandong, China, student health survey, cardiovascular risk prediction
- MeSH terms
- Adolescent, Child, Humans, Waist Circumference, Obesity, Abdominal, Pediatric Obesity
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