CoChat
Sign Up
Cited by 72Obesity, Physical Activity, DietBody Composition Measurement TechniquesDiabetes, Cardiovascular Risks, and Lipoproteins

Cut-off Values of Body Mass Index, Waist Circumference, and Waist-to-Height Ratio to Identify Excess Abdominal Fat: Population-Based Screening of Japanese Schoolchildren

Open access
Fujita, Yuki, Kouda, Katsuyasu, Nakamura, Harunobu, Iki, Masayuki·2011·Journal of Epidemiology
DOI 10.2188/jea.je20100116PMC PMC3899408
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: School-based screening and prevention programs for adiposity generally target school children in grades 4 and 6 (age 9-11 years). The aims of this study were to evaluate the validity of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in identifying abdominal adiposity in fifth-grade Japanese school children and to determine optimal cut-off values for anthropometric measures. METHODS: The target population was fifth-grade school children enrolled in 2 schools in Shizuoka, Japan between 2008 and 2010; 422 of the 466 children participated in the present study. Abdominal adiposity was defined as percent trunk fat in the 95th percentile or higher, as determined by dual-energy x-ray absorptiometry (DXA). We analyzed the validity of BMI, WC, and WHtR using receiver operating characteristic (ROC) curve analysis. The Youden index was used to determine cut-off values of BMI, WC, and WHtR that identify excess abdominal fat. RESULTS: Optimal cut-off values to identify abdominal adiposity were 20.8 kg/m(2) (BMI), 76.5 cm (WC), and 0.519 (WHtR) for boys, and 19.6 kg/m(2) (BMI), 73.0 cm (WC), and 0.499 (WHtR) for girls. Areas under the ROC curve were 0.983 (BMI), 0.987 (WC), and 0.981 (WHtR) for boys, and 0.981 (BMI), 0986 (WC), and 0.992 (WHtR) for girls. CONCLUSIONS: BMI, WC, and WHtR successfully identified a high proportion of children with excess abdominal fat as measured by DXA, demonstrating that these measures are useful indices for school screening.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2188/jea.je20100116

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • For Japanese children aged 9-11 years, WHtR values of 0.519 for boys and 0.499 for girls were determined to be the most appropriate cutoffs for diagnosing abdominal obesity.

    “For Japanese children aged 9−11 years, WHtR values of 0.519 for boys and 0.499 for girls were determined to be the most appropriate cutoffs for diagnosing abdominal obesity.31”

    From Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents (2022) · cites this paper as [31]

    Table 3 in the Results reports optimal WHtR cutoffs of 0.519 for boys and 0.499 for girls to identify excess abdominal fat. However, the Methods specify that the study population was fifth-grade children aged 10, not children across ages 9–11; the wider age range describes screening programs in the Background. Page numbers are unavailable in our copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 24

  1. [2]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 12226553
  2. [3]Maffeis C, Banzato C, Talamini G; Obesity Study Group of the Italian Society of Pediatric Endocrinology and Diabetology Waist-to-height ratio, a useful index to identify high metabolic risk in overweight children. J Pediatr. 2008; 152: 207– 13 10.1016/j.jpeds.2007.09.021 18206690 · DOI
  3. [4]Huang SH, Weng KP, Hsieh KS, Ou SF, Lin CC, Chien KJ, Effects of a classroom-based weight-control intervention on cardiovascular disease in elementary-school obese children. Acta Paediatr Taiwan. 2007; 48: 201– 6 18265541
  4. [5]Hoelscher DM, Feldman HA, Johnson CC, Lytle LA, Osganian SK, Parcel GS, School-based health education programs can be maintained over time: results from the CATCH Institutionalization study. Prev Med. 2004; 38: 594– 606 10.1016/j.ypmed.2003.11.017 15066362 · DOI
  5. [6]Resnicow K, Cross D, Lacosse J, Nichols P Evaluation of a school-site cardiovascular risk factor screening intervention. Prev Med. 1993; 22: 838– 56 10.1006/pmed.1993.1076 8115342 · DOI
  6. [7]Bush PJ, Zuckerman AE, Theiss PK, Taggart VS, Horowitz C, Sheridan MJ, Cardiovascular risk factor prevention in black schoolchildren: two-year results of the “Know Your Body” program. Am J Epidemiol. 1989; 129: 466– 82 2916540
  7. [8]Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr. 1999; 134: 668– 74 10.1016/S0022-3476(99)70279-9 10356132 · DOI
  8. [9]Kouda K, Nakamura H, Nishio N, Fujita Y, Takeuchi H, Iki M Trends in body mass index, blood pressure, and serum lipids in Japanese children: Iwata population-based annual screening (1993–2008). J Epidemiol. 2010; 20: 212– 8 10.2188/jea.JE20090079 20208399 PMC3900843 · DOI
  9. [10]Salcedo Aguilar F, Martínez-Vizcaíno V, Sánchez López M, Solera Martínez M, Franquelo Gutiérrez R, Serrano Martínez S, Impact of an after-school physical activity program on obesity in children. J Pediatr. 2010; 157: 36– 42.e3 10.1016/j.jpeds.2009.12.046 20227726 · DOI
  10. [11]Kouda K, Nakamura H, Fan W, Takeuchi H Negative relationships between growth in height and levels of cholesterol in puberty: a 3-year follow-up study. Int J Epidemiol. 2003; 32: 1105– 10 10.1093/ije/dyg207 14681284 · DOI
  11. [12]Caballero B, Clay T, Davis SM, Ethelbah B, Rock BH, Lohman T, Pathways: school-based, randomized controlled trial for the prevention of obesity in American Indian schoolchildren. Am J Clin Nutr. 2003; 78: 1030– 8 14594792 PMC4863237
  12. [13]Gortmaker SL, Peterson K, Wiecha J, Sobol AM, Dixit S, Fox MK, Reducing obesity via a school-based interdisciplinary intervention among youth: Planet Health. Arch Pediatr Adolesc Med. 1999; 153: 409– 18 10201726
  13. [14]Takada H, Harrell J, Deng S, Bandgiwala S, Washino K, Iwata H Eating habits, activity, lipids and body mass index in Japanese children: the Shiratori Children Study. Int J Obes Relat Metab Disord. 1998; 22: 470– 6 10.1038/sj.ijo.0800610 9622345 · DOI
  14. [15]Kanda A, Watanabe Y, Kawaguchi T Estimation of obesity in schoolchildren by measuring skinfold thickness. Public Health. 1997; 111: 29– 32 10.1038/sj.ph.1900316 9033221 · DOI
  15. [16]Dencker M, Thorsson O, Lindén C, Wollmer P, Andersen LB, Karlsson MK BMI and objectively measured body fat and body fat distribution in prepubertal children. Clin Physiol Funct Imaging. 2007; 27: 12– 6 10.1111/j.1475-097X.2007.00709.x 17204032 · DOI
  16. [17]Nambiar S, Hughes I, Davies PS Developing waist-to-height ratio cut-offs to define overweight and obesity in children and adolescents. Public Health Nutr. 2010; 13: 1566– 74 10.1017/S1368980009993053 20100388 · DOI
  17. [18]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 10919946
  18. [20]Freedman DS, Sherry B The validity of BMI as an indicator of body fatness and risk among children. Pediatrics. 2009; 124 Suppl 1: S23– 34 10.1542/peds.2008-3586E 19720664 · DOI
  19. [21]Pietrobelli A, Faith MS, Allison DB, Gallagher D, Chiumello G, Heymsfield SB Body mass index as a measure of adiposity among children and adolescents: a validation study. J Pediatr. 1998; 132: 204– 10 10.1016/S0022-3476(98)70433-0 9506629 · DOI
  20. [22]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 10.1136/bmj.320.7244.1240 10797032 PMC27365 · DOI
  21. [23]Definition and the diagnostic standard for metabolic syndrome—Committee to Evaluate Diagnostic Standards for Metabolic Syndrome. Nippon Naika Gakkai Zasshi. 2005; 94: 794– 809 (in Japanese) 15865013
  22. [24]Hara K, Matsushita Y, Horikoshi M, Yoshiike N, Yokoyama T, Tanaka H, A proposal for the cutoff point of waist circumference for the diagnosis of metabolic syndrome in the Japanese population. Diabetes Care. 2006; 29: 1123– 4 10.2337/dc05-2540 16644651 · DOI
  23. [25]Nakata K, Choo J, Hopson MJ, Ueshima H, Curb JD, Shin C, Stronger associations of sagittal abdominal diameter with atherogenic lipoprotein subfractions than waist circumference in middle-aged US white and Japanese men. Metabolism. 2010; 59: 1742– 51 10.1016/j.metabol.2010.04.019 20580038 PMC2978280 · DOI
  24. [26]Araki S, Dobashi K, Kubo K, Kawagoe R, Yamamoto Y, Kawada Y, Prevalence of ‘obesity disease’ and ‘metabolic syndrome’ in obese pediatric outpatients at the University Hospital of Occupational and Environmental Health, Japan. J UOEH. 2008; 30: 309– 19 18783012

Cited by

Sorted by citations

Authors
Fujita, Y., Kouda, K., Nakamura, H., & Iki, M.
Affiliations
  • Kindai University (JP)
  • Kobe University (JP)
ORCID
Venue
Journal of Epidemiology
Publisher
Japan Epidemiological Association
Published
2011
Volume
21
Issue
3
Pages
191-196
ISSN
  • 0917-5040 (ISSN-L)
  • 1349-9092
DOI
10.2188/jea.je20100116
PMC
PMC3899408
OpenAlex
W1970039014
Cited by
72
References
1
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 14 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 7 · 2015: 5 · 2014: 6 · 2013: 5 · 2012: 6
FWCI
5.66
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Epidemiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
abdominal fat, body mass index, waist circumference, waist-to-height ratio, cut-off values, school-based screening, childhood obesity, anthropometric indices, sex differences
MeSH terms
Body Height, Child, Female, Humans, Japan, Male, Mass Screening, Obesity, Reference Values, ROC Curve, School Health Services, Reproducibility of Results, Body Mass Index, Abdominal Fat, Waist Circumference

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review