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Cited by 33Obesity, Physical Activity, DietBody Composition Measurement TechniquesDiabetes, Cardiovascular Risks, and Lipoproteins

Reference Values for Waist Circumference and Waist–Height Ratio in Korean Children and Adolescents

Open access
Lee, Jieun, Kang, Sung-Chan, Kwon, Obin, Hwang, Seung-sik, Moon, Jin Soo, Kim, Jaehyun·2022·Journal of Obesity & Metabolic Syndrome
DOI 10.7570/jomes22033PMC PMC9579477
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Abstract

Background: Abdominal obesity, which is a strong indicator of cardiometabolic risk, is widely evaluated using waist circumference (WC) and waist-height ratio (WHtR). In Korea, the reference values for WC for children and adolescents were published in 2007 and need to be revised. Moreover, there is no reference for WHtR. The aim of this study was to establish new reference values for WC and WHtR in Korean children and adolescents. Methods: Data of 20,033 subjects from the Korea National Health and Nutrition Examination Survey (2007-2019) were used. Tables for reference values and the graphs of smoothed percentile curves of WC and WHtR for children and adolescents aged 2-18 years by sex were generated using the LMS method and locally estimated scatterplot smoothing regression analysis after removing extreme values. Results: Sex-specific reference tables and percentile curves for WC and WHtR were developed. In the new WC curves, the 10th, 50th, and 90th percentile lines were lower than the corresponding lines of the 2007 reference for both sexes. The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years in both sexes. In the logistic regression analysis, the WC and WHtR z-scores showed higher odds ratios for predicting cardiometabolic risk factors than the body mass index z-score. Conclusion: New WC and WHtR reference values for Korean children and adolescents aged 2-18 years were developed using the latest statistical methods. These references will help monitor and track WC and WHtR for evaluating abdominal obesity among at-risk children and adolescents in Korea.

AI snapshot

Written from the paper’s full text.

TL;DR

New sex-specific waist circumference (WC) and waist–height ratio (WHtR) reference tables and percentile curves were developed for Korean children and adolescents aged 2–18 years using KNHANES 2007–2019 data. The new WC curves were lower than the 2007 reference, and WC and WHtR z-scores predicted cardiometabolic risk factors with higher adjusted odds ratios than BMI z-score.

Key findings

  • Among 20,033 participants aged 2–18 years, sex-specific reference tables and smoothed percentile curves were generated for WC and WHtR.
  • In the new WC curves, the 10th, 50th, and 90th percentile lines were lower than the corresponding lines of the 2007 reference for both sexes.
  • WHtR curves showed sex-specific differences but a relative plateau among those aged ≥10 years in both sexes.
  • WC and WHtR z-scores were significantly correlated (r²=0.846, P<0.001 for boys; r²=0.834, P<0.001 for girls), and both had higher adjusted odds ratios for all cardiometabolic risk factors than BMI z-score.

Methods

  • Cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2007–2019; among 113,724 enrolled individuals, 22,495 aged ≤20 years with anthropometric data were candidates, and 20,033 aged 2–18 years were included for reference curves and tables.
  • Height, weight, and WC were measured by trained personnel; WC was measured at the midpoint between the lowest rib margin and highest iliac crest during expiration, and WHtR was calculated as WC divided by height.
  • Reference values were generated using the LMS method with Box-Cox transformation and locally estimated scatterplot smoothing (LOESS) regression in Stata 16.1; logistic regression adjusted for age and sex evaluated associations between WC, WHtR, and BMI z-scores and cardiometabolic risk factors.

Limitations

  • The paper states that the charts were derived from cross-sectional data and that WC and WHtR values were presented by age in years, not months, limiting precise application to narrower age groups.
  • The paper states that further research is needed to determine the optimal WHtR cutoff point.
  • Evident from the text: cardiometabolic risk factor evaluation was restricted to participants aged 10–18 years with blood pressure or laboratory data (12,158 individuals), so predictive performance was not assessed in younger children.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.7570/jomes22033

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

16 of 31 cited sources checked · 5 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The 2007 Korean National Growth Charts WC reference did not adopt standardized measurements of WC.

    “The currently used WC reference, which was published in the 2007 Korean National Growth Charts, has several drawbacks; specifically, its development did not adopt standardized measurements of WC, only included several percentile values, presented no graphical charts, and did not exclude children and adolescents with severe obesity.18,19”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] source
    • cites [19] source

      The Results section compares WC values with the 2007 Korean National Growth Charts, and the Discussion describes the charts’ underlying measurement years, but neither addresses whether their WC measurements were standardized. The measurement protocol in Materials and Methods describes this paper’s own data, not how the 2007 reference was developed (searched: standardized WC measurements, 2007 reference measurement protocol). (LLM, conf=0.74)

      Experimental — accuracy not yet measured
  • Premisecitation

    For diagnosis of metabolic syndrome in children and adolescents, as well as in adults, WC rather than BMI is used as a diagnostic criterion.

    “For diagnosis of metabolic syndrome (MS) in children and adolescents, as well as in adults, WC rather than BMI is used as a diagnostic criterion.13-15”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [13] source
    • cites [14] source

      The Methods and the adult/proposed pediatric definitions table show that ATP III uses waist circumference for adults and that this paper's proposed pediatric definition also uses it, rather than BMI. But the paper says there is no standard pediatric definition and describes another pediatric definition based on BMI, so the claim is too broad if read as applying to pediatric diagnosis generally. The supplied passages have section labels but no page numbers. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [15] source
  • Premisecitation

    BMI has the drawback of not adequately reflecting the proportions of body fat and muscle mass because it is calculated by simply dividing body weight by the square of height.

    “However, BMI has the drawback of not adequately reflecting the proportions of body fat and muscle mass because it is calculated by simply dividing body weight by the square of height.10”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Premisecitation

    The 2007 WC reference did not exclude children and adolescents with severe obesity.

    “The currently used WC reference, which was published in the 2007 Korean National Growth Charts, has several drawbacks; specifically, its development did not adopt standardized measurements of WC, only included several percentile values, presented no graphical charts, and did not exclude children and adolescents with severe obesity.18,19”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [18] source
    • cites [19] source

      The Discussion says the 2007 waist-circumference reference used measurements from 1997 and 2005, when childhood obesity had already increased. Neither that passage nor the passages found by searching for exclusion and severe obesity state whether children and adolescents with severe obesity were excluded from the reference. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    Subjects with weight for height <−3 SD or >+2 SD were excluded to prevent skewness.

    “Among KNHANES participants 1–20 years of age, those with weight for height <−3 standard deviation (SD) or >+2 SD were excluded. These cutoff values for subject selection were used in previous Korean Growth Charts and are considered appropriate for preventing skewness.9”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] source

      The Data exclusion section says the 2017 Korean growth charts excluded weight-for-height values below −3 SD or above +2 SD for weight-for-age, BMI-for-age, and weight-for-height charts to avoid skewing. It does not describe applying those exclusions to KNHANES participants aged 1–20; the charts used other development datasets, and some chart types used a +3 SD upper cutoff. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Study design and conductcitation

    The newly developed WC reference adopted up-to-date statistical methodology, including removal of subjects with extreme weight, smoothing of percentile lines, and the LMS estimation method.

    “To overcome the drawbacks of previous reference charts, the newly developed WC reference adopted up-to-date statistical methodology, such as the removal of subjects with extreme weight, smoothing of percentile lines, and the LMS estimation method, which was applied in the 2017 Korean National Growth Charts.9”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [16] source
    • cites [17] source

      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)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Pediatric abdominal obesity is a strong predictor of cardiometabolic risk factors and cardiovascular disease in adulthood.

    “Several studies have recently identified pediatric abdominal obesity as a strong predictor of cardiometabolic risk factors and cardiovascular disease in adulthood.11,12”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [11] source
    • cites [12] source

      The Conclusions (page unavailable) identify waist-to-height ratio as a reliable predictor of metabolic syndrome in Korean children and adolescents, supporting the link between abdominal size and pediatric cardiometabolic risk. The Introduction says cardiometabolic risk-factor clustering can track into adulthood, but the paper does not establish that pediatric abdominal obesity predicts cardiovascular disease in adulthood; its Conclusions call for long-term follow-up. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The prevalence of abdominal obesity in Korean children and adolescents aged 10-18 years was estimated as 9.66% using the 2007 reference values.

    “In a recent study, the prevalence of abdominal obesity in Korean children and adolescents aged 10–18 years was estimated as 9.66% using the 2007 reference values.27”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [27] source

      The Results report that central obesity prevalence increased among Korean children and adolescents, and the Methods describe waist-circumference reference values. However, our copy does not report a 9.66% prevalence estimate or identify those reference values as the 2007 values; a Discussion passage mentions 2007 only in connection with revised IDF criteria. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A recent study using KNHANES data to analyze WHtR in children and adolescents aged 10−18 years showed LMS data and percentile values, but it was limited by the lack of data from subjects under the age of 10, that the analysis was conducted without removing extreme values, and the possibility of WHtR variability at both ends of the age spectrum.

    “A recent study using KNHANES data to analyze WHtR in children and adolescents aged 10−18 years showed LMS data and percentile values, but it was limited by the lack of data from subjects under the age of 10, that the analysis was conducted without removing extreme values, and the possibility of WHtR variability at both ends of the age spectrum.33”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [33] source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    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”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] source

      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

  • May combine two claims.

    Premisecitation

    WC and WHtR are important abdominal obesity-related indicators associated with cardiometabolic risk factors and metabolic syndrome.

    “WC and WHtR are important abdominal obesity-related indicators associated with cardiometabolic risk factors and MS.12”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    According to a recent study of Korean adolescents 13-18 years of age, the cutoff value of WHtR for diagnosing abdominal obesity was 0.48, which is lower than 0.5.

    “According to a recent study of Korean adolescents 13−18 years of age, the cutoff value of WHtR for diagnosing abdominal obesity was 0.48, which is lower than 0.5.19”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Findingown data

    The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years in both sexes.

    “The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years in both sexes.”
    • Also stated in: § New references for WC and WHtR · plain
      “The WHtR curves showed sex-specific differences, although they demonstrated a relative plateau among those aged ≥10 years regardless of sex.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    WC and WHtR reference values were developed using up-to-date methodology and the latest nationally representative anthropometric data.

    “In conclusion, WC and WHtR reference values were developed using up-to-date methodology and the latest nationally representative anthropometric data.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    Children and adolescents with WHtR ≥0.5 are highly likely to have abdominal obesity, so further evaluation may be necessary.

    “Therefore, children and adolescents with WHtR ≥0.5 are highly likely to have abdominal obesity, so further evaluation may be necessary.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A study has shown that WHtR reflects body fat better than WC in children and adolescents.

    “It is not clear which of these indicators is superior, although a study has shown that WHtR reflects body fat better than WC in children and adolescents.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The charts were derived from cross-sectional data.

    “First, the charts were derived from cross-sectional data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    WHtR has been used for diagnosis of abdominal obesity.

    “WHtR, which is calculated as WC divided by height, has been used for diagnosis of abdominal obesity.28”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] source

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Children and adolescents with abdominal obesity are more likely to be classified as normal if the reference values are derived from data in which the prevalence of obesity is elevated.

    “Furthermore, children and adolescents with abdominal obesity are more likely to be classified as normal if the reference values are derived from data in which the prevalence of obesity is elevated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    International studies have shown that the WHtR cutoff of 0.5 is not applicable to children or adolescents, and that it would be better to use WHtR percentiles specific for age and sex.

    “International studies have also shown that the WHtR cutoff of 0.5, which is mainly used in adults, is not applicable to children or adolescents, who are still growing, and that it would be better to use WHtR percentiles that are specific for age and sex.16,32”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [16] source
    • cites [32] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    WHtR may be widely used as a screening risk factor for cardiometabolic risk due to its simplicity of calculation, even if it is not superior to WC.

    “WHtR may be widely used as a screening risk factor for cardiometabolic risk due to its simplicity of calculation, even if it is not superior to WC.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    WHtR could be useful for defining abdominal obesity because it is easy to calculate and has a simple cutoff value of ≥0.5.

    “WHtR could be useful for defining abdominal obesity because it is easy to calculate and has a simple cutoff value of ≥0.5.29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] source
18 of 18

  • The paper relies on this without support.

    There is no reference for WHtR in Korean children and adolescents.

    “Moreover, there is no reference for WHtR.”

  • The paper relies on this without support.

    WC is positively associated with height, limiting its accuracy as an indicator of abdominal obesity.

    “However, WC is positively associated with height, limiting its accuracy as an indicator of abdominal obesity.”

  • The paper relies on this without support.

    WHtR is consistent according to age and sex and is a good indicator for assessing abdominal obesity.

    “Alternatively, the waist–height ratio (WHtR) has been used in recent years because it is consistent according to age and sex and is a good indicator for assessing abdominal obesity.”
3 of 3

Self-check

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

Each contradiction between two passages listed here was confirmed by an independent check.

  • 2007 WC reference described both as having and lacking graphical curves

    Minor

    The paper says the 2007 WC reference presented no graphical charts, but later describes WC curves as having been presented in that growth chart.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Cole TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45-60.

Cited by

Still being checked.

Related

Authors
Lee, J., Kang, S.-C., Kwon, O., Hwang, S.-S., Moon, J. S., & Kim, J.
Affiliations
  • Inje University Ilsan Paik Hospital (KR)
  • Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Korea
  • Seoul National University (KR)
  • Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
ORCID
Venue
Journal of Obesity & Metabolic Syndrome
Publisher
Korean Society for the Study of Obesity
Published
2022-09-08
Volume
31
Issue
3
Pages
263-271
ISSN
  • 2508-6235 (ISSN-L)
  • 2508-7576
DOI
10.7570/jomes22033
PMC
PMC9579477
OpenAlex
W4294993025
Semantic Scholar
622058bb93e340b4aec75ab8f9904a0ed65574b8
Cited by
33
References
37
Citations by year
2026: 12 · 2025: 12 · 2024: 6 · 2023: 3
FWCI
4.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Obesity & Metabolic Syndrome (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Seoul National University Bundang Hospital (09-2019-0008)
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
waist circumference, waist-to-height ratio, abdominal obesity, reference values, percentile curves, children and adolescents, cardiometabolic risk, body mass index, sex differences, Korean children

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