Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.

1st Faculty of Medicine Charles University Prague Czech Republic

College of Health and Agricultural Sciences University College Dublin Dublin Ireland

Department of Food and Nutrition and Sport Science University of Gothenburg Gothenburg Sweden

Department of Food and Nutrition National Centre of Public Health and Analyses Sofia Bulgaria

Department of Health and Inequality Division of Mental and Physical Health Norwegian Institute of Public Health Oslo Norway

Department of Nutrition Dietetics and Food Studies Uppsala University Sweden

Department of Nutritional Sciences and Dietetics International Hellenic University Thessaloniki Greece

Department of Preventive Medicine Lithuanian University of Health Sciences Kaunas Lithuania

Department of Research and Health Statistics Centre for Disease and Prevention Control Riga Latvia

Department of Social and Policy Sciences University of Bath Bath UK

Faculty of Medicine Ss Cyril and Methodius University Skopje North Macedonia

Institute of Computer Science Czech Academy of Sciences Prague Czech Republic

Institute of Public Health Skopje North Macedonia

National Nutrition Surveillance Centre School of Public Health Physiotherapy and Sports Science University College Dublin Dublin Ireland

Obesity Management Centre Institute of Endocrinology Prague Czech Republic

School of Health Sciences Örebro University Örebro Sweden

School of Public Health and Community Medicine at Institute of Medicine University of Gothenburg Gothenburg Sweden

Spanish Agency for Food Safety and Nutrition Ministry of Consumer Affairs Madrid Spain

World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases Division of Country Health Programmes WHO Regional Office for Europe Moscow Russian Federation

Zobrazit více v PubMed

Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-2223.

Whitaker RC, Pepe MS, Wright JA, Seidel KD, Dietz WH. Early adiposity rebound and the risk of adult obesity. Pediatrics. 1998;101(3):E5.

Cho SJ, Kim EY, Rho YI, et al. The long-term follow-up studies of childhood obesity after puberty. Korean J Pediatr Gastroenterol Nutr. 2003;6(1):47-53.

Spinelli A, Buoncristiano M, Nardone P, et al. Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017. Obes Rev. 2021;e13214. https://doi.org/10.1111/obr.13214

Vanderwall C, Clark RR, Eickhoff J, Carrel AL. BMI is a poor predictor of adiposity in young overweight and obese children. BMC Pediatr. 2017;17(1):135. https://doi.org/10.1186/s12887-017-0891-z

Pouliot MC, Després 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(7):460-468.

Brambilla P, Bedogni G, Moreno LA, 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(1):23-30.

O'Connor M, Ryan J, Foley S. Best single-slice location to measure visceral adipose tissue on paediatric CT scans and the relationship between anthropometric measurements, gender and VAT volume in children. Br J Radiol. 2015;88(1054):20140711.

Xi B, Zong X, Kelishadi R, Litwin M, et al. International waist circumference percentile cutoffs for central obesity in children and adolescents aged 6 to 18 years. J Clin Endocrinol Metab. 2020;105(4):e1569-e1583.

Kelly AS, Dengel DR, Hodges J, Zhang L, Moran A, Chow L. The relative contributions of the abdominal visceral and subcutaneous fat depots to cardiometabolic risk in youth. Clin Obes. 2014;4(2):101-107.

McCarthy HD, Ashwell M. A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message -“keep your waist circumference to less than half your height”. Int J Obes (Lond). 2006;30(6):988-992.

Wijnhoven TM, Branca F. WHO European Childhood Obesity Surveillance Initiative. Protocol, version January 2008. Copenhagen: WHO Regional Office for Europe; 2008.

Louer AL, Simon DN, Switkowski KM, Rifas-Shiman SL, Gillman MW, Oken E. Assessment of Child Anthropometry in a Large Epidemiologic Study. J Vis Exp. 2017;120:e54895.

Wijnhoven TM, van Raaij JM, Spinelli A, et al. WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children. Pediatr Obes. 2013;8(2):79-97.

WHO European Childhood Obesity Surveillance Initiative. Protocol, version October 2012. Copenhagen: World Health Organization Regional Office for Europe; 2012.

WHO European Childhood Obesity Surveillance Initiative: overweight and obesity among 6-9-year-old children. Report of the third round of data collection 2012-2013. Copenhagen, Denmark: WHO Regional Office for Europe; 2018 https://www.euro.who.int/__data/assets/pdf_file/0010/378865/COSI-3.pdf. Accessed March 19, 2020.

Wijnhoven TM, van Raaij JM, Yngve A, et al. WHO European childhood obesity surveillance initiative: Health-risk behaviours on nutrition and physical activity in 6-9-year-old school children. Public Health Nutr. 2015;18(17):3108-3124.

Wijnhoven TM, van Raaij JM, Breda J. WHO European Childhood Obesity Surveillance Initiative: implementation of round 1 (2007/2008) and round 2 (2009/2010). Copenhagen, Denmark: WHO Regional Office for Europe; 2014 http://wwweurowhoint/__data/assets/pdf_file/0004/258781/COSI-report-round-1-and-2_final-for-webpdf Accesed March 19, 2020.

World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series. No. 854. Geneva: 1995. http://apps.who.int/iris/bitstream/10665/37003/1/WHO_TRS_854.pdf

Breda J, McColl K, Buoncristiano M, et al. Methodology and implementation of the WHO European Childhood Obesity Surveillance Initiative (COSI). Obes Rev. 2021;e13215. https://doi.org/10.1111/obr.13215

WHO criteria BMI-for-age2007. http://www.who.int/growthref/who2007_bmi_for_age/en/

Nations U. United Nations Standard Country Code, Series M. MiscellaneousStatisticalPapers. No. 49. New York: United Nations. ST/ESA/STAT/SER.M/49. Availablefrom: https://unstats.un.org/unsd/methodology/m49/2020

WHO anthropo software. http://www.who.int/growthref/tools/en/

Blössner M, Siyam A, Borghi E, Onyango A, de Onis M. WHO AnthroPlus for personal computers manual: software for assessing growth of the world's children and adolescents. Geneva: World Health Organization; 2009.

R core. 2017, R software. http://cran.at.r-project.org/

Nagy P, Kovacs E, Moreno LA, et al. Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study. Int J Obes (Lond). 2014;38(Suppl 2):S15-S25.

Cole TJ, Flegal KM, Nicholls D, Jackson AA. Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ. 2007;335(7612):194.

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320(7244):1240-1243.

Mokha JS, Srinivasan SR, Dasmahapatra P, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolict risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr. 2010;10(1):73.

Bacopoulou F, Efthymiou V, Landis G, Rentoumis A, Chrousos GP. Waist circumference, waist-to-hip ratio and waist-to-height ratio reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatr. 2015;15(1):50.

Nawarycz T, Haas GM, Krzyżaniak A, Schwandt P, Ostrowska-Nawarycz L. Waist circumference and waist-to-height ratio distributions in Polish and German schoolchildren: comparative analysis. Int J Prev Med. 2013;4(7):786-796.

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. Int J PediatrObes. 2009;4(4):381-388.

McCarthy H, Jarrett K, Crawley H. The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr. 2001;55:902-907.

Hassapidou M, Tzotzas T, Makri E, et al. Prevalence and geographic variation of abdominal obesity in 7- and 9-year-old children in Greece; World Health Organization Childhood Obesity Surveillance Initiative 2010. BMC Public Health. 2017;17(1):126.

Vorwieger E, Kelso A, Steinacker JM, Kesztyüs D, URMEL-ICE study group. Cardio-metabolic and socio-environmental correlates of waist-to-height ratio in German primary schoolchildren: a cross-sectional exploration. BMC Public Health. 2018;18(1):280.

Shungin D, Winkler TW, Croteau-Chonka DC, et al. New genetic loci link adipose and insulin biology to body fat distribution. Nature. 2015;518(7538):187-196.

Pulit SL, Karaderi T, Lindgren CM. Sexual dimorphism in genetic loci linked to body fat distribution. Biosci Rep. 2017;37(1). https://doi.org/10.1042/bsr20160184

Moreno LA, Fleta J, Mur L, Rodriquez G, Sarría A, Bueno M. Waist circumference values in Spanish children-gender related differences. Eur J Clin Nutr. 1999;53(6):429-433.

Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit J. Are age references for waist circumference, hip circumference and waist-to-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr. 2005;164(4):216-222.

Brannsether B, Roelants M, Bjerknes R, Júlíusson PB. Waist circumference and waist-to-height ratio in Norwegian children 4-18 years of age: reference values and cut-offs. Acta Paediatr. 2011;100(12):1576-1582.

Schwandt P, Haas GM. Is the ratio waist circumference to height (WHtR) of 0.5 a universal measure for abdominal adiposity in children and adolescents? Int J Obes (Lond). 2016;40(7):1141-1142.

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(4):383-389.

Poh BK, Jannah AN, Chong LK, Ruzita AT, Ismail MN, McCarthy D. Waist circumference percentile curves for Malaysian children and adolescents aged 6.0-16.9 years. Int J PediatrObes. 2011;6(3-4):229-235.

Song P, Li X, Gasevic D, Flores AB, Yu Z. BMI, waist circumference reference values for Chinese school-aged children and adolescents. Int J Environ Res Public Health. 2016;13(6):589.

Mukherjee S, Leong HF, Wong XX. Waist circumference percentiles for Singaporean children and adolescents aged 6-17 years. Obes Res Clin Pract. 2016;10(Suppl 1):S17-S25.

de Assis MAA, Rolland-Cachera MF, de Vasconcelos FAG, et al. Central adiposity in Brazilian schoolchildren aged 7-10 years. Br J Nutr. 2007;97(4):799-805.

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(4):482-488.

Blüher S, Molz E, Wiegand S, et al. Adiposity patients registry initiative and German competence net obesity. Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development. J Clin Endocrinol Metab. 2013;98(8):3384-3393.

Sijtsma A, Bocca G, L'abée C, Liem ET, Sauer PJ, Corpeleijn E. Waist-to-height ratio, waist circumference and BMI as indicators of percentage fat mass and cardiometabolic risk factors in children aged 3-7 years. Clin Nutr. 2014;33(2):311-315.

Inokuchi M, Matsuo N, Takayama JI, Hasegawa T. Waist-to-height ratio centiles by age and sex for Japanese children based on the 1978-1981 cross-sectional national survey data. Int J Obes (Lond). 2016;40(1):65-70.