The main purpose of the study was to define optimal criterion-referenced cut-points for cardiorespiratory fitness (CRF) associated with overweight/obesity. In this cross-sectional study, participants were 1,612 children aged 7-14 years (mean age ± SD = 9.7 ± 2.4 years; 52.5% girls). CRF was assessed by the Maximal multistage 20-m shuttle run test, from which maximal oxygen uptake (VO2max) was estimated. Anthropometric indices included body-mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Receiver operating characteristic (ROC) curves were performed to determine cut-off points. In boys, the optimal cut-off points of CRF in defining overweight/obesity for BMI, WC, and WHtR were 44.6, 46.4, and 46.9 mlO2/kg/min. The areas under the curves (AUC) were 0.83 (95% CI 0.78-0.88, p < 0.001), 0.77 (95% CI 0.71-0.83, p < 0.001), and 0.90 (95% CI 0.86-0.93, p < 0.001). In girls, the optimal cut-off points were 41.0, 40.8, and 40.7 mlO2/kg/min for BMI, WC, and WHtR, with the AUCs of 0.86 (95% CI 0.82-0.90, p < 0.001), 0.83 (95% CI 0.79-0.88), and 0.88 (95% CI 0.84-0.93, p < 0.001). In conclusion, our newly developed cut-off points for CRF assessed by the Maximal multistage 20-m shuttle run test may adequately detect primary school-aged boys and girls with general and abdominal obesity.

Department of Educational Studies Faculty of Teacher Education University of Rijeka Rijeka Croatia

Department of General and Applied Kinesiology Faculty of Kinesiology University of Zagreb Zagreb Croatia

Department of Primary Teacher Education Faculty of Education University of Ljubljana Ljubljana Slovenia

Department of Primary Teacher Education Faculty of Educational Science University of Pula Pula Croatia

Department of Sport Motorics and Methodology in Kinanthropology Faculty of Sports Studies Masaryk University Brno Czechia

Recruitment and Examination Faculty of Science Masaryk University Brno Czechia

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Adegboye A. R., Anderssen S. A., Froberg K., Sardinha L. B., Heitmann B. L., Steene-Johannessen J., et al. . (2011). Recommended aerobic fitness level for metabolic health in children and adolescents: a study of diagnostic accuracy. Br. J. Sports Med. 45, 722–728. doi: 10.1136/bjsm.2009.068346, PMID: PubMed DOI

Alberti K. G., Zimmet P., Shaw J. (2006). Metabolic syndrome--a new world-wide definition. A consensus statement from the international diabetes federation. Diabet. Med. 23, 469–480. doi: 10.1111/j.1464-5491.2006.01858.x, PMID: PubMed DOI

Ashwell M., Mayhew L., Richardson J., Rickayzen B. (2014). Waist-to-height ratio is more predictive of years of life lost than body mass index. PLoS One 9:e103483. doi: 10.1371/journal.pone.0103483, PMID: PubMed DOI PMC

Boddy L. M., Thomas N. E., Fairclough S. J., Tolfrey K., Brophy S., Rees A., et al. . (2012). ROC generated thresholds for field-assessed aerobic fitness related to body size and cardiometabolic risk in schoolchildren. PLoS One 7:e45755. doi: 10.1371/journal.pone.0045755, PMID: PubMed DOI PMC

Brambilla P., Bedogni G., Moreno L. A., Goran M. I., Gutin B., Fox K. R., et al. . (2006). Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. Int. J. Obes. 30, 23–30. doi: 10.1038/sj.ijo.0803163, PMID: PubMed DOI

Burns R. D., Hannon J. C., Brusseau T. A., Eisenman P. A., Saint-Maurice P. F., Welk G. J., et al. . (2015). Cross-validation of aerobic capacity prediction models in adolescents. Pediatr. Exerc. Sci. 27, 404–411. doi: 10.1123/pes.2014-0175, PMID: PubMed DOI

Cerhan J. R., Moore S. C., Jacobs E. J., Kitahara C. M., Rosenberg P. S., Adami H. O., et al. . (2014). A pooled analysis of waist circumference and mortality in 650,000 adults. Mayo Clin. Proc. 89, 335–345. doi: 10.1016/j.mayocp.2013.11.011, PMID: PubMed DOI PMC

Cureton K. J., Mahar M. T. (2014). Critical measurement issues/challenges in assessing aerobic capacity in youth. Res. Q. Exerc. Sport 85, 136–143. doi: 10.1080/02701367.2014.898979, PMID: PubMed DOI

Díez-Fernández A., Sánchez-López M., Mora-Rodríguez R., Notario-Pacheco B., Torrijos-Niño C., Martínez-Vizcaíno V. (2014). Obesity as a mediator of the influence of cardiorespiratory fitness on cardiometabolic risk: a mediation analysis. Diabetes Care 37, 855–862. doi: 10.2337/dc13-0416, PMID: PubMed DOI

Garrido-Miguel M., Cavero-Redondo I., Álvarez-Bueno C., Rodríguez-Artalejo F., Moreno L. A., Ruiz J. R., et al. . (2019). Prevalence and trends of overweight and obesity in European children from 1999 to 2016: a systematic review and meta-analysis. JAMA Pediatr. 173:e192430. doi: 10.1001/jamapediatrics.2019.2430, PMID: PubMed DOI PMC

Gomes T. N., Katzmarzyk P. T., dos Santos F. K., Souza M., Pereira S., Maia J. A. (2014). Overweight and obesity in portuguese children: prevalence and correlates. Int. J. Environ. Res. Public Health 11, 11398–11417. doi: 10.3390/ijerph111111398, PMID: PubMed DOI PMC

Gupta N., Goel K., Shah P., Misra A. (2012). Childhood obesity in developing countries: epidemiology, determinants, and prevention. Endocr. Rev. 33, 48–70. doi: 10.1210/er.2010-0028, PMID: PubMed DOI

Hanley J. A., McNeil B. J. (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143, 29–36. doi: 10.1148/radiology.143.1.7063747, PMID: PubMed DOI

Högström G., Nordström A., Nordström P. (2014). High aerobic fitness in late adolescence is associated with a reduced risk of myocardial infarction later in life: a nationwide cohort study in men. Eur. Heart J. 35, 3133–3140. doi: 10.1093/eurheartj/eht527, PMID: PubMed DOI

Hopkins W., Marshall S., Batterham A., Hanin J. (2009). Progressive statistics for studies in sports medicine and exercise science. Med. Sci. Sports Exerc. 41, 3–13. doi: 10.1249/MSS.0b013e31818cb278, PMID: PubMed DOI

Kasović M., Štefan L., Petrić V. (2021a). Secular trends in health-related physical fitness among 11-14-year-old Croatian children and adolescents from 1999 to 2014. Sci. Rep. 11:11039. doi: 10.1038/s41598-021-90745-y, PMID: PubMed DOI PMC

Kasović M., Štefan L., Petrić V., Štemberger V., Blaževič I. (2021b). Functional endurance capacity is associated with multiple other physical fitness components in 7–14-year-olds: a cross-sectional study. BMC Public Health 21:669. doi: 10.1186/s12889-021-10702-2, PMID: PubMed DOI PMC

Lang J. J., Belanger K., Poitras V., Janssen I., Tomkinson G. R., Tremblay M. S. (2018). Systematic review of the relationship between 20m shuttle run performance and health indicators among children and youth. J. Sci. Med. Sport 21, 383–397. doi: 10.1016/j.jsams.2017.08.002, PMID: PubMed DOI

Lang J. J., Tremblay M. S., Ortega F. B., Ruiz J. R., Tomkinson G. R. (2019). Review of criterion-referenced standards for cardiorespiratory fitness: what percentage of 1 142 026 international children and youth are apparently healthy? Br. J. Sports Med. 53, 953–958. doi: 10.1136/bjsports-2016-096955, PMID: PubMed DOI

Léger L., Lambert J., Goulet A., Rowan C., Dinelle Y. (1984). Aerobic capacity of 6 to 17-year-old Quebecois—20-meter shuttle run test with 1-minute stages. Can. J. Appl. Sport Sci. 9, 64–69. PMID: PubMed

Lindberg L., Danielsson P., Persson M., Marcus C., Hagman E. (2020). Association of childhood obesity with risk of early all-cause and cause-specific mortality: a Swedish prospective cohort study. PLoS Med. 17:e1003078. doi: 10.1371/journal.pmed.1003078, PMID: PubMed DOI PMC

Lobelo F., Pate R. R., Dowda M., Liese A. D., Ruiz J. R. (2009). Validity of cardiorespiratory fitness criterion-referenced standards for adolescents. Med. Sci. Sports Exerc. 41, 1222–1229. doi: 10.1249/MSS.0b013e318195d491, PMID: PubMed DOI

McCarthy H. D., Ashwell M. (2006). 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. 30, 988–992. doi: 10.1038/sj.ijo.0803226, PMID: PubMed DOI

Mesa J. L., Ruiz J. R., Ortega F. B., Wärnberg J., González-Lamuño D., Moreno L. A., et al. . (2006). Aerobic physical fitness in relation to blood lipids and fasting glycaemia in adolescents: influence of weight status. Nutr. Metab. Cardiovasc. Dis. 16, 285–293. doi: 10.1016/j.numecd.2006.02.003, PMID: PubMed DOI

Milanović S. M., Morović M. L., Bukal D., Križan H., Buoncristiano M., Breda J. (2020). Regional and sociodemographic determinants of the prevalence of overweight and obesity in children aged 7-9 years in Croatia. Acta Clin. Croat. 59, 303–311. doi: 10.20471/acc.2020.59.02.14, PMID: PubMed DOI PMC

Moreira C., Santos R., Ruiz J. R., Vale S., Soares-Miranda L., Marques A. I., et al. . (2011). Comparison of different VO2max equations in the ability to discriminate the metabolic risk in Portuguese adolescents. J. Sci. Med. Sport 14, 79–84. doi: 10.1016/j.jsams.2010.07.003, PMID: PubMed DOI

NCD Risk Factor Collaboration (NCD-RisC) (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 390, 2627–2642. doi: 10.1016/S0140-6736(17)32129-3, PMID: PubMed DOI PMC

Ogden C. L., Flegal K. M., Carroll M. D., Johnson C. L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288, 1728–1732. doi: 10.1001/jama.288.14.1728, PMID: PubMed DOI

Ortega F. B., Artero E. G., Ruiz J. R., España-Romero V., Jiménez-Pavón D., Vicente-Rodriguez G., et al. . (2011). Physical fitness levels among European adolescents: the HELENA study. Br. J. Sports Med. 45, 20–29. doi: 10.1136/bjsm.2009.062679, PMID: PubMed DOI

Ortega F. B., Ruiz J. R., Castillo M. J., Sjöström M. (2008). Physical fitness in childhood and adolescence: a powerful marker of health. Int. J. Obes. 32, 1–11. doi: 10.1038/sj.ijo.0803774, PMID: PubMed DOI

Pojskic H., Eslami B. (2018). Relationship between obesity, physical activity, and cardiorespiratory fitness levels in children and adolescents in Bosnia and Herzegovina: an analysis of gender differences. Front. Physiol. 9:1734. doi: 10.3389/fphys.2018.01734, PMID: PubMed DOI PMC

Reilly J. J., Kelly J. (2011). Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int. J. Obes. 35, 891–898. doi: 10.1038/ijo.2010.222, PMID: PubMed DOI

Rice M. E., Harris G. T. (2005). Comparing effect sizes in follow-up studies: ROC area, Cohen’s d, and r. Law Hum. Behav. 29, 615–620. doi: 10.1007/s10979-005-6832-7, PMID: PubMed DOI

Ruiz J. R., Huybrechts I., Cuenca-García M., Artero E. G., Labayen I., Meirhaeghe A., et al. . (2015). Cardiorespiratory fitness and ideal cardiovascular health in European adolescents. Heart 101, 766–773. doi: 10.1136/heartjnl-2014-306750, PMID: PubMed DOI

Ruiz J. R., Ortega F. B., Rizzo N. S., Villa I., Hurtig-Wennlöf A., Oja L., et al. . (2007). High cardiovascular fitness is associated with low metabolic risk score in children: the European youth heart study. Pediatr. Res. 61, 350–355. doi: 10.1203/pdr.0b013e318030d1bd, PMID: PubMed DOI

Ruiz J. R., Ramirez-Lechuga J., Ortega F. B., Castro-Piñero J., Benitez J. M., Arauzo-Azofra A., et al. . (2008). Artificial neural network-based equation for estimating VO2max from the 20 m shuttle run test in adolescents. Artif. Intell. Med. 44, 233–245. doi: 10.1016/j.artmed.2008.06.004, PMID: PubMed DOI

Santos R., Moreira C., Ruiz J. R., Vale S., Soares-Miranda L., Moreira P., et al. . (2012). Reference curves for BMI, waist circumference and waist-to-height ratio for Azorean adolescents (Portugal). Public Health Nutr. 15, 13–19. doi: 10.1017/S1368980011002230, PMID: PubMed DOI

Shigaki G. B., Barbosa C. L. C., Batista M. B., Romanzini C. L. P., Gonçalves E. M., Junior H. S., et al. . (2020). Tracking of health-related physical fitness between childhood and adulthood. Am. J. Hum. Biol. 32:e23381. doi: 10.1002/ajhb.23381, PMID: PubMed DOI

Silva G., Aires L., Mota J., Oliveira J., Ribeiro J. C. (2012). Normative and criterion-related standards for shuttle run performance in youth. Pediatr. Exerc. Sci. 24, 157–169. doi: 10.1123/pes.24.2.157, PMID: PubMed DOI

Silva D., Lang J. J., Barnes J. D., Tomkinson G. R., Tremblay M. S. (2018). Cardiorespiratory fitness in children: evidence for criterion-referenced cut-points. PLoS One 13:e0201048. doi: 10.1371/journal.pone.0201048, PMID: PubMed DOI PMC

Silva D. A., Tremblay M., Pelegrini A., Silva R. J. D. S., Oliveira A. C. C., Petroski E. L. (2016). Association between aerobic fitness and high blood pressure in adolescents in Brazil: evidence for criterion-referenced cut-points. Pediatr. Exerc. Sci. 28, 312–320. doi: 10.1123/pes.2015-0172, PMID: PubMed DOI

Taylor R. W., Jones I. E., Williams S. M., Goulding A. (2000). 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. 72, 490–495. doi: 10.1093/ajcn/72.2.490, PMID: PubMed DOI

Tuan S., Su H., Chen Y., Li M., Tsai Y., Yang C., et al. . (2018). Fat mass index and body mass index affect peak metabolic equivalent negatively during exercise test among children and adolescents in Taiwan. Int. J. Environ. Res. Public Health 15:263. doi: 10.3390/ijerph15020263, PMID: PubMed DOI PMC

Venckunas T., Mieziene B., Emeljanovas A. (2018). Aerobic capacity is related to multiple other aspects of physical fitness: a study in a large sample of Lithuanian schoolchildren. Front. Physiol. 9:1797. doi: 10.3389/fphys.2018.01797, PMID: PubMed DOI PMC

Welk G. J., Laurson K. R., Eisenmann J. C., Cureton K. J. (2011). Development of youth aerobic-capacity standards using receiver operating characteristic curves. Am. J. Prev. Med. 41, S111–S116. doi: 10.1016/j.amepre.2011.07.007, PMID: PubMed DOI

World Health Organization (2017). Adolescent Obesity and Related Behaviours: Trends and Inequalities in the WHO European Region, 2002–2014: Observations From the Health Behavior in School-Aged Children (HBSC) WHO Collaborative Cross-National Study. Geneva: World Health Organization.