Population-based references for waist and hip circumferences, waist-to-hip and waist-to-height ratios for children and adolescents, and evaluation of their predictive ability

Abstract

Abstract Purpose Childhood obesity is a public health problem globally as well as in Poland. This paper aimed to provide age- and sex-specific waist circumference (WC), hip circumference (HC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) normative values for Polish children and adolescents aged 3 − 18 years for more precise monitoring of abdominal fat accumulation. Methods The WC, HC, WHtR and WHR references were constructed with the lambda, mu, sigma (LMS) method using data from two nationally representative health surveys: the OLA study and the OLAF study, the largest available pediatric surveys in Poland which provided measured height, weight, WC, HC and blood pressure for 22,370 children and adolescents aged 3 − 18 years. The predictive ability of newly established references for overweight/obesity as defined by the International Obesity Task Force criteria and elevated blood pressure was tested with Receiver Operating Characteristic (ROC). Abdominal obesity cut-offs linked to adult cardiometabolic cut-offs were established. Results Reference values for WC, HC, WHtR and WHR are presented, as well as WC, WHtR and WHR cut-off values linked to adult’s cut-offs of cardiometabolic risk. The predictive value for overweight and obesity of population-based waist, hip and WHtR references was outstanding – AUC ROC > 0.95 in both sexes, whereas with regard to the elevated blood pressure predictive ability was low – AUC ROC < 0.65. Conclusions This paper presents the first waist, hip, WHtR and WHR references for Polish children and adolescents aged 3–18 years. The 90th and 95th percentile and cut-offs linked to adult thresholds for cardiometabolic risk are proposed as cut-offs for abdominal obesity.