Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years

Abstract

BackgroundCentral obesity has been associated with the risk of cardiovascular and metabolic disease in children and anthropometric indices predictive of central obesity include waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). South Asian children have higher body fat distribution in the trunk region but the literature regarding WC and related indices is scarce in this region. The study was aimed to provide age- and gender-specific WC, WHR and WHtR smoothed percentiles, and to explore prevalence and correlates of central obesity, among Pakistani children aged five to twelve years.MethodsA population-based cross-sectional study was conducted with a representative multistage random cluster sample of 1860 primary school children aged five to twelve years in Lahore, Pakistan. Smoothed percentile curves were constructed for WC, WHR and WHtR by the LMS method. Central obesity was defined as having both age- and gender-specific WC percentile ≥90th and WHtR ≥0.5. Chi-square test was used as the test of trend. Multivariate logistic regression was used to quantify the independent predictors of central obesity and adjusted odds ratios (aOR) with 95% CI were obtained. Linear regression was used to explore the independent determinants of WC and WHtR. Statistical significance was considered at P < 0.05.ResultsFirst ever age- and gender-specific smoothed WC, WHR and WHtR reference curves for Pakistani children aged five to twelve years are presented. WC increased with age among both boys and girls. Fiftieth WC percentile curves for Pakistani children were higher as compared to those for Hong Kong and British children, and were lower as compared to those for Iranian, German and Swiss children. WHR showed a plateau pattern among boys while plateau among girls until nine years of age and decreased afterwards. WHtR was age-independent among both boys and girls, and WHtR cut-off of ≥0.5 for defining central obesity corresponded to 85th WHtR percentile irrespective of age and gender. Twelve percent children (95% CI 10.1-13.0) had a WC ≥90th percentile and 16.5% children (95% CI 14.7-18.1) had a WHtR ≥0.5 while 11% children (95% CI 8.9-11.6) had both WC ≥90th percentile and WHtR ≥0.5. Significant predictors of central obesity included higher grade, urban area with high socioeconomic status (SES), high-income neighborhood and higher parental education. Children studying in higher grade (aOR 5.11, 95% CI 1.76-14.85) and those living in urban area with high SES (aOR 82.34, 95% CI 15.76-430.31) showed a significant independent association. Urban area with high SES and higher parental education showed a significant independent association with higher WC and higher WHtR while higher grade showed a significant independent association with higher WC.ConclusionsComprehensive worldwide reference values are needed to define central obesity and the present study is the first one to report anthropometric indices predictive of central obesity for Pakistani school-aged children. Eleven percent children were centrally obe...

Use of waist to hip ratio in the determination of the body composition in preschool children in Latvian population

“…Th e present study shows the same tendency in girls, however, there is no statistically signifi cant decrease in the WHR with age in boys. In a study by Mustaq et al (2011), the WHR showed a plateau pattern among the boys aged 5-13 years; in girls, the study showed a decrease in the WHR from 9 years of age [14]. Th erefore, the present data is credible in showing changes in the WHR in the Latvian preschool children.…”

“…Th e WHR is one of the predictors in central obesity in adolescents [18]. Th ere have been studies about the WHR in preschool children in several populations, like Pakistan, Chile and Mexico [13,14,24]; and it is not the WHO which recommended it as a routine method in preschool children.…”

Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method

“…24 Third, all studies were selected because they used the same physical growth indicator, they used the same anatomical point, and they adopted the same statistician procedure (LMS method) for the construction of percentile values. [10][11][12][13][14][15][16][17][18][19][20] These similarities were important to able the inter-study comparison. Finally, this study selected children from different regions (urban and rural) and school systems (public and private) from colombo.…”

“…BMI percentile values were compared with data from WHO, 15 US center for Disease control and Prevention, 16 Pakistan, 20 India 13 and germany. 17 Wc percentile values were compared with data from germany, 18 Pakistan, 14 Mexico, 11 Hong Kong 19 and India. 12 Finally, WHtR percentile values were compared with those from India, 12 Hong Kong, 19 Pakistan 14 and norway.…”

“…[10][11][12][13][14][15][16][17][18][19][20] These curves apply the LMS method, a statistical procedure for more robust estimation of percentiles values, especially if the physical growth variables do not have a symmetrical distribution in the population. 21,22 Some studies also used the LMS method to compare body mass and height percentiles from Brazilian children with those of other countries.…”