Changes in pediatric waist circumference percentiles despite reported pediatric weight stabilization in the United States

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d3230835e198">Background</h5> <p id="P1">Obesity is a global health concern but the United States has reported a leveling in obesity rates in the pediatric population. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d3230835e203">Objective</h5> <p id="P2">To provide updated waist circumference (WC) percentile values, identify differences across time and discuss differences within the context of reported weight stabilization in a nationally representative sample of American children. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d3230835e208">Methods</h5> <p id="P3">Percentiles for WC in self-identified African Americans (AA), European Americans (EA) and Mexican Americans (MA) were obtained from 2009–2014 National Health and Nutrition Examination Survey data (NHANES2014). Descriptive trends across time in 10th, 25 <sup>th</sup>, 50 <sup>th</sup>, 75 <sup>th</sup> and 90 <sup>th</sup> percentile WC distributions were identified by comparing NHANES2012 with previously reported NHANESIII (1988–94). </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d3230835e225">Results</h5> <p id="P4">WC increased in a monotonic fashion in AA, EA and MA boys and girls. When compared with NHANESIII data, a clear left shift of percentile categories was observed such that values that used to be in the 90 <sup>th</sup> percentile are now in the 85 <sup>th</sup> percentile. Differences in WC were observed in EA and MA boys during a reported period of weight stabilization. </p> </div><div class="section"> <a class="named-anchor" id="S5">  </a> <h5 class="section-title" id="d3230835e236">Conclusion and Relevance</h5> <p id="P5">WC has changed in the US pediatric population across time, even during times of reported weight stabilization, particularly among children of diverse racial/ethnic backgrounds. </p> </div>

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Most cited references 22

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Regression Quantiles

Roger Koenker, Gilbert Bassett (1978)

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Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents.

José R Fernández, David Redden, Angelo Pietrobelli … (2004)

To describe and provide estimates of the distribution of waist circumference (WC) according to percentiles in African-, European-, and Mexican-American children, and to test for group differences at different percentiles. Cross-sectional data from the Third National Health and Nutrition Examination Survey (NHANES III) were examined. The sample evaluated included 9713 nonpregnant persons 2 to 18 years of age with measured values of WCs. Age-, sex-, and ethnicity-specific percentiles were estimated via percentile regression. WC measurements increased in a monotonic fashion across ages but at nonconstant rates and in a manner that varied across age and sex. At higher percentiles of the distribution, estimates of WC differ between Mexican-American (MA) and European-American (EA) and between African-American (AA) and European-American (EA), and, in some cases, exceeded the adult cutoff value for obesity-related disease risk at as early as 13 years of age. Age-, sex-, and ethnicity-specific WC percentiles are available for US children and adolescents and can be used as an assessment tool that could impact public health recommendations. Results suggest concern with respect to high WC values among certain ethnic groups.

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BMI, waist-circumference and waist-hip-ratio as diagnostic tests for fatness in adolescents.

S Rössner, Y Linné, M Neovius (2005)

To evaluate the diagnostic accuracy of body mass index (BMI, kg/m(2)), waist-circumference (WC) and waist-hip-ratio (WHR) as diagnostic tests for detecting fatness in adolescents. A cross-sectional analysis of 474 healthy adolescents aged 17 y was used. Measurements of height, weight, WC, hip-circumference and body fat percentage (%BF) were obtained. The diagnostic accuracy for detecting excess fatness was evaluated through receiver operating characteristics (ROC) analyses with %BF, measured by densitometry (air-displacement plethysmography), as reference test. BMI and WC showed strong positive correlation (r=0.68-0.73; P<0.0001) with %BF in both sexes, but the correlation was weaker for WHR (r=0.30-0.41; P<0.0001). For overweight and obesity in boys and obesity in girls, the area under the ROC curve was high (0.96-0.99) for BMI and WC. WHR was not significantly better than chance as diagnostic test for obesity in girls. For BMI and WC, highly sensitive and specific cutoffs for obesity could be derived, while larger trade-offs were needed for detecting overweight in girls. The cutoffs producing equal sensitivity and specificity were lower than the ones minimizing the absolute number of misclassifications. The latter approached internationally recommended reference values, but were still several units lower for BMI in girls and several centimeters lower for WC in boys. BMI and WC were found to perform well as diagnostic tests for fatness, while WHR was less useful. The discrepancies between cutoffs producing equal sensitivity and specificity, cutoffs minimizing the absolute number of misclassifications and internationally recommended reference values for overweight and obesity highlight the importance of specifying the characteristics of classification systems for different settings.