Skip to main content
Log in

Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice?

  • Original Paper
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The aim of this study was to present age references for waist circumference (WC), hip circumference (HC), and waist/hip ratio (WHR) in Dutch children. Cross-sectional data were obtained from 14,500 children of Dutch origin in the age range 0–21 years. National references were constructed with the LMS method. This method summarises the distribution by three smooth curves representing skewness (L curve), the median (M curve), and coefficient of variation (S curve). The correlations between body mass index-standard deviation score (BMI-SDS), the circumferences and their ratio, and demographic variables were assessed by (multiple) regression analysis for three age groups: 0-<5 years (1), 5-<12.5 years (2), and 12.5-<21 years (3). A cut-off for clinical use was suggested based on the International Obesity Task Force criteria for BMI. Mean WC and HC values increased with age. Mean WC was slightly higher in boys than in girls, and this difference was statistically significant from 11 years of age onwards. In contrast, HC was significantly higher in girls than in boys from 9 years onwards. The correlation between WC-SDS and BMI-SDS ( r =0.73, P <0.01) and between HC and BMI-SDS ( r =0.67, P <0.01) increased with age. With regard to WHR-SDS, a low correlation was found for 12.5–20 years of age ( r =0.2, P <0.01). WC-SDS correlated positively with height SDS ( r =0.35, P <0.01). Conclusion:Waist circumferences can be used to screen for increased abdominal fat mass in children, whereby a cut-off point of 1.3 standard deviation score seems most suitable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

BMI :

body mass index

HC :

hip circumference

IOTF :

International Obesity Task Force

QQ :

quantile-quantile plot

WC :

waist circumference

WFH :

weight-for-height

WHR :

waist-hip ratio

References

  1. Ashwell M, Cole TJ, Dixon AK (1996) Ratio of waist circumference to height is strong predictor of intra-abdominal fat. BMJ 313: 559–560

    CAS  Google Scholar 

  2. van Buuren S, Fredriks AM (2001) Worm plot: a simple diagnostic device for modelling growth reference curves. Stat Med 20: 1259–1277

    Article  PubMed  Google Scholar 

  3. van Buuren S, van Dommelen P, Zandwijken GRJ, Grote FK, Wit JM, Verkerk PH (2004) Towards evidence based referral criteria for growth monitoring. Arch Dis Child 89: 336–341

    Google Scholar 

  4. Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11: 1305–1319

    CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  6. Daniels SR, Khoury PR, Morrison JA (2000) Utility of different measures of body fat distribution in children and adolescents. Am J Epidemiol 152: 1179–1184

    Article  CAS  PubMed  Google Scholar 

  7. Ellis KJ (1996) Measuring body fatness in children and young adults: comparison of bioelectric impedance analysis, total body electrical conductivity, and dual-energy X-ray absorptiometry. Int J Obes Relat Metab Disord 20: 866–873

    Google Scholar 

  8. Fredriks AM, Van Buuren S, Burgmeijer RJ, Meulmeester JF, Beuker RJ, Brugman E Roede MJ, Verloove-Vanhorick SP, Wit JM (2000) Continuing positive secular growth change in The Netherlands 1955–1997. Pediatr Res 47: 316–323

    CAS  PubMed  Google Scholar 

  9. Fredriks AM, Buuren S Van, Wit JM, Verloove-Vanhorick SP (2000) Body mass index measurements in 1996–7 compared with 1980. Arch Dis Child 82: 107–112

    Google Scholar 

  10. Fredriks, AM, van Buuren S, Hira Sing RA, Wit JM, Verloove-Vanhorick SP (2004) Alarming prevalences of overweight and obesity for children of Turkish, Moroccan and Dutch origin in the Netherlands according to the international standard. Acta Paediatr (in press)

  11. Freedman DS, Serdula MK, Scrinivasan R, Berenson S (1999) Relation of circumferences and skinfold thickness to lipid and insulin concentrations in children and adolescents: the Bogulesa heart Study. Am J Clin Nutr 69: 308–317

    CAS  PubMed  Google Scholar 

  12. Flodmark CE, Sveger T, Nilsson-Ehle P (1994) Waist measurement correlates to a potantially atherogenic lipoprotein profile in obese 12–14-year-old children. Acta Paediatr 83: 941–945

    CAS  PubMed  Google Scholar 

  13. Gillum RF (1999) Distribution of waist-to-hip ratio, other indices of body fat distribution and obesity and associations with HDL cholesterol in children and young adults aged 4–19 years: the Third National Health and Nutrition Examination Survey. Int J Obes Relat Metab Disord 23: 556–563

    Google Scholar 

  14. Gower BA, Nagy TR, Goran MI (2001) Visceral fat, insulin sensitivity, and lipids in prepubertal children. Diabetes 50: 477–478

    CAS  Google Scholar 

  15. Growth charts 1997. Dutch Growth Study TNO/LUMC (2002) Bohn Stafleu van Loghum, Houten, The Netherlands

  16. Guo SS, Roche AF, Chumlea WC, Gardner JD, Siervogel RM (1994) The predictive value of childhood body mass index values for overweight at age 35 years. Am J Clin Nutr 59: 810–819

    CAS  PubMed  Google Scholar 

  17. Hara M, Saitou E, Iwata F, Okada T, Harada K (2002) Waist-to-height ratio is the best predictor of cardiovascular disease risk factors in Japanese schoolchildren. J Atheroscler Thromb 9: 127–132

    PubMed  Google Scholar 

  18. Kissebah AH (1996) Intra-abdominal fat: is it a major factor in developing diabetes and coronary artery disease? Diabetes Res Clin Pract 30[Suppl]: 25–30

  19. van der Kooy K, Leenen R, Seidell JC, Deurenberg P, Droop A, Bakker CJ (1993) Waist-hip ratio is a poor predictor of changes in visceral fat. Am J Clin Nutr 57: 327–333

    PubMed  Google Scholar 

  20. Kushi LH, Kaye SA, Folsom AR, Soler JT, Prineas RJ (1988) Accuracy and reliability of self-measurement of body girths. Am J Epidemiol 28: 740–748

    Google Scholar 

  21. Lean MEJ, Han TS, Seidell JC (1995) Impairment of health and quality of life in people with large waist circumference. Lancet 351: 853–856

    Article  Google Scholar 

  22. Lemieux S, Prud’homme D, Bouchard C, Tremblay A, Despres JP (1996) A single threshold value of waist girth identifies normal weight and overweight subjects with excess visceral adipose tissue. Am J Clin Nutr 64: 685–693

    CAS  PubMed  Google Scholar 

  23. McCarthy HD, Ellis SM, Cole TJ (2003) Central overweight and obesity in British youth aged 11–16 years: cross sectional surveys of waist circumference. BMJ 326: 624

    Article  PubMed  Google Scholar 

  24. Maffeis C, Pietrobelli A, Grezzania, Provera S, Tato L (2001) Waist circumference and cardio vascular risk factors in prepubertal children. Obes Res 9: 179–187

    CAS  PubMed  Google Scholar 

  25. Maffeis C, Grezzani A, Pietrobelli A, Provera S, Tato L (2001) Does waist circumference predict fat gain in children? Int J Obesity 25: 978–983

    Article  CAS  Google Scholar 

  26. Molarius A, Seidell JC (1998) Selection of anthropometric indicators for classification of abdominal fatness- a critical review. Int J Obes 22: 719–727

    Article  CAS  Google Scholar 

  27. Moreno LA, Fleta J, Mur L, Rodriguez G, Sarria A, Bueono M (1997) Indices of body fat distribution in Spanish children aged 14.0–14.9 years. J Pediatr Gastroenterol Nutr 25: 175–181

    Article  CAS  PubMed  Google Scholar 

  28. Moreno LA, Fleta J, Mur L, Rodriguez G, Sarria A, Bueono M (1999) Waist circumference values in Spanish children-Gender related differences. Eur J Clin Nutr 53: 429–433

    Article  CAS  PubMed  Google Scholar 

  29. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueono M (2002) Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 91: 1307–1312

    Article  CAS  PubMed  Google Scholar 

  30. Owens S, Litaker M, Allison J, Riggs S, Ferguson M, Gutin B (1999) Prediction of visceral adipose tissue from simple anthropometric measurements in youths with obesity. Obes Res 7: 16–22

    CAS  PubMed  Google Scholar 

  31. Poskitt EME (2002) At risk “waistlines”. Acta Paediatr 91: 1283–1284

    CAS  PubMed  Google Scholar 

  32. Rankinen T, Kim SY, Perusse L, Despres JP, Bouchard C (1999) The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord 23: 801–809

    Article  CAS  PubMed  Google Scholar 

  33. de Ridder CM, De Boer RW, Seidell JC, Nieuwenhoff CM, Jeneson JA, Bakker CJ, Zonderland ML, Erich WB (1992) Body fat distribution in pubertal girls quantified by magnetic resonance imaging. Int J Obes Relat Metab Disord 16: 443–449

    Google Scholar 

  34. Sarria A, Moreno LA, Garcia-Llop LA, Fleta J, Morellon MP, Bueno M (2001) Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents. Acta Paediatr 90: 387–392

    Article  CAS  PubMed  Google Scholar 

  35. Taylor RW, Jones IE, Williams SM, 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 years. Am J Clin Nutr 72: 490–495

    CAS  PubMed  Google Scholar 

  36. Wattigney WA, Webber LS, Srinivasan SR, Berenson GS (1995) The emergence of clinically abnormal levels of cardiovascular disease risk factor variables among young adults: the Bogalusa Heart Study. Prev Med 24: 617–626

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was carried out in co-operation with the Well Baby Clinics and Municipal Health Services and was financially supported by The Ministry of Health, Welfare and Sports, Netherlands Organisation for Health Research and Development, Nutricia Nederland BV, and Pfizer BV.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Miranda Fredriks.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fredriks, A.M., van Buuren, S., Fekkes, M. et al. Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice?. Eur J Pediatr 164, 216–222 (2005). https://doi.org/10.1007/s00431-004-1586-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-004-1586-7

Keywords

Navigation