Developing waist circumference, waist-to-height ratio percentile curves for Pakistani children and adolescents aged 2–18 years using Lambda-Mu-Sigma (LMS) method

Muhammad Asif; Muhammad Aslam; Saima Altaf; Sajid Mustafa

doi:10.1515/jpem-2019-0527

Artikel

Developing waist circumference, waist-to-height ratio percentile curves for Pakistani children and adolescents aged 2–18 years using Lambda-Mu-Sigma (LMS) method

Muhammad Asif , Muhammad Aslam , Saima Altaf und Sajid Mustafa

Veröffentlicht/Copyright: 5. Juli 2020

Veröffentlicht von

Veröffentlichen auch Sie bei De Gruyter Brill

Manuskript einreichen Informationen für Autor*innen Erkunden Sie dieses Fachgebiet

Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 33 Heft 8

Abstract

Objectives

Children from different countries and with different ethnic backgrounds have a distinct pattern of central fat deposition. Therefore, it is essential to develop population-specific percentiles of waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-height ratio exponent (WHtR (exp)) for the evaluation of central obesity. The objective of this study was to develop age-and-gender-specific smoothed WC and WHtR percentile curves for the Pakistani children and adolescents aged 2–18 years.

Methods

A cross-sectional data-set from a multi-ethnic anthropometric survey was considered. A sample of 10,668 healthy subjects (boys = 51.92%; and girls = 48.08%), aged 2–18 years was studied. Height (cm) and WC (cm) of each subject was measured under standard procedure and WHtR & WHtR (exp) were calculated. Age-and-gender-specific smoothed curves were obtained using the lambda-mu-sigma (LMS) method and compared with percentile curves obtained from different countries.

Results

Except few early ages, the WC values increased with age in both sexes. Both boys and girls had approximately similar WC during 6–11 years of age and after age of 11, the boys had larger WC than the girls had. For WHtR, the centile curves showed a continuous decrease by 16 years of age and then increased gradually. WHtR of the girls in various ages were having similar or higher than those of the boys. In comparison of WC 50th and 90th percentiles with other countries, it was found that except few ages, the Pakistani children had larger WC than the other reference populations and the results of WHtR were also comparable to the other nations.

Conclusions

We present new reference data of WC, WHtR and WHtR (exp) using a representative sample of the Pakistani children aged 2–18 years. These reference values can be used provisionally for early detection of central obesity and its associated risks in the Pakistani children.

Keywords: central obesity; lambda-mu-sigma (LMS) method; Pakistani children; waist circumference; waist-to-height ratio; waist-to-height ratio exponent

Corresponding author: Dr. Muhammad Aslam, Ph.D., Associate Professor, Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan. Phone: +923009550007, E-mail: aslamasadi@bzu.edu.pk

Acknowledgments

We very well acknowledge to our all data collection team members, the school’s head and very thankful to all school teachers for their continuous cooperation during data collection. We are also very grateful to all the participating children and their parents for their active and unconditional cooperation.

Research funding: This research received no specific grant from any funding health agency in the public, commercial, or non-profit sectors.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors declare that they have no competing interests.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Departmental Ethics Committee of Bahauddin Zakariya University, Multan. Pakistan.
Consent for publication: Not applicable.
Availability of data and material: The datasets used for the current study are available from the corresponding author on reasonable request.

References

1. Yanping, L, Zhai, F, Yang, X, Schouten, EG, Hu, X, He, Y, et al. Determinants of childhood overweight and obesity in China. Br J Nutr 2007;97:210–15.10.1017/S0007114507280559Suche in Google Scholar PubMed

2. Mushtaq, MU, Gull, S, Mushtaq, K, Shahid, U, Shad, MA, Akram, J. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr and Phys Activity 2011;8:130. https://doi.org/10.1186/1479-5868-8-130.Suche in Google Scholar

3. Dietz, WH, Robinson, TN. Overweight children and adolescents. N Eng J Med 2005;352:2100–9. https://doi.org/10.1056/nejmcp043052.Suche in Google Scholar

4. Lobstein, T, Baur, L, Uauy, R. Obesity in children and young people: a crisis in public health. Obes Rev 2004;5(suppl 1):4–85. https://doi.org/10.1111/j.1467-789x.2004.00133.x.Suche in Google Scholar

5. Mushtaq, MU, Gull, S, Abdullah, HM, Shahid, U, Shad, MA, Akram, J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatrics 2011;11:105. https://doi.org/10.1186/1471-2431-11-105.Suche in Google Scholar

6. Sowers, JR. Obesity as a cardiovascular risk factor. The Am J Med 2003;115(Suppl 8A):37S–41.10.1016/j.amjmed.2003.08.012Suche in Google Scholar PubMed

7. Asif, M, Aslam, M, Altaf, S. Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis. J Pediatr Endocrinol Metabol 2018;31:971–7. https://doi.org/10.1515/jpem-2018-0193.Suche in Google Scholar

8. Sousa, S, Pires, N, Salvador, EP, Barros, AK, Polisel, CG, de Carvalho, WR. Anthropometric predictors of abdominal adiposity in adolescents. J Exer Physiol Online 2016;19:66–76.Suche in Google Scholar

9. Magalhaes, ELDM, Sant, LFDRS, Priore, SE, Franceschini, SDCC. Waist circumference, wait/height ratio, and neck circumference as parameters of central obesity assessment in children. Rev Paul Pediatr 2014;32:273–82.10.1016/S2359-3482(15)30022-1Suche in Google Scholar

10. Browning, LM, Hisich, SD, Ashwell, M. A suprematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable boundary value. Nutr Res Rev 2010;23:247–69. https://doi.org/10.1017/s0954422410000144.Suche in Google Scholar

11. McCarthy, HD, Jarrett, KV, Crawley, HF. The development of waist circumference percentiles in British children aged 5.0 to 16.9 years. Eur J Clin Nutr 2001;55:902–7. https://doi.org/10.1038/sj.ejcn.1601240.Suche in Google Scholar

12. Bacopoulou, F, Efthymiou, V, Landis, G, Rentoumis, A, Chrousos, GP. Waist circumference, waist-to-hip ratio and waist-to-height reference percentiles for abdominal obesity among Greek adolescents. BMC Pediatrics 2015;15:50. https://doi.org/10.1186/s12887-015-0366-z.Suche in Google Scholar

13. Zvonar, M, Stefan, L, Kasovic, M. Percentile curves for body-mass index, waist circumference, waist-to-height ratio and waist-to-height ratio (exp) in Croatian adolescents. Int J Environ Res Pub Health 2019;16:1920. https://doi.org/10.3390/ijerph16111920.Suche in Google Scholar

14. Katzmarzyk, PT. Waist circumference percentiles for Canadian youth 11-18 year of age. Eur J Clin Nutr 2004;58:1011–15. https://doi.org/10.1038/sj.ejcn.1601924.Suche in Google Scholar

15. Sung, RY, SO, H, Choi, KC, Nelson, EA, Li, AM, Yin, JA, et al. Waist circumference and waist-to-height ratio of Hong Kong Chinese children. BMC Public Health 2008;8:324. https://doi.org/10.1186/1471-2458-8-324.Suche in Google Scholar

16. Bamoshmoosh, M, Massetti, L, Aklan, H, Al-Karewany, M, Al-Goshae, H, Modesti, PA. Central obesity in Yemeni children: A population based cross-sectional study. World J Cardiol 2013;5:295–304. https://doi.org/10.4330/wjc.v5.i8.295.Suche in Google Scholar

17. Kuriyan, RK, Thomas, T, Losesh, DP, Sheth, NR, Mahendra, A, Joy, R, et al. Waist circumference and waist for height percentiles in Urban South Indian children aged 3-16 years. Indian Pediatr 2011;48:765–71. https://doi.org/10.1007/s13312-011-0126-6.Suche in Google Scholar

18. Pakistan National Human Development Report. Unleashing the Potential of a Young Pakistan. United Nations Development Programme, Pakistan; 2017. Available from: http://hdr.undp.org/en/content/national-human-development-report-2017-pakistan.Suche in Google Scholar

19. Asif, M, Aslam, M, Mustafa, S, Altaf, S. Age-specific differences and interrelation between anthropometric variables in Pakistani children aged 2 to 19 years. Rawal Med J 2018;43:164–69.Suche in Google Scholar

20. Tybor, DJ, Lichtenstein, AH, Dallal, GE, Must, A. Waist-to-height ratio is correlated with height in US children and adolescents aged 2-18 years. Int J Pediatr Obes 2008;3:148–51. https://doi.org/10.1080/17477160802068957.Suche in Google Scholar

21. Cole, TJ. Fitting smoothed centile curves to reference data. J R Stat Soc Ser 1988;151:385–418. https://doi.org/10.2307/2982992.Suche in Google Scholar

22. Cole, TJ. The LMS method for constructing normalized growth standards. Eur J Clin Nutr 1990;44:45–60.Suche in Google Scholar

23. Fernandez, JR, Redden, DT, Pietrobelli, A, Allison, DB. Waist circumference percentiles in nationally representative samples of African-American, European-American and Mexican-American children and adolescents. J Pediatr 2004;145:439–44. https://doi.org/10.1016/j.jpeds.2004.06.044.Suche in Google Scholar

24. Mukherjee, S, Fong, LH, Wong, XX. Waist circumference percentiles for Singaporean children and adolescents aged 6-17 years. Obesity Res & Clin Prac 2016;10:S17–25. https://doi.org/10.1016/j.orcp.2016.04.004.Suche in Google Scholar

25. Wang, J, Thornton, JC, Bari, S, Williamson, B, Gallagher, D, Heymsfield, SB, et al. Comparisons of waist circumferences measured at 4 sites. The Am J Clin Nutr 2003;77:379–84. https://doi.org/10.1093/ajcn/77.2.379.Suche in Google Scholar

26. Liu, A, Hills, AP, Hu, X, Li, Y, Du, L, Xu, L, et al. Waist circumference cut-off values for the prediction of cardiovascular risk factors in Chinese school-aged children: a cross-sectional study. BMC Public Health 2010;10:82. https://doi.org/10.1186/1471-2458-10-82.Suche in Google Scholar

27. Sant’Anna, MS, Tinoco, AL, Rosado, LE, Sant’Ana, LF, Mello, AC, Brito, IS, et al. Body fat assessment by bioelectrical impedance and its correlation with different anatomical sites used in the measurement of waist circumference in children. J Pediatr (Rio J) 2009;85:61–6.10.2223/JPED.1871Suche in Google Scholar PubMed

28. Bosy-Westphal, A, Booke, CA, Blocker, T, Kossel, E, Goele, K, Later, W, et al. Measurement site for waist circumference affects its accuracy as an index of visceral and abodiminal subcutaneous fat in a Caucasian population. J Nutr 2010;140:954–61. https://doi.org/10.3945/jn.109.118737.Suche in Google Scholar

29. Zimmet, PZ, Alberti, KG. Introduction: Globalization and the non-communicable disease epidemic. Obesity (Silver Spring) 2006;14:1–3. https://doi.org/10.1038/oby.2006.1.Suche in Google Scholar

30. World Health Organization. Waist circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation Geneva, 8-11 December 2008. Geneva, Switzerland: WHO Press; 2011.Suche in Google Scholar

31. Wildman, RP, Gu, D, Reynolds, K, Duan, X, He, J. Appropriate body mass index and waist circumference cutoffs for categorization of overweight and central adiposity among Chinese adults. Am J Clin Nutr 2004;80:1129–36. https://doi.org/10.1093/ajcn/80.5.1129.Suche in Google Scholar

32. Ashwell, M, Hsieh, SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2005;56:303–7. https://doi.org/10.1080/09637480500195066.Suche in Google Scholar

33. Brannsether, B, Rowlants, M, Bjerknes, R, Juliusson, PB. Waist circumference and waist-to-height ratio in Norwegian children 4-18 years of age: reference values and cut-off levels. Acta Paediatr 2011;100:1576–82. https://doi.org/10.1111/j.1651-2227.2011.02370.x.Suche in Google Scholar

34. Xiong, F, Garnett, SP, Cowell, CT, Biesheuvel, C, Zeng, Y, Long, CL, et al. Waist circumference and waist-to-height ration in Han Chinese Children living in Chongqing, south-west China. Public Health Nutr 2010;14:20–6. https://doi.org/10.1017/s136898001000042x.Suche in Google Scholar

35. Mazicioglu, MM, Kurtoglu, S, Ozzturk, A, Hatipoglu, N, Cicek, B, Ustunbas, HB. Percentiles and mean values for neck circumference in Turkish children aged 6-18 years. Acta Pediatr 2010;99:1847–53. https://doi.org/10.1111/j.1651-2227.2010.01949.x.Suche in Google Scholar

36. Hosseini, M, Motlagh, ME, Yousefifard, M, Qorbani, M, Ataei, N, Asayesh, H, et al. Neck circumference percentiles of Iranian children and adolescents: The weight disorders survey of CASPIAN IV study. Int J Endocrinol Metabol 2017;15:e13569. https://doi.org/10.5812/ijem.13569.Suche in Google Scholar

37. Klunder-Klunder, M, Flores-Huerta, S. Waist circumference values according to height percentiles: a proposal to evaluate abdominal obesity in Mexican children and adolescents between 6 and 16 years of age. Arch of Med Res 2011;42:515–22. https://doi.org/10.1016/j.arcmed.2011.09.004.Suche in Google Scholar

Received: 2019-11-09

Accepted: 2020-04-11

Published Online: 2020-07-05

Published in Print: 2020-08-27

Sie haben derzeit keinen Zugang zu diesem Inhalt.

Artikel in diesem Heft

https://doi.org/10.1515/jpem-2019-0527

Schlagwörter für diesen Artikel

central obesity; lambda-mu-sigma (LMS) method; Pakistani children; waist circumference; waist-to-height ratio; waist-to-height ratio exponent