• Biljana Stojanoska Bojadzieva Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
  • Niki Matveeva Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
  • Biljana Zafirova Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
  • Biljana Trpkovska Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
  • Elizabeta Chadikovska Institute of Anatomy, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, R of North Macedonia
  • Irina Angelovska University Clinic for Pulmonology and Allergology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia


Obesity in children and adolescents in the world is reaching a scale of an epidemic. It is considered the most widespread disease in children in many countries, especially in developed countries. The aim of this study was to define WC and WHR among Macedonian adolescents aged 11 to 14 years. A cross-sectional study was performed in 2013-2015, comprising a sample of 1267 adolescents of the Republic of Macedonia aged 11 to 14 years; 646 males and 621 females. Weight, height, body mass index (BMI), waist circumference (WC), hip circumference (HC) and waist-to-hip ratio (WHR) were measured and percentiles were calculated using Cole’s Lambda, Mu and Sigma (LMS) method. The relation between WHR and general obesity, as defined by the International Obesity Task Force, was investigated with receiver operating characteristic (ROC) analysis. The boys had statistically significant higher values ​​in all anthropometric measures, except in HC where statistically significant gender differences were not found. BMI, WC, and HC increased with the age. The obtained reference percentile curves can be used temporarily for obesity screening in children and adolescents.

Keywords: abdominal obesity; adolescents, anthropometric measurements.


1.Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, et al. Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord. 2000; 24(11):1453-8. DOI: 10.1038/sj.ijo.0801401.
2.Despres JP, Lemieux I, Bergeron J, Pibarot P, Mathieu P, Larose E, et al (2008). Abdominal obesity and the metabolic syndrome: contribution to global cardiometabolic risk. Arterioscler. Thromb Vasc Biol. 2008; 28(6):1039-49. DOI: 10.1161/ATVBAHA.107.159228.
3.Koster A, Leitzmann MF, Schatzkin A, Mouw T, Adams KF, van Eijk JT, et al. Waist circumference and mortality. Am J Epidemiol. 2008; 167(12):1465-75. DOI: 10.1093/aje/kwn079.
4.Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004; 79(3):379-84. DOI: 10.1093/ajcn/79.3.379.
5.Taylor RW, Jones IE, Williams SM, Goulding A. 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 y. Am J Clin Nutr. 2000; 72(2):490-5 DOI: 10.1093/ajcn/72.2.490.
6.Brambilla P, Bedogni G, Moreno LA, Goran MI, Gutin B, Fox KR, et al (2006). Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcuta- neous adipose tissue in children. Int J Obes. 2006; 30 (1): 23-30. DOI: 10.1038/sj.ijo.0803163.
7.Rankinen T, Kim SY, Perusse L, Despres JP, Bouchard C. The prediction of abdominal visceral fat level from body composition and anthropometry: ROC analysis. Int J Obes Relat Metab Disord. 1999; 23(8):801-9. DOI: 10.1038/sj.ijo.0800929.
8.Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006; 1(1):11-25. DOI: 10.1080/17477160600586747.
9.Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, Grant S. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ. 2006; 333(7577):1041.
10.Gontarev S, Kalac R. Association between obesity and socioeconomic factors in Macedonian children and adolescents. Advanced in Life Sciences and Health 2014; 1(1):55-63.
11.Fredriks AM, van Buuren S, Fekkes M, Verloove-Vanhorick SP, Wit JM. Are age references for waist circumference, hip circumference and waist-hip ratio in Dutch children useful in clinical practice? Eur J Pediatr. 2005; 164(4):216-22. DOI: 10.1007/s00431-004-1586-7.
12.Virani N. Reference curves and cut-off values for anthropometric indices of adiposity of affluent Asian Indian children aged 3-18 years. Ann Hum Biol. 2011; 38(2):165-74. DOI: 10.3109/03014460.2010.504194.
13.Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L. Waist circumference and cardiovascular risk factors in pre-pubertal children. Obes Res. 2001; 9(3):179-87. DOI: 10.1038/oby.2001.19.
14.Campagnolo PD, Hoffman DJ, Vitolo MR. Waist-to-height ratio as a screening tool for children with risk factors for cardiovascular disease. Ann Hum Biol.2011; 38(3):265-70. DOI: 10.3109/03014460.2010.526147.
15.Roswall J, Bergman S, Almqvist-Tangen G, Alm B, Niklasson A, Nierop AF, et al. Population-based waist circumference and waist-to-height ratio reference values in preschool children. Acta Paediatr. 2009; 98(10):1632-6. DOI: 10.1111/j.1651-2227.2009.01430.x.
16.World Health Organization. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995.
17.Nawarycz LO, Krzyzaniak A, Stawinska-Witoszynska B, Krzywinska-Wiewiorowska M, Szilagyi-Pagowska I, Kowalska M, et al. Percentile distributions of waist circumference for 7–19-year-old polish children and adolescents. Obes Rev. 2010;11(4):281-8. DOI:10.1111/j.1467-789X.2009.00694.x.
18.Kuriyan R, Tinku T, Lokesh 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(10):765-71. DOI: 10.1007/s13312-011-0126-6.
19.Brannsether B, Roelants M, Bjerknes R, Júlíusson P. 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(12):1576-82. DOI:10.1111/j.1651-2227.2011.02370.x
20.Hatipoglu N, Ozturk A, Mazicioglu MM, Kurtoglu S, Seyhan S, Lokoglu, F. Waist circumference percentiles for 7- to 17-year-old Turkish children and adolescents. Eur J Pediatr. 2008; 167(4):383-9. DOI: 10.1007/s00431-007-0502-3.
21.Jackson RT, Al Hamad N, Prakash P, Al SM. Waist circumference percentiles for Kuwaiti children and adolescents. Public Health Nutr. 2011; 14(1):70-6. DOI: 10.1017/S1368980010002600.
22.Haas GM, Liepold E, Schwandt P . Percentile curves for fat patterning in German adolescents. World J Pediatr. 2011; 7:16-23.
23.McCarthy HD, Jarrett KV, Crawley HF. The development of waist circumference percentiles in British children aged 5.0-16.9 y. Eur J Clin Nutr. 2001; 55 (10):902-7. DOI: 10.1038/sj.ejcn.1601240.
24.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(4):439-44. DOI: 10.1016/j.jpeds.2004.06.044.
25.Eisenmann JC. Waist circumference percentiles for 7- to 15-year-old Australian children. Acta Paediatr. 2005; 94(9):1182-5. DOI: 10.1080/08035250510029352.
26.Chiotis D, Krikos X, Tsiftis G, Hatzisymeon M, Maniati-Christidi M, Dacou-Voutetaki A. Body mass index and prevalence of obesity in subjects of Hellenic origin aged 0–18 years, living in the Athens area. Ann Clin Pediatr Univ Atheniensis 2000; 51:139-54.
27.Moreno LA, Fleta J, Mur L, Rodriquez G, Sarria A, Bueno M. Waist circumference values in Spanish children-gender related differences. Eur J Clin Nutr. 1999; 53:429-33.
28.Sijtsma A, Bocca G, L’abée C, Liem ET, Sauer PJ, Corpeleijn E. Waist-to-height ratio, waist circumference and BMI as indicators of percentage fat mass and cardiometabolic risk factors in children aged 3-7 years. Clin Nutr. 2014; 33(2): 311-5. DOI: 10.1016/j.clnu.2013.05.010
How to Cite
BOJADZIEVA, Biljana Stojanoska et al. INDICATORS OF ABDOMINAL OBESITY: WAIST CIRCUMFERENCE AND WAIST-TO-HIP RATIO IN ADOLESCENTS OF NORTH MACEDONIA. Journal of Morphological Sciences, [S.l.], v. 4, n. 1, p. 138-144, mar. 2021. ISSN 2545-4706. Available at: <>. Date accessed: 19 may 2021.