ABC | Volume 114, Nº3, March 2020

Original Article Santos et al. Waist circumference of children in Brazil Arq Bras Cardiol. 2020; 114(3):530-537 Figure 2 – Comparison of children 50th WC percentiles curves between 13 different countries. A: Comparison between 6-10 years old boys; B: Comparison between 6-1- years old girls. C: Comparison between boys (C) and girls (D) WC 50th percentiles curves from different Brazilian studies. 70,00 65,00 55,00 6 7 8 9 10 6 7 8 9 10 6 7 8 9 10 6 7 8 9 10 50,00 60,00 Mean Waist Circunferemce (cm) Boys Girls Boys Age (years) Age (years) Age (years) Age (years) Girls 65,00 61,00 63,00 57,00 55,00 59,00 Mean Waist Circunferemce (cm) 65,00 61,00 63,00 57,00 55,00 59,00 Mean Waist Circunferemce (cm) 70,00 65,00 55,00 50,00 60,00 Mean Waist Circumference (cm) EUA Country Country INDIA PAKISTAN MALAYSIA NORWAY CHINA POLLAND GERMANY HOLLAND AUSTRALIA MEXICO GREAT BRITAIN BRAZIL BRAZIL – 2007 BRAZIL – 2015 Country BRAZIL – 2007 BRAZIL – 2015 A B C D EUA Country INDIA PAKISTAN MALAYSIA NORWAY CHINA POLLAND GERMANY HOLLAND AUSTRALIA MEXICO GREAT BRITAIN BRAZIL Furthermore, the proposed WC cut-off values for obesity provide a strong approximation of both normal weight (eutrophic) and obesity as defined by the international BMI categorization. No more than 7% of eutrophic children would have a higher WC cut-off value, which would indicate increased BMI. In such cases, other potential explanations may be present, such as initial fat excess caracterized by central obesity or additional clinical alterations (such as gastrintestinal disorders, amongst others). Regarding obese children, almost 87% may have been dignosed with obesity merely by measuring the WC. Moreover, WC is both simple and feasible measurement tool requiring inexpensive and user-friendly equipment, and little technical expertise, making it possible to carry out measurements on a scheduled basis in all schools. Our results demonstrate that Brazilian children present elevated 50 th percentile WC values, with boys’ values occupying roughly the third top place and girls the forth top place of all countries analyzed. Even more importantly, plotting the 50 th percentile WC values obtained in 2007 with the current ones confirms the increment of values across all ages in boys and more intensively in girls. While The International Diabetes Federation (IDF) suggests that the metabolic syndrome (MetS) should not be diagnosed in children younger than 10 years, weight reduction should be considered in those with abdominal obesity, as measured by waist circumference. The correlation of visceral adipose tissue and waist circumference in children was confirmed and it is an independent predictor of insulin resistance, lipid levels and blood pressure - all components of MetS. The IDF consensus definition of MetS in children and adolescents was intended to agree upon a universally accepted characterization for facilitating MetS diagnosis and to accelerate preventive measures before the child or adolescent develops diabetes or cardiovascular disease. Obesity, particularly in the abdominal region, is associated with increased risk for cardiovascular disease and type 2 diabetes. 49 534