Racial Differences in the Sums of Skinfolds and Percentage of Body Fat Estimated from Impedance in Black and White Girls, 9 to 19 Years of Age: The National Heart,Lung, and Blood Institute Growth and Health Study

Objectives: This National Heart, Lung, and Blood Institute Growth and Health Study report assesses racial differences in fat patterning in black and white girls ages 9 to 19 years, comparing the sum of triceps and subscapular skinfolds (SSFs) and percentage of body fat (%BF) from impedance as two indices of adiposity. It is hypothesized that racial differences in fat patterning manifest during puberty. Research Methods and Procedures: SSF and %BF were measured annually. Racial differences in SSF and %BF were evaluated by age. Associations between %BF and SSF were evaluated using the Pearson's correlations coefficient. Classification agreement was evaluated using the kappa‐statistic. Effects of pubertal stage and race on classification agreement were examined using multivariate models. Results: White girls had a greater mean %BF at 9 to 12 years of age; black girls had a greater %BF thereafter. Black girls had a greater mean SSF at every age. The correlation coefficient between SSF and %BF was 0.79, and there was good agreement between %BF and SSF in separating high (>85th percentile) from not high (kappa = 0.60 for whites and 0.66 for blacks). SSF associated more with %BF in prepuberty and early puberty than in late puberty. Discussion: Despite good correlations between %BF and SSF, the two methods indicate different fat patterns in black and white girls.     

The Diabetes Alert study: growth, fatness, and fat patterning, adolescence through adulthood in Mexican Americans

Diabetes Alert is a multidisciplinary genetic and epidemiological study of Type II (non insulin-dependent) diabetes in Texas Mexican Americans. We report the anthropometry of 1,155 individuals 10 to 70 or more years with particular reference to overweight, fatness, and anatomical fat patterning in the sample. Children ages 10-18 of both sexes are growing at the 50th percentile of the reference data (U.S. Health and Nutrition Examination Survey-1) for height, Wt/Ht2, and triceps and subscapular skinfolds. Adults are well below median height but well above median Wt/Ht2 and skinfolds. Prevalence of obesity (Wt/Ht2 greater than or equal to 30) among adults is typically 30% or higher by age 30. Diabetics compared to age/sex-matched non diabetics have shorter sitting heights, have more upper body fat (subscapular skinfold), have less lower body fat (lateral calf skinfold), and were heavier at maximum weight and at age 18. The ratio of lower to upper body fat distribution decreases over the life cycle, being highest at adolescence and lowest at ages 40-50 in both sexes. Our results show a precipitous weight gain after maturity in the sample and an association of diabetes with differences in anatomical fat patterning. The age-related changes in fat patterning need to be explained in terms of their ecological and genetic influences.     

Evidence of genetic influence on central body fat in middle-aged twins

The heritability of centrally and peripherally deposited subcutaneous body fat, as measured by thickness of subscapular and triceps skinfolds respectively, was examined in 173 monozygotic and 178 dizygotic pairs of white male twins, ages 54 to 65 years, who participated in the second examination of the National Heart, Lung, and Blood Institute's Twin Study. The heritability of two indices of body fat distribution (subscapular/triceps ratio and subscapular-triceps difference) and two indices of overall obesity (body mass index and sum of skinfolds) were also assessed. Evidence for a genetic influence on central deposition of body fat was suggested in that the classical estimate of heritability for subscapular skinfold thickness was 0.77 (p less than 0.0001). After adjusting subscapular skinfold for the overall level of obesity, heritability was reduced but remained highly significant (0.40, p = 0.003). Heritability estimates for triceps skinfold thickness and for the two fat distribution indices were substantially lower and were not statistically significant after adjustment for overall obesity. High classical estimates of heritability were also observed for both measures of overall obesity: 0.70 for BMI and 0.73 for sum of skinfolds. However, these two estimates were biased upward because of lower total variances among monozygotic compared to dizygotic twins in this sample. The more conservative and unbiased among-component estimates also suggested substantial heritability for each measure (0.35, p = 0.08 and 0.53, p = 0.01, respectively). The heritability of overall obesity emphasizes the importance of adjusting measures of fat distribution for overall obesity before assessing its heritability.     

Sub-cutaneous tissue growth in boys of the Gaddi tribe, Himachal Pradesh, India

Gaddi boys from the Bharmour sub-tehsil of the Chamba District (Himachal Pradesh, India) aged from 4 to 20 years were studied cross-sectionally during 1974-1975 for skin and sub-cutaneous tissue thickness. The patterns of change of skinfolds at triceps and calf (limb skinfolds) are similar to each other, but different from that of the subscapular and suprailiac (trunk skinfolds), which in turn also follow a similar pattern. The trunk skinfolds decrease from 5 to 7-8 years, sharply in the beginning, but slowly thereafter, and remain almost constant until age 12 and gain in thickness during adolescence. The limb skinfolds decrease in thickness from 5 to 11-12 years, and then they increase slowly. A comparison of skinfolds of the Gaddi boys with other neighbouring as well as distant populations reveals that, by and large, the Gaddi boys possess smaller amounts of sub-cutaneous tissue. Nutritional inadequacies, hard work and adverse environmental factors of moderate altitudes seem to put great stress on the development of sub-cutaneous fat among Gaddi boys. Standards of growth of triceps skinfold for this population are provided.     

Anthropometric data in middle-aged women. The population study of women in G?teborg 1968-1969.

Body weight, body height, skinfolds, circumferences and weight indices in a population sample of 1462 women in ages between 38 and 60 years are presented. Significant age differences were noted. High correlations (r) were found between body weight and triceps and subscapular skinfolds (0.62 and 0.72 respectively) and between body weight and arm, waist and buttock circumferences (0.75-0.88). Age differences were mostly noted between 46 and 50 years of age. After that age there was a comparatively greater increase of the waist circumference than of the buttock circumference, while triceps skinfold seemed to decrease after the age of 50 indicating an altered adipose tissue distribution from the extremities to the trunk with increasing age. When taking data from a previous study of body weight in the same population of women into consideration it seems that the age differences in body weight found in cross-sectional study like the present one may to a large extent depend on differences between different cohorts studied.     

Development of subcutaneous fat in Spanish and Latin American children and adolescents: Reference values for biceps,triceps, subscapular and suprailiac skinfolds

Subcutaneous fat skinfolds represent a reliable assessment instrument of adiposity status. This study provides current percentile references for four subcutaneous skinfolds (biceps, triceps, subscapular, suprailiac) applicable to children and adolescents in Spain and in Latin American countries where data are scarce.The design consisted of a cross-sectional multicenter study performed with identical methods in 5 countries (Argentina, Cuba, Mexico, Spain and Venezuela). Total sample comprised 9163 children and youths (boys 4615 - girls 4548) aged 6–18 years, healthy and without apparent pathologies. Percentiles 3, 5, 10, 25, 50, 75, 90, 95 and 97 were calculated by the LMS method. Sexual dimorphism was assessed using the t-test and age differences with ANOVA. Normalized growth percentile references were obtained according to sex and age for each skinfold. The mean values of four skinfolds were significantly greater in girls than boys (p < 0.001) and, in both sexes, all skinfolds show statistical differences through age (p < 0.001) with different magnitudes.Except triceps in girls, peaks between 11 and 12 years of age are more noticeable in boys than in girls. Although the general model of growth is known, the skinfold measurements show variability among populations and differences of magnitude are presented according to the analyzed population. Therefore, these age and sex-specific reference percentile values for biceps, triceps, subscapular and suprailiac skinfolds, derived from a large sample of Spanish and Latin American children and adolescents, are a useful tool for adiposity diagnosis in this population for which no reference values were available.     

男性青少年脂肪组织分布与相对骨龄的关系——Fels追踪研究

本文对Fels追踪研究中8—17岁男性青少年的相对骨龄与脂肪分布类型之间的关系做了分析。按体重/身高~2调整后,如用每个年龄的三种皮褶厚度(ST)指数的均值表示脂肪分布类型的话,8—12岁时,脂肪分布类型呈外周型分布,但13岁后开始朝向心型发展呈全身性分布。如用肩胛下ST/(肩胛下ST+肱三头肌区ST)的比例表示的话,那么14—17岁时,相对骨龄早者(简称早组)与相对骨龄晚者(简称晚组)相比,前者有较明显的向心型分布倾向。13—14岁时,早组的上述比值的年增长明显大于晚组。但是,按脂肪分布类型指数等级的基线和体重/身高~2调整之后,7、11或14岁时的相对骨龄不能预测17岁时的脂肪分布类型指数的等级。所以,我们可以得出这样的结论:如按本文的比例指数加以定量的话,脂肪分布类型与男性青少年的相对骨龄只有微弱的关系。他们的脂肪分布类型可能与其它成熟指征(如男性青春期的第二性征)有明显的关系。     

Sexual dimorphism in schoolchildren of the Villa IAPI neighborhood (Quilmes,Buenos Aires,Argentina)

Villa IAPI is a poor neighborhood of about 5,000 inhabitants in the overpopulated conurbano bonaerense at the outskirts of the city of Buenos Aires. Most of the adult male residents are construction workers; the rest are temporary workers, underemployed, or unemployed. The inhabitants of Villa IAPI suffer the effects of many adverse socio-economic conditions, including poor nutrition, deficient sanitation, and inadequate medical care. Seven anthropometric variables were measured on 765 children from 6 to 14 years old to test for the presence of an altered pattern of sexual dimorphism. It was found that there were practically no sex differences in standing height and upper-arm muscle circumference. In some age groups, there was a weak but significant sexual dimorphism in body weight and sitting height. The greatest and most persistent dimorphism was found in head circumference, and in triceps and subscapular skinfolds. In all except two age groups, head circumference in males was significantly greater than in females. The other dimorphic variables (body weight, sitting height, and triceps and subscapular skinfolds) showed the opposite relationship. Essentially, females showed increments in subcutaneous fat, while reduced growth in muscle and bone was evident in males. The hypothesis of “better female canalization” can explain the altered dimorphic pattern found in the malnourished Villa IAPI population. © 1993 Wiley-Liss, Inc.     

Short and plump physique of Mexican-American children

Mexican-American children are shorter but relatively heavier than non-Hispanic whites and blacks. The objectives of this paper are to assess the extent to which this "short and plump" physique occurs in data collected in two national surveys (HANES I and II); to determine variations by age, sex, and socioeconomic status; and to investigate the anthropometric characteristics that may account for the overweight. Three groups, defined on the basis of reported ancestry and observed race, are studied: Mexican-Americans (MEXAME), non-Hispanic Whites, (EURAME), and blacks (BLACK). Short stature was clearly associated with the poverty index (PI) in all three groups. MEXAMEs with a PI greater than 1.6 were similar in stature to EURAMEs at the same income level at ages 1-11 years but not at 12-17 years. On the other hand, MEXAMEs were shorter than BLACKs at all ages and income levels. The body mass index (kg/cm2) and poverty were unrelated. With respect to the anthropometric characteristics examined that are related to the body mass index, MEXAMEs and EURAMEs were similar in sitting height as a proportion of total height, arm muscle and fat areas, and triceps skinfold but different in the following ways: MEXAMEs had narrower elbow but broader bitrochanteric breadths and larger chest circumferences and subscapular skinfolds. Greater upper body dimensions and fatfolds seem to best describe the physique of MEXAMEs. However, in multiple regressions, these anthropometric characteristics failed to account fully for the greater relative weight of MEXAMEs as compared to EURAMEs.     

Body composition and fat distribution among older Jat females: A rural–urban comparison

The aim of the present cross-sectional study is to describe and compare age related changes in body composition and fat patterning among rural and urban Jat females of Haryana State, India. A total of 600 females (rural = 300, urban = 300), ranging in age from 40 to 70 years were selected by the purposive sampling method. Body weight, height, two circumferences (waist and hip) and skinfold thickness at five different sites (biceps, triceps, calf, subscapular, and supra-iliac) were taken on each participant. To study total adiposity, indices such as body mass index (BMI), grand mean thickness (GMT), total body fat and percentage fat were analyzed statistically. The fat distribution pattern was studied using waist/hip ratio, subscapular/triceps ratio and responsiveness of five skinfold sites towards accumulation of fat at different sites with advancing age. Results indicate a decline in almost every dimension including level of fatness between the mid-fourth and mid-fifth decades of life in both rural and urban females. Urban Jat females were heavier (57.36 kg vs. 56.07 kg, p > 0.05) and significantly taller (1553.3 mm vs. 1534.5 mm, p < 0.001) than their rural counterparts. Urban females also exhibited higher mean values for both the circumferences, five skinfold thicknesses as well as for lean body mass, total fat and percentage fat than the rural females. This is also evident from their higher mean values for body mass index and grand mean thickness. Waist/hip ratio values in rural and urban females showed upper body fat predominance, with urban females having relatively more abdominal fat. Results of subscapular/triceps ratio showed that rural and urban females gained proportionally similar amounts of subcutaneous fat at trunk and extremity sites until 45 years of age. Subsequently trunk skinfolds increased relatively more in thickness. The magnitude of this increase was comparatively greater in rural females up to 55 years and among urban females from 55 to 70 years. The profiles of subcutaneous fat accumulation and sensitivity of each skinfold site also revealed more fat deposition in the trunk region compared to extremities in both rural and urban females. The present study demonstrated differential rates of fat redistribution among rural and urban females.     

Ecogeographical associations between climate and human body composition: analyses based on anthropometry and skinfolds

In the 19th century, two "ecogeographical rules" were proposed hypothesizing associations of climate with mammalian body size and proportions. Data on human body weight and relative leg length support these rules; however, it is unknown whether such associations are attributable to lean tissue (the heat-producing component) or fat (energy stores). Data on weight, height, and two skinfold thickness were obtained from the literature for 137 nonindustrialized populations, providing 145 male and 115 female individual samples. A variety of indices of adiposity and lean mass were analyzed. Preliminary analyses indicated secular increases in skinfolds in men but not women, and associations of age and height with lean mass in both sexes. Decreasing annual temperature was associated with increasing body mass index (BMI), and increasing triceps but not subscapular skinfold. After adjusting for skinfolds, decreasing temperature remained associated with increasing BMI. These results indicate that colder environments favor both greater peripheral energy stores, and greater lean mass. Contrasting results for triceps and subscapular skinfolds might be due to adaptive strategies either constraining central adiposity in cold environments to reduce cardiovascular risk, or favoring central adiposity in warmer environments to maintain energetic support of the immune system. Polynesian populations were analyzed separately and contradicted all of the climate trends, indicating support for the hypothesis that they are cold-adapted despite occupying a tropical region. It is unclear whether such associations emerge through natural selection or through trans-generational and life-course plasticity. These findings nevertheless aid understanding of the wide variability in human physique and adiposity.     

Differences in the mean fat cell diameter of males between 1 and 48 months of age

The mean fat cell diameter was determined from measurements of abdominal adipose cells, obtained during inguinal hernia repair, of 126 white and 95 black males ranging in age from 1 through 48 months of age. The mean diameters of black and white subjects did not differ significantly, suggesting that differences in fatness among adults of these two ethnic groups have their origin beyond the age range of this study. The mean fat cell diameter increased through the 6-8 month age group, decreased until the end of the first year, and then levelled off through 48 months of age. Comparison of this curve with those for the triceps, subscapular, abdominal, and suprailiac skinfolds of the same subjects showed generally parallel courses except for the triceps, which continued to increase in size after the means of fat cell diameters and the other skinfolds had levelled off. Our data indicate that changes in body fatness on the trunk at least in the first 4 years of life may be accounted for by changes in fat cell size.     

Growth profile of rural Meitei children of Manipur state of India

Patterns of growth in 10 anthropometric measurements among the rural Manipuri children (N=425), aged 5 to 14 years, with poor socio-economic backgrounds are reported. The anthropometric dimensions include weight, stature, sitting-height, head, chest and midupper-arm circumferences, biepicondylar widths of humerus and femur, and triceps and biceps skinfolds. Except skinfolds, the boys measured more than the girls in all measurements at all ages, except from 10 to 12 years in weight, stature, sitting-height, and chest and mid-upper-arm circumferences. Across all ages, the girls had thicker fat folds. Up to 12 years, the children lie approximately on the 10th centile of NCHS in stature and weight. The arm circumferences was below the 3rd centile of the Dutch children, until 11 years. The triceps fat fold fluctuated between 10th and 25th centiles of US whites. The rural Meiteis were taller and heavier than rural Burmese and urban Meiteis. The overall growth performance of the rural Meitei children was poor as compared to US, Urban Chinese, and well-nourished Indian children.     

达斡尔族成人的皮褶厚度及其年龄变化

测量了456例（男216,女240例）达斡尔族成人的4项皮褶（三头肌皮褶、肩胛下皮褶、髂前上棘皮褶与腓肠肌皮褶）厚度值,分析了达斡尔族成人皮褶厚度随年龄变化的特征。研究表明：（1）男性躯干皮下脂肪厚于四肢。女性肩胛下皮褶最厚,三头肌皮褶次之。（2）女性4项皮褶厚度值高于男性。（3）男性30—44岁皮下脂肪较厚,45岁以后皮褶厚度下降。女性50岁以后肩胛下皮褶值明显下降,其余3项值在40岁以后下降。（4）男性全身皮褶厚度值多呈正相关。女性这种现象不明显。（5）达斡尔族成人皮下脂肪发育逊于北京、大连城市中的汉族,但优于宁夏农村的回族。     

达斡尔族学生皮下脂肪发育的研究

作者内蒙古莫力达瓦达斡尔族自治旗１７５９例中小学生项项皮褶厚度及体脂发育情况进行了调查研究。结果表明：（１）达斡尔族学生进入青春期后,随着年龄的增长,男性躯干部皮变厚,四肢部皮褶变薄,女性躯干、四肢部皮褶均增厚。（２）１２岁后,女性皮褶厚度显著大于男性。（３）青春发育早期,男性体脂逐渐有下降,女性于１２－１４岁体脂迅速增加。（４）总体说来,达斡尔族学生并不偏于肥胖。     

Body fat in urban and rural male college students of Eastern India

Male college students (N = 381) residing in several districts of Eastern India, classified into two groups, urban (N = 193) and rural (N = 188), were studied by anthropometric measurements of skinfold thicknesses in several sites of the body to determine their body fat content. The mean value of percentage of body fat was found to be significantly higher (P < 0.001) in the urban group of students (12.07 ± 3.04) than in the rurals (11.04 ± 2.63). The mean values of skinfold thicknesses of the biceps, triceps, and subscapular regions were also found to be higher in urbans (P < 0.01), but no such significant differences in mean values of supra-iliac and abdominal skinfolds were found between the two groups of students. Most of the subjects of both the groups had a greater thickness of the abdominal skinfold compared to thickness of the biceps, triceps, and suprailiac skinfolds. It was found that the college students of Eastern India were leaner than the youths of North America, Europe, Japan, and Northern India.     

Fatness and fat patterning in relation to age changes and menarche

The present study assesses changes with age in fatness and fat patterning in a cross-sectional sample of Spanish schoolgirls from 6 to 16 years of age living in an urban area (Madrid). Arm muscle area and arm fat area were derived from middle-upper arm anthropometry. Body mass index (weight/height²) and the sum of the skinfold thicknesses at three sites (triceps, subscapular and suprailiac) were computed as indices of adiposity; and two indices of subcutaneous fat distribution were also defined: the natural logarithms of subscapular/triceps and suprailiac/triceps skinfold thickness ratios. Changes with age in these variables are described, including some pattern changes found in amount of fatness as well as in fat distribution at pubescence. At this time, there is a plateau in fat deposition, and even a fat loss the average (at triceps site). Prior to pubescence, subcutaneous fat distribution changes from «pheripheral» to a more generalized pattern, but no well-defined pattern of change is found after the onset of menarche. Furthermore, the effect of the onset of puberty on all these variables is analyzed.     

Gender differences in fat patterning in children living in Ankara

Body composition is an excellent indicator for assessing obesity and nutritional status of both individuals and populations. Youth obesity has important health and social implications, because a large proportion of adult obesity has its origin in childhood. Numerous studies report that adverse levels of cardiovascular diseases risk factors are associated with adiposity in children. Concerning the Turkish population there is up to now only limited information with regard to adiposity in children. The aim of this study was therefore to determine the anthropometric and body composition characteristics and to investigate sex differences in fat patterning including fat distribution in a group of children living in Ankara. The present study evaluated the body composition of 332 boys and 269 girls aged between 8 and 11 years, attending public schools. It was carried out by a cross-sectional study and was focused on that anthropometric variables, which reflect body fat and fat-free mass. Anthropometric measurements including height, weight, triceps and subscapular skinfolds thickness were carried out on these children. The body mass index (BMI) was also calculated. The measurements were used to estimate the two-compartment model of body composition: fat-free mass (FFM) and body fat (BF) from skinfold equations. The mean fat percentage in boys is highest at 11 years (16.8%) and lowest at 10 years (15.6%). In girls these figures come to 18.2% and 17.1%, respectively. Girls of these age groups have a significantly larger percentage of body fat and skinfold thickness. At this young age there is therefore clear evidence of sexual dimorphism in fat patterning, as girls are showing a greater subcutaneous adiposity, which is mainly contributed by the triceps fat. The body fat (kg) increases in both sexes all over the investigated age groups. The Pearson correlation matrix showed a high significant relation between the anthropometric measurements (p < 0.01). The present study confirms the findings that sexual dimorphism of fat patterning in children is to be seen in the age of 8 - 11 years. It furthermore presents basic data of body composition, which could serve as reference data in other studies on the Turkish population.     

Birth Weight and Its Relationship to Size Attained and Relative Fat Distribution at 7 to 12 Years of Age

The relationship between birth weight and relative subcutaneous fat distribution at school age was considered in 131 boys and 106 girls 7 to 12 years of age. Relative fat distribution at school age was estimated with the ratio of the subscapular to triceps skinfolds (S/T) for the total sample, and with the ratio of the sum of two trunk (subscapular, midaxillary) to the sum of two extremity (triceps, medial calf) skinfolds (T/E) for subsamples of 102 boys and 63 girls. There were no sex differences in the S/T ratio (mm/mm), boys 0.62 ± 0.15, girls 0.63 ± 0.18; T/E ratio (mm/mm), boys 0.58 ± 0.13, girls 0.59 ± 0.16; and BMI (kg/m²), boys 17.1 ± 2.4, girls 16.9 ± 2.2. Second order partial correlations, controlling for age and the BMI or age and sum of skinfolds, between birth weight and the skinfold ratios are, respectively, ?0.22 and ?0.20 (p<0.01) for S/T and ?0.29 and ?032 (p<0.01) for T/E in girls, and ?0.18 and ?0.17 (p<0.05) for S/T and ?0.06 and ?0.6 for T/E in boys. Though low, the correlations suggest that as birth weight decreases proportionally more subcutaneous fat is accumulated on the trunk than on the extremities, more so in females than in males. Results of stepwise multiple regression analyses indicate that birth weight accounts for from 2% to 8% of the variance in relative subcutaneous fat distribution at school age.     

Waist Circumference and Cardiovascular Risk Factors in Prepubertal Children

Objective: Intra‐abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body‐fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body‐fat distribution and cardiovascular risk factors are available in children, especially before puberty. Research Methods and Procedures: This cross‐sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high‐density lipoprotein (HDL) cholesterol, low‐density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. Results: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. Discussion: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood‐lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.