Among Chinese children and adolescents with normal BMI, central obesity (WHtR ≥ 0.50) was associated with a higher burden of blood pressure, suggesting waist-based anthropometric assessment may complement BMI in identifying normal-weight youth with an unfavorable blood pressure profile, though confirmation in contemporary pediatric cohorts is warranted.
Central obesity was uncommon among normal-BMI Chinese children and adolescents in the China Health and Nutrition Survey.
Central obesity was independently associated with higher odds of above-normal blood pressure among normal-BMI youth.
Central obesity was also associated with higher odds of high blood pressure among normal-BMI youth.
Standardized absolute risk differences associated with central obesity were several percentage points for both blood pressure outcomes.
The associations were generally consistent across sensitivity analyses and subgroups.
Exploratory longitudinal analyses were directionally compatible with the primary findings but were limited by few exposed observations.
The authors conclude that waist-based assessment may complement BMI for identifying normal-weight youth with an unfavorable blood pressure profile.
This study looked at Chinese children and adolescents aged 7-17 whose body mass index (BMI) was in the normal range. BMI doesn't show where body fat is stored, so some young people who look normal by BMI may still carry extra fat around the waist. The researchers used survey data collected between 1993 and 2011 and defined central obesity as a waist-to-height ratio of 0.50 or more. About 4.3% of the normal-BMI observations showed central obesity. Those young people had higher odds of above-normal blood pressure (odds ratio 1.43) and of high blood pressure (odds ratio 1.54) after accounting for other factors. This translated to roughly 5.1 and 3.5 percentage points higher absolute risk, respectively. The pattern was similar for boys and girls, urban and rural settings, and across survey periods. Follow-up analyses pointed in the same direction but had too few exposed cases to be firm. This research suggests that measuring waist size relative to height may help identify normal-weight young people who have a less favorable blood pressure profile, in addition to BMI. The data are observational and come from older surveys, so the study cannot show that central fat causes higher blood pressure, and the authors note that confirmation in more recent groups of children is needed.
Zhang X, Chen L, Peng J, Su L, Cao X, Chen F. (2026). Central obesity and blood pressure burden among Chinese children and adolescents with normal body mass index: a repeated-measures analysis of the China health and nutrition survey.. Frontiers in public health. https://doi.org/10.3389/fpubh.2026.1973651