Abdominal obesity among Chinese children and adolescents: a systematic review and meta-analysis of prevalence and study-level heterogeneity.

BACKGROUND: Abdominal obesity in youth is a nutrition-related public health concern and may capture cardiometabolic risk beyond BMI. We aimed to estimate the pooled prevalence of abdominal obesity among Chinese children and adolescents and explore study-level heterogeneity. METHODS: PubMed, Web of Science, Embase, CNKI, WanFang, and VIP were searched from inception to December 31, 2025. Eligible studies reported abdominal obesity prevalence among children and adolescents in China. Random-effects meta-analysis of proportions was performed. Subgroup analyses and exploratory meta-regression assessed variation by survey year, sex, urban-rural setting, diagnostic criterion, and study quality. RESULTS: Twenty-eight studies contributing 30 prevalence estimates were included. The pooled prevalence was 20.0% (95% CI: 19.0-22.0%; 95% prediction interval: 11.9-31.3%), with very high heterogeneity (I2 = 99.54%, p < 0.001). Pooled estimates were higher in urban than rural populations (22.8% vs. 16.7%) and in male than female strata (23.1% vs. 16.4%), while estimates were similar between waist-to-height ratio and waist circumference criteria. Survey year was not significantly associated with prevalence in linear or spline-based meta-regression, and multivariable meta-regression did not identify significant study-level predictors. CONCLUSION: Standardized waist-based surveillance, alongside BMI, is needed to improve comparability across studies and to support school- and community-based prevention strategies targeting central adiposity in Chinese youth. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251053503, identifier PROSPERO (CRD420251053503).