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

BackgroundAbdominal 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.MethodsPubMed, 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.ResultsTwenty-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.ConclusionStandardized 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 Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251053503, identifier PROSPERO (CRD420251053503).