Comparisons of waist circumferences measured at 4 sites

Background: Waist circumference (WC) is now accepted as a practical measure of adipose tissue distribution. Four body sites for WC measurements are commonly used, as follows: immediately below the lowest ribs (WC1), the narrowest waist (WC2), the midpoint between the lowest rib and the iliac crest (WC3), and immediately above the iliac crest (WC4). Objective: We sought to compare the magnitude and reliability of WC measured at these 4 sites in males and females. Design: WC was measured at each site 1 time in all subjects [49 males and 62 females, aged 7-83 y, with a body mass index (in kg/ m(2)) of 9-43] and 3 times in a subgroup (n = 93) by one experienced observer using a heavy-duty inelastic tape. Body fat was measured in a subgroup (n = 74) with the use of dual-energy X-ray absorptiometry. Results: The mean values of WC were WC2 < WC 1 < WC3 < WC4 (P < 0.01) in females and WC2 < WC 1, WC3, and WC4 (P < 0.01) in males. For all 4 sites, measurement reproducibility was high, with intraclass correlation (r) values > 0.99. WC values were significantly correlated with fatness; correlations with trunk fat were higher than correlations with total body fat in both sexes. Conclusions: WC values at the 4 commonly used anatomic sites differ in magnitude depending on sex, are highly reproducible, and are correlated with total body and trunk adiposity in a sex-dependent manner. These observations have implications for the use of WC measurements in clinical practice and patient-oriented research.