title: Comparisons of waist circumferences measured at 4 sites.
abstract: 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.
  
  
  METHODS
  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 < WC1 < WC3 < WC4 (P < 0.01) in females and WC2 < WC1, 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.
authors.affiliation: Body Composition Unit and New York Obesity Research Center, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York 10025, USA. jw9@columbia.edu
authors.forename: Jack
authors.initials: J
authors.lastname: Wang
authors.forename: John C
authors.initials: JC
authors.lastname: Thornton
authors.forename: Salina
authors.initials: S
authors.lastname: Bari
authors.forename: Bennett
authors.initials: B
authors.lastname: Williamson
authors.forename: Dympna
authors.initials: D
authors.lastname: Gallagher
authors.forename: Steven B
authors.initials: SB
authors.lastname: Heymsfield
authors.forename: Mary
authors.initials: M
authors.lastname: Horlick
authors.forename: Donald
authors.initials: D
authors.lastname: Kotler
authors.forename: Blandine
authors.initials: B
authors.lastname: Laferrère
authors.forename: Laurel
authors.initials: L
authors.lastname: Mayer
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.forename: Richard N
authors.initials: RN
authors.lastname: Pierson
mesh_terms: D000005:Abdomen; D015502:Absorptiometry, Photon / Q000379:methods; D000273:Adipose Tissue / Q000033:anatomy & histology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000886:Anthropometry / Q000379:methods*; D001823:Body Composition; D001824:Body Constitution; D015992:Body Mass Index; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D014781:Viscera