Measurement matters: A systematic review of waist measurement sites for determining central adiposity

Objectives Overweight and obesity are global health threats and accurate measures of adiposity are essential for monitoring and treatment. Body mass index has traditionally been utilised, however, waist circumference also assesses central adiposity; strongly associated with development of cardiovascular disease and Type 2 Diabetes Mellitus. Waist circumference can be measured in different locations on the trunk. We aimed to synthesize the literature regarding effectiveness of different locations of waist circumference for measuring percentage body fat and central adiposity in adults with cardiovascular disease or Type 2 Diabetes Mellitus. Design A systematic review, conducted using searches PubMed, Medline, Scopus and Embase. Publications were selected and critically appraised through standardised systematic review methodology. Subjects 11 observational studies, comprising 8514 participants, mean age range 36.3–69.4 years, from various geographic regions. Results Waist circumferences measured at all locations were strongly correlated with body mass index. Waist circumference-mid (midline between the lowest rib and iliac crest) was the most accurate measure of visceral fat and percentage body fat in both sexes. Additionally, waist circumference-mid was most sensitive to visceral fat changes over time. Waist circumference-umbilicus and waist circumference-iliac crest were also valid and reliable measures of visceral fat in both sexes. According to our findings, ethnicity has a huge impact on applying waist circumference measures, particularly between Asians and Caucasians. Conclusions There was strong evidence indicating that waist circumference-mid is the most valid and responsive measure to assess visceral fat, % body fat, and visceral fat change over time in both sexes.