Measurement of Waist Circumference

Midabdominal or iliac crest?

  1. Hung-Yuan Li, MD, PHD4
  1. 1Department of Internal Medicine, Division of Endocrinology, Cardinal Tien Hospital, Xindian, Taiwan
  2. 2School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
  3. 3Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  4. 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  5. 5Department of Radiology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
  6. 6Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
  7. 7Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
  8. 8Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
  9. 9Division of Clinical Pathology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
  10. 10Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
  11. 11Chia Nan University of Pharmacy and Science, Tainan, Taiwan
  1. Corresponding authors: Jung-Nan Wei, wei.j5209{at}, and Hung-Yuan Li, larsli{at}
  1. W.-Y.M., C.-Y.Y., and S.-R.S. contributed equally to this study.

  2. J.-N.W. and H.-Y.L. contributed equally to this study.


OBJECTIVE Waist circumference (WC) is used to define central obesity. This study aimed to compare the performance of two recommended locations of WC measurement.

RESEARCH DESIGN AND METHODS A cohort of 1,898 subjects who were without diabetes from 2006–2012 were followed for a median of 31 months (Taiwan Lifestyle Study). The WC-IC, recommended by the National Cholesterol Education Program Third Adult Treatment Panel, was measured at the superior border of the iliac crest, and the WC-mid, recommended by World Health Organization and International Diabetes Federation, was measured midway between the lowest ribs and the iliac crest. The abdominal subcutaneous fat area (SFA) and visceral fat area (VFA) were assessed by computed tomography.

RESULTS There was greater difference between WC-IC and WC-mid measurements in women than in men (P < 0.001). Both WC-IC and WC-mid correlated significantly with BMI, VFA, and SFA (all P < 0.001). WC-mid was better correlated to VFA than WC-IC, particularly in women, and it correlated more strongly to blood pressure, plasma glucose, hemoglobin A1c, triglyceride levels, HDL cholesterol, and C-reactive protein (all P < 0.05). The association of WC-mid with hypertension, diabetes, and metabolic syndrome was slightly better than that of WC-IC (area under the receiver operator curve 0.7 vs. 0.69, 0.71 vs. 0.68, and 0.75 vs. 0.7, respectively; all age-adjusted P < 0.05). With 90 cm (male)/80 cm (female) as criteria for central obesity, WC-mid, but not WC-IC, predicted the incidence of diabetes development (age adjusted P = 0.003).

CONCLUSIONS WC-mid is a better measurement to define central obesity than WC-IC, particularly in women.

  • Received July 22, 2012.
  • Accepted November 15, 2012.

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