Abstract
The objective of this study was to assess the validity of the self-/home-measured waist circumference (WC) method in children/adolescents at three sites: at the level of the umbilicus, immediately above the iliac crest, and at the midpoint of the lower margin of the last palpable rib and top of the iliac crest. A cross-sectional study of 3360 Hong Kong Chinese children/adolescents was conducted, with 2980 (88.7%) participants included in the final analysis. The WC of children aged 6 to 9 was measured at the three sites by their parent/guardian at home followed by measurement by trained assessors at school within one week. Children/adolescents between the ages of 10 and 17 self-measured their WC at the three sites during school hours, followed by measurements by the trained assessors. Bland-Altman limits of agreement (LOA) analysis was performed to evaluate between-measurement agreement. The difference between assessor- and self-/home-measured WC was defined as ≤ ±2.5 cm for the upper and lower LOA at all three sites as an a priori criterion based on the assessor-measured inter-rater results. The results showed that most measurements (about 96%) at each site was within 95% of the LOA. Of the three measurement sites, the smallest LOA interval width was found at the umbilicus site, with an upper LOA of 5.08 and 7.13 and lower LOA of -2.61 and -3.43 in boys and girls, respectively. In conclusion, the range of LOA was relatively large, exceeding the acceptable limits of the predefined a priori criterion of upper and lower LOA, and thus suggesting disagreement between the two measurement methods. The use of WC as a measure of abdominal obesity in clinical practice/epidemiological studies should be restricted to measurement by trained health professionals/research staff.
Highlights
IntroductionThe incidence of overweight and obesity (defined as weight exceeding 120% of the median weight for height) in Hong Kong children/adolescents aged 6 to 18 years was about 20% in 2013–2014 [1]
The incidence of overweight and obesity in Hong Kong children/adolescents aged 6 to 18 years was about 20% in 2013–2014 [1]
To the best of our knowledge, few studies to date have sought to validate self- and home-measured Waist circumference (WC) in adolescents and young children, respectively, at any of these three WC measurement sites, self-reported WC in adolescents/children has been found to correlate with assessor-measured WC using intra-class correlation (ICC) statistics without predefined benchmark locations for the WC measurement site [10]
Summary
The incidence of overweight and obesity (defined as weight exceeding 120% of the median weight for height) in Hong Kong children/adolescents aged 6 to 18 years was about 20% in 2013–2014 [1]. The common WC measurement sites in clinical settings and epidemiological studies are at the midpoint of the lower rib and top of the iliac crest [4], at the top of the iliac crest [5], and at the level of the umbilicus [9]. The objectives of the study reported were to assess the agreement between self/home-measured WC and assessormeasured WC at three WC sites, namely, at the level of the umbilicus (WC1) [9], immediately above the iliac crest (WC2) [5], and at the midpoint of the lower margin of the last palpable rib and top of the iliac crest (WC3) [4]
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