Agreement between self-/home-measured and assessor-measured waist circumference at three sites in adolescents/children

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.