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Updated: Jul 12, 2026

Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
What is the best way to measure waist circumference?
Mary C J Rudolf1, Jenny Walker, Tim J Cole
1Community Paediatrics, University of Leeds, Leeds, UK. mary.rudolf@leedsth.nhs.uk
Insights
Waist circumference measurement in children shows high correlation with BMI SDS across three methods. The site 4 cm above the umbilicus is recommended for clinical use due to convenience and child preference.
Area of Science:
- Pediatrics
- Cardiovascular Health
- Anthropometry
Background:
- Waist circumference is a valuable pediatric metric linked to adult cardiovascular risk.
- Current inconsistencies in measurement methods may cause confusion.
- Standardization is needed for reliable pediatric health assessments.
Purpose of the Study:
- To evaluate the consistency of three different waist circumference measurement methods in children.
- To compare these methods against body mass index standard deviation score (BMI SDS).
- To identify the most practical and child-friendly measurement site.
Main Methods:
- Assessed three waist circumference measurement techniques in a cohort of overweight and normal-weight children.
- Expressed measurements as standard deviation scores (SDS) using the British 1990 reference.
- Correlated waist circumference SDS with BMI SDS and analyzed for bias and variability.
Main Results:
- All three waist circumference methods showed high correlation with BMI SDS.
- Significant bias and variability were observed between the different measurement sites.
- The measurement site 4 cm above the umbilicus was found to be the most convenient and preferred by children.
Conclusions:
- While all methods correlate with BMI SDS, variability exists.
- The 4 cm above umbilicus method is recommended for clinical practice in children.
- Further validation against visceral fat (e.g., MRI) is needed to establish a gold standard.
Abstract:
Waist circumference is a measure of potential value in paediatrics, given its relation to cardiovascular risk in adults. However, three different methods of measurement are currently in use, giving potential for confusion. This study was undertaken to assess consistency across the measures in a population of overweight and normal weight children. We found that when expressed as standard deviation score (SDS) on the British 1990 reference, all three methods correlated highly with body mass index standard deviation score (BMI SDS); however, there was bias and variability between the measures. Based on ease of measurement, the site 4 cm above the umbilicus was the most convenient. This method was also endorsed by children's views. We therefore recommend that 4 cm above the umbilicus is adopted for clinical use until such time as the methods are verified against the gold standard of visceral fat, as measured by magnetic resonance imaging scan.
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