Anthropometric Techniques

Anthropometric indices used to measure fat patterning include skinfold thicknesses, circumferences, sagittal diameter, and ratios such as

Visceral Fat Area
Figure 2 Cross-sectional images of the abdomen obtained by MRI. (A) Small subcutaneous fat area and enlarged visceral fat area. (B) Small visceral fat area in comparison with subcutaneous fat depot.

waist-to-hip, waist-to-thigh, waist-to-height, and subscapular-to-triceps skinfolds. Skinfold thicknesses and skinfold ratios have not been found to be very well correlated with metabolic measurements or with visceral fat and are not recommended for use as indicators of fat patterning. Numerous equations using combinations of anthropometric measurements to predict the amount of visceral fat have not offered substantial improvement over the simpler measurements, and an accurate equation has yet to be developed.

Waist circumference (WC) alone and waist-to-hip ratio (WHR) are the most popular anthropometric methods used to measure fat distribution in both clinical and community settings. Both measures are correlated with visceral fat, with a correlation coefficient (r) generally ranging from 0.5 to 0.8. It is problematic that there is no uniform method of defining the location at which the waist and hip measurement should be assessed (Table 1). Waist

Table 1 Anatomical locations used to measure waist and hip circumferences

Waist circumference

One-third between the xyphoid process and umbilicus Narrowest part of torso

Midway between xyphoid process and umbilicus

Midway between lower rib and iliac crest

One inch (~2.5cm) above umbilicus

Level of umbilicus

Level of iliac crest

Immediately below the lowest rib

Immediately above the iliac crest

Hip circumference

Largest horizontal circumference around the buttocks Level of iliac crest

Maximal circumference between superior border of iliac crest and thigh region 4 cm below superior iliac crest circumferences measured at four sites (immediately below the lowest rib, at the narrowest point, midpoint between the lowest rib and the iliac crest, and immediately above the iliac crest) have been compared and found to differ from each other. Other work has shown that the highest correlations with risk factors were obtained when WHR was calculated as the waist measured at the point midway between the lower rib margin and iliac crest (approximately 1 inch (~2.5 cm) above the umbilicus) or when the waist was measured at the umbilicus and hips measured at the widest point of the buttocks. Although two different waist measurements have been demonstrated to perform equally well, the bony landmark measurement (the point midway between the lower rib margin and iliac crest) may be preferred since the umbilicus may shift position when an individual gains or loses weight. The World Health Organization (WHO) has recommended measuring the waist at the midpoint between the lowest rib and the iliac crest, whereas immediately above the iliac crest is the site recommended by the National Institutes of Health (NIH).

Sagittal diameter, the height of the abdomen measured with the subject in the supine position, can be measured anthropometrically or by imaging. Figure 3 shows a technique for the anthropometric measurement of sagittal diameter using a caliper. Measurement is usually taken at the largest supine anteroposterior diameter between the xyphoid process and umbilicus. Some studies have found sagittal diameter to be a better indicator of visceral fat than WHR. Correlations between sagittal diameter and amount of visceral fat range from r = 0.51 to r = 0.87, with higher correlations occurring when sagittal diameter is measured using imaging

Figure 3 Sagittal diameter measured anthropometrically using calipers.

techniques. In general, correlations tend to be higher in men than women.

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Reasonable care has been taken to ensure that the information presented in this book is accurate. However, the reader should understand that the information provided does not constitute legal, medical or professional advice of any kind.

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