Evaluating CMR

Clinical Tools

Waist Circumference

Association Between Waist Circumference and Intra-abdominal Fat

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Increases in abdominal fat are largely responsible for increases in waist circumference. Abdominal fat can be divided into two major components: subcutaneous fat and intra-abdominal fat. Subcutaneous fat lies just below the skin and is outside the abdominal muscle wall, whereas intra-abdominal (visceral) fat is located inside the abdominal muscular wall and lies in between the organs or viscera. Waist circumference is a good correlate of both total abdominal fat and its sub-compartments. However, the importance of waist circumference in predicting health risk is more commonly thought to be due to the relationship between waist circumference and intra-abdominal fat. Indeed, waist circumference is a stronger predictor of intra-abdominal fat than BMI (17-23). Because intra-abdominal fat is a strong independent predictor of morbidity (24-27) and mortality (28), considerable attention has been given to the ability of waist circumference to predict intra-abdominal fat.

Previous studies have reported that the percentage of error for estimates of intra-abdominal fat using waist circumference is roughly 25 to 35% (18-21). Factors such as age, gender, race, and fitness partly explain the variation in the amount of intra-abdominal fat for a given waist circumference (29-31). These differences in the amount of intra-abdominal fat for a given waist circumference may explain why different waist cut-offs are needed for men and women and for different racial groups. For example, Filipino women with a waist circumference of 80 cm would be expected to have 22% more intra-abdominal fat than Caucasian women and 35% more intra-abdominal fat than African American women with the same waist circumference (31).

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28. Kuk JL, Katzmarzyk PT, Nichaman MZ, et al. Visceral Fat is an Independent Predictor of All-Cause Mortality in Men. Obes Res In Press.
29. Kuk JL, Lee S, Heymsfield SB, et al. Waist circumference and abdominal adipose tissue distribution: influence of age and sex. Am J Clin Nutr 2005; 81: 1330-4.
30. Janssen I, Katzmarzyk PT, Ross R, et al. Fitness alters the associations of BMI and waist circumference with total and abdominal fat. Obes Res 2004; 12: 525-37.
31. Araneta MRG and Barrett-Connor E. Ethnic Differences in Visceral Adipose Tissue and Type 2 Diabetes: Filipino, African-American, and White Women. Obesity Res 2005; 13: 1458-65.