Waist Circumference Measurement Methodology Study ...

NATIONAL CENTER FOR HEALTH STATISTICS

Vital and Health Statistics

Series 2, Number 182

January 2019

Waist Circumference Measurement Methodology Study: National Health and Nutrition Examination Survey, 2016

Data Evaluation and Methods Research

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Suggested citation

Ostchega Y, Seu R, Sarafrazi Isfahani N, Zhang G, Hughes JP, Miller I. Waist circumference measurement methodology study: National Health and Nutrition Examination Survey, 2016. National Center for Health Statistics. Vital Health Stat 2(182). 2019.

Library of Congress Cataloging-in-Publication Data

Names: National Center for Health Statistics (U.S.), issuing body. Title: Waist circumference measurement methodology study : National Health

and Nutrition Examination Survey, 2016. Other titles: Vital and health statistics. Series 2, Data evaluation and

methods research ; no. 182. | DHHS publication ; no. 2019-1382. Description: Hyattsville, Maryland : U.S. Department of Health and Human

Services, Centers for Disease Control and Prevention, National Center for Health Statistics, January 2019. | Series: Vital and health statistics. Series 2, Data evaluation and methods research ; number 182 | Series: DHHS pub ; number 2019-1382 | Includes bibliographical references. Identifiers: LCCN 2018054057 | ISBN 0840606931 (pbk.) Subjects: | MESH: National Health and Nutrition Examination Survey (U.S.) | Waist Circumference | Research Design | Evaluation Studies as Topic | Obesity, Abdominal--epidemiology | Health Surveys | United States-epidemiology | Statistics Classification: LCC RA645.O23 | NLM W2 A N148vb no.182 2019 | DDC 362.1963/98--dc23 LC record available at

For sale by the U.S. Government Publishing Office Superintendent of Documents Mail Stop: SSOP Washington, DC 20401?0001 Printed on acid-free paper.

NATIONAL CENTER FOR HEALTH STATISTICS

Vital and Health Statistics

Series 2, Number 182

January 2019

Waist Circumference Measurement Methodology Study: National Health and Nutrition Examination Survey, 2016

Data Evaluation and Methods Research

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

Hyattsville, Maryland January 2019 DHHS Publication No. 2019?1382

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director Jennifer H. Madans, Ph.D., Associate Director for Science

Division of Health and Nutrition Examination Surveys

Kathryn S. Porter, M.D., M.S., Director Ryne Paulose-Ram, M.A., Ph.D., Associate Director for Science

Division of Research and Methodology

Jennifer D. Parker, Ph.D., Director Donald Malec, Ph.D., Associate Director for Science

Contents

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Survey Description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Waist Circumference Methodology Study Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Outcome Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Covariates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Statistical Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Text Figures

1. Lufkin tape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2. Gulick II Plus tape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 3. National Heart, Lung, and Blood Institute waist circumference measurement at the iliac crest . . . . . . . . . . . . . . 4 4. Belly button location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5. Wrapping the Gulick II Plus tape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 6. Gulick tape?zero line measurement by observer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 7. Multi-Ethnic Study of Atherosclerosis waist circumference measurement using Lufkin tape . . . . . . . . . . . . . . . . 5 8. Multi-Ethnic Study of Atherosclerosis waist circumference measurement using Gulick II Plus tape. . . . . . . . . . . . . 5 9. World Health Organization waist circumference measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Text Tables

A. Waist circumference measurement protocols for survey participants aged 20 and over for 2016 . . . . . . . . . . . . . 2 B. Randomization order for waist circumference measurement done on skin by health technician . . . . . . . . . . . . . . 3 C. Reliabilities for waist circumference measurement for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 D. Mean waist circumference measurement among men, by National Heart, Lung, and Blood Institute and

World Health Organization for 2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 E. Mean waist circumference measurement among women, by National Heart, Lung, and Blood Institute

and World Health Organization for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 F. Mean waist circumference measurement among men, by National Heart, Lung, and Blood Institute and

Multi-Ethnic Study of Atherosclerosis-Gulick II Plus tape for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 G. Mean waist circumference measurement among women, by National Heart, Lung, and Blood Institute

and Multi-Ethnic Study of Atherosclerosis-Gulick II Plus tape for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 H. Mean waist circumference measurement among men, by National Heart, Lung, and Blood Institute and

Multi-Ethnic Study of Atherosclerosis-Lufkin tape for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Series 2, Number 182

iii

NATIONAL CENTER FOR HEALTH STATISTICS

Contents--Con.

J. Mean waist circumference measurement among women, by National Heart, Lung, and Blood Institute and Multi-Ethnic Study of Atherosclerosis-Lufkin tape for 2016 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

K. Mean waist circumference measured over clothes among men, by National Heart, Lung, and Blood Institute and Multi-Ethnic Study of Atherosclerosis-assisted measurement for 2016 . . . . . . . . . . . . . . . . . . . 10

M. Mean waist circumference measured over clothes among women, by National Heart, Lung, and Blood Institute and Multi-Ethnic Study of Atherosclerosis-assisted measurement for 2016. . . . . . . . . . . . . . . . . . . . 10

N. Sensitivity and specificity of abdominal obesity defined by National Heart, Lung, and Blood Institute-waist circumference and other protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

NATIONAL CENTER FOR HEALTH STATISTICS

iv

Series 2, Number 182

Waist Circumference Measurement Methodology Study: National Health and Nutrition Examination Survey, 2016

by Yechiam Ostchega, Ph.D., R.N., Rie Seu, B.A., Neda Sarafrazi Isfahani, Ph.D., Guangyu Zhang, Ph.D., Jeffery P. Hughes, M.P.H., and Ivey Miller, R.T., National Center for Health Statistics

Abstract

Objective

This report compares five methods of waist circumference (WC) measurements: 1) the National Heart, Lung, and Blood Institute (NHLBI-WC); 2) the World Health Organization (WHO-WC); 3) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Gulick II Plus tape; 4) the Multi-Ethnic Study of Atherosclerosis (MESA-WC) using Lufkin tape; and 5) assisted self-measurement over clothes (MESA-assisted).

Method

During 2016, measurements were obtained from 2,297 participants aged 20 and over, who participated in the National Health and Nutrition Examination Survey (NHANES). The mean differences and sensitivity and specificity for abdominal obesity (AO) were calculated between the NHLBI-WC (reference) and the other four WC measurements.

Results

The mean difference between NHLBI-WC and WHO-WC was 0.81 cm for men and 3.21 cm for women (p 0.0125 for both); between NHLBI-WC and MESA-WC (Gulick)

was ?0.68 cm for men (p 0.0125) and ?0.89 cm for women; between NHLBI-WC and MESA-WC (Lufkin) was 0.02 cm for men and 0.08 cm for women; and between NHLBI-WC and MESA-assisted was ?0.71 cm for men and 1.34 cm for women (p 0.0125 for both). Sensitivity and specificity for AO, with NHLBI-WC as a reference, for men were greater than 90% for all methods; for women, sensitivity and specificity for AO for MESA-WC (Lufkin) were greater than 90%; for women, WHO-WC, MESAWC (Gulick), and MESA-assisted methods were greater than 85%.

Conclusion

Aside from the differences between NHLBI-WC and WHO-WC measurements among women, other differences between NHLBI and other protocols were less than or equal to 1.5 cm.

Keywords: abdominal obesity ? NHANES

Introduction

Waist circumference (WC) is a measurement used to estimate abdominal subcutaneous and visceral fat stores. Higher values of WC (WC greater than 102 cm for men and greater than 88 cm for women) are associated with an increased risk for type 2 diabetes, high blood cholesterol, high blood pressure, and heart disease (1). The underlying metabolic process for this risk factor is insulin resistance syndrome associated with increased visceral fat stores (1). Increased WC is also one of the diagnostic criteria for metabolic syndrome, which is highly correlated with cardiovascular diseases (1?4). A number of factors are associated with the variation in visceral adipose tissue distribution, including body mass index (BMI), age, sex, and race and ethnicity (1).

The National Health and Nutrition Examination Survey (NHANES) collects data on selected chronic diseases, such as cardiovascular disease and diabetes. Since 1988 to the present, NHANES measures WC in the mobile examination center (MEC) using a protocol recommended by the National Heart, Lung, and Blood Institute, referred to as NHLBI-WC (5?7). However, there are a number of different protocols to measure WC in clinical or research settings. Among them are the World Health Organization (WHO) protocol, referred to as WHO-WC and the Multi-Ethnic Study of Atherosclerosis (MESA) protocol, referred to as MESA-WC (8,9).

Since its inception in 1956, NHANES has provided a platform to test and explore methodologies (9). Given that there are several protocols being used by other studies and organizations to measure WC, the National Center for Health Statistics (NCHS) undertook a methodology study

Series 2, Number 182

1

NATIONAL CENTER FOR HEALTH STATISTICS

embedded in the usual NHANES survey operations protocol to test and compare different methods of WC measurement.

Each protocol measures WC at a different anatomical landmark. NHLBI-WC measures WC at the level of the iliac crest. WHO-WC measures WC at the midpoint between the highest point of the iliac crest and the lowest rib. MESA-WC measures WC at the level of the umbilicus. Out of the three WC measurements, MESA is the least intrusive, requiring minimal skin exposure, whereas the other two involve more skin exposure to obtain measurements. Also, a number of studies have shown that MESA-WC and variations of MESAWC (e.g., measurement 1 inch above the umbilicus) could be self-measured over clothing, and the measurement obtained was an independent and significant indicator for obesity-related health risks (10?12). However, the validity of self-measuring MESA-WC has been questioned, by recent studies (13,14). Given the potential for this type of approach to be used in studies where less skin contact and exposure may be desirable or necessary, a fourth protocol, the MESAassisted, was tested, which consisted of measurements taken by a participant over clothing with assistance from a trained health technician if necessary. The aim of this methodology study was to compare WC measurement values obtained by NHLBI-WC, the reference, to WHO-WC, MESA-WC using Gulick II Plus tape, MESA-WC using Lufkin, and MESA-assisted.

Methods

Survey Description

NHANES is conducted by NCHS to assess the health and nutritional status of a representative sample of the noninstitutionalized civilian U.S. population. Descriptions of the NHANES sample design and data collection methods are available on the NHANES website from: . nhanes. Participants in NHANES receive a detailed in-person home interview followed by physical assessments at a MEC. All procedures in NHANES, including the WC measurement study, were approved by the NCHS Research Ethics Review Board, and written informed consent was obtained from all participants.

Waist Circumference Methodology Study Design

The purpose of the study was to compare four protocols to obtain WC measurements: 1) WHO-WC, 2) MESA-WC using Gulick II Plus tape, 3) MESA-WC using Lufkin, and 4) MESAassisted with NHLBI-WC, which is the standard reference protocol. The main intent was to assess similarities and differences among these protocols. However, it should be emphasized that there is no plan to change how WC is collected in NHANES, namely using the NHLBI protocol. The data collected from the WC measurement study are available to researchers via a restricted-use data file, which can be accessed through the NCHS Research Data Centers (RDC) from: .

During NHANES 2016, 2,781 adults aged 20 and over were eligible for the methodology study. Among these adults, 309 never received NHLBI measurements, 25 were pregnant women and therefore excluded, and an additional 150 NHANES participants missed one or more of the other WC measurements. There was a final analytic sample of 2,297 (83%) participants: 1,143 were men and 1,154 were women. The overall response rate for survey years 2015?2016 for adults aged 20 and over was 54.8%.

Five WC measurements were performed during the MEC visit with each eligible NHANES participant. Table A describes the five measurements, which are further described under "outcome variables." MESA-assisted was performed, with coaching from the health technician (HT). The HT alone performed the other four WC measurements over the skin and at the level of the specific anatomical landmarks. The order of four of the protocols (NHLBI-WC, WHO-WC, MESAWC using Lufkin tape, and MESA-WC using the Gulick II Plus tape) were randomized; see Table B for the randomizing schema for the four HT-obtained WC measurements. The WC component of the NHANES automated information technology system was updated with prompts to ensure that the HT and the recorders were performing the correct protocol with the correct data entry screen in the order the randomization process assigns. The MESA-assisted part of the study was not randomized as the randomization was only for the measurements obtained directly over anatomical

Table A. Waist circumference measurement protocols for survey participants aged 20 and over for 2016

Protocol

MESA-assisted1 MESA-WC MESA-WC WHO-WC

NHLBI-WC

Measurement

Coached, self-measure Health technician Health technician Health technician

Health technician

Anatomical landmark

At the level of the umbilicus At the level of the umbilicus At the level of the umbilicus At the midpoint between the highest point of the

iliac crest and the lowest rib At the level of the iliac crest

Condition

Over street clothing On skin On skin On skin

On skin

Tape used

Gulick Gulick Lufkin Lufkin

Lufkin

1The MESA-assisted WC measurement was carried out before changing into the MEC examination gown or before leaving the MEC after changing back into street clothes.

NOTES: MESA is Multi-Ethnic Study of Atherosclerosis. WC is waist circumference. WHO is the World Health Organization. NHLBI is National Heart, Lung, and Blood Institute. MEC is mobile examination center.

SOURCE: NCHS, National Health and Nutrition Examination Survey, 2016.

NATIONAL CENTER FOR HEALTH STATISTICS

2

Series 2, Number 182

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download