IJCS | Volume 32, Nº2, May/June 2019

DOI: 10.5935/2359-4802.20180080 290 VIEWPOINT International Journal of Cardiovascular Sciences. 2019;32(3)290-292 Mailing Address: Tiago Chaves Rua Rodolpho Paulo Rocco, s/n. Postal Code: 21941-913, Ilha do Fundão, Rio de Janeiro, RJ - Brazil. E-mail: tiagochavesrj@gmail.com , tiagosaojorge@hotmail.com Abdominal Circumference or Waist Circumference? Tiago de Oliveira Chave s a nd Michel Silva Rei s Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brazil Manuscript received December 8, 2017; revised manuscript February 20, 2018; accepted March 03, 2018. Waist Circumference; Waist - Hip Ratio; Abdominal Circumference; Cardiovascular Diseases; Risk Factors; Anthropometry. Keywords Circumference measures, also called perimetry, are part of the anthropometric evaluation. 1 Important Brazilian guidelines, as well as the Brazilian Society of Cardiology (SBC), 2 have considered the abdominal circumference values as a point of reference to classify the risk for cardiovascular disease development. However,what is the adequate terminology that should be used to quantify the increased cardiovascular disease risk: abdominal circumference or waist circumference? In national books, 3,4 measures of waist and abdominal circumferences are addressed as being distinct measures. The optimal point for waist circumference measurement is located between the last rib and the iliac crest, at its smallest perimeter. For the abdominal circumference, the most accurate measurement has been proposed as that taken on the umbilical scar. According to the World Health Organization (WHO) 5 and the European Society of Cardiology (ESC), 6 the cardiovascular risk classification is carried out based on the waist circumference measure and this parameter should be measured at midpoint between the last rib and the iliac crest. The same thing occurs in studies published in the English language, such as the one by Acar et al. 1 For them, themethodological criterion used tomeasure waist circumference was determined according to the same recommendations adopted by theWHO 5 and by the ESC. 6 This study 1 , as well as the international guidelines, 5,6 calls this body segment as “waist circumference”, which translates as “circunferência da cintura” in Portuguese, not “circunferência abdominal”. Considering these facts, and even though there is a literature review on the subject, 7 why do the main Brazilian guidelines still use the nomenclature “abdominal circumference” instead of “waist circumference”? The International Society for the Advancement of Kinanthropometry (ISAK), 8 which has a manual of anthropometric measurements, also describes the measurement process used to measure the waist circumference as the intersection between the last rib and the border of the iliac crest, corroborating other international guidelines. 5,6 Another classic article, which also used the “waist circumference” nomenclature as a component of some equations for predicting body fat, was that by Jackson and Pollock. 9 This study was crucial for the advancement and consolidation of anthropometry. Moreover, based on the measurement of some anthropometric parameters used in this study, it was possible to validate the predictive formula for fat percentage in the male gender. 9 However, the authors did not detail how the methodological process of this anthropometric measurement was performed, making it impossible to conclude whether the same criteria proposed by theWHO, 5 by ESC 6 and by ISAK 8 were used. Other relevant points are the evaluationcriteriaproposed by different authors, which were assessed in another study. 10 What were the methodological standards used by the researchers who used the “waist circumference” nomenclature in their respective studies? Were there differences in these anthropometric assessments? In the face of this impasse, Wang et al. 10 carried out a study in 2003 and reported the identification of 14 sites and, consequently, different methodological processes for the measurement of waist circumference. These 14 sites were separated into groups, aiming to identify possible differences after applying the statistical treatment. The groups were divided as follows: (1) immediately below the last rib; (2) at the smallest circumference