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Licensed Unlicensed Requires Authentication Published by De Gruyter May 24, 2018

Wrist circumference as a novel predictor of obesity in children and adolescents: the CASPIAN-IV study

  • Gita Shafiee , Mostafa Qorbani EMAIL logo , Ramin Heshmat , Shirin Djalalinia , Mohammad Esmaeil Motlagh , Tahereh Arefirad , Armita Mahdavi Gorabi , Fereshteh Najafi , Hamid Asayesh and Roya Kelishadi EMAIL logo



Recent studies have discussed the application of wrist circumference as an easy-to-use predictor of general and abdominal obesity. The aim of the current study is to evaluate the association of wrist circumference with generalized and abdominal obesity and to determine its sex- and age-specific optimal cutoff points in association with generalized and abdominal obesity in a national sample of pediatric population.


This nationwide survey was conducted among 14,880 students, aged 6–18 years, selected through a multistage, random cluster sampling method from rural and urban areas of 30 provinces in Iran from 2011 to 2012. Anthropometric indices (weight, height, wrist circumference, waist circumference [WC], hip circumference [HC]) were measured by standard protocols using calibrated instruments. Body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. By considering the area under the curve (AUC) of the receiver operator characteristic (ROC) curves, we evaluated the association of wrist circumference with obesity indices and determined its sex- and age-specific optimal cutoff points in association with obesity. AUC: 0.5, AUC: 0.5–0.65 and AUC: 0.65–1.0 were interpreted as equal to chance, moderately and highly accurate tests, respectively.


Overall, 13,486 children and adolescents with a mean age of 12.47±3.36 years completed the study (participation rate of 90.6%). In both genders, wrist circumference had a significant correlation with anthropometric measures including weight, height, BMI, WC, HC and WHtR. In all age groups and both genders, wrist circumference performed relatively well in classifying individuals into overweight (AUC: 0.67–0.75, p<0.001), generalized obesity (AUC: 0.81–0.85, p<0.001) and abdominal obesity (AUC: 0.82–0.87, p<0.001).


Wrist circumference is suggested to be a useful index for assessing excess weight in the pediatric age group. Its easy measurement without the need of calculation ratios might make it as a routine measurement in daily clinical practice and in large epidemiological studies.


Authors extend their sincere thanks to the large team which worked on this project at national level.

  1. Author contributions: RK, GS and MEM participated in the study design and drafted the manuscript. RH and MQ participated in the study design and statistical analysis and drafted the manuscript. SD and GA contributed to the study design. TA, HA and FN contributed to the data acquisition. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Received: 2017-05-19
Accepted: 2018-04-16
Published Online: 2018-05-24
Published in Print: 2018-07-26

©2018 Walter de Gruyter GmbH, Berlin/Boston

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