Assessment of Child Anthropometry in a Large Epidemiologic Study

Summary

In epidemiologic studies of children, well-trained research staff can accurately and precisely assess weight, height, sitting height, skinfold thicknesses, and body circumferences.

Abstract

A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to understand health effects of child growth and adiposity. Gold standard methods of measuring adiposity, such as dual X-ray absorptiometry (DXA), may not be feasible in large field studies. Research staff can, however, complete anthropometric measurements, such as body circumferences and skinfold measurements, using inexpensive portable equipment. In this protocol we detail how to obtain manual anthropometric measurements from children, including standing and sitting height, weight, waist circumference, hip circumference, mid-upper arm circumference, triceps skinfold thickness, and subscapular skinfold thickness, and procedures to assess the quality of these measurements. To demonstrate accuracy of these measurements, among 1,110 school-aged children in the pre-birth cohort Project Viva we calculated Spearman correlation coefficients comparing manual anthropometric measurements with a gold standard measure of body fat, DXA fat mass¹. To address reliability, we evaluate intra-rater technical error of measurement at a quality control session conducted on adult female volunteers.

Introduction

Overweight and obesity remain at epidemic levels, with approximately one-third of US children and two-thirds of adults having overweight or obesity, according to 2011 - 2012 estimates². Overweight, obesity, and excess body fat confer greater risk of adverse cardiometabolic outcomes, including Type 2 diabetes and cardiovascular diseases, as well as other adverse physical and psychological health outcomes, including asthma and depression^3,4,5,6.

Most studies that examine associations between ....

Protocol

All the procedures are approved by the Harvard Pilgrim Health Care Institutional Review Board.

1. Training Procedures

1. Have the trainees (research assistants) complete a multi-day, multiple hour training program to learn proper positioning, watch training videos, and receive in-person training from an experienced auxologist.
   1. Instruct the trainees to practice performing measurements on each other, while an auxologist or resident anthropometry expert evaluates each trainee's technique and makes appropriate adjustments.
   2. Organize a workshop with external volunteers, optimally of a variety of ages and body types....

Results

This analysis addresses precision of the manual anthropometric measurements using data generated from quality control (QC) procedures, and evaluates intra-rater measurement error by Technical Error of Measurement (TEM) ¹². TEM ranges of acceptability are based on calculations of repeated intra-rater anthropometric measures, where 95% of measurement discrepancy is due to factors other than rater imprecision^12,

Discussion

Accurate body composition measures are critical for properly assessing childhood growth in research studies. Researchers widely accept DXA as a gold standard method, and many criticize manual anthropometric measures as being imprecise and inaccurate. However, this analysis of anthropometric techniques to estimate body fat suggests that well-trained research assistants who follow a standardized protocol can conduct manual anthropometric measures with excellent accuracy, yielding adiposity estimates that are highly correla.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Stadiometer	Weigh and Measure, LLC	SSWM-1	Basic Shorr board (without smooth slide features) can also be used. In order to accommodate the width of children's hips during sitting height, the base of a stadiometer should be approximately 60 cm wide or larger.
Bioimpedance scale	Tanita Coporation of America	TBF 300A (model is discontinued), DC-430U is comparable	Scale is used for weight and bioimpedance. Any digital, standardized scale can be used for weight only.
Skinfold Caliper	Holtain Limited	n/a	This model uses a dial gauge in graduations of 0.2 mm. Models with a linear gauge are also acceptable.
Hip/waist tape measure	Gulick II Plus Measuring Tape	67019	This model uses compression bands, which makes it easier to identify how firmly the tape measure is being pulled. The compression band is not necessary, but highly recommended.
MUAC measuring tape (ShorrTape© Measuring Tape)	Weigh and Measure, LLC	STape	The tape measure should be flexible with a single or double slotted insertion window.