Elsevier

Nutrition

Volume 19, Issue 6, June 2003, Pages 481-486
Nutrition

Applied nutritional investigation
Harmonization of anthropometric measurements for a multicenter nutrition survey in Spanish adolescents

https://doi.org/10.1016/S0899-9007(03)00040-6Get rights and content

Abstract

Objective

Although the need for accurate anthropometric measurement has been repeatedly stressed, reports on growth and physical measurements in human populations rarely include estimates of measurement error. We describe the standardization process and reliability of anthropometric measurements carried out in a pilot study.

Methods

For the intraobserver assessment of anthropometric measurements, we studied 101 adolescents (58 boys and 43 girls) from five cities. For interobserver assessment, we studied 10 adolescents from the same class in Zaragoza and different from those in the intraobserver sample.

Results

For skinfold thickness, intraobserver technical errors of measurement (TEMs) in general were smaller than 1 mm; for circumferences, TEMs in general were smaller than 1 cm. Intraobserver reliability for skinfold thickness was greater than 95% for almost all cases; for circumferences, intraobserver reliability generally was greater than 95%. Interobserver TEMs ranged from 1 to 2 mm for the six skinfold thicknesses measured; for circumferences, TEMs were smaller than 1 cm for the arm, biceps, and waist and between 1 and 2 cm for the hip and thigh. Interobserver reliabilities for skinfold thickness and circumference were always greater than 90%, except for biceps skinfold.

Conclusions

Our results are in agreement with those recommended in the literature. Therefore, these anthropometric measures seem to be adequate to assess body composition in a multicenter survey in adolescents.

Introduction

Because of its importance to health, body composition is commonly investigated in epidemiologic, clinical, and population studies. Reliable methods for measurement of body fat and fat distribution therefore are important. During the past decade, investigators have emphasized the accuracy of newer techniques, such as dual-energy x-ray absorptiometry, magnetic resonance imaging, and computed tomography, for measuring body composition; nevertheless, anthropometry is the most widely used method, and it recently has been used to estimate fat distribution.1, 2 The distinct advantages of anthropometry are that it is portable, non-invasive, inexpensive, and useful in field studies, and there is a substantial literature available on the subject.3

Although the need for accurate anthropometric measurement has been repeatedly stressed, reports on growth and physical measurements in human populations rarely include estimates of measurement error. Reliability is the degree to which within-subject variability is due to factors other than measurement error variance or physiologic variation. The lower the variability between repeated measurements of the same subject by one (intraobserver differences) or two or more (interobserver differences) observers, the greater is the precision. The most commonly used measures of precision are the technical error of measurement (TEM) and the coefficient of reliability (R). The use of two error estimates, TEM and R, can provide most of the information needed to determine whether a series of anthropometric measurements can be considered accurate.4 As with any quantitative biological measure, in anthropometric assessment it is important to minimize error. Poor precision in measurement of an anthropometric variable will lead to underestimation of correlations with other variables.5 The main sources of error of imprecision are random imperfections in the measuring instruments or in the measuring and recording techniques.

Adolescence is a decisive period during human life because of multiple physiologic and psychological changes that take place. We developed a research project to evaluate the nutrition status of Spanish adolescents from five cities, Granada, Madrid, Murcia, Santander, and Zaragoza, which is called the Alimentación y Valoración del Estado Nutricional en Adolescentes (AVENA Study). Before carrying out the field work, we conducted a pilot study. For anthropometric assessment, in the pilot study we standardized the methods of measurement and obtained the intra- and interobserver errors of measurement. We describe the standardization process and the reliability of the anthropometric measurements carried out in the pilot study.

Section snippets

Population and design

In September 2000, we conducted a 2-d theoretical and practical workshop in Madrid with the five researchers who planned to perform the anthropometric measurements. All five anthropometrists had experience in the anthropometric assessment of nutrition status. The aim of the workshop was to standardize the methodology and use it as a reference, as determined by an experienced anthropometrist (L.A.M.).6, 7, 8 In October 2000, we conducted the pilot study in the five cities to assess the

Results

Table II shows the intraobserver TEM and %R for each anthropometric measurement in the five cities. For skinfold thickness, TEMs in general were smaller than 1 mm, except for the suprailiac skinfold in Madrid and the thigh skinfold in Madrid and Santander. For circumferences, TEMs were smaller than 1 cm, except for waist circumference in Murcia and hip circumference in Granada, Madrid, Murcia, and Santander. Reliability for skinfold thickness was greater than 95% for all cases, except for

Discussion

In choosing the instrument to assess nutrition status, researchers often elect to measure only height and weight. These measures are quick and simple and require only limited training. More comprehensive measurement sets that include skinfold thickness and circumference require more training and produce different degrees of error. Skinfold thickness is accepted as body fatness predictor for two reasons: approximately 40% to 60% of total body fat is in the subcutaneous region of the body, and

Acknowledgements

The authors thank all the adolescents who participated in this pilot study, especially those from the Colegio Escuelas Pías (Zaragoza, Spain) who participated in the intra- and interobserver assessments.

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    This study was supported by the Spanish Ministry of Health (FIS 00/0015).

    *

    Coordinator: A. Marcos, Madrid. Principal Investigators: M. Bueno, Zaragoza; M. J. Castillo, Granada; M. García Fuentes, Santander; A. Marcos, Madrid; S. Zamora, Murcia. Collaborating Centers: Universidad de Granada (M. J. Castillo, M. D. Cano, Biochemistry; A. Gutierrez, J. L. Mesa, J. Ruiz, physical capacity; M. Delgado, P. Tercedor, physical activity); Instituto de Nutrición y Bromatología CSIC-UCM, Madrid (A. Marcos, M. Gonzalez-Gross, M. Joyanes, F. Sanchez-Muñiz, E. Nova, S. Medina, J. Weinberg, S. Gomez, A. Montero, B. de la Rosa, S. Sanmartin, J. Romeo, R. Alvarez, coordination, immunology; L. Barrios, statistical analysis; A. Leyva, psychological assessment); Departamento de Fisiología, Universidad de Murcia, Murcia (S. Zamora, M. Garaulet, F. Perez-Llamas, J. C. Baraza, J. F. Marin, F. Perez de Heredia, M. A. Fernandez, C. González, R. García, C. Torralba, E. Donat, E. Morales, M. D. García, J. A. Martínez, J. J. Hernandez, A. Asensio, F. J. Plaza, M. J. Lopez, diet analysis); Departamento de Pediatría, Universidad de Cantabria, Santander (M. García Fuentes, D. Gonzalez-Lamuño, P. de Rufino, R. Perez Prieto, M. D. Fernandez, T. Amigo, genetic study); Universidad de Zaragoza, Zaragoza (M. Bueno, L. S. Moreno, A. Sarría, J. Fleta, G. Rodríguez, C. M. Gil, M. I. Mesana, J. A. Casajús, anthropometric assessment).

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