Name: assessment of child anthropometry in a large epidemiologic study
Uploaded: 2017-02-02T13:00:00
Description: Watch this Scientific Journal Video about Assessment of Child Anthropometry in a Large Epidemiologic Study at JoVE.com

We greatly appreciate the contributions of our expert anthropometry trainers Irwin Shorr and Jorge Chavarro; the many volunteers who have allowed themselves to be pinched and measured in our anthropometry workshops, and the Project Viva mothers and children for their invaluable contributions. We'd like to extend a special thanks to members of the Project Viva research staff, past and present, especially to Nicole Witham and Marleny Ortega, for their contribution to the video accompanying this manuscript. Funding from the National Institutes of Health supported this work (R01 HD 034568, K24 HD069408).

All the procedures are approved by the Harvard Pilgrim Health Care Institutional Review Board.
1. Training Procedures
<ol>
	<li>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.
	<ol>
		<li>Instruct the trainees to practice performing measurements on each other, while an auxologist or resident anthropometry expert evaluates each trainee...

<ol>
	<li>Boeke, C. E., Oken, E., Kleinman, K. P., Rifas-Shiman, S. L., Taveras, E. M., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlations+among+adiposity+measures+in+school-aged+children.">Correlations among adiposity measures in school-aged children.</a> BMC Pediatrics. 13 (99), (2013).</li><li>Ogden, C. L., Carroll, M. D., Kit, B. K., Flegal, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+childhood+and+adult+obesity+in+the+United+States,+2011-2012.">Prevalence of childhood and adult obesity in the United States, 2011-2012.</a> JAMA. 311 (8), 806-814 (2014).</li><li>Erermis, S., Cetin, N., Tamar, M., Bukusoglu, N., Akdeniz, F., Goksen, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+obesity+a+risk+factor+for+psychopathology+among+adolescents.">Is obesity a risk factor for psychopathology among adolescents.</a> Pediatr Int. 46 (3), 296-301 (2004).</li><li>Gunnell, D., Frankel, S., Nachahal, K., Peters, T., Smith, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Childhood+obesity+and+adult+cardiovascular+mortality:+A+57-y+follow-up+study+based+on+the+boyd+orr+cohort.">Childhood obesity and adult cardiovascular mortality: A 57-y follow-up study based on the boyd orr cohort.</a> AJCN. 67 (6), 1111-1118 (1998).</li><li>Vanhala, M., Vanhala, P., Kumpusalo, E., Halonen, P., Takala, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+between+obesity+from+childhood+to+adulthood+and+the+metabolic+syndrome:+Population+based+study.">Relation between obesity from childhood to adulthood and the metabolic syndrome: Population based study.</a> Brit Med J. 317 (7154), 319 (1998).</li><li>Papoutsakis, C., Priftis, K. N., Drakouli, M., Prifti, S., Konstantaki, E., Chondronikola, M., Antonogeorgos, G., Matziou, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Childhood+overweight/obesity+and+asthma:+is+there+a+link?+A+systematic+review+of+recent+epidemiologic+evidence.">Childhood overweight/obesity and asthma: is there a link? A systematic review of recent epidemiologic evidence.</a> J Acad Nutr Diet. 113 (1), 77-105 (2013).</li><li>Rifas-Shiman, S. L., Rich-Edwards, J. W., Scanlon, K. S., Kleinman, K. P., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Misdiagnosis+of+overweight+and+underweight+children+younger+than+2+years+of+age+due+to+length+measurement+bias.">Misdiagnosis of overweight and underweight children younger than 2 years of age due to length measurement bias.</a> MedGenMed. 7 (4), 56 (2005).</li><li>Horan, M., Gibney, E., Molloy, E., McAuliffe, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methodologies+to+assess+paediatric+adiposity.">Methodologies to assess paediatric adiposity.</a> Ir J Med Sci. 814 (1), 1-16 (2014).</li><li>Wells, J. C., Fewtrell, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+body+composition.">Measuring body composition.</a> Arch Dis Child. 91 (7), 612-617 (2006).</li><li>Wells, J. C., Fuller, N. J., Dewit, O., Fewtrell, M. S., Elia, M., Cole, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Four-component+model+of+body+composition+in+children:+Density+and+hydration+of+fat-free+mass+and+comparison+with+simpler+models.">Four-component model of body composition in children: Density and hydration of fat-free mass and comparison with simpler models.</a> Am J Clin Nutr. 69 (5), 904-912 (1999).</li><li>Damilakis, J., Adams, J. E., Guglielmi, G., Link, T. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+exposure+in+X-ray-based+imaging+techniques+used+in+osteoporosis.">Radiation exposure in X-ray-based imaging techniques used in osteoporosis.</a> Eur J Radiol. 20 (11), 2707-2714 (2010).</li><li>Ulijaszek, S. J., Kerr, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anthropometric+measurement+error+and+the+assessment+of+nutritional+status.">Anthropometric measurement error and the assessment of nutritional status.</a> Brit J Nutr. 82 (3), 165-177 (1999).</li><li>Oken, E., Baccarelli, A. A., Gold, D. R., Kleinman, K. P., Litonjua, A. A., DeMeo, D., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cohort+profile:+Project+Viva.">Cohort profile: Project Viva.</a> Int J Epidemiol. 44 (1), 37-48 (2015).</li><li>Ulijaszek, S. J., Lourie, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-+and+inter-observer+error+in+anthropometric+measurement.">Intra- and inter-observer error in anthropometric measurement.</a> Anthropometry: the Individual and the Population. , 30-55 (1994).</li><li>H&#228;ggstr&#246;m, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+gallery+of+Mikael+H&#228;ggstr&#246;m+2014.">Medical gallery of Mikael H&#228;ggstr&#246;m 2014.</a> Wikiversity Journal of. Medicine. 1 (2), (2014).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acromion+of+Scapula05.">Acromion of Scapula05.</a> DBCLS. , (2013).</li></ol>

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...

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 depression3,4,5,6.
Most studies that examine associations between obesity and later-life health outcomes assume accurate measurements of weight and length/height. Categories of weight status in adults and children include underweight (body mass index (BMI) &#60; 18.0 kg/m2 for adults and &#60; 5th age-sex-specific percentile for children), normal weight (BMI 18.0 to &#60; 25.0 kg/m2 for adults and 5th to &#60; 85th percentile for children), overweight (BMI 25.0 to &#60; 30.0 kg/m2 for adults and 85th to &#60; 95th percentile for children), and obesity (BMI &#8805; 30 kg/m2 for adults and &#8805; 95th percentile for children). Even minor measurement errors can influence these categorizations, especially in children for whom errors that appear small on an absolute scale can represent a large error relative to the child&#39;s size7. For example, in a prior study of children under 2 years of age, comparisons of length measured by the conventional clinical paper-and-pencil method with the recumbent length-board method indicated that paper-and-pencil method systematically overestimated length by an average of 1.3 (1.5) cm &#8212; an error that results in substantial misclassification7.
Using BMI to estimate adiposity offers many advantages for research, including the low equipment cost and minimal burden of height and weight measurement, as well as the opportunity to leverage self-report and clinical measures. However, even with accurate measurement of height and weight, variation in BMI does not necessarily reflect variation in adiposity, since BMI incorporates both lean and fat mass1. Thus, methods that directly measure adiposity are also important for understanding relationships with health outcomes.
Gold standard methods of adiposity and body composition measurement generally rely on technological methods, including air displacement plethysmography (ADP), hydrostatic weighing, magnetic resonance imaging (MRI), and computed tomography (CT), as well as dual X-ray absorptiometry (DXA)8,9,10. While these methods provide some of the most accurate measures of body composition, many of them are not practical in pediatric research studies, especially those that are field-based. For example, hydrostatic weighing requires that individuals be completely submerged in water. ADP equipment has, until quite recently, been available only to measure infants up to 8 kg or children and adults over the age of 6 years, but not toddlers or preschool-age children. CT scans emit a large amount of radiation compared with the other techniques, and the long acquisition time for MRI makes it impractical for many studies8. DXA emits about 1/500 the radiation dose of a CT scan, approximately the equivalent of one day of natural background radiation11, making it an attractive option for research studies involving children. All of these methods, however, are expensive to purchase and none are portable, making them infeasible for field-based studies with limited funding. Bioelectrical impedance analysis (BIA), which measures the impedance of a minute electrical signal sent through the body to estimate body composition, can be less expensive and more portable, but assumptions underlying the calculation of body fat are not applicable to small children10.
In contrast to these technology-based measures, manual anthropometric measures can be performed by a trained observer in most field settings and at a substantially lower equipment cost. Manual anthropometry includes measurements of height, weight, circumferences, and skinfold thicknesses8. Other advantages of manual anthropometry are that it involves no unnecessary radiation exposure, and skilled staff can obtain them efficiently. However, a common concern about manual anthropometric measurements is that they may be both inaccurate and imprecise12.
Obtaining accurate and precise measurements is possible with standardized procedures, adequate training, and sufficient attention to quality control (QC) procedures. The Project Viva team has developed a manual anthropometry training protocol that can yield high-quality, reproducible measures of stature, circumferences, and skinfold thickness. Over more than a decade, we have applied this training and QC protocol to mothers and children in Project Viva, a longitudinal, pre-birth cohort study13. Project Viva staff collected anthropometric measures on child during visits at birth (0 - 3 days), and with both the mother and child at the following time points: infancy (4.9 - 10.6 months), early childhood (2.8 - 6.3 years), mid-childhood (6.6 - 10.9 years), and early teen (11.5 - 16.5 years) 13.
This paper describes the protocol we developed and refined for measurement of height, weight, skinfold thicknesses (triceps and subscapular skinfolds), and body circumferences (waist, hip, and mid-upper arm circumferences [MUAC]) in Project Viva. We also describe how we have assessed both manual anthropometric measurement precision by means of technical error of measurement (TEM) calculations and accuracy in comparison to gold standard DXA measurements.

<table border="0" cellpadding="0" cellspacing="0" width="596">
	<tbody>
		<tr height="210">
			<td height="210" style="height:210px;width:216px;">Stadiometer</td>
			<td style="width:95px;">Weigh and Measure, LLC&#160;</td>
			<td style="width:119px;">SSWM-1</td>
			<td style="width:167px;">Basic Shorr board (without smooth slide features) can also be used. In order to accommodate the width of children&#39;s hips during sitting height, the base of a stadiometer should be approximately 60 cm wide or larger.</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">Bioimpedance scale&#160;</td>
			<td style="width:95px;">Tanita Coporation of America</td>
			<td style="width:119px;">TBF 300A (model is discontinued), DC-430U is&#160; comparable&#160;&#160;&#160;</td>
			<td style="width:167px;">Scale is used for weight and bioimpedance. Any digital, standardized scale can be used for weight only.</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">Skinfold Caliper</td>
			<td style="width:95px;">Holtain Limited</td>
			<td style="width:119px;">n/a</td>
			<td style="width:167px;">This model uses a dial gauge in graduations of 0.2 mm. Models with a linear gauge are also acceptable.&#160;&#160;</td>
		</tr>
		<tr height="189">
			<td height="189" style="height:189px;width:216px;">Hip/waist tape measure</td>
			<td style="width:95px;">Gulick II Plus Measuring Tape</td>
			<td style="width:119px;">67019</td>
			<td style="width:167px;">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.</td>
		</tr>
		<tr height="105">
			<td height="105" style="height:105px;width:216px;">MUAC measuring tape (ShorrTape&#169; Measuring Tape)&#160;</td>
			<td style="width:95px;">Weigh and Measure, LLC</td>
			<td style="width:119px;">STape</td>
			<td style="width:167px;">The tape measure should be flexible with a single or double slotted insertion window.</td>
		</tr>
	</tbody>
</table>

assessment of child anthropometry in a large epidemiologic study

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.

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 imprecision12,<sup class=...

Watch this Scientific Journal Video about Assessment of Child Anthropometry in a Large Epidemiologic Study at JoVE.com

Assessment of Child Anthropometry in a Large Epidemiologic Study

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

A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to ...

Research

JoVE Journal

Medicine

Biomarkers in an Animal Model for Revealing Neural, Hematologic, and Behavioral Correlates of PTSD

Identification of biomarkers representing the evolution of the pathophysiology of Post Traumatic Stress Disorder (PTSD) is vitally important, not only for ...

Real-time fMRI Biofeedback Targeting the Orbitofrontal Cortex for Contamination Anxiety

We present a method for training subjects to control activity in a region of their orbitofrontal cortex associated with contamination anxiety using ...

A Novel Surgical Approach for Intratracheal Administration of Bioactive Agents in a Fetal Mouse Model

Prenatal pulmonary delivery of cells, genes or pharmacologic agents could provide the basis for new therapeutic strategies for a variety of genetic and ...

A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon  motion during dynamic tasks and can provide a complementary methodological  approach ...

An Isolated Working Heart System for Large Animal Models

Since its introduction in the late 19th century, the Langendorff isolated heart perfusion apparatus, and the subsequent development of the working heart ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic ...

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo

Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo

Plasma coagulation as a form of electrocautery is used in liver surgery for decades to seal the large liver cut surface after major hepatectomy to prevent ...

Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS

One of the leading causes of morbidity and mortality in patients with heart failure is right ventricular (RV) dysfunction, especially if it is due to ...

Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex

The concept of objective nociceptive assessment and optimal pain management have gained increasing attention. Despite the known negative short- and ...