Assuring Pediatric Nutrition in the Community

FREQUENTLY USED GUIDELINES:
Assessing Nutritional Status - Other Parameters: Skinfold and arm circumference

What do skinfold and arm circumference measurements tell me about a child’s nutritional status?
When taken properly, these measurements can help with the interpretation of weight and weight for height measurements. Skinfold thickness measurements use subcutaneous fat to estimate an individual’s body fatness. Measurements of triceps skinfold (midway between the acromion and olecranon) are generally used. Subscapular and suprailiac measurements can also provide information. Mid upper arm circumference measurements can be used, in combination with triceps skinfold, to estimate body fat and muscle reserves.

Percentiles for triceps skinfold measurements, upper arm circumference, arm muscle circumference, arm muscle area, and arm fat area have been published:

Frishancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr 1981;54:2540.

Take skinfold thickness measurements with the proper equipment and technique. Calipers should be calibrated; plastic calipers are not accurate. Measurements should be made by trained persons only, since precise measures require practice to assure accuracy and reliability. See Lohman, et al for detailed information about technique and standardization.

Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Human Kinetics Publishing. 1988.

Measurements of skinfold thickness and arm circumference are not indicated for infants under 1 year of age because there are no reference data for this population. Reference data from older children cannot be used to extrapolate standards for infants since body composition changes with age. Also, it is extremely difficult to obtain accurate circumference and skinfold measurements for infants because of tissue compressibility.

Children with atypical body composition (e.g., children with hypotonia, hypertonia, and muscle wasting disorders) should not be compared to the published data. Serial measurements made by the same, trained individual are the most useful.