Protocol - Body Composition - Suprailiac Skinfold Thickness
Measurement of the study subject subcutaneous fat mass using calipers to measure skinfold thickness over the suprailiac site. Skinfold thicknesses may also be measured at the number of other sites, including the midaxillary, pectoral, abdominal, anterior thigh, suprapatellar, medical calf, biceps, and forearm sites. If these latter sites are of interest, definitions and protocols are available in manuals that describe anthropometric measurement.
There are several overarching, critical issues for high-quality data collection of anthropometric measures that optimize the data in gene-environment etiologic research. These issues include: 1) the need for training (and re-training) of study staff in anthropometric data collection; 2) duplicate collection of measurements, especially under field conditions; 3) use of more than one person for proper collection of measurements where required; 4) accurate recording of the protocols and the measurement units of data collection; and 5) use of required and properly calibrated equipment.
The notion of recommending replicate measurements comes from the reduction in random errors of measurement and accompanying improved measurement reliability when the mean of multiple measurements is used rather than the a single measurement. This improvement in measurement reliability, however, depends upon the reliability of a single measurement in the hands of the data collectors in a particular study (Himes, 1989). For example, if a measure like recumbent length in a given study has a measurement reliability of 0.95 (expressed as an intraclass correlation coefficient), taking a second measurement and using the mean of the two in analyses will only improve the reliability to 0.97, yielding only a 2% reduction in error variance for the additional effort. If in the same study the reliability of a single triceps skinfold measurement was 0.85, using the mean including a replicate measurement would raise the reliability to 0.92 and yield a 7% reduction in error variance, more than a three-fold better improvement compared with recumbent length.
Because the benefits of taking replicate measurements are so closely linked with the existing measurement reliability, it is recommended that as a part of the training of those who will be collecting anthropometry data, a reliability study be conducted that will yield measurement reliability estimates for the data collectors, protocols, settings and participants involved in that particular study (Himes, 1989). If the measurement reliability for a single measurement ≥ 0.95 the recommendation is that replicate measurement are not necessary and will yield little practical benefit. If the measurement reliability <0.95 the recommendation is to include replicate measurements as prescribed.
If replicate measurements are indicated because of relatively low reliability, a second measurement should be taken, including repositioning the participant. A third measurement should be taken if the first two measurements differ by >3.0 mm. If it is necessary to take a third measurement, the two closest measurements are averaged. Should the third measurement fall equally between the first two measurements, all three should be averaged.
The Expert Review Panel notes that measurements should be made at the precision levels of the calipers chosen (dial graduation mark). Suggestions for acceptable calipers and their precision are given below.
The participant stands and holds the right side of the exam gown up so that the right hip area is exposed. It may be necessary to lower the exam pants slightly to expose the area. The examiner stands behind the participant and palpates the hip area for the right iliac crest. The examiner marks a horizontal line at the high point of the iliac crest and then crosses the line to indicate the midaxillary. The examiner places his/her thumb (left) on the intersecting marks and picks up the skinfold with the thumb and fingers. The skinfold should slope downward and forward at a 45º angle extending toward the pubic symphysis (see Exhibit 1). The caliper is placed perpendicular to the skinfold about 2.0 cm medial to the fingers and the skinfold is measured to the nearest 0.2 mm.
Exhibit 1. Location of suprailiac skinfold
Protocol Name from Source:
National Health and Nutrition Examination Survey III, 1988 Anthropometry Procedures Manual
Personnel and Training Required
Trained to use skinfold calipers, NHANES training video available at: http://www.cdc.gov/nchs/nhanes/nhanes3/anthropometric_videos.htm
Skinfold caliper, the type of caliper used should be recorded. A table of commonly used skinfold calipers appears below.
Harpenden Skinfold Caliper
0 to 80 mm
0.2 mm, accurate to 0.2 mm
Lange Skinfold Caliper
0 to 60 mm
1.0 mm, accurate to 0.5 mm
Holtain Tanner/Whitehouse Skinfold Caliper
0 to 46 mm
0.2 mm, accurate to 0.2 mm
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||No|
Mode of Administration
Infant, Toddler, Child, Adolescent, Adult, Senior
Participants aged 2 months and older; the comparable skinfold for neonates is the flank skinfold
Throughout all of the cycles where skinfolds were collected, NHANES kept to a rigorous training and reliability schedule for their anthropometrists, and the NHANES protocols are consistent with best practices in the field. Skinfold-based measures of fatness and fat distribution in children and adults have been consistently found to agree better with fatness and fat distribution measured by dual-energy x-ray absorptiometry (DXA) than other commonly used indices of body composition, e.g., body mass index (BMI) and waist-to-hip ratio (WHR), that are collected in field situations.
|Common Data Elements (CDE)||Person Suprailiac Skinfold Thickness Body Composition Percentage Value||5021276||CDE Browser|
|Human Phenotype Ontology||Epidermal hyperkeratosis||HP:0007543||HPO|
Process and Review
The Expert Review Panel #1 reviewed the measures in the Anthropometrics, Diabetes, Physical Activity and Physical Fitness, and Nutrition and Dietary Supplements domains.
Guidance from the ERP includes:
a. Added a new protocol
b. New Data Dictionary
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey III, 1988 Anthropometry Procedures Manual Available at http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/nchs/manuals/anthro.pdf
Addo, O. Y., & Himes, J. H. (2014). Are field measures of adiposity sufficient to establish fatness-related linkages with metabolic outcomes in adolescents. Eur J Clin Nutr, 68(6), 671-676. doi: 10.1038/ejcn.2014.14
Addo, O. Y., Pereira, M. A., & Himes, J. H. (2012). Is skinfold thickness as good as DXA when measuring adiposity contributions to insulin resistance in adolescents? Amer J Hum Bio, 24(6), 806-811. doi: 10.1002/ajhb.22321
Fosbol, M., & Zehran, B. (2014). Contemporary methods of body composition measurement. Clinical Physiology and Functional Imaging, 35(2), 81-97. doi:1111/cpf.12152.
Himes, J. H. (1989). Reliability of anthropometric methods and replicate measurements. American Journal of Physical Anthropology, 79(1), 77-80.
Ketel, I. J. G., Volman, M. N. M., Seidell, J. C., Stehouwer, C. D. A., Twisk, J. W., & Lambalk, C. B. (2007). Superiority of skinfold measurements and waist over waist-to-hip ratio for determination of body fat distribution in a population-based cohort of Caucasian Dutch adults. Eur J Endocr, 156(6), 655-661. doi: 10.1530/eje-06-0730
Lohman, T. G., Roche, A. F., & Martorell, R. (1988). Anthropometric standardization reference manual (31, pp. 1493-1494). Champaign, IL, Human Kinetics Books.
Ward, L. C., Poston, L., Godfrey, K. M., & Koletzko, B. (2013). Assessing early growth and adiposity: Report from an Early Nutrition Academy workshop. Annals of Nutrition and Metabolism, 63(1-2), 120-130. doi:10.1159/000350702
Wang, J., Thornton, J. C., Kolesnik, S., Pierson, R. N., Jr. (2000). Anthropometry in body composition. An overview. Annals of the New York Academy of Science, 904, 317-326.
Wells, J. C. K. (2014). Toward Body Composition Reference Data for Infants, Children, and Adolescents. Advances in Nutrition: An International Review Journal, 5(3), 320S-329S. doi: 10.3945/an.113.005371
Wohlfahrt-Veje, C., Tinggaard, J., Winther, K., Mouritsen, A., Hagen, C. P., Mieritz, M. G., . . . Main, K. M. (2014). Body fat throughout childhood in 2647 healthy Danish children: agreement of BMI, waist circumference, skinfolds with dual X-ray absorptiometry. Eur J Clin Nutr, 68(6), 664-670. doi: 10.1038/ejcn.2013.282
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX020305030000||Is the team adequately staffed so that more more||N/A|
|PX020305090000||Was a caliper placed perpendicular to the more||N/A|
|PX020305020000||Will duplicate measurements taken?||N/A|
|PX020305080000||Did the examiner grasp the skinfold with his more||N/A|
|PX020305070000||Did the examiner stand behind the subject, more||N/A|
|PX020305100000||What is the caliper measurement to the more||N/A|
|PX020305050000||Has the staff been properly trained in the more||N/A|
|PX020305040000||Has the staff been properly trained to more||N/A|
|PX020305060000||Was the participant instructed to stand more||N/A|
|PX020305010000||Have the study staff undergone any training more||N/A|
October 1, 2015
Body composition defined most broadly refers to the proportions of fat mass (FM) and fat-free mass (FFM) or lean body mass (LBM) but also encompasses a related concept of regional body fatness. With an increase in FM or adiposity, there may be changes in the relative distribution of fat, for example, toward visceral or dorsal deposits and away from limb fat. Regional distribution of fat also changes normally with maturation and differentially between sexes; changes that may be aggravated by overweight or obesity. Early identification of patterns of regional fatness that may be associated with risky profiles is also encouraged.
Scientific and practical guidance on which protocol may be best suited for a study’s needs are offered here: Body Composition Guidance
The study of body composition looks at the differences in bone, muscle, organs, and fat. Body composition analysis is an indicator of overall health as determined by a person's percentage of fat and lean mass. Body composition tests are designed to give a "whole picture" of the body, but measures can also be used to estimate regional fat distribution. This information is useful to help develop nutrition and exercise programs to benefit the individual and to assess risk for later-life chronic diseases.
Anthropometrics, body fat, body mass index, BMI, obesity lean body mass, muscle mass, fat body mass, diabetes, bone density, bone mineral density, BMD, body fat, bone mass, fat mass, skinfold thickness, BIA, metabolic syndrome, DEXA, DXA, NHANES