Protocol - Height - Standing Height
Standing height is measured from the top of the participant’s head to his or her heels. This measure is taken among participants, usually older than 2 years of age, who are able to stand unassisted.
The Anthropometrics Expert Review Panel suggests that the measurements be taken to the nearest 0.1 cm.
Three measurement protocols (Standing Height, Recumbent Height, and Knee Height) accommodate various groups of participants. Self-Reported Height should be used as a last resort only. Several overarching, critical issues for high-quality data collection of anthropometric measures that optimize the data in gene-environment etiologic research include (1) the need for training (and retraining) 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 on the reliability of a single measurement in the hands of the data collectors in a particular study (Himes, 1989). For example, if a measure such as standing height 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 measurements in analyses will improve the reliability to only 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 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 is greater than or equal to 0.95, the recommendation is that replicate measurement are not necessary and will yield little practical benefit. If the measurement reliability is less than 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 more than 1.0 cm. 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.
Standing Height, Recumbent Length, and Knee Height protocols are part of an examination study. Self-Reported Height may be part of a personal or self-administered interview.
Note: Detailed videos illustrating the procedure can be found on the NHANES website (http://www.cdc.gov/nchs/nhanes/nhanes3/anthropometric_videos.htm)
Standing Height Protocol
Ask the participant to remove hair ornaments, jewelry, buns, or braids from the top of the head that interfere with the measurement. Shoes should be removed.
Ask the participant to stand erect against the backboard with the body weight evenly distributed and both feet flat on the stadiometer platform (Exhibit 1). The participant’s feet should be positioned with the heels together and toes pointed slightly outward at approximately a 60 degree angle. Check to be sure that the back of the head, shoulder blades, buttocks, and heels make contact with the backboard of the stadiometer.
NOTE: Depending on the overall body conformation of the individual, all four contact points - head, shoulders, buttocks, and heels - may or may not touch the stadiometer backboard (Exhibit 2). For example, elderly survey participants may have kyphosis, a forward curvature of the spine that appears as a hump at the upper back. In particular, dowager’s hump is a form of kyphosis that creates a hump at the back of the neck. Additionally, some overweight survey participants cannot stand straight while touching all four contact points to the backboard. In such instances it is important to obtain the best measurement possible according to the protocol.
Stature measurements are made with the head aligned in the Frankfort horizontal plane (Exhibit 2). The head is in the Frankfort plane when the horizontal line from the ear canal to the lower border of the orbit of the eye is parallel to the floor and perpendicular to the vertical backboard (see Exhibit 2). Many people will assume this position naturally, but for some survey participants the examiner may need to gently tilt the head up or down to achieve the proper alignment. Instruct the survey participant to look straight ahead.
If you cannot position the participant such that his or her trunk remains vertical above the waist, that the arms and shoulders are relaxed, and that the head is positioned in the Frankfort plane, be sure to note this in the measurement record. This information might be useful to interpret study findings. In the National Health and Nutrition Examination Study 2007-08, a comment described as "Not Straight" is noted in the stature record.
Once positioned, lower the stadiometer headpiece so that it rests firmly on top of the participant’s head, with sufficient pressure to compress the hair. Instruct the survey participant to stand as tall as possible, take a deep breath, and hold this position. The act of taking a deep breath helps straighten the spine to yield a more consistent and reproducible stature measurement. Notice that the inhalation will cause the headpiece to rise slightly.
As soon as the participant inhales, record the measurement. After recording the measurement, tell the participant to relax. Once the measurement is taken, raise the stadiometer headpiece and have the participant step away from the stadiometer.
Adjustments for shoes and hair: When participants cannot remove hair braids, buns, and headwear that interferes with the stature measurement, measure the distance from the scalp to the top of the hair with a small ruler to the nearest 0.1 cm. If shoes are worn, measure the height of the shoe heel to the nearest 0.1 cm. A corrected height value can be calculated by subtracting these distances from the original stature measurement, thus yielding an adjusted stature value.
Exhibit 1. Stadiometer with a fixed length backboard and an adjustable headpiece
Exhibit 2. Body Orientation for Standing Height Measurement and Frankfort Horizontal Plane
Personnel and Training Required
Technicians should be trained in the basic techniques of anthropometric measurements and specifically in using a stadiometer and positioning participants into the Frankfort plane position.
Stadiometer with a fixed-length backboard and an adjustable head piece
|Specialized requirements for biospecimen collection||No|
|Average time of greater than 15 minutes in an unaffected individual||No|
Mode of Administration
Toddler, Child, Adolescent, Adult, Senior
This measure includes four protocols, and each protocol relates to the age of the participant and his or her ability to stand up straight. A fourth protocol for self-reported height is included but is considered a protocol of last resort when direct measurement of height or its proxy is not possible.
The standing height protocol is used for participants 2 years of age or older who can stand unassisted.
The recumbent length protocol is used for all infants and children from birth through 47 months of age.
The knee height protocol was used for participants 60 years of age or older or for individuals who cannot stand unassisted.
Study subject aged 16 years or older or by a knowledgeable adult proxy for children younger than 16 years of age.
*NOTE: Self-reported height values are considered to be less accurate and are used only when measured height cannot be obtained.
The National Health and Nutrition Examination Survey 2007-2008 protocols were selected as best practice methodology and are the most widely used protocols to assess height.
|caDSR Common Data Elements (CDE)||Person Height Value||2179643||CDE Browser|
|Logical Observation Identifiers Names and Codes (LOINC)||PhenX - standing height||62294-4||LOINC|
|Human Phenotype Ontology||Abnormality of body height||HP:0000002||HPO|
Body Mass Index (BMI), Waist-to-Height Ratio (WtHR)
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:
Added replicate measure language
Changed unit of measurement
Back-compatible: no changes to Data Dictionary
Previous version in Toolkit archive (link)
Protocol Name from Source
National Health and Nutrition Examination Survey (NHANES), Anthropometry Procedures Manual, 2007
Centers for Disease Control and Prevention, National Center for Health Statistics. (2007). National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Certification for the Spanish translation can be found here.
Himes, J. H. (1989). Reliability of anthropometric methods and replicate measurements. American Journal of Physical Anthropology, 79, 77-80.
|Variable Name||Variable ID||Variable Description||dbGaP Mapping|
|PX020703010100||Standing Height measured in centimeter, more||N/A|
|PX020703010200||Standing Height measured in centimeter, more||N/A|
|PX020703010300||Standing Height measured in centimeter, more||N/A|
|PX020703020100||Standing Height measured in centimeter, more||N/A|
|PX020703020200||Standing Height measured in centimeter, more||N/A|
|PX020703020300||Standing Height measured in centimeter, more||N/A|
|PX020703030100||Standing Height measured in centimeter, more||N/A|
|PX020703030200||Standing Height measured in centimeter, more||N/A|
|PX020703030300||Standing Height measured in centimeter, more||N/A|
|PX020703040100||Standing Height measured in centimeter, average||N/A|
|PX020703040200||Standing Height measured in centimeter, average||Variable Mapping|
|PX020703040300||Standing Height measured in centimeter, average||Variable Mapping|
March 27, 2009
Height is the distance from the top of the participant’s head to the heels of his or her feet (i.e., the vertical length).
Height or stature is used to assess body size and bone length. Recumbent length is used to measure length of infants, and knee height may be used to estimate height when stature cannot be measured in older adults.
Anthropometrics, body mass index, BMI, stature, Waist-to-Height Ratio, WHtR, NHANES, gerontology, aging, geriatrics
|Protocol ID||Protocol Name|
|20701||Height - Knee Height|
|20702||Height - Recumbent Length|
|20703||Height - Standing Height|
|20704||Height - Self-Reported Height|