NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY III Body Measurements (Anthropometry) Westat, Inc. 1650 Research Boulevard Rockville, MD 20850 (301) 251-1500 October 1988 TABLE OF CONTENTS Chapter Page 1. INTRODUCTION TO ANTHROPOMETRY . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 1.1 Overview of Anthropometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 1.2 Purpose of Anthropometrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 2. EQUIPMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 2.1 Description of Exam Room in MEC . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1 2.2 Description of Equipment and Supplies . . . . . . . . . . . . . . . . . . . . . . . . 2-1 2.3 Start of Stand Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2 2.3.1 Equipment and Setup Procedures . . . . . . . . . . . . . . . . . . . . . . 2-2 2.3.1.1 Weight Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2 2.3.1.2 Setting the Printer for Weight Scale . . . . . . . . . . . . . 2-2 2.3.1.3 Stadiometer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 2.3.2 Calibration Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3 2.3.2.1 Mediform Large Sliding Caliper . . . . . . . . . . . . . . . 2-3 2.3.2.2 Small Sliding Breadth Calipers . . . . . . . . . . . . . . . . 2-4 2.3.2.3 Infant Measuring Board . . . . . . . . . . . . . . . . . . . . . 2-4 2.3.2.4 Stadiometer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4 2.3.2.5 Digital Weight Scale . . . . . . . . . . . . . . . . . . . . . . . 2-5 2.3.2.6 Skinfold Calipers . . . . . . . . . . . . . . . . . . . . . . . . . . 2-5 2.3.3 Daily Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 2.3.3.1 Skinfold Calipers . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 2.3.3.2 Weight Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 2.3.3.3 Infant Measuring Board . . . . . . . . . . . . . . . . . . . . . 2-6 2.3.3.4 Stadiometer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6 2.4 Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 2.4.1 Cleaning of Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 2.4.2 Malfunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 2.5 End of Stand Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7 2.5.1 Pack-Up Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 2.5.2 Pack-Up Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 iii TABLE OF CONTENTS (continued) Chapter Page 2.5.2.1 Calipers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 2.5.2.2 Weight Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 2.5.2.3 Printer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 2.5.2.4 Stadiometer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 2.5.2.5 Body Measurement Cabinet . . . . . . . . . . . . . . . . . . 2-9 3. EXAMINATION PROTOCOL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 3.1 Eligibility Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 3.2 Pre-Examination Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1 3.2.1 Role of Anthropometric Examiner and Recorder . . . . . . . . . . . 3-1 3.2.2 Measuring and Recording Guidelines . . . . . . . . . . . . . . . . . . . 3-4 3.3 Examination Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 3.3.1 Protocol Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 3.3.1.1 Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4 3.3.1.2 Standing Height . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5 3.3.1.3 Sitting Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7 3.3.1.4 Upper Leg Length . . . . . . . . . . . . . . . . . . . . . . . . . 3-9 3.3.1.5 Knee Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9 3.3.1.6 Biacromial Breadth . . . . . . . . . . . . . . . . . . . . . . . . 3-12 3.3.1.7 Biiliac Breadth . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-12 3.3.1.8 Upper Arm Length . . . . . . . . . . . . . . . . . . . . . . . . 3-12 3.3.1.9 Arm Circumference . . . . . . . . . . . . . . . . . . . . . . . . 3-14 3.3.1.10 Abdominal (Waist) Circumference . . . . . . . . . . . . . . 3-14 3.3.1.11 Buttocks (Hip) Circumference . . . . . . . . . . . . . . . . . 3-16 3.3.1.12 Thigh Circumference . . . . . . . . . . . . . . . . . . . . . . . 3-16 3.3.1.13 Skinfolds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-16 3.3.1.14 Elbow Breadth . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-20 3.3.1.15 Wrist Breadth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-24 3.3.1.16 Sequence of Measurement Components, SP Position, and Examiner Equipment for Adults 20+ . . . . . . . . . 3-26 3.3.1.17 Measuring Children under Eight Years of Age . . . . . 3-27 3.3.1.18 Measuring Handicapped SP’s . . . . . . . . . . . . . . . . . 3-28 iv TABLE OF CONTENTS (continued) Chapter Page 3.3.2 Examination Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-29 3.3.2.1 Automated System . . . . . . . . . . . . . . . . . . . . . . . . . 3-29 3.3.2.2 Hardcopy Data Form . . . . . . . . . . . . . . . . . . . . . . . 3-35 3.4 Postexamination Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-38 4. LOGS AND RECORDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 4.1 Daily Appointment Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 4.2 Daily Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1 4.3 Equipment Calibration Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 4.4 Shipment of Forms and Logs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4 5. QUALITY CONTROL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 5.1 Examination Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 5.1.1 Automated System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 5.1.2 Hardcopy Exam Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 5.2 Examination Data Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 5.2.1 Tracking of Data Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 5.2.2 Shipping Data Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 5.3 Equipment Calibrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 5.4 Review, Observations and Replication . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 5.5 Refresher Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3 6. SAFETY PROCEDURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 6.1 Equipment Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 6.2 SP Movement and Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 6.3 Emergency Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1 v TABLE OF CONTENTS (continued) List of Exhibits Exhibit Page 3-1 SP Position for Standing Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6 3-2 SP Position for Sitting Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-8 3-3 SP Position for Upper Leg Length Location and Upper Leg Midpoint . . . . . . . . 3-10 3-4 SP Position for Knee Height . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-11 3-5 SP Position for Arm Length Position and Location of Upper Arm Midpoint . . . . 3-13 3-6 Measuring Tape Position for Abdominal (waist) Circumference . . . . . . . . . . . . . 3-15 3-7 Measuring Tape Position for Buttocks Circumference . . . . . . . . . . . . . . . . . . . . 3-17 3-8 Location of Triceps Skinfold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-19 3-9 Location of Subscapular Skinfold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-21 3-10 Location of Suprailiac Skinfold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-22 3-11 SP Position for Elbow Breadth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-23 3-12 Bones of the Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-25 3-13 Body Measurement All Ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-36 4-1 Body Measurement Daily Log Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2 4-2 Equipment Calibration Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3 vi 1. INTRODUCTION TO ANTHROPOMETRY 1.1 Overview of Anthropometry Nutrition is a major determinant of health, and the resolution of many nutritional issues of public health concern requires survey data. One of the major aims of NHANES III is to provide information useful for studying the relationship among diet, nutritional status, and health. In addition to dietary intake methodologies, questionnaire material, hematological tests, and nutritional biochemistries, the assessment of nutritional status requires a series of stature, weight, and other anthropometric dimensions. Anthropometryis thestudyof themeasurement ofthe humanbody interms ofthe dimensions ofbone,muscle,andadipose (fat)tissue. Measures ofsubcutaneousadiposetissueareimportant because individuals with large values are reported to be at increased risks for hypertension, adult-onset diabetes mellitus, cardiovascular disease, gallstones, arthritis, and other disease, and forms of cancer. Combined with the dietary and related questionnaire data, and the biochemical determinations, anthropometry is essential and critical information needed to assist in describing the data collected from persons in the NHANES III sample. 1.2 Purpose of Anthropometrics Actual stature, weight, and body measurements including skinfolds, girths, and breadths will be collected in the MEC for purposes of assessing growth, body fat distribution, and for provision of reference data. Measurements of stature and weight will allow for a revision of the child growth charts which are based in part on data collected in NHES cycles II and III and data from the Fels Longitudinal Study. Anthropometric measurements such as skinfolds and circumferences and bioelectrical impedance (amethodusedtoestimatetheamountofleantissue)willallowcross-sectionalanalysisoftherelationship between obesity and risk of disease. Therefore, many of the measurements included in NHANES III will repeat ones made in previous NHANES and HHANES so that trend analyses can be conducted. Some measures have been added to provide further information on body frame size and fat distribution, while others have been dropped because new data have determined that other measures are more informative. 1-1 2. EQUIPMENT 2.1 Description of Exam Room in MEC The body measurement room is located in trailer #4 of the MEC. The room is equipped with some unique features designed to facilitate an accurate and efficient measurement procedure. These featuresincludestrategicallyplacedmirrorsandacustom-builttableforSP’stositon. TheToledoscale, stadiometer, and infant measurement board are all contained in this room. The body measurement room is shared with the allergy component and the MEC computer. 2.2 Description of Equipment and Supplies The equipment and supplies necessary for body measurements are as follows: Body measurement table Toledo self-zeroing weight scale Stadiometer Infant measuring board Measurement box for sitting height Insertion tape Steel measuring tape Holtain skinfold caliper Holtain small sliding breadth caliper 2 Mediform large sliding calipers Polaroid Land camera with close-up photographic lens Special light attachment for camera Polaroid film Calculator Computer terminal Weights for scale calibration Calibrations rods Step wedge standards Cosmetic pencils (wax base) Footstool Scissors - blunt edge Paper tape White vinegar Alcohol Baby oil Gauze 4x4 2-1 Inventory of Equipment and Supplies At the beginning of each stand and at the end of each stand, the health technician should take an inventory of the equipment and supplies needed for the body measurement examination component as discussed in Standardized Procedures. Any pieces of equipment that are missing should be reported to the MEC manager. 2.3 Start of Stand Procedures Unpackthecalipersandsuppliesandarrangeaccordinglyintheroom. Cleanandcalibratethe equipment as discussed in this chapter. 2.3.1 Equipment and Setup Procedures 2.3.1.1 Weight Scale a. Plug in the power cord. b. Untape the weight blocks and move to the front of the scale. c. Remobilizethescaleplatformbyremovingthetablepaperbetweentheplatformandscale base. 2.3.1.2 Setting the Printer for Weight Scale The printer comprises a bank of numbers and letters that indicate, from left to right, time (AM or PM), date and weight. To set the time/date function displayed in the LED on the front panel, do the following: a. Plug the power cord into the power outlet. b. Find the two push buttons on the panel of the printer above the attached power cable. The top one is the "set" button; the bottom one is the "advance" button. 2-2 c. Press the "set" button to cause the right most LED digit to begin blinking. Press the "advance" button to advance the numerals until the correct year designation appears. Press "set" once again to fix that numeral in the LED and cause the second digit from the right to begin blinking. d. Follow the above process through the six-digit field that represents the date and the four- digit field that represents the time. Although the time must be set according to a 24-hour clock, time will appear on the AM and PM. e. Whenallthedigitshavebeencorrectlyset,pressthe"set"buttontwicetostartthetiming operation. 2.3.1.3 Stadiometer a. Plug the light into the power outlet. b. Untape the light from the camera-holding bar. c. Untape the horizontal bar. 2.3.2 Calibration Procedures 2.3.2.1 Mediform Large Sliding Caliper a. The caliper is calibrated at the beginning of the stand and once every two weeks during the stand. b. Use the small and medium calibration rods. c. The caliper reading should agree with the known values of the calibration bars. d. Record the caliper readings on the Equipment Calibration Log under the appropriate headings. e. If the two readings do not agree, inform the MEC manager and use the spare set of calipers. 2-3 2.3.2.2 Small Sliding Breadth Calipers a. Calibrate the small sliding breadth calipers at the beginning of the stand and once every two weeks during the stand using the step wedge standard. b. The caliper reading should agree with the known values of the step wedge standard measurements. c. Record the caliper readings on the Equipment Calibration Log. d. Ifanyabnormalityisnoticed,usethesparesetofsmallslidingbreadthcalipersandnotify the MEC manager. 2.3.2.3 Infant Measuring Board a. Theinfantmeasuringboardischeckedatthebeginningofeachstandandonceeverytwo weeks by placing the calibration rod(s) on the board to check that the board has not been damaged during transit. Check the digital counter reading against the known values of the calibration rod(s) to make sure they agree. b. Record the counter reading on the Equipment Calibration Log under the appropriate heading. If the two readings do not agree, inform the MEC manager. 2.3.2.4 Stadiometer a. Calibrate the height scale at the beginning of each stand, once every two weeks, and at the end of each stand after all examinations. b. Place the calibration rods separately on the floor of the stadiometer. c. Place the horizontal bar of the stadiometer firmly against the top of each calibration rod. d. Take a Polaroid photograph of the stadiometer tape. The measurement should be equal to the knownvalue of each calibration rod. If it is not, adjust thesighting window on the height scale until the measurement does agree and rephotograph the stadiometer tape. 2-4