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Skinfold measurement for older adults

Skinfold measurement for older adults

Liu L-K, KSinfold W-J, Liu C-L, Chen L-Y, Skinfold measurement for older adults M-H, Peng L-N, et al. PDF Split View Views. In addition, ALST is used to identify sarcopenia [ 6 ]. Age Ageing.

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Anthropometric Measurements

Skinfold measurement for older adults -

Skinfolds are useful when assessing body fat percentage , and can help evaluate subcutaneous fat distribution throughout the body. Measurements are done by using skinfold calipers, and can determine central fat mass distribution and subcutaneous abdominal fat. You just need to have calipers, a tape measure, and an anthropometer on hand.

This form of assessment can help determine total percent body fat, as well as subcutaneous fat regions throughout the body. Since skinfold thickness may be a better predictor of percent body fat, studies have found that adolescent skinfold thickness is a better predictor of high body fatness in adults than BMI.

A body composition assessment can also help determine any health problems that your client may have. These results allow dietitians to monitor the effects of nutritional intervention, physical activity, and sports, as well as nutrition-related disease progression.

While there are many different ways to assess body composition, research shows that skinfold thicknesses are more strongly associated with body fatness than BMI.

Find out the resources that will save you time and improve the nutritional follow-up of your patients. Try it now. Before you start including these types of measurements in your appointments, it is essential to follow these basic principles.

TIP: In addition to taking correct skinfold measurements, you must also ensure the best possible nutrition service. Learn how in this article. Although you can determine the body mass of your clients using a body composition scale, it is also possible to deduce it by using certain predictive formulas.

Here are a few to consider. You can also use some of these other predictive equations. Our team has combined them in a guide , which you can download for free by clicking below:. We present below some practical information to measure the main skinfolds.

The measurement of these skinfolds is necessary for the use of absolute predictive equations, described further ahead. The triceps skinfold site should be marked on the posterior surface of the arm , on the midline of the triceps muscle, halfway between the acromion and radius.

The skinfold should be picked up parallel to the long axis of the arm. The subject should be standing, with their arms relaxed along the torso. The tester should be behind the subject, on their right side. The location of the skinfold should be marked 2cm below the subscapular skinfold site by using an anthropometric tape , laterally and obliquely.

The biceps skinfold should be marked in the anterior surface of the arm , over the biceps, and halfway between the acromion and radius. The patient should be standing, with their arms relaxed along the torso. The skinfold should be picked up vertically parallel to the length of the arm.

Iliocristale point: the most lateral point of the upper margin of the iliac crest. The subject should be standing with their arms relaxed along the torso.

They can also cross the right upper arm over the torso. To verify the data normality, the Shapiro—Wilk test was applied. For the Multicompartmental anthropometric equation development, we adopted previous procedures [ 32 , 33 ], briefly described below.

However, it will be added to the multivariate model due to its theoretical relevance and assumption of improving the model; g then multivariate β parameters were determined, with the proposition of equations and residual distribution for each dependent variable; h Akaike information criterion AIC statistic to ensure greater quality and simplicity of the statistical model.

The details of the statistical procedures have been previously described in adolescents of both sexes [ 32 , 33 ]. Finally, the predicted residual error sum of squares PRESS statistic was used to measure the effectiveness of the predicted equations for each dependent variable.

The procedure may be understood as design efficiency in estimating the actual parameters by a virtual simulation that is, from the exclusion of an observation, equations are proposed with the remaining sample and replicated through cross-validation for each participant that was excluded.

For validation, we follow the following steps: a the correlation coefficients were estimated between predicted and measured values and b cross-validation by PRESS method, coefficients of determination Q 2 PRESS , and error S PRESS for each dependent variable ALST, BMC, and FM [ 40 ].

Table 1 shows the anthropometric and BC measures of the eligible participants. Men were statistically taller, heavier, larger, and longer in most comparisons with women.

Also had higher values of ALST, BMC, and residual mass. The Kaiser—Meyer—Olkin test showed the sample adequacy and resulted in a value of 0. Next, a multivariate linear regression model was developed, simultaneously for the three dependent variables from variables selected in the univariate models.

The categorical sex variable has not been previously tested in the models; however, it was added to the multivariate procedure due to its theoretical relevance, as demonstrated by their significant differences in Table 1.

The equations presented below in Table 3 , should be also presented as:. Higher precision and cross-validation values of PRESS, Q 2 PRESS, and low SEE PRESS were found for each dependent variable Table 3.

Model standardized residuals. ALST: appendicular lean soft tissue; FM: fat mass; BMC: bone mineral content. To the best of our knowledge, this is the first study that proposes a valid anthropometric model to simultaneously estimate FM, ALST, and BMC in older adults from a multicompartmental approach.

DXA was used as a reference method due to its advantages in estimating all components by a single scan [ 42 ]. Our proposed model with three anthropometric variables plus sex showed high prediction coefficients and low errors to simultaneously predict ALST, FM, and BMC.

Since BC is affected by sex [ 43 ], and changes in BC due to aging occur differently between men and women [ 44 ], the inclusion of the variable sex was made arbitrarily in the models generated in this study. Therefore, the current prediction equations are useful for estimating and monitoring ALST, FM, and BMC in older adults of both sexes.

Current anthropometric models to estimate BC in older adults have several limitations, causing errors in the estimation of BC. Furthermore, they have been developed using a bi-compartmental model 2-C that determines FM and FFM [ 45 , 46 , 47 ], and this model is based on linear relationship between subcutaneous fat, total fat, and BD.

However, this is not true, because during the aging process there is age-related adipose tissue redistribution that is, an accumulation of visceral and abdominal fat occurs [ 48 ]. Additionally, these equations do not evaluate ALST and BMC which are components that change during aging.

Progressive and metabolically unfavorable changes in BC have long been observed with aging [ 50 ]. In a prospective study that investigated age-dependent changes over two decades, the main results found were an increase in BM, BMI, and FM until the age of approximately 70 and 75 years, after these parameters start to decrease [ 51 ].

Regarding the changes in the SMM, the studies have shown a greater reduction in men than in women, with a more accentuated decline between 70 and 79 years old in both sexes [ 35 , 50 ].

However, the pattern and rate of age-related changes in BC may vary by sex, ethnicity, physical activity level, and caloric intake [ 52 ]. DXA is the most popular technique for measuring BC [ 53 ] and it has been shown to be a reliable method of FFM during aging [ 54 ]. Furthermore, DXA may be considered the current reference technique for assessing SMM and BC in research and clinical practice [ 53 ].

The principle of DXA depends on the property of X-rays to be attenuated in proportion to the composition and depth of the material the beam is crossed. The DXA scanner emits two different energy beams 40 and 70 keV.

From the number of photons that are transmitted concerning the number detected the quantity of BMC and soft tissue fat and FFM can be determined [ 53 ]. Therefore, DXA can be used as a reference method to propose equations using anthropometry for clinical and professional practice [ 56 ].

The anthropometric measurements are performed in both the geriatric nutritional assessment and epidemiological studies because they are painless, safe, non-invasive, simple, and low-cost procedures, which permit the estimation of the body components and also the calculation of nutritional indicators using predictive equations [ 21 ].

The main anthropometric measurements used in older adults for this purpose are weight, height, calf and waist circumferences, as well as the triceps, biceps, subscapular and suprailiac skinfolds [ 21 ].

The current investigation has several strengths. As far as we know, this is the first study that proposes equations to estimate the main components of BC from the same anthropometric variables for older adults.

This implies a reduction in the prediction error and facilitates its use in epidemiological studies. Another positive point is that we included the variable sex in the generated models, facilitating the application in large groups of both sexes.

However, the current state-of-the-art method for BC measurement in the four compartments model 4-C models at the molecular level, as it includes the evaluation of the main FFM components, thus reducing the effect of biological variability.

Nonetheless, it requires sophisticated and highly specialized technical equipment; it implies the propagation of measurement errors, difficult to apply in certain population groups, and is time-consuming.

Furthermore, it has high costs, making it difficult to use on large samples [ 57 ]. Nevertheless, DXA represents a reference method for the assessment of human BC in the research field [ 42 , 58 ] and it is widely considered the gold standard for BC assessment in clinical practice because of its advantages [ 56 ].

Another point to consider is that overnight fast impacts the hydration status and this can influence body composition measurement [ 59 ]. Moreover, reference values of BC assessed by DXA on adults over 60 years old are available from the National Health and Nutrition Examination Survey — and other studies on the local population [ 60 ].

Although it is a program designed to assess the health of adults and children in the United States, these reference values should be helpful in the evaluation of a variety of adult abnormalities involving fat, LST, and bone.

As hypothesized, using a multivariate regression model, simple anthropometric measures can be used to simultaneously estimate body components ALST, FM, and BMC in older adults of both sexes. Their true measured values DXA were As noted, the values are close to the measured DXA values for ALST These values can be compared with the reference values National Health and Nutrition Examination Survey NHANES [ 60 ] and be useful for many applications in clinical and field practice.

Thus, keeping the balance rate of fat, muscle and bone is essential to preserving metabolic homeostasis, and health status and positively contributes to successful aging [ 56 ]. For this reason, the assessment of BC in older adults is critical and could be an additional preventive strategy for age-related diseases [ 56 ], which may result in sarcopenia [ 4 , 6 , 64 ], osteoporosis [ 65 ] sarcopenic obesity [ 43 ] osteosarcopenic obesity 2 and osteosarcopenia [ 66 ].

This should impair muscle strength, and functional capacity, as well as greater morbidity and mortality in older adults [ 67 ]. Therefore, the current prediction equations could increase the available options for the estimation of BC in older adults.

Lastly, future studies should evaluate the efficiency of these equations applied in longitudinal and intervention studies. Our findings demonstrated that the anthropometric prediction equations developed in this study provide a reliable, practical, and low-cost instrument to assess the components that most change during the aging process.

These results suggest that the equations can be valid alternatives and reliable information about BC in older adults since the internal validation method PRESS presented high internal validity, high coefficients of determination, and low prediction errors.

Jiang Y, Zhang Y, Jin M, Gu Z, Pei Y, Meng P. Aged-Related Changes in Body Composition and Association between Body Composition with Bone Mass Density by Body Mass Index in Chinese Han Men over year-old.

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Sarcopenia: revised European consensus on definition and diagnosis. Article PubMed Central Google Scholar. Kirk B, Al Saedi A, Duque G. Osteosarcopenia: A case of geroscience. Aging Med Milton. Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ.

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Cagliari: UNICApress; LOHMAN, T. Dual-Energy X-Ray Absorptiometry. In: Heymsfield, S. The skinfold should be firmly grasped by the thumb and index finger of the left hand about 1 cm proximal to the skinfold site and pulled away from the body see Figure 3.

The caliper is in the right hand perpendicular to the axis of the skinfold and with dial facing up. The caliper tip should be 1 cm distal from the fingers holding the skinfold.

The dial is read approx. Measurement is recorded to the nearest 0. Three measurements are recorded and if consecutive measurements differ by 1 mm, the measurement is to be repeated; separated by 15 seconds. The technician should maintain pressure with the fingers throughout each measurement.

Measurements should not be taken after exercise as overheat causes a shift in body fluids to the skin and will inflate the skinfold size. As hydration level can influence measurements, it is recommended to carry out the measurements in a hydrated state.

Figure 4 An example of a calibration block. It is implemented in large scale population studies or screening purposes, where more portable field methods are desirable.

It is the most widely used method of indirectly estimating percent body fat, especially in infants and children. Several equations are available. Source [14] Estimates derived using these equations have been compared to those from the criterion 4-component model see Figures 5 and 6.

Author s Population Equation s Lohman et al. Equation Bias 1 Limits of agreement Correlation Slaughter et al. Dauncey et al. Sen et al. Schmelzle et al. DEXA validation studies in infancy are based on a piglet model. Deierlein et al. Catalano et al.

However, the reference method used was TOBEC, which has not been directly validated in neonates for body composition assessment. Aris et al. Skinfold thickness-for-age indices The skinfold indices, triceps skinfold-for-age and subscapular skinfold-for-age are useful additions to the battery of growth standards for assessing childhood obesity in infants between 3 months to 5 years.

Strengths and limitations. An overview of skinfold thickness methods is outlined in Table 5. The majority of national reference data available are for skinfolds at the triceps and subscapular locations.

The triceps skinfold varies considerably by sex and can reflect changes in the underlying triceps muscle rather than an actual change in body fatness.

Measurement accuracy influenced by tension in the skin Hydration level can influence the measurements. Dehydration reduces the skinfold size. Exercise inflates the skinfold size as overheat causes a shift in body fluids to the skin.

Oedema and dermatitis increase the skinfold size. Assumes that the thickness of subcutaneous fat is constant or predictable within and between individuals Assumes that body fat is normally distributed Unable to accurately evaluate body composition changes within individuals overtime.

Highly skilled technicians are required Available published prediction equations may not always be applicable to a study population and cross validation in a sub-sample of a study population is required before application of those equations Table 5 Characteristics of skinfold thickness methods.

Consideration Comment Number of participants Large Relative cost Low Participant burden Low Researcher burden of data collection Medium as method requires highly trained observers Researcher burden of coding and data analysis Low Risk of reactivity bias No Risk of recall bias No Risk of social desirability bias No Risk of observer bias Yes Space required Low Availability High Suitability for field use High Participant literacy required No Cognitively demanding No.

Table 6 Use of skinfold thickness methods in different populations. Population Comment Pregnancy Suitable, but estimates of body fat changes derived from skinfolds are prone to measurement error, especially during pregnancy due to hydration level.

Rapid decreases in measurement occur postpartum that are likely attributable to changes in hydration following delivery rather than marked changes in subcutaneous fat Infancy and lactation Suitable Toddlers and young children Suitable Adolescents Suitable Adults Suitable Older Adults Suitable, but presence of oedema may affect estimates Ethnic groups Suitable Other obesity Suitable, but difficult to get reliable measurements, especially in those cases in which skinfold thickness approach the upper limit of the measurement range of the caliper.

Further considerations. Resources required. Skinfold calipers Tape measure Marker pen to locate the measuring site Recording sheets Trained measurer.

Aris IM, Soh SE, Tint MT, Liang S, Chinnadurai A, Saw SM, et al. Body fat in Singaporean infants: development of body fat prediction equations in Asian newborns.

European journal of clinical nutrition. Medical Commission Sports Med 42; Bray GA, Bouchard C. Handbook of Obesity: Volume 1: Epidemiology, Etiology, and Physiopathology. Boye KR, Dimitriou T, Manz F, Schoenau E, Neu C, Wudy S, Remer T: Anthropometric assessment of muscularity during growth: estimating fat-free mass with 2 skinfold-thickness measurements is superior to measuring mid-upper arm muscle area in healthy pre-pubertal children.

Am J Clin Nutr 76; Brozek, J. Densitometric analysis of body composition: Revision of some quantitative assumptions. Annals of the New York Academy of Sciences, , Butte NF: Body composition during the first 2 years of life: An updated reference Pediatr Res 47; Catalano PM, Thomas AJ, Avallone DA, Amini SB.

Anthropometric estimation of neonatal body composition. American journal of obstetrics and gynecology. Cauble JS, Dewi M, Hull HR. Validity of anthropometric equations to estimate infant fat mass at birth and in early infancy. BMC pediatrics. Chambers AJ, Parise E, McCrory JL, Cham R: A comparison of prediction equations for the estimation of body fat percentage in non-obese and obese older Caucasian adults in the United States.

J Nutr Health Ageing 18; Dauncey MJ, Gandy G, Gairdner D. Assessment of total body fat in infancy from skinfold thickness measurements. Archives of disease in childhood. Davidson LE, Wang J, Thornton JC, Kaleem Z, Silva-Palacios F, Pierson RN, Heymsfiled SB, Gallagher D: Predicting Fat Percent by Skinfolds in Racial Groups: Durnin and Womersley Revisited.

Med Sci Sports Exerc 43; Duren DL, Sherwood RJ, Czerwinski SA, Lee M, Choh AC, Siervogel RM, Chumlea WC: Body Composition Methods: Comparisons and Interpretations J Diab Sci Technol 2; Deierlein AL, Thornton J, Hull H, Paley C, Gallagher D.

An anthropometric model to estimate neonatal fat mass using air displacement plethysmography. Durnin JV, Womersley J: Body fat assessed from the total body density and its estimation from skinfold thickness: measurements on men and women aged from 16 to 72 years.

British Journal of Nutrition 32; 77 Duren DL, Sherwood RJ, Czerwinski SA, Lee M, Choh AC, Siervogel RM, et al. Body composition methods: comparisons and interpretation. Journal of diabetes science and technology.

Skinfol evaluation of elderly people oldr of great measuremrnt. Two-component methods for body Sjinfold assessment, such Quinoa for breakfast anthropometry msasurement Skinfold measurement for older adults impedance Hydrating night creamsare widely used in clinical practice, but their Quinoa for breakfast assumptions may be invalid in Skinfo,d people. Dual-energy Android fat accumulation absorptiometry DXA is a relatively new method for reliable and direct measurements of body mass in its three basic components: total body bone mineral content TBBMCmineral free lean tissue mass LTMand fat. Body fat percentage was estimated in 67 men aged 20—95 by anthropometric measurements skinfold thickness, body mass index, or BMIBIA, and DXA. Age-specific equations were used for anthropometry and BIA. Limits of agreement were calculated between DXA and the other methods. Skinfold measurement for older adults

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