We greatly appreciate the contributions of our expert anthropometry trainers Irwin Shorr and Jorge Chavarro; the many volunteers who have allowed themselves to be pinched and measured in our anthropometry workshops, and the Project Viva mothers and children for their invaluable contributions. We'd like to extend a special thanks to members of the Project Viva research staff, past and present, especially to Nicole Witham and Marleny Ortega, for their contribution to the video accompanying this manuscript. Funding from the National Institutes of Health supported this work (R01 HD 034568, K24 HD069408).

All the procedures are approved by the Harvard Pilgrim Health Care Institutional Review Board.
1. Training Procedures
<ol>
	<li>Have the trainees (research assistants) complete a multi-day, multiple hour training program to learn proper positioning, watch training videos, and receive in-person training from an experienced auxologist.
	<ol>
		<li>Instruct the trainees to practice performing measurements on each other, while an auxologist or resident anthropometry expert evaluates each trainee&#39;s technique and makes appropriate adjustments.</li>
		<li>Organize a workshop with external volunteers, optimally of a variety of ages and body types, ideally a representative sample of the study population. Have the trainees measure each volunteer a minimum of two times per measurement.</li>
	</ol>
	</li>
	<li>After completing the training program, have the trainees spend approximately an additional 40 - 50 h practicing manual anthropometry techniques on one another and volunteers. During this time, observe the trainees, monitoring adherence to protocol and proper technique. Give each trainee the necessary amount of training based on innate skill level and previous experience.</li>
</ol>
2. Preparation of Subjects
<ol>
	<li>Instruct participants to wear light clothing that allows easy access to the extremities and torso while maintaining modesty, optimally a standard outfit provided by the research staff.</li>
</ol>
3. Height
<ol>
	<li>Measure height using a well-constructed stadiometer, which can be wall-mounted or portable. Either way, take measurements while ensuring that the stadiometer is set up against a wall on a hard, flat surface. 
	NOTE: Among children under the age of 2 years, measure recumbent length instead of standing height. Recumbent length measurements require different procedures8, not detailed in this protocol.</li>
	<li>Ask the participant, before stepping on the stadiometer, to remove any items that could impede measurements. For example, shoes, thick socks, hats, and hair accessories (e.g. hats, headbands, hair bands on the crown of head).</li>
	<li>Guide the participant back onto the board until the participant&#39;s buttocks, shoulder blades, or back of head make contact with the board.</li>
	<li>While facing the participant, instruct the participant to stand on the board with feet spread approximately 2 feet apart. Ask the participant to slowly inch his/her legs back together until the legs, mid-thighs, knees, or feet make contact.</li>
	<li>Instruct the participant to stand as straight as possible, without slouching or leaning. Ensure that feet are flat on the bottom of the height board or floor, and arms hang down by the participant&#39;s sides. Confirm that weight is evenly distributed between the left and right sides of the body.</li>
	<li>Visually verify that the mid-axillary line is perpendicular to the floor. Instruct the participant to move his/her feet away from the back of the stadiometer if necessary to achieve this position. 
	NOTE: The mid-axillary line is an imaginary line in the coronal plane midway between the anterior axillary line and the posterior axillary line, extending from the center of the axilla down through the most superior part of the iliac crest (Figure 1).</li>
</ol>
<img alt="Figure 1" src="/files/ftp_upload/54895/54895fig1.jpg" /> 
Figure 1: Location of the Mid-axillary Line. A coronal line halfway between the anterior and posterior axillary lines15. <a href="https://cloudfront-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54895/54895fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<ol start="7">
	<li>Ask the participant to stand up straight. Ensure that one or more of the following body parts makes contact with back of the stadiometer: feet, head, shoulders, or buttocks.</li>
	<li>Place the participant&#39;s head into the Frankfort Plane (Figure 2).
	<ol>
		<li>Determine the Frankfort Plane by doing the following: Looking at the side of the participant&#39;s head, draw an imaginary line from the lowest margin of the eye orbit to the highest margin at the opening of the ear canal. Position the head so that the imaginary line is parallel to the floor and perpendicular to the stadiometer.</li>
	</ol>
	</li>
</ol>
<img alt="Figure 2" src="/files/ftp_upload/54895/54895fig2.jpg" /> 
Figure 2: The Frankfort Plane. A horizontal plane that passes through the inferior margin of the orbit and the tragion (notch above the tragus of the ear) 16. <a href="https://cloudfront-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54895/54895fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<ol start="9">
	<li>Remind the participant to stand straight and tall, and position the headpiece firmly on top of his/her head with sufficient pressure to compress the hair and make contact with the skull. With the headpiece at eye level, take the measurement to the nearest tenth of a centimeter.</li>
</ol>
4. Sitting Height
<ol>
	<li>Place the stadiometer on top of a sturdy stool tall enough to allow the participant&#39;s legs to form a 90&#176; angle with the ground. Alternatively, if the stadiometer is wall-mounted, place a stool of known height in front of the stadiometer.</li>
	<li>Ask the participant to sit on the stadiometer or on top of the stool so that the buttocks are touching the back of the board.</li>
	<li>Have the participant sit as erect as possible, with buttocks, shoulders and/or head touching the back of the board. Ensure that the mid-axillary line (as described in 3.6) is perpendicular to the stool and parallel to the stadiometer.</li>
	<li>Guide the participant&#39;s knees directly in front of his/her body, and place his/her hands on the thighs.</li>
	<li>Place the participant&#39;s head into the Frankfort Plane. Refer to 3.8.</li>
	<li>Position the headpiece firmly on top of the participant&#39;s head with sufficient pressure to compress the hair and make contact with the skull.</li>
	<li>While directly facing the measuring index with the headpiece at eye level, take measurement to the nearest tenth of a centimeter.</li>
</ol>
5. Weight
<ol>
	<li>Instruct the participant to wear either light clothing or the standard clothing provided at the onset of the anthropometric measurements, to empty his/her bladder, and to remove his/her shoes before attempting the weight measurement.</li>
	<li>Ask the participant, to stand on the scale. Record the measurement to the nearest tenth of a kilogram.</li>
</ol>
6. Waist Circumference
<ol>
	<li>Instruct the participant to stand erect, still, and lateral to a chair, ideally in front of a mirror. Sit facing the mirror, with the participant&#39;s right or left hip bone at eye level. Instruct the participant to cross his/her arms in front while holding up his/her shirt.</li>
	<li>Sitting to the side of the participant, locate the anterior part of the hip bone, which is usually the portion of the hip bone that is most easily identified through dense adipose tissue. Palpate upward along the hip bone to locate the iliac crest, the superior ridge of the hip bone. Continue to palpate the iliac crest until reaching the intersection between the uppermost point of the iliac crest and the mid-axillary line (refer to section 3.6 to locate mid-axillary line). Identify site with a self-adhesive sticker.</li>
	<li>Repeat 6.2 on the other side of the participant&#39;s body.</li>
	<li>While the participant stands perpendicular to the mirror, gently place the measuring tape around the waist on top of the two stickers with the zero side (or base) of the tape measure below. Using the mirror as a guide, adjust the tape so that it is on a level, horizontal plane across the front, back, and both sides.</li>
	<li>Tighten the tape, without pulling the skin. As this is a fine balance, start with the tape measure pinching the skin slightly. Then slowly loosen the tape measure to form a smooth line along the skin, so that the skin is no longer constricted. Place the tape measure firmly on skin without cinching the participant&#39;s waist, so that there are neither gaps in the tape measure nor pinched skin.</li>
	<li>At the end of the participant&#39;s natural exhalation, read the tape to the nearest tenth of a centimeter. 
	NOTE: This measurement is most effectively performed in the presence of mirrors or two research assistants. One researcher, alone, cannot observe proper placement of the tape measure on all sides of the body. The mirrors and/or additional staff member compensate for obstructed areas, informing proper tape measure placement.</li>
</ol>
7. Hip Circumference
<ol>
	<li>Instruct the participant to stand erect next to a chair, perpendicular to the mirror. Ask the participant to fold his/her arms in front of the body with feet pressed together.</li>
	<li>Sit to the side of the participant and face the mirror, so that eyes are level with the participant&#39;s hips.</li>
	<li>Place the measuring tape around the hips over lightweight, tight-fighting clothing. Anchor the tape measure at the maximum protuberance of the buttocks. Adjust the tape so that it is on a horizontal plane around the body. Hold the tape measure firmly. Similarly to the waist measurement, tighten the tape measure so that skin is pinched. Release the tape measure slowly until there is a smooth line around the tape measure.</li>
	<li>Holding the tape measure firmly and flatly, read the measurement to the nearest tenth of a cm.</li>
</ol>
8. Mid-Upper Arm Circumference (MUAC)
<ol>
	<li>Instruct the participant to lift his/her shirtsleeve to shoulder height, to ensure that measurement is conducted directly on skin. While the participant is standing, position his/her right arm so that it is flexed at a 90&#176; angle at the elbow with the palm facing up and fingertips pointing straight ahead.</li>
	<li>Stand behind the participant. Locate the posterior lateral shoulder bone that connects the participant&#39;s shoulder blade and clavicle bone (Figure 3). This bony structure, known as the acromion process, will serve as initial point zero on the tape measure.</li>
</ol>
<img alt="Figure 3" src="/files/ftp_upload/54895/54895fig3.jpg" /> 
Figure 3: Anatomy of the Shoulder. Shoulder anatomy includes the acromion process, identified in red17. <a href="https://cloudfront-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54895/54895fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<ol start="3">
	<li>Extend the tape down the midline of the back of the arm, past the bony tip of the elbow, known as the olecranon. Using a tape measure the distance between the acromion process and the olecranon to the nearest tenth of a centimeter and place a self-adhesive sticker halfway between the olecranon and the acromion process over the posterior center of the humorous.</li>
	<li>Hold the participant&#39;s arm slightly away from body, to ensure that muscles are relaxed.</li>
	<li>Standing to the right and slightly behind the participant, wrap the MUAC Tape (small, flip tape) around the upper arm so that it covers the self-adhesive sticker. Ensure that the tape measure is perpendicular to the arm length.</li>
	<li>Pull the tape so that there are no gaps in tape or areas of skin constriction. As with the hip and arm circumferences, this is a fine balance. Use greater tension and slowly release the tape until there are no further areas of pinched skin.</li>
	<li>Read the measurement and record to the nearest tenth of a centimeter.</li>
</ol>
9. Triceps Skin Fold Thickness
<ol>
	<li>Use the sticker placement at the posterior midpoint of the participant&#39;s arm (as determined by steps 8.1 - 8.3). Instruct the participant to stand upright, with shoulders relaxed and arms hanging loosely.</li>
	<li>Standing behind the participant, identify a location approximately 2 cm above the sticker at the upper arm midpoint. Grasp a sizable fold of skin between the thumb and index finger about 1 - 2 cm into the skin. Roll the skin between fingers. 
	NOTE: If the skinfold rolls easily between the fingers, it likely contains only skin and subcutaneous fat. If the skinfold does not roll easily or the grasp is particularly painful for the participant, it may contain muscle.</li>
	<li>Shake the skin and/or roll fingers slowly to adjust the fold so that it contains only skin and subcutaneous fat, not muscle. Measure all subcutaneous fat above the muscle.</li>
	<li>Hold the skinfold parallel to the arm. Place the skinfold caliper jaw perpendicular to the length of the fold and on either side of the marked midpoint.</li>
	<li>While holding the skinfold, completely release grip on the caliper lever. The caliper dial will continue to decrease as the skin is compressed by the caliper jaws. Hold the skin between the caliper jaws for 4 full s, after which time the skin should be fully compressed. After 4 s, record the measurement to the nearest two tenths of a centimeter. 
	NOTE: If it is the correct amount of skin and subcutaneous tissue, the measurement (as read on the caliper dial) will decrease less rapidly or will not decrease at all after 4 s. If the measurement value on the caliper dial continues to decrease rapidly, the skinfold did not contain enough subcutaneous fat. Should this be the case, wait two minutes for the compressed skin to return to normal. Retry the measurement by grasping a thicker fold.</li>
</ol>
10. Subscapular Skinfold Thickness
<ol>
	<li>Instruct the participant to stand upright, with shoulders relaxed and arms hanging loosely.</li>
	<li>Standing behind the participant, palpate the lowermost tip of the scapula. Locate the measurement site, two centimeters below the lower tip of the scapula, and place the calipers there.</li>
	<li>Grasp a sizable fold of skin between the thumb and index finger on a diagonal approximately 2 cm above and to the left of the measurement site. The skin should roll easily between fingers if it contains only skin and subcutaneous fat. Adjust the skinfold, so that the measurement contains only skin and subcutaneous fat.</li>
	<li>Place the caliper jaws perpendicular to the measurement site, so that the measurement is taken parallel to the medial, inferior bone of the scapula. While holding the skinfold, completely release grip on the caliper lever. Record measurement to the nearest two tenths of a cm after 4 s.</li>
	<li>Ensure that the caliper dial remains consistent or decreases only minimally after 4 s. A rapidly decreasing measure on the caliper dial indicates that not enough subcutaneous fat has been obtained. If this is the case, wait 2 min for the compressed skin to return to normal. Retry the measurement by grasping a thicker fold.</li>
</ol>
11. Quality Control (QC) Procedures
<ol>
	<li>Require all staff members, including experienced and new research staff members, to measure volunteers during the QC sessions. Obtain an equal number of volunteers and staff members to maximize efficiency. If the study staff consists of 1-3 people, request at least four volunteers to ensure that reliability is properly assessed.</li>
	<li>Designate one individual to be the gold standard rater for the QC session, either a quality rater from the research staff or an outside expert. Ensure that he/she has a proven record of reliability (both intra-rater reliability and reliability when compared to either a skilled auxologist or a gold standard, such as DXA).</li>
	<li>Have all study staff members conduct each manual anthropometric measure two or more times on each volunteer.</li>
	<li>Calculate intra-rater and inter-rater reliability after the QC session, using technical error of measurement (TEM). 
	NOTE: TEM is used to assess the difference between two measurements that is attributable to measurement error12. TEM is the square root of measurement error variance: TEM= <img alt="Equation 1" src="/files/ftp_upload/54895/54895eq1.jpg" />, where d2 is either the difference between repeated measurements by each research assistant (intra-rater reliability) or the difference between the sum of the anthropometry expert&#39;s replicates minus the sum of a research assistant&#39;s replicates (inter-rater reliability)12.</li>
	<li>Identify staff members whose inter- or intra-rater TEM values fall outside of the predetermined TEM range of acceptability14. Provide more training for staff members whose anthropometric measures fall outside of the acceptable range, prior to allowing field data collection from study participants.</li>
</ol>

<ol>
	<li>Boeke, C. E., Oken, E., Kleinman, K. P., Rifas-Shiman, S. L., Taveras, E. M., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correlations+among+adiposity+measures+in+school-aged+children.">Correlations among adiposity measures in school-aged children.</a> BMC Pediatrics. 13 (99), (2013).</li><li>Ogden, C. L., Carroll, M. D., Kit, B. K., Flegal, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+childhood+and+adult+obesity+in+the+United+States,+2011-2012.">Prevalence of childhood and adult obesity in the United States, 2011-2012.</a> JAMA. 311 (8), 806-814 (2014).</li><li>Erermis, S., Cetin, N., Tamar, M., Bukusoglu, N., Akdeniz, F., Goksen, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+obesity+a+risk+factor+for+psychopathology+among+adolescents.">Is obesity a risk factor for psychopathology among adolescents.</a> Pediatr Int. 46 (3), 296-301 (2004).</li><li>Gunnell, D., Frankel, S., Nachahal, K., Peters, T., Smith, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Childhood+obesity+and+adult+cardiovascular+mortality:+A+57-y+follow-up+study+based+on+the+boyd+orr+cohort.">Childhood obesity and adult cardiovascular mortality: A 57-y follow-up study based on the boyd orr cohort.</a> AJCN. 67 (6), 1111-1118 (1998).</li><li>Vanhala, M., Vanhala, P., Kumpusalo, E., Halonen, P., Takala, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relation+between+obesity+from+childhood+to+adulthood+and+the+metabolic+syndrome:+Population+based+study.">Relation between obesity from childhood to adulthood and the metabolic syndrome: Population based study.</a> Brit Med J. 317 (7154), 319 (1998).</li><li>Papoutsakis, C., Priftis, K. N., Drakouli, M., Prifti, S., Konstantaki, E., Chondronikola, M., Antonogeorgos, G., Matziou, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Childhood+overweight/obesity+and+asthma:+is+there+a+link?+A+systematic+review+of+recent+epidemiologic+evidence.">Childhood overweight/obesity and asthma: is there a link? A systematic review of recent epidemiologic evidence.</a> J Acad Nutr Diet. 113 (1), 77-105 (2013).</li><li>Rifas-Shiman, S. L., Rich-Edwards, J. W., Scanlon, K. S., Kleinman, K. P., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Misdiagnosis+of+overweight+and+underweight+children+younger+than+2+years+of+age+due+to+length+measurement+bias.">Misdiagnosis of overweight and underweight children younger than 2 years of age due to length measurement bias.</a> MedGenMed. 7 (4), 56 (2005).</li><li>Horan, M., Gibney, E., Molloy, E., McAuliffe, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methodologies+to+assess+paediatric+adiposity.">Methodologies to assess paediatric adiposity.</a> Ir J Med Sci. 814 (1), 1-16 (2014).</li><li>Wells, J. C., Fewtrell, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Measuring+body+composition.">Measuring body composition.</a> Arch Dis Child. 91 (7), 612-617 (2006).</li><li>Wells, J. C., Fuller, N. J., Dewit, O., Fewtrell, M. S., Elia, M., Cole, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Four-component+model+of+body+composition+in+children:+Density+and+hydration+of+fat-free+mass+and+comparison+with+simpler+models.">Four-component model of body composition in children: Density and hydration of fat-free mass and comparison with simpler models.</a> Am J Clin Nutr. 69 (5), 904-912 (1999).</li><li>Damilakis, J., Adams, J. E., Guglielmi, G., Link, T. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radiation+exposure+in+X-ray-based+imaging+techniques+used+in+osteoporosis.">Radiation exposure in X-ray-based imaging techniques used in osteoporosis.</a> Eur J Radiol. 20 (11), 2707-2714 (2010).</li><li>Ulijaszek, S. J., Kerr, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anthropometric+measurement+error+and+the+assessment+of+nutritional+status.">Anthropometric measurement error and the assessment of nutritional status.</a> Brit J Nutr. 82 (3), 165-177 (1999).</li><li>Oken, E., Baccarelli, A. A., Gold, D. R., Kleinman, K. P., Litonjua, A. A., DeMeo, D., Gillman, M. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cohort+profile:+Project+Viva.">Cohort profile: Project Viva.</a> Int J Epidemiol. 44 (1), 37-48 (2015).</li><li>Ulijaszek, S. J., Lourie, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-+and+inter-observer+error+in+anthropometric+measurement.">Intra- and inter-observer error in anthropometric measurement.</a> Anthropometry: the Individual and the Population. , 30-55 (1994).</li><li>H&#228;ggstr&#246;m, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+gallery+of+Mikael+H&#228;ggstr&#246;m+2014.">Medical gallery of Mikael H&#228;ggstr&#246;m 2014.</a> Wikiversity Journal of. Medicine. 1 (2), (2014).</li><li>. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acromion+of+Scapula05.">Acromion of Scapula05.</a> DBCLS. , (2013).</li></ol>

The authors have nothing to disclose.

Accurate body composition measures are critical for properly assessing childhood growth in research studies. Researchers widely accept DXA as a gold standard method, and many criticize manual anthropometric measures as being imprecise and inaccurate. However, this analysis of anthropometric techniques to estimate body fat suggests that well-trained research assistants who follow a standardized protocol can conduct manual anthropometric measures with excellent accuracy, yielding adiposity estimates that are highly correlated with DXA1. In addition to individual measures, combinations of manual anthropometric measures, such as the sum of skinfold thickness and weight to height ratio, are highly correlated with measures of DXA body fat. The purpose of this protocol is to standardize processes for eight commonly used anthropometric measures, to improve accuracy and allow comparison between research studies and pooling of results.
Critical Steps within the Protocol
Accurate assessment of body composition with manual anthropometry requires sufficient time for training and the conduct of quality control procedures to ensure precision and accuracy. Given the lead time required, research assistants optimally should be available for a minimum of 24 months. Equipment should be sturdy and regularly checked for calibration. To achieve high levels of reliability, raters must follow all steps of the anthropometric protocol precisely, as even minor alterations affect accuracy. Anecdotal evidence suggests that improper identification of anatomical measurement sites, hand placement, and tautness of measurement equipment cause the greatest variation between measures. With attention to detail, the enclosed protocol provides a clear method of collecting precise measurements yet it also shows that protocol alone is insufficient to achieve universally accurate results in the field.
Modifications and Troubleshooting
Low intra-rater TEM values achieved by research staff members who completed brief but rigorous training suggest a high level of repeatability. Trainers should provide additional training, however, to research assistants with TEM values outside of the range of acceptability for any measurement. To ensure that research assistants achieve precise measures in the field, all trainees undergo a certification process. Trainees must pass two field QC assessments in order to be fully certified as anthropometric raters. In this analysis, two raters achieved waist circumference measures outside of the TEM range of acceptability (as shown in Table 1), thus did not pass the certification process. These trainees received additional supervision and training prior to repeating their QC assessments and independent field data collection. While the outlined QC procedures provide overall confidence in a research assistant&#39;s ability, they do not produce immediate feedback at the time of the field measurement. One approach to overcoming this limitation is to have two observers each perform the measurement on the same subject. If numbers differ, the research assistants can take additional measurements; data analysts may use the mean of the two research assistants&#39; measures.
Limitations of the Technique
Manual anthropometric assessment requires time and training, with ongoing monitoring of quality. However, other methods also may require substantial training or other start-up costs in addition to the costs of the equipment. For example, Massachusetts (where Project Viva is conducted) requires that anyone conducting a DXA scan be certified as a radiologic technologist or licensed physician. Project Viva research assistants studied for an average of 60 h for the 3-h long test, for which registration cost $425. Additionally, manual anthropometry cannot directly assess visceral fat, in contrast to some imaging techniques.
Significance of the Technique with Respect to Existing/Alternative Methods
All approaches to measuring body composition have advantages and disadvantages. Manual anthropometry can be used at all ages, confers no risks, and has minimal costs. However, the success of these methods depends on the availability of a stable staff able to spend weeks or months completing the training procedures and to follow protocols precisely.
Future Applications or Directions
With minor alterations, these techniques can also be adapted for other anthropometric measures, such as recumbent length, and chest and thigh skinfolds. In summary, this paper demonstrates that with training and QC, research assistants can perform manual anthropometric methods for assessment of adiposity in children with precision and accuracy. These methods are safe, low-cost, and require minimal, portable equipment and are therefore suitable for field studies among children.

Overweight and obesity remain at epidemic levels, with approximately one-third of US children and two-thirds of adults having overweight or obesity, according to 2011 - 2012 estimates2. Overweight, obesity, and excess body fat confer greater risk of adverse cardiometabolic outcomes, including Type 2 diabetes and cardiovascular diseases, as well as other adverse physical and psychological health outcomes, including asthma and depression3,4,5,6.
Most studies that examine associations between obesity and later-life health outcomes assume accurate measurements of weight and length/height. Categories of weight status in adults and children include underweight (body mass index (BMI) &#60; 18.0 kg/m2 for adults and &#60; 5th age-sex-specific percentile for children), normal weight (BMI 18.0 to &#60; 25.0 kg/m2 for adults and 5th to &#60; 85th percentile for children), overweight (BMI 25.0 to &#60; 30.0 kg/m2 for adults and 85th to &#60; 95th percentile for children), and obesity (BMI &#8805; 30 kg/m2 for adults and &#8805; 95th percentile for children). Even minor measurement errors can influence these categorizations, especially in children for whom errors that appear small on an absolute scale can represent a large error relative to the child&#39;s size7. For example, in a prior study of children under 2 years of age, comparisons of length measured by the conventional clinical paper-and-pencil method with the recumbent length-board method indicated that paper-and-pencil method systematically overestimated length by an average of 1.3 (1.5) cm &#8212; an error that results in substantial misclassification7.
Using BMI to estimate adiposity offers many advantages for research, including the low equipment cost and minimal burden of height and weight measurement, as well as the opportunity to leverage self-report and clinical measures. However, even with accurate measurement of height and weight, variation in BMI does not necessarily reflect variation in adiposity, since BMI incorporates both lean and fat mass1. Thus, methods that directly measure adiposity are also important for understanding relationships with health outcomes.
Gold standard methods of adiposity and body composition measurement generally rely on technological methods, including air displacement plethysmography (ADP), hydrostatic weighing, magnetic resonance imaging (MRI), and computed tomography (CT), as well as dual X-ray absorptiometry (DXA)8,9,10. While these methods provide some of the most accurate measures of body composition, many of them are not practical in pediatric research studies, especially those that are field-based. For example, hydrostatic weighing requires that individuals be completely submerged in water. ADP equipment has, until quite recently, been available only to measure infants up to 8 kg or children and adults over the age of 6 years, but not toddlers or preschool-age children. CT scans emit a large amount of radiation compared with the other techniques, and the long acquisition time for MRI makes it impractical for many studies8. DXA emits about 1/500 the radiation dose of a CT scan, approximately the equivalent of one day of natural background radiation11, making it an attractive option for research studies involving children. All of these methods, however, are expensive to purchase and none are portable, making them infeasible for field-based studies with limited funding. Bioelectrical impedance analysis (BIA), which measures the impedance of a minute electrical signal sent through the body to estimate body composition, can be less expensive and more portable, but assumptions underlying the calculation of body fat are not applicable to small children10.
In contrast to these technology-based measures, manual anthropometric measures can be performed by a trained observer in most field settings and at a substantially lower equipment cost. Manual anthropometry includes measurements of height, weight, circumferences, and skinfold thicknesses8. Other advantages of manual anthropometry are that it involves no unnecessary radiation exposure, and skilled staff can obtain them efficiently. However, a common concern about manual anthropometric measurements is that they may be both inaccurate and imprecise12.
Obtaining accurate and precise measurements is possible with standardized procedures, adequate training, and sufficient attention to quality control (QC) procedures. The Project Viva team has developed a manual anthropometry training protocol that can yield high-quality, reproducible measures of stature, circumferences, and skinfold thickness. Over more than a decade, we have applied this training and QC protocol to mothers and children in Project Viva, a longitudinal, pre-birth cohort study13. Project Viva staff collected anthropometric measures on child during visits at birth (0 - 3 days), and with both the mother and child at the following time points: infancy (4.9 - 10.6 months), early childhood (2.8 - 6.3 years), mid-childhood (6.6 - 10.9 years), and early teen (11.5 - 16.5 years) 13.
This paper describes the protocol we developed and refined for measurement of height, weight, skinfold thicknesses (triceps and subscapular skinfolds), and body circumferences (waist, hip, and mid-upper arm circumferences [MUAC]) in Project Viva. We also describe how we have assessed both manual anthropometric measurement precision by means of technical error of measurement (TEM) calculations and accuracy in comparison to gold standard DXA measurements.

<table><tbody><tr><td>Stadiometer</td><td>Weigh and Measure, LLC&amp;nbsp;</td><td>SSWM-1</td><td>Basic Shorr board (without smooth slide features) can also be used. In order to accommodate the width of children&#039;s hips during sitting height, the base of a stadiometer should be approximately 60 cm wide or larger.</td></tr><tr><td>Bioimpedance scale</td><td>Tanita Coporation of America</td><td>TBF 300A (model is discontinued), DC-430U is comparable</td><td>Scale is used for weight and bioimpedance. Any digital, standardized scale can be used for weight only.</td></tr><tr><td>Skinfold Caliper</td><td>Holtain Limited</td><td>n/a</td><td>This model uses a dial gauge in graduations of 0.2 mm. Models with a linear gauge are also acceptable.&amp;nbsp;&amp;nbsp;</td></tr><tr><td>Hip/waist tape measure</td><td>Gulick II Plus Measuring Tape</td><td>67019</td><td>This model uses compression bands, which makes it easier to identify how firmly the tape measure is being pulled. The compression band is not necessary, but highly recommended.</td></tr><tr><td>MUAC measuring tape (ShorrTape&amp;copy; Measuring Tape)&amp;nbsp;</td><td>Weigh and Measure, LLC</td><td>STape</td><td>The tape measure should be flexible with a single or double slotted insertion window.</td></tr></tbody></table>

assessment of child anthropometry in a large epidemiologic study

A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to understand health effects of child growth and adiposity. Gold standard methods of measuring adiposity, such as dual X-ray absorptiometry (DXA), may not be feasible in large field studies. Research staff can, however, complete anthropometric measurements, such as body circumferences and skinfold measurements, using inexpensive portable equipment. In this protocol we detail how to obtain manual anthropometric measurements from children, including standing and sitting height, weight, waist circumference, hip circumference, mid-upper arm circumference, triceps skinfold thickness, and subscapular skinfold thickness, and procedures to assess the quality of these measurements. To demonstrate accuracy of these measurements, among 1,110 school-aged children in the pre-birth cohort Project Viva we calculated Spearman correlation coefficients comparing manual anthropometric measurements with a gold standard measure of body fat, DXA fat mass1. To address reliability, we evaluate intra-rater technical error of measurement at a quality control session conducted on adult female volunteers.

This analysis addresses precision of the manual anthropometric measurements using data generated from quality control (QC) procedures, and evaluates intra-rater measurement error by Technical Error of Measurement (TEM) 12. TEM ranges of acceptability are based on calculations of repeated intra-rater anthropometric measures, where 95% of measurement discrepancy is due to factors other than rater imprecision12,14. A higher TEM indicates greater variability among measurements. Acceptable measurements, as analyzed in relation to TEM ranges of acceptability, fall below or within TEM ranges of acceptability. Large TEM values, that is TEM values above the range, indicate unreliability and indicate need for additional training. In this analysis, we present TEM values both in native units and in percent TEM, calculated by (average TEM/mean of the measure)*100, to compare across multiple anthropometric measures with different units.
Table 1 shows intra-rater TEM values from a QC session the Project Viva research team conducted on five healthy adult female volunteers. Six research assistants measured the volunteers repeatedly for a maximum of 60 times per anthropometric component. Each woman provided 55 measures, on average. TEM values fell within the range of acceptability for each measure, indicating low variability between measurements and thus accurate technique12,14. Research assistants most precisely measured height (% TEM = 0.2) followed by hip circumference (% TEM = 0.7). Research assistants were least precise at measuring subscapular skinfold thickness (% TEM = 7.4) and triceps skinfold thickness (% TEM = 6.9). Two members of the research staff achieved TEM values for waist circumference that were above the range of acceptability (TEM = 2.1; TEM = 3.0), signaling need for further training.
Data used to calculate TEM values are presented in Figure 4 and Figure 5. Figure 4 shows all height measurements obtained at the QC session described above. Each volunteer provided an average of 11 height measurements. Height measurements ranged from 151.4 cm to 166.4 cm amongst the five volunteers. Individual volunteer variation ranged from 1.3 cm (for the volunteer represented in red) to 4.1 cm (for the volunteer represented in orange) across all six raters. Most height measurements were within 1.0 cm of each other. The research assistant represented by circles was least accurate in measuring height, with several outlying measurements. This signals need for more training. Figure 5 shows all subscapular skinfold thickness measurements obtained at the QC session. Skinfold thickness measurements ranged from 8.6 cm to 33.8 cm amongst the five volunteers. Volunteer variation ranged from 1.6 cm (for the volunteer represented in blue) to 9.6 cm (for the volunteer represented in green). Research staff members experienced greater inter-rater reliability for subscapular skinfold thickness measurements than for height measurements.
Table 2 is adapted from a previous analysis by Boeke et al.1 on 1,110 Project Viva participants measured during mid-childhood (age 6.5 - 10.9 years). This table addresses accuracy of manual anthropometric measures of body fat, expressed as Spearman correlations with gold standard DXA measures. DXA fat was highly correlated with all manual anthropometric measures including weight (rs= 0.80), waist circumference (rs= 0.81), and sum of triceps + subscapular skinfold thickness (rs= 0.90) but was less strongly correlated with height (rs= 0.47).
<img alt="Figure 4" src="/files/ftp_upload/54895/54895fig4.jpg" /> 
Figure 4: Scatterplot of Height Measurements. Height measurements (cm) taken by six research assistants during QC session on five adult female volunteers. Each volunteer is represented by a different color. Each research assistant is represented by a different shape. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54895/54895fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" src="/files/ftp_upload/54895/54895fig5.jpg" /> 
Figure 5: Scatterplot of Subscapular Skinfold Thickness Measurements. Subscapular skinfold thickness measurements (cm) taken by six research assistants during QC session on five adult female volunteers. Each volunteer is represented by a different color. Each research assistant is represented by a different shape. <a href="https://cloudflare-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/54895/54895fig5large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="2" rowspan="2"></td>
			<td rowspan="2">No. of&#160; measures&#160;</td>
			<td rowspan="2">Mean&#160;</td>
			<td colspan="6" rowspan="2">TEM for each of the 6 research staff&#160;</td>
			<td rowspan="2">Mean TEM</td>
			<td colspan="2">Acceptable&#160;</td>
			<td rowspan="2">% TEM</td>
		</tr>
		<tr>
			<td colspan="2">TEM range[1]&#160;</td>
		</tr>
		<tr>
			<td colspan="2"></td>
			<td></td>
			<td></td>
			<td>1</td>
			<td>2</td>
			<td>3</td>
			<td>4</td>
			<td>5</td>
			<td>6</td>
			<td></td>
			<td colspan="2"></td>
			<td></td>
		</tr>
		<tr>
			<td colspan="2">Height (cm)</td>
			<td>55</td>
			<td>160.4</td>
			<td>0.2</td>
			<td>0.3</td>
			<td>0.4</td>
			<td>0.4</td>
			<td>0.1</td>
			<td>0.5</td>
			<td>0.3</td>
			<td colspan="2">0.1 - 1.3</td>
			<td>0.2</td>
		</tr>
		<tr>
			<td colspan="2">Waist circumference (cm)</td>
			<td>54</td>
			<td>77.1</td>
			<td>2.1</td>
			<td>3.0&#160;</td>
			<td>0.4</td>
			<td>0.4</td>
			<td>0.4</td>
			<td>1.5</td>
			<td>1.3</td>
			<td colspan="2">1.0 - 1.6</td>
			<td>1.9</td>
		</tr>
		<tr>
			<td colspan="2">Hip circumference (cm)</td>
			<td>54</td>
			<td>99.2</td>
			<td>0.5</td>
			<td>1.1</td>
			<td>0.8</td>
			<td>0.2</td>
			<td>0.6</td>
			<td>0.6</td>
			<td>0.6</td>
			<td colspan="2">1.2 - 1.4</td>
			<td>0.7</td>
		</tr>
		<tr>
			<td colspan="2">Mid upper arm circumference (cm)</td>
			<td>56</td>
			<td>27.9</td>
			<td>0.3</td>
			<td>0.4</td>
			<td>0.4</td>
			<td>0.2</td>
			<td>0.2</td>
			<td>0.3</td>
			<td>0.3</td>
			<td colspan="2">0.1 - 0.6</td>
			<td>1.1</td>
		</tr>
		<tr>
			<td colspan="2">Subscapular skinfold thickness (mm)</td>
			<td>56</td>
			<td>14.5</td>
			<td>0.8</td>
			<td>0.9</td>
			<td>0.7</td>
			<td>0.4</td>
			<td>0.1</td>
			<td>0.9</td>
			<td>0.6</td>
			<td colspan="2">0.1 - 7.4</td>
			<td>7.4</td>
		</tr>
		<tr>
			<td colspan="2">Triceps skinfold thickness (mm)</td>
			<td>55</td>
			<td>16.7</td>
			<td>0.7</td>
			<td>0.7</td>
			<td>1.2</td>
			<td>0.9</td>
			<td>0.1</td>
			<td>1.9</td>
			<td>0.9</td>
			<td colspan="2">0.1 - 3.7</td>
			<td>6.9</td>
		</tr>
	</tbody>
</table>
Table 1: Intra-rater Reliability (within Measurer). Technical error of measurement (TEM) for each of the anthropometric measures, within each individual measurer. Data from six Project Viva research assistants performing repeated measures on five adult women. TEM calculated as <img alt="Equation 2" src="/files/ftp_upload/54895/54895eq2.jpg" />, where d2 is the difference between repeated measurements by each research staff member (intra-rater reliability)12. A higher TEM indicates greater variability within the repeat measurements collected by each individual. %TEM calculated as (average TEM/mean of the measure)*100.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>Height&#160;</td>
			<td>Weight&#160;</td>
			<td>Weight:</td>
			<td>BMI</td>
			<td>Waist circ&#160;</td>
			<td>SS+TR</td>
			<td>DXA fat&#160;</td>
		</tr>
		<tr>
			<td></td>
			<td>(cm)</td>
			<td>(kg)</td>
			<td>Height</td>
			<td>&#160;(kg/m2)</td>
			<td>(cm)</td>
			<td>(mm)</td>
			<td>(kg)</td>
		</tr>
		<tr>
			<td>N</td>
			<td>1110</td>
			<td>1110</td>
			<td>1110</td>
			<td>1110</td>
			<td>1106</td>
			<td>1103</td>
			<td>875</td>
		</tr>
		<tr>
			<td>Mean (SD)</td>
			<td>128.8 (7.8)</td>
			<td>29.0 (7.9)</td>
			<td>0.22 (0.05)</td>
			<td>17.2 (3.1)</td>
			<td>60.0 (8.3)</td>
			<td>19.9 (9.8)</td>
			<td>7.5 (3.9)</td>
		</tr>
		<tr>
			<td></td>
			<td colspan="7">Spearman correlation coefficient</td>
		</tr>
		<tr>
			<td>Height</td>
			<td>1.00</td>
			<td>0.80</td>
			<td>0.66</td>
			<td>0.38</td>
			<td>0.56</td>
			<td>0.33</td>
			<td>0.47</td>
		</tr>
		<tr>
			<td>Weight</td>
			<td></td>
			<td>1.00</td>
			<td>0.98</td>
			<td>0.84</td>
			<td>0.87</td>
			<td>0.69</td>
			<td>0.80</td>
		</tr>
		<tr>
			<td>Weight: Height</td>
			<td></td>
			<td></td>
			<td>1.00</td>
			<td>0.93</td>
			<td>0.90</td>
			<td>0.75</td>
			<td>0.84</td>
		</tr>
		<tr>
			<td>BMI</td>
			<td></td>
			<td></td>
			<td></td>
			<td>1.00</td>
			<td>0.86</td>
			<td>0.79</td>
			<td>0.83</td>
		</tr>
		<tr>
			<td>Waist circumference</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td>1.00</td>
			<td>0.73</td>
			<td>0.81</td>
		</tr>
		<tr>
			<td>SS+TR</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td>1.00</td>
			<td>0.90</td>
		</tr>
		<tr>
			<td>DXA fat</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td>1.00</td>
		</tr>
	</tbody>
</table>
Table 2: Correlations between Each of Several Anthropometric Measures and with DXA Body Fat among 1110 Project Viva Children at 6.5 - 10.9 Years. Adapted from Boeke et al1. BMI = body mass index; SS = subscapular skinfold; TR = triceps skinfold; DXA = dual X-ray absorptiometry.

Watch this Scientific Journal Video about Assessment of Child Anthropometry in a Large Epidemiologic Study at JoVE.com

Assessment of Child Anthropometry in a Large Epidemiologic Study

In epidemiologic studies of children, well-trained research staff can accurately and precisely assess weight, height, sitting height, skinfold thicknesses, and body circumferences.

A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to ...

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27.0K Views.  Harvard Medical School and Harvard Pilgrim Health Care Institute. In epidemiologic studies of children, well-trained research staff can accurately and precisely assess weight, height, sitting height, skinfold thicknesses, and body circumferences. 

Video: Assessment of Child Anthropometry in a Large Epidemiologic Study

A Method for Manipulating Blood Glucose and Measuring Resulting Changes in Cognitive Accessibility of Target Stimuli

Much research in social psychology has investigated the impact of bodily energy need on cognition and decision-making. As such, blood glucose, the body's primary energy source, has been of special interest to researchers for years. Fluctuations in blood glucose have been linked to a variety of changes in cognitive and behavioral processes, such as self-control, political attitudes, and eating behavior. To help meet growing interest in the links between bodily energy need and these processes, this manuscript offers a simple methodology to experimentally manipulate blood glucose using a fasting procedure followed by administration of a sugar-sweetened, unsweetened, or artificially-sweetened beverage. This is followed by presentation of a method for measuring resulting changes in implicit cognition using a lexical decision-task. In this task, participants are asked to identify whether strings of letters are words or non-words and response latencies are recorded. Sample results from a recent publication are presented as an example of the applications for the experimental manipulation of blood glucose and the lexical decision task measures.

The authors introduce a method for manipulating blood glucose and measuring resulting changes in cognitive accessibility of target words using a lexical decision task.

Much research in social psychology has investigated the impact of bodily energy need on cognition and decision-making.  As such, blood glucose, the body's ...

Behavior

Measuring Cardiac Autonomic Nervous System (ANS) Activity in Children

The autonomic nervous system (ANS) controls mainly automatic bodily functions that are engaged in homeostasis, like heart rate, digestion, respiratory rate, salivation, perspiration and renal function. The ANS has two main branches: the sympathetic nervous system, preparing the human body for action in times of danger and stress, and the parasympathetic nervous system, which regulates the resting state of the body.
ANS activity can be measured invasively, for instance by radiotracer techniques or microelectrode recording from superficial nerves, or it can be measured non-invasively by using changes in an organ's response as a proxy for changes in ANS activity, for instance of the sweat glands or the heart. Invasive measurements have the highest validity but are very poorly feasible in large scale samples where non-invasive measures are the preferred approach. Autonomic effects on the heart can be reliably quantified by the recording of the electrocardiogram (ECG) in combination with the impedance cardiogram (ICG), which reflects the changes in thorax impedance in response to respiration and the ejection of blood from the ventricle into the aorta. From the respiration and ECG signals, respiratory sinus arrhythmia can be extracted as a measure of cardiac parasympathetic control. From the ECG and the left ventricular ejection signals, the preejection period can be extracted as a measure of cardiac sympathetic control. ECG and ICG recording is mostly done in laboratory settings. However, having the subjects report to a laboratory greatly reduces ecological validity, is not always doable in large scale epidemiological studies, and can be intimidating for young children. An ambulatory device for ECG and ICG simultaneously resolves these three problems.
Here, we present a study design for a minimally invasive and rapid assessment of cardiac autonomic control in children, using a validated ambulatory device 1-5, the VU University Ambulatory Monitoring System (VU-AMS, Amsterdam, the Netherlands,<a href="http://www.vu-ams.nl" target="_blank"> www.vu-ams.nl</a>).

Measuring Cardiac Autonomic Nervous System ANS Activity in Children

Measurement of autonomic nervous system activity usually confines the researcher and participant to the laboratory, which may provide an intimidating environment to children. The VU University Ambulatory Monitoring System (VU-AMS) device can record cardiac autonomic control in any setting. The VU-AMS proved very amenable to testing in children.

The autonomic nervous system (ANS) controls mainly automatic bodily functions that are engaged in homeostasis, like heart rate, digestion, respiratory ...

Sample Preparation to Bioinformatics Analysis of DNA Methylation: Association Strategy for Obesity and Related Trait Studies

Obesity is directly connected to lifestyle and has been associated with DNA methylation changes that may cause alterations in the adipogenesis and lipid storage processes contributing to the development of the disease. We demonstrate a complete protocol from selection to epigenetic data analysis of patients with and without obesity. All steps from the protocol were tested and validated in a pilot study. 32 women participated in the study, in which 15 individuals were classified with obesity according to Body Mass Index (BMI) (45.1 &#177; 5.4 kg/m2); and 17 individuals were classified without obesity according to BMI (22.6 &#177; 1.8 kg/m2). In the group with obesity, 564 CpG sites related to fat mass were identified by linear regression analysis. The CpG sites were in the promoter regions. The differential analysis found 470 CpGs hypomethylated and 94 hypermethylated sites in individuals with obesity. The most hypomethylated enriched pathwayswere in the RUNX, WNT signaling, and response to hypoxia. The hypermethylated pathways were related to insulin secretion, glucagon signaling, and Ca2+. We conclude that the protocol effectively identified DNA methylation patterns and trait-related DNA methylation. These patterns could be associated with altered gene expression, affecting adipogenesis and lipid storage. Our results confirmed that an obesogenic lifestyle could promote epigenetic changes in human DNA.

The present study describes the workflow to manage DNA methylation data obtained by microarray technologies. The protocol demonstrates steps from sample preparation to data analysis. All procedures are described in detail, and the video shows the significant steps.

Obesity is directly connected to lifestyle and has been associated with DNA methylation changes that may cause alterations in the adipogenesis and lipid ...

Genetics

Physical Activity Measurement in Children Accepting Table Tennis Training

An increasing body of evidence now shows that the majority of children in China experience lower levels of physical activity (PA) than the recommended guideline. Table tennis is a compound and technically difficult game that is popular in China; undertaking table tennis training in clubs can help children to elevate their levels of PA. Given that children cannot complete self-evaluated questionnaires themselves and caregiver-based observations are not suitable for children, we hypothesized that an actigraphy-based method can be an objective method to measure PA. In the present study, we describe a procedure that can be used to evaluate PA levels using an actigraphic device and software. Furthermore, since hip-worn devices are known to reduce compliance, we attempted to assess the agreement between hip-worn and wrist-worn device data. Collectively, our results indicate that these devices are suitable for measuring PA and leisure time physical activity (LTPA) levels. Together with subjective questionnaires, both hip-worn and wrist-worn devices are highly suitable for evaluating PA in Chinese children undergoing table tennis training in clubs.

This study proposes an accelerometer-based method to objectively measure physical activity (PA) and leisure time physical activity (LTPA) in Chinese children accepting table tennis training in clubs.

An increasing body of evidence now shows that the majority of children in China experience lower levels of physical activity (PA) than the recommended ...

Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts

The purpose of this paper is to introduce a promising, novel method to aid in the assessment of bone quality in forensically relevant skeletal remains. BMD is an important component of bone&#39;s nutritional status and in skeletal remains of both juveniles and adults, and it can provide information about bone quality. For adults remains, it can provide information on pathological conditions or when bone insufficiency may have occurred. In juveniles, it provides a useful metric to elucidate cases of fatal starvation or neglect, which are generally difficult to identify. This paper provides a protocol for the anatomical orientation and analysis of skeletal remains for scanning via dual-energy X-ray absorptiometry (DXA). Three case studies are presented to illustrate when DXA scans can be informative to the forensic practitioner. The first case study presents an individual with observed longitudinal fractures in the weight bearing bones and DXA is used to assess bone insufficiency. BMD is found to be normal suggesting another etiology for the fracture pattern present. The second case study employed DXA to investigate suspected chronic malnutrition. The BMD results are consistent with results from long bone lengths and suggest the juvenile had suffered from chronic malnutrition. The final case study provides an example where fatal starvation in a fourteen-month infant is suspected, which supports autopsy findings of fatal starvation. DXA scans showed low bone mineral density for chronological age and is substantiated by traditional assessments of infant health. However, when dealing with skeletal remains taphonomic alterations should be considered before applying this method.

Bone mineral density (BMD) is an important factor in understanding nutritional intake. For human skeletal remains, it is a useful metric to assess quality of life in both juveniles and adults, particularly in fatal starvation and neglect cases. This paper provides guidelines for scanning human skeletal remains for forensic purposes.

The purpose of this paper is to introduce a promising, novel method to aid in the assessment of bone quality in forensically relevant skeletal remains. ...

'Boden Food Plate': Novel Interactive Web-based Method for the Assessment of Dietary Intake

Different methods can be used in research to assess dietary intake, many of which are still paper-based. Written estimated food diaries are often utilized in clinical trials, despite being a burden for both study participants and researchers. This method requires participant literacy, it is time consuming, labor intensive, and can easily lead to under-reporting. With advancements in technology, there is a growing interest in electronic diaries that automate the dietary assessment process. These are focused on improving accuracy, reducing both time and cost and providing users with a visual and more enjoyable experience. The methodology presented here aimed to validate the &#39;Boden Food Plate&#39;, a novel web-based platform for self-recording of food and drink items, compared to a traditional estimated food diary. The application was also rated on a satisfaction scale by study participants using a paper-based questionnaire. Sixty-seven participants completed the dietary measures on both the three-day electronic and paper food diaries. For the analysis, only dietary data completed at both study time points (baseline and week six) was utilized. Despite small mean differences between dietary data collection methods, Bland Altman analysis showed fairly wide 95% limits of agreement between the electronic platform and the written estimated food diary and there were few cases which did not fall within the 95% confidence intervals. Overall, participants found the electronic food diary to be more fun than the paper method and as easy to use as hard copy diaries. The new platform has potential as a self-recording tool for the collection of dietary data, particularly when utilized in clinical trial settings. However, further validation studies are needed to improve the validity of this novel electronic dietary data collection tool.

The &#39;Boden Food Plate&#39; is an electronic food diary designed to be an interactive and fun method to collect dietary intake using visual depictions. The purpose of this study was to validate the web-based application against a traditional three-day estimated food diary method.

Different methods can be used in research to assess dietary intake, many of which are still paper-based. Written estimated food diaries are often utilized ...

Quantified Assessment of Infant's Gross Motor Abilities Using a Multisensor Wearable

Developing objective and quantitative methods of early gross motor assessment is essential to better understand neurodevelopment and to support early therapeutic interventions. Here, we&#160;present&#160;a method to quantify gross motor performance using a multisensor wearable, MAIJU (Motility Assessment of Infants with a JUmpsuit), which offers an automated, scalable,&#160;quantitative, and objective assessment using&#160;a fully automated cloud-based pipeline. This wearable suit is equipped with four movement sensors that record synchronized data to a mobile phone utilizing a low-energy Bluetooth connection. An offline analysis in the cloud server generates fully analyzed results within minutes for each recording. These results include a graphical report of the recording session and a detailed result matrix that gives second-by-second classifications for posture, movement, infant carrying, and free playtime. Our recent results show the virtue of such&#160;quantified motor assessment&#160;providing&#160;a potentially&#160;effective method for distinguishing variations in the infant&#39;s gross motor development.

This paper outlines the assessment of infants' gross motor performance with a multisensor wearable and its fully automated deep learning-based analysis pipeline. The method quantifies the posture and movement patterns of infants from lying supine until they master walking independently.

Developing objective and quantitative methods of early gross motor assessment is essential to better understand neurodevelopment and to support early ...

Neuroscience

Impact of Underweight Status on Retinal and Choroidal Thickness

Determining Gender-Based Differences in Retinal and Choroidal Thickness in Underweight Individuals via Swept-Source Optical Coherence Tomography

Despite improvements in reducing hunger in recent years, undernutrition remains a global public health problem. This study utilizes the swept-source optical coherence tomography (SS-OCT) technique to assess changes in retinal and choroidal thickness in underweight subjects. Ophthalmic examinations were conducted on all adults participating in this cross-sectional research. Depending on their body mass index (BMI), the participants were divided into two groups: the underweight group and the normal group. The study included the right eyes of the underweight adults and an equal number of age- and gender-matched normal-weight subjects. The retinal thickness showed no significant difference between the underweight and normal groups (P &gt; 0.05 for all). In males, the retina of the center and inner ring in the underweight group was significantly thinner than that in the normal group, while no such results were found in females. The choroid in the underweight group was significantly thinner compared to that in the normal group (all P &lt; 0.05). Being underweight may affect choroidal thickness in both males and females. In comparison with underweight females, underweight males may experience more retinal damage. These findings contribute to a better understanding of the pathogenesis underlying specific ocular diseases in malnourished individuals.

Here, swept-source optical coherence tomography (SS-OCT) is used to compare retinal and choroidal thickness in adults with and without malnutrition, contributing to a better understanding of the pathogenesis of ocular diseases in malnourished individuals.

Despite improvements in reducing hunger in recent years, undernutrition remains a global public health problem. This study utilizes the swept-source ...

3D Optical Imaging for Rapid Body Size and Composition Assessment

Clinical Anthropometrics and Body Composition from 3-Dimensional Optical Imaging

The body size and composition assessment is commonly included in the routine management of healthy athletes as well as of different types of patients to personalize the training or rehabilitation strategy. The digital anthropometric analyses described in the following protocol can be performed with recently introduced systems. These new tools and approaches have the potential to be widely used in clinical settings because they are very simple to operate and enable the rapid collection of accurate and reproducible data. One system consists of a rotating platform with a weight measurement plate, three infrared cameras, and a tablet built into a tower, while the other system consists of a tablet mounted on a holder. After image capture, the software of both systems generates a de-identified three-dimensional humanoid avatar with associated anthropometric and body composition variables. The measurement procedures are simple: a subject can be tested in a few minutes and a comprehensive report (including the three-dimensional scan and body size, shape, and composition measurements) is automatically generated.

Author Spotlight: Advancements in 3D Optical Imaging for Comprehensive Body Composition Assessment in Modern Research

The procedures for body size, shape, and composition assessment through commercially available solutions for three-dimensional optical imaging enable the rapid collection of accurate and reproducible data. Clinicians could implement the acquisition of innovative and useful biomarkers (&#34;e-tape&#34; measurements) in routine evaluations of patients to assist in characterizing&#160;their health status.

The body size and composition assessment is commonly included in the routine management of healthy athletes as well as of different types of patients to ...

Ultrasound Assessment of Aortic and Carotid Artery Intima-media Thickness in Children and Adolescents

Carotid intima-media thickness (IMT), measured using high-resolution B-mode ultrasonography, is a widely utilized surrogate marker of subclinical atherosclerosis, the pathophysiological process underlying most clinical cardiovascular disease events. Atherosclerosis is a gradual disease that originates early in life, thus, there has been increased interest in measuring carotid IMT in childhood and adolescence to assess structural change in the arterial vasculature in response to adverse exposures. However, the timing of atherosclerosis varies across the vascular tree. Primordial atherosclerotic lesions are present in the abdominal aorta as early as infancy, compared to mid-adolescence for the common carotid. Measurement of IMT at either site is susceptible to several technical challenges that need to be considered, especially in younger children. In this paper, we provide a detailed stepwise method for high-quality assessment of IMT of the abdominal aorta and common carotid artery in the young. We also provide insight into the appropriateness of either site when exploring the associations between early-life exposures and later-life cardiovascular disease.

The present article describes the methodological considerations for the noninvasive assessment of abdominal aortic and carotid intima-media thickness using B-mode ultrasonography. This technique is commonly used in the developmental origins of health and disease research as a surrogate for early arterial changes.

Assessment of Child Anthropometry in a Large Epidemiologic Study

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