1052 TheAmerican Journal of Clinical Nutrition 27: OCTOBER 1974, pp. 1052-1058. Printed in U.S.A.

Triceps skin fold and upper arm muscle sizenorms for assessment of nutritional status1’2

A. Roberto Frisancho, Ph.D.3

ABSTRACT Basect on a cross-sectional sample of 12,396 white subjects aged 0 to 44 years,

derived from the United States Ten-State Nutrition Survey of 1968-1970, percentiles for rightupper arm circumference and triceps skin fold are reported. From these measurements for each

individual, the arm muscle diameter, arm muscle circumference, and arm muscle area were

calculated. Thereafter, age- and sex-specific percentiles for all three estimates of muscle sizewere obtained. The development of subcutaneous fat, as indicated by the triceps skin fold, in

males is characterized by slow apposition, while in females, is continuous throughoutchildhood, adolescence, and adulthood. Sexual dimorphism in triceps skin fold is defined by

the age of 3 years, and by adulthood, females exceed males by 83%. The muscle area in theupper arm during childhood exhibits considerable changes with age. Sexual dimorphism is

defmed by the age of 13 years, and by adulthood, males exceed females by about 56%. The

amount of subcutaneous fat and degree of muscularity in children reflects the individual calorie

and protein reserve. However, measurements of subcutaneous fat among populations

characterized by a low degree of fatness may not be a sensitive indicator of nutritional status

and growth. On the other h�snd, measurements of muscularity in children do serve as an

adequate general index of nutritional status and growth in size. Am. J. Clin. Nutr. 27:

1052-1058, 1974.

Because the size of the muscle mass is anindirect indicator of protein reserve, measure-ment of limb muscle size has been usedcurrently to assess the nutritional status ofchildren (1-3). These evaluations are usuallymade through comparison of the estimated

upper arm muscle circumference of a givenpopulation against the “standard” (1). It mustbe noted, however, that this standard formuscle circumference for the ages of 1 to 60months was calculated using the arm circum-ference of Polish children (reported in 1964)

and the triceps skin folds of British children(reported in 1955 (4) and 1962 (5)). In thesame manner, the muscle circumference forchildren 6 to 15 years was estimated from thearm circumference of British children (reportedin 1955 (4, 5)) and the triceps skin folds ofchildren in the United States obtained prior toWorld War II and reported in 1941 (6). It isquite evident that normative data derived

through this procedure are not applicable interms of time or population. Clearly, there is acrucial need for the development of moreappropriate estimates of muscle size. Therefore,the purpose of this article is to provideestimates of upper arm muscle size derived

from the arm circumference and triceps skinfolds of the white population in the UnitedStates.

Materials and methods

Sample

This study is based on a cross-sectional sample of5,637 males and 6,759 females aged 0 to 44 years,derived from the Ten-State Nutrition Survey of1968-1970. This survey was based on a stratifiedprobability sample of families and unrelated indi-viduals residing in the states of Texas, Louisiana,Kentucky, Michigan, New York, Massachusetts, Wash-

ington, California, West Virginia, and South Carolina.The sampling procedure included a large proportion offamilies who, according to the 1960 census, wereliving in low-income areas and a small proportion offamilies living in middle- and upper-income areas (7).Although the primary interest in each state was

‘From the Center for Human Growth and Develop-

ment, The University of Michigan, Ann Arbor,Michigan 48104.

2Supported in part by Contract HSM 21 72-522with the Center for Disease Control, Atlanta, Georgia,and with the use of raw data from the Ten-StateNutrition Survey of 1968-1970.

� Associate Scientist of the Center forHuman Growth and Development and Associate

Professor of Anthropology.

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

UPPER ARM CIRCUMFERENCE AND TRICEPS SKIN FOLDS 1053

malnutrition among the poor, the universe of theTen-State Nutrition Survey does not include all of thelower-income groups within a state, nor is it restrictedto only the poor. Rather, the target population alsoincluded middle- and upper-income individuals who,because of changes in residential patterns since 1960,were living in the selected areas when the survey wasconducted (7). The mean average income for thesample included in this study was $13,122.

Measurements

The survey included standard anthropometric mea-surements for the assessment of body size andnutritional status. In this article, we report informa-tion for the upper arm circumference and triceps skinfolds for the whole sample of whites who participatedin the Ten-State Nutrition Survey.

1) Upper arm circumference (millimeters) wasmeasured to the nearest millimeter with a steel tapewith the right arm hanging relaxed. The measurementwas taken midway between the tip of the acromionand olecranon process.

2) Triceps skin fold (millimeters) was measured to

the nearest tenth of a millimeter with a LangeSkin-fold Caliper having a pressure of 10 g/mm2 ofcontact surface area. The measurement was taken onthe back of the arm and midway between the point ofthe acromion and olecranon process while the arm washanging relaxed.

Estimates of muscle size

The following three estimates of muscle size were

derived:1) Arm muscle diameter (millimeters) was esti-

mated by computation (8-10) as follows:

Arm muscle diameter (mm) =

arm circumference (mm) -

triceps skin fold (mm)

2) Arm muscle circumference (mm) was derived bycomputation (1, 2, 11) as follows:

Arm muscle circumference (mm) =

arm circumference -ir (triceps skin fold)

3) Arm muscle area (mm2) was calculated (12, 13)as follows:

Arm muscle area (mm2) (arm diameter2)

It must be noted that the calculations of musclesize in the upper arm are only approximations for four

reasons. First, the circumference of muscle does not

include an estimate of bone diameter, and anyvariation in humeral diameter is therefore not account-able. The deletion of humeral diameter in thecalculation may result in an overestimation of male inrelation to female values, as male humeri are on theaverage greater in diameter than those of the female,regardless of the nutritional status of the population.Second, the equations assume that the upper arm iscylindrical in form, an assumption subject to someinaccuracy. For example, because flattening of the

arm is more prevalent in males than in females (14), it

may result in an overestimation of male muscle area toan increasing degree as the cross-sectional configura-

tion approaches rectangularity. Third, the equationsdo not take into account variations in skin fold

compressibility. Clegg and Kent (15) indicate thatfemale triceps skin-fold compressibility is 4.8% greaterthan that of the male. In this study the averageskin-fold was 7 mm and the maximum value was 21mm. According to these data, the greater femaleskin-fold compressibility could result in an underesti-mation of female muscle circumference by an averageof 3.1 mm. However, the estimates of muscle size can

be affected significantly at the upper levels (95thpercentile) of the distribution and may preventadequate comparisons because skin-fold compressibil-ity increases when the skin-fold thickness is over 21mm. Fourth, as the measurements of skin folds andupper arm circumference were taken by severaltechnicians, the magnitude of the measurement errorcannot be quantified.

Results and discussion

Table 1 gives the percentiles for the mid-

upper arm circumference and triceps skin fold.

Arm circumference

As shown by the 50th percentile values, thearm circumference between the age of 1 and 5

years increases approximately 11% in girls and

15% in boys. Between 6 and 13 years, theincrease in boys is almost 32% and 34% in girls;between 14 and 30 years, males show anincrease of 27%, whereas in females this equals

only 13%.These data suggest that the arm circum-

ference either during childhood (1 to 5 years)or adolescence is not independent of age as is

currently assumed. Nevertheless, it must benoted that, for example, compared with heightor weight during childhood, the arm circum-ference shows a small change. Therefore, asindicated by other investigators (1-3, 13, 16)evaluations of nutritional status based on armcircumference during childhood may not re-quire an exact knowledge of age.

Triceps skin fold

Boys at the age of 2 years have a mediantriceps skin fold of 10 mm (for the 50th

percentile), which thereafter declines gradually,and at approximately the age of 8 years,reaches its lowest value (8 mm). After this age,they exhibit a slow increase, and by the age of12 years, reach a peak of 11 mm. This is the

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

1054 FRISANCHO

TABLE 1Percentiles for upper arm circumference and triceps skin folds for

whites of the Ten-State Nutrition Survey of 1968-1970

Age

Arm circumference percentiles, mm

Triceps skin foldpercentiles, mm

Age Midpoint,group years No. 5th 15th 50th 85th 95th 5th 15th 50th 85th 95th

Males0.0-0.4 0.3 41 113 120 134 147 153 4 5 8 12 15

0.5-1.4 1 140 128 137 152 168 175 5 7 9 13 151.5-2.4 2 177 141 147 157 170 180 5 7 10 13 14

2.5-3.4 3 210 144 150 161 175 182 6 7 9 12 143.5-4.4 4 208 143 150 165 180 190 5 6 9 12 144.5-5.4 5 262 146 155 169 185 199 5 6 8 12 165.5-6.4 6 264 151 159 172 188 198 5 6 8 11 156.5-7.4 7 309 154 162 176 194 212 4 6 8 11 147.5-8.4 8 301 161 168 185 205 233 5 6 8 12 17

8.5-9.4 9 287 165 174 190 217 262 5 6 9 14 199.5-10.4 10 315 170 180 200 228 255 5 6 10 16 22

10.5-11.4 11 294 177 186 208 240 276 6 7 10 17 25

11.5-12.4 12 294 184 194 216 253 291 5 7 11 19 2612.5-13.4 13 266 186 198 230 270 297 5 6 10 18 2513.5-14.4 14 207 198 211 243 279 321 5 6 10 17 2214.5-15.4 15 179 202 220 253 302 320 4 6 9 19 2615.5-16.4 16 166 217 232 262 300 335 4 5 9 20 2716.5-17.4 17 142 230 238 275 306 326 4 5 8 14 2017.5-24.4 21 545 250 264 292 330 354 4 5 10 18 2524.5-34.4 30 679 260 280 310 344 366 4 6 11 21 2834.5-44.4 40 616 259 280 312

Females345 371 4 6 12 22 28

0.0-0.4 0.3 46 107 118 127 145 150 4 5 8 12 13

0.5-1.4 1 172 125 134 146 162 170 6 7 9 12 15

1.5-2.4 2 172 136 143 155 171 180 6 7 10 13 152.5-3.4 3 163 137 145 157 169 176 6 7 10 12 143.5-4.4 4 215 145 150 162 176 184 5 7 10 12 14

4.5-5.4 5 233 149 155 i69 185 195 6 7 10 13 165.5-6.4 6 259 148 158 170 187 202 6 7 10 12 156.5-7.4 7 273 153 162 178 199 216 6 7 10 13 177.5-8.4 8 270 158 166 183 207 231 6 7 10 15 198.5-9.4 9 284 166 175 192 222 255 6 7 11 17 249.5-10.4 10 276 170 181 203 236 263 6 8 12 19 2410.5-11.4 11 268 173 186 210 251 280 7 8 12 20 2911.5-12.4 12 267 185 196 220 256 275 6 9 13 20 2512.5-13.4 13 229 186 204 230 270 294 7 9 14 23 3013.5-14.4 14 184 201 214 240 284 306 8 10 15 22 2814.5-15.4 15 197 205 216 245 281 310 8 11 16 24 3015.5-16.4 16 187 211 224 249 286 322 . 8 10 15 23 2716.5-17.4 17 142 207 224 250 291 328 9 12 16 26 3117.5-24.4 21 836 215 233 260 297 329 9 12 17 25 3124.5-34.4 30 1153 230 243 275 324 361 9 12 19 29 36

34.5-44.4 40 933 232 250 286 340 374 10 14 22 32 39

so-called preadolescent fat wave (1 7). After contrast, females between 2 and 8 years remainboys reach this age, the triceps skin fold stable. Thereafter, they show a rapid increase,declines until they are 17 years old, when they reaching a median value of 16 mm by the age ofattain a low value of 8 mm. The median value 1 5 years, and during adulthood the medianfor adults is only between 10 and 12 mm. In values are between 17 and 22 mm.

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

UPPER ARM CIRCUMFERENCE AND TRICEPS SKIN FOLDS 1055

#{176}The age group and n are the same as in Table 1.

Muscle size muscle area from age 1 to 12 years increases

steadily. This trend, however, is not noticeableTables 2 and 3 give the percentiles for the when the size of the muscle is expressed in

diameter, circumference, and area of muscle, terms of diameter and circumference. ForThese data show that in both boys and girls, the example, between 1 and 5 years in boys and

TABLE 2Percentiles for upper arm diameter and upper arm circumference forwhites of the Ten-State Nutrition Survey of 1968-1970

Arm muscle

Agemidpoint,

diameter percentiles, mm circumfer ence perce ntiles, mm

years” 5th 15th 50th 85th 95th 5th 15th 50th 85th 95th

Males0.3 26 30 34 40 42 81 94 106 125 1331 32 34 39 44 46 100 108 123 137 1462 35 37 40 44 46 111 117 127 138 146

3 36 38 42 46 48 114 121 132 145 1524 38 39 43 48 50 118 124 135 151 157

5 39 41 45 50 53 121 130 141 156 1666 40 43 47 51 53 127 134 146 159 1677 41 43 48 52 55 130 137 151 164 1738 44 46 50 55 59 138 144 158 174 1859 44 46 51 58 64 138 143 161 182 200

10 45 48 53 59 64 142 152 168 186 202

11 48 50 55 62 67 150 158 174 194 21112 49 52 58 66 70 153 163 181 207 22113 51 54 62 71 77 159 169 195 224 24214 53 58 67 74 84 167 182 211 234 26515 55 59 70 80 86 173 185 220 252 27116 59 65 73 83 89 186 205 229 260 281

17 66 69 78 86 92 206 217 245 271 29021 69 74 82 91 97 217 232 258 286 305

30 70 77 86 94 100 220 241 270 295 31540 71 76 86 96 101 222 239 270 300 318

Females0.3 27 29 33 37 40 86 92 104 115 1261 31 32 37 41 43 97 102 117 128 1352 34 36 40 44 46 105 112 125 140 1463 34 37 41 44 46 108 116 128 138 143

4 36 38 42 46 48 114 120 132 146 1525 38 40 44 48 51 119 124 138 151 1606 38 41 45 49 53 121 129 140 155 1657 39 42 47 52 56 123 132 146 162 175

8 41 44 48 53 59 129 138 151 168 1869 43 45 50 56 62 136 143 157 176 193

10 44 47 52 58 62 139 147 163 182 19611 44 48 55 62 67 140 152 171 195 20912 48 51 57 64 68 150 161 179 200 212

13 49 53 59 66 71 155 165 185 206 22514 53 56 61 70 74 166 175 193 221 23415 52 55 62 70 74 163 173 195 220 23216 54 57 64 72 83 171 178 200 227 26017 54 56 62 71 77 171 177 196 223 24121 54 58 65 73 80 170 183 205 229 253

30 56 60 68 78 87 177 189 213 245 272

40 57 61 69 80 89 180 192 216 250 279

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

of children be based on

areas as well. With the

1056 FRISANCHO

TABLE 3Percentiles for arm muscle area of whites derived from the Ten-State Nutrition Survey of 1968-1970

Male arm Female arm

Agemidpoint,

years”

muscle a re� percent iles, mm muscle a rea percentil es, mm

5th 15th 50th 85th 95th 5th 15th 50th 85th 95th

0.3 522 703 892 1,244 1,414 591 670 866 1,058 1,2721 791 928 1,201 1,500 1,690 756 821 1,084 1,304 1,4602 978 1,082 1,284 1,525 1,686 885 991 1,241 1,551 1,6933 1,027 1,163 1,384 1,670 1,842 928 1,068 1,298 1,516 1,6284 1,106 1,224 1,451 1,805 1,973 1,040 1,143 1,390 1,693 1,8285 1,171 1,342 1,579 1,930 2,193 1,119 1,227 1,516 1,825 2,0456 1,275 1,435 1,700 2,019 2,220 1,163 1,333 1,563 1,902 2,1747 1,342 1,485 1,815 2,152 2,386 1,213 1,384 1,700 2,096 2,4338 1,506 1,647 1,987 2,398 2,729 1,322 1,513 1,818 2,239 2,7589 1,522 1,637 2,074 2,645 3,188 1,473 1,625 1,955 2,477 2,978

10 1,608 1,832 2,239 2,753 3,239 1,528 1,727 2,115 2,637 3,06611 1,801 1,987 2,406 3,000 3,544 1,551 1,842 2,335 3,018 3,48612 1,874 2,126 2,603 3,401 3,902 1,781 2,052 2,558 3,183 3,58213 2,012 2,273 3,013 3,998 4,661 1,905 2,178 2,711 3,382 4,01414 2,231 2,645 3,544 4,358 5,601 2,186 2,430 2,952 3,883 4,35815 2,375 2,729 3,867 5,060 5,826 2,126 2,387 3,031 3,838 4,27916 2,741 3,331 4,184 5,363 6,266 2,316 2,510 3,198 4,096 5,38617 3,373 3,743 4,771 5,826 6,713 2,316 2,502 3,058 3,968 4,61221 3,748 4,273 5,315 6,529 7,411 2,289 2,679 3,341 4,164 5,08930 3,837 4,634 5,802 6,912 7,918 2,486 2,856 3,606 4,772 5,88940 3,938 4,563 5,820 7,183 8,041 2,566 2,926 3,724 4,991 6,195

a The age group and n are the same as in Table 1.

girls, there is an increase of nearly 35% inmuscle area, whereas in diameter or circum-

ference, the comparable value amounts to onlyapproximately 16%. In other words, estimatesof muscle diameter and circumference under-estimate the magnitude of the tissue changes.

In boys, the greatest 2-year increase inmuscle area occurs between the ages of 15 and

17 years, at which time there is an increase of

904 mm2 or nearly 23%. In girls, the greatestincrement occurs between the ages of 12 and

14 years, increasing almost 15% in muscle area(L� = 394 mm2).

Until the age of 12 years, sexual dimorphismin terms of muscle area is not well defined. Atthe age of 13 years, males exceed females by11% and, during adolescence, this differenceincreases sharply. By the age of 40 years, thesexual dimorphism in the muscle area is over56%. These sex differences are less markedwhen the muscle size is expressed either indiameter or circumference.

Because the muscle area shows greaterchanges with age than the diameter or circum-ference, it would be advisable that evaluations

of nutritional statusestimates of musclenomogram given recently by Gurney andJelliffe (18), the difficulties of calculatingmuscle areas are simplified.

The use of skin-fold thickness in the assess-ment of nutritional status of children is based on

the assumption that increased subcutaneous fat,

resulting from either high calorie intake or lowenergy expenditure, reflects a greater caloriereserve. From which it follows that fatter

children for their age are both taller anddevelopmentally more advanced than averagechildren (17, 19-27). This generalization issupported by animal experimental studies mdi-cating that overnutrition speeds maturation anddimensional growth (28). However, we must

point out that in some parts of the world itseems likely that, as we indicated by our studies

of Central American samples (10, 29, 30), thelevels of fatness that are considered average inthe United States populations cannot be found

except in the upper ranges of the distribution.Consequently, evaluations of nutritional status

based on skin-fold thickness of children from

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

UPPER ARM CIRCUMFERENCE AND TRICEPS SKIN FOLDS 1057

populations characterized by a low degree of

fatness may not be that sensitive (10, 29, 30).Experimental and clinical studies have shown

that the decrease in muscle mass, determinedeither through creatinine output or limb mea-

surements, during malnutrition exhibit a greater

reduction than body weight (31-33). Thisreduction in muscle size occurs as a compensa-tory mechanism to provide amino acids forgluconeogenesis and protein synthesis in theliver (34). These indications would suggest thatif the skeletal musculature is well maintained,the protein requirements for growth and body

tissues have been met. In other words, a child

with greater muscle size would reflect a greater

protein reserve than a less muscular one.Indeed, previous investigations have pointedout that differences in the development of

muscle are associated with differences in nutri-tional background (9, 35). Our investigations

on samples from Central America indicate that

during growth, greater muscularity is related togreater stature, showing that measurements of

muscularity in children of underdeveloped

countries do serve as a general index ofnutritional status and growth in size.

In view of these reasons, the applicability of

the present data will certainly depend on thepopulation to which it is applied. Furthermore,

any evaluation of nutritional status must takeinto account that there are variations in the

amount of subcutaneous fat and muscle and inthe pattern of fat deposition (36-39). For thisreason, and as recently pointed out by Jelliffe

and Jelliffe (16), there is a critical need forlocally applicable standards. It is hoped that thepresent article is a contribution toward this

end. ElThe author acknowledges the assistance of Mrs.

Kathleen Font and Mrs. Diane Clark in the preparationof this study.

References

1. JELLIFFE, D. B. The assessment of the nutri-tional status of the community. World HealthOrgan. Monograph Ser. No. 53. Geneva. 1966.

2. JELLIFFE, E. R. P., AND D. B. JELLIFFE(editors). The arm circumference as a publichealth index of protein-calorie malnutrition ofearly childhood. J. Trop. Pediat. 15: 176, 1969.

3. Assessment of protein nutritional status: a com-mittee report. Committee on Procedures forAppraisal of Protein-Calorie Malnutrition. Am. J.Clin. Nutr. 23: 807, 1970.

4. HAMMOND, W. H. Measurement and interpreta-

tion of subcutaneous fat, with norms for children

and young adult males. Brit. J. Prevent SocialMed. 9: 201, 1955.

5. TANNER, J. M., AND R. H. WHITEHOUSE.Standards for subcutaneous fat in British children.Brit. Med. J. 1: 446, 1962.

6. O’BRIEN, R., M. A. GIRSHIK AND E. P. HUNT,Body measurements of American boys and girlsfor garment and pattern construction. Washing-

ton, D. C.: U.S. Dept. Agriculture (Miscellaneous

PubI. No. 454), 1941.7. Ten-State Nutrition Survey 1968-1970, I. Histor-

ical Development, II. Demographic Data. Atlanta:

U.S. Dept. of Health, Education and Welfare,Center for Disease Control Publ. No. (HSM)

72-813 1, 1972.

8. BRO2�EK, J. Body measurements including skin-fold thickness, as indicator of body composition.In: Techniques for Measuring Body Composition,edited by J. Brolek and A. Henschel. Washington,D. C.: Natl. Aced. Sci.-Nat. Res. Council, 1961.

9. McFIE, J., AND H. F. WELBOURN. Effect ofmalnutrition in infancy on the development of

bone, muscle and fat. J. Nutr. 76: 97, 1962.10. FRISANCHO, A. R., AND S. M. GARN. Skin-

fold thickness and muscle size: implications fordevelopmental status and nutritional evaluation of

children from Honduras. Am. J. Clin. Nutr. 24:

541, 1971.11. STINI, W. A. Reduced sexual dimorphism in

upper arm muscle circumference associated with

protein-deficient diet in a South Americanpopulation. Am. J. Phys. Anthropol. 36: 341,

1972.

12. BAKER, P. T., E. E. HUNT AND S. T. SEN. Thegrowth and interrelations of skin folds and

brachial tissues in man. Am. J. Phys. Anthropol.

16: 39, 1958.13. GURNEY, J. M. XVI. Rapid assessment in a

refugee camp in Nigeria. J. Trop. Pediat. 15: 241,1969.

14. OSBORNE, R. H., AND F. V. DeGEORGE.Genetic basis of morphological variation. Cam-

bridge: Harvard Univ. Press, 181, 1959.

15. CLEGG, E. J., AND C. KENT. Skin-fold compres-

sibility in young adults. Human Biol. 39: 418,1967.

16. JELLIFFE, D. B., AND E. F. P. JELLIFFE.Age-independent anthropometry. Am. J. Chin.Nutr. 24: 1377, 1971.

17. GARN, S. M., AND J. A. HASKELL. Fatthickness and developmental status in childhoodand adolescence. Am. J. Diseases Children 99:

746, 1960.18. GURNEY, J. M., AND D. B. JELLIFFE. Arm

anthropometry in nutritional assessment: nomo-gram for rapid calculation of muscle circum-

ference and cross-sectional muscle and fat areas.

Am. J. Clin. Nutr. 26: 912, 1973.

19. GARN, S. M., AND J. A. HASKELL. Fat andgrowth during childhood. Science 130: 1711,1959.

20. TALBOT, N. B. Obesity in children. Med. Clin. N.

Am. 29: 1217, 1945.

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from

1058 FRISANCHO

21. FRY, P. C. A comparative study of “obese”

children selected on the basis of fat pads. Am. J.

Clin. Nutr. 6: 453, 1953.22. PECKOS, P. C. Caloric intake in relation to

physique in children. Science 117: 631, 1953.23. AVAADE, F. Obese Children. Copenhagan:

Danish Science Press, 1955.24. WOLFF, 0. H. Obesity in childhood: a study of

the birth weight, the height, and the onset of

puberty. Quart. J. Mcd. 24: 109, 1955.25. LLOYD, J. K., 0. H. WOLFF AND W. S.

WHELEN. Childhood obesity: a long-term studyof height and weight. Brit. Med. J. 15: 145, 1961.

26. REYNOLDS, E. L. Sexual maturation and the

growth of fat, muscle and bone in girls. ChildDevelop. 17: 121, 1946.

27. REYNOLDS, E. L. The distribution of subcutan-

eous fat in childhood and adolescence. (Mono-graph). Soc. Res. Child Develop. 15: 189, 1950.

28. HAMMOND, J. Progress in the physiology of farm

animals. London: Butterworths, 1954.29. FRISANCHO, A. R., AND S. M. GARN. Rela-

tionship of skinfolds and muscle size to growth of

children. I. Costa Rica. Am. J. Phys. AnthropoL35: 85, 1971.

30. FRISANCHO, A. R., AND S. M. GARN. The

implications of skinfolds and muscle size to

developmental and nutritional status of CentralAmerican children. III. Guatemala. Trop.

Geograph. Med. 23: 167, 1971.31. WATERLOW, J. C., AND C. B. MENDES.

Composition of muscle in malnourished human

infants. Nature 180: 1361, 1957.

32. MILLER, A. T., AND C. S. BLYTH. Estimationof lean body mass and body fat from basaloxygen consumption. J. Appl. Physiol., 5: 73,1952.

33. STANDARD, K. L, V. G. WILLIS AND J. C.WATERLOW. Indirect indications of muscle massin malnourished infants. Am. J. Clin. Nutr. 7:

271, 1959.34. ARROYAVE, G., AND H. CASTELLANOS. Role

of the adrenal cortical system in the response ofchildren to severe protein malnutrition. Am. J.

Clin. Nutr. 9: 186, 1961.35. SABHARWAL, K. P., 5. MORALES AND J.

MENDEZ. Body measurements and creatinineexcretion among upper and lower socio-economicgroups of girls in Guatemala. Human Biol. 38:131, 1966.

36. MALINA, R. M. Skinfolds in American Negro andWhite children. J Am. Dietet. Assoc. 59: 34,1971.

37. ROBSON, J. R. K., M. BAZIN AND R. SODER-STROM. Ethnic differences in skin-fold thickness.Am. J. Clin. Nutr. 24: 864, 1971.

38. ROBSON, J. R. K. Skin-fold thickness in appar-ently normal Mrican adolescents. J. Trop. Med.Hyg. 67: 209, 1964.

39. PISCOPO, J. Skinfold and other anthropometricalmeasurements of pre-adolescent boys from threeethnic groups. Res. Quart. Am. Assoc. HealthPhys. Educ. Recreation 33: 255, 1962.

by guest on Septem

ber 26, 2014ajcn.nutrition.org

Dow

nloaded from