Am J Clin Nutr 1981 Frisancho 2540 5

8/11/2019 Am J Clin Nutr 1981 Frisancho 2540 5

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T he A m er ica n Journa l o fC l in ic a l N u tri tion

34: N O VE M B ER 1981 , p p . 254 0-2 545 . P r in te d in U .S .A .

1981 Am er ican S ociety for C lin ic al N utrition

ew no rm s o f uppe r lim b fa t and m usc le a reas

fo r assessm en t o f n u tr it ion a l s ta tu s

A . Rob erto F r isanch o ,2 P h .D .

A BSTR AC T B ased on m easu rem en ts of tric eps sk info ld th ick nes s and upper arm circum fe r-

enc e o fa cross -sec tio nal s am ple of 19 ,09 7 wh ite su b je cts ag ed 1 to 7 4 y r. d erived from th e U nited

S tates H ealth and Nu tri tion al Ex am ina tion Survey of 19 7 1 to 19 74 , the arm m uscle circ um ferenc e,

arm m usc le a rea . an d a rm fa t a re a w ere c a lcu la te d . T h ere a fte r a g e an d se x s pe c ific pe rcen ti les fo r

all th re e es tim ate s o f upp er arm tis sue s w ere ob tain ed . B a sed on em p irical and th eo retical ev id enc e.

it is recom m ended tha t as ses sm ents o f nu tri tion al sta tus be m ade on th e b asis of a rea s o f fa t an d

areas ofm u scle rather than d ire ct sk in fo ld th ickn ess an d arm c ircum ference . It is a lso recom m ended

th at the se new norm s sho uld rep lac e th ose cur ren tly in use.

A m . J . C lin . N u tr .

3 4: 2 54 0- 25 45 ,

9 8

K EY W OR D S G row th , stand ard s, nu tritiona l sta tu s, a rm fat are as. arm m uscle are as

In troduct ion

In recen t years an th ropom e tric eva lua tions

o f the u ppe r lim b h av e becom e va luab le in

the asse ssm en t o f nu tr ition al sta tu s o f ch il-

d ren and ad u lts . T h is is based o n the ev id en ce

tha t the o rgan ism , w h en faced w ith nu tr i-

tion al re str ic tio n , u tiliz es its nu tritio na l re -

se rves sto red in the fo rm o f sk ele ta l m usc le

p ro te in , v iscera l p ro te in , an d fat. It is a ssum ed

tha t th e tr icep s sk in fo ld th ickn ess in d icate s

th e ca lo rie re se rves sto red in th e fo rm of fat

1 -4 , and the arm m usc le size re flec ts the

re se rv es o f m usc le p ro te in 1 , 2 , 4 , w h ile the

leve ls o f c ircu latin g pro te in , such as tran sfe r-

r in o r a lbum in ind ica te th e v isce ra l p ro te in

statu s 5 . In a p rev ious stud y , w e have p ub-

lished p ercen tiles fo r tric eps sk in fo lds an d

estim a te s o f m u scle a rea fo r w h ite s de riv ed

from the T en-S tate N u tritio n Su rvey 1 . A l-

thou gh th is su rvey in clu ded ind iv idu als from

m idd le and uppe r incom e lev els , the sam p le

w as h eav ily w eig h ted tow ard the low er in -

com e group s in each state 1 . H ence , it d id

no t con stitu te a n atio na l po pu latio n sam ple .

F u rth erm o re , th is stud y d id no t g ive in fo r-

m a tion fo r su b jects o lde r than 4 4 yr, and its

app licab ility to o ld er sub jec ts is lim ited . F or

th is reason , and in v iew o f the w id e sp read

u se o f these norm s, w e have dec ided to de rive

new and m o re app licab le standa rds from the

da ta sets o f th e H ea lth and N u tritio na l Ex -

am in atio n Survey I HA N E S I o fthe U nited

2540

S ta te s , co llec ted during 1 97 1 an d 1974 .

The refo re , the pu rpo se o f the p resen t stud y is

to p rov id e n ew percen tiles fo r tr icep s sk in -

fo lds, and es tim a tes o f up pe r arm fat and

m u sc le area de rived from an th ro pom e tric

m easu rem en ts o f w h ite sam p les o f H A N E S

I.

M ate r ials and m eth ods

S amp l e

T his stud y is ba sed u pon a c ros s-se ctiona l sam p le of

19 .09 7 wh ite su b je cts aged 1 to 74 . of w hom 8.2 04 w ere

m ale s and 10 .89 3 w ere fem a les de riv ed from the H ealth

an d

Nu tritiona l Ex am ina tion Su rvey I da ta se ts. Th e

d ata w ere c o lle c ted du rin g

April 19 71 an d Ju ne 1974

an d the sam ple w as sele cted f rom the N ation al P rob a-

b il ity sam p le th at repre sen ted th e c iv i lian n oninst itu t ion -

al ized popula tio n o f w hite s. T he sam ple size for b lack s

w as to o sm all to b e inc lud ed as p art o fthe presen t no rm s .

Th e m ean va lue s for tric eps sk info ld of age s 1 to 17 fo r

th e

yr of 1 971 to 1 972 h ave been prev ious ly p ublish ed

6 . H ow ev er, nei the r the data for tr icep s sk in fo ld s afte r

17 yr o ld no r an y triceps sk info ld m easurem en ts for any

age s dur ing the yr 1 973 to 1 974 have been publish ed .

S im ila rly . n one o f th e da ta for up per a rm circum fe renc e

h as be en pub lished b efo re .

e surements

U ppe r a rm c ircu mferen ce cm w as m ea sured to th e

n ea rest cm w ith

a s te e l tap e

w ith the n igh t arm h ang ing

I F rom the C en ter fo r H um an G row th and D eve lop -

m en t and th e D ep artm ent o f A nth rop olo gy . U niv ersi ty

o f M ic hig an

A nn A rbo r, M I 48109 .

2 R esearch S cien tist.


2/6

U PPE R A R M FA T A N D M U S C L E A R E A S T A N D A R D S 25 41

re lax ed . T he m eas ure m e n t w as tak en m idw ay be tw een o u t in

p r ev io u s

pu b lic ations ( I ) the calcu latio ns o f u ppe r

th e t ip o f the ac rom ion and o tec ran on pro ces s. T ric ep s arm f at and m u scle areas are o n ly app rox im atio ns . F irs t,

s k in f o ld (m m ) w as m e asu red to the neares t m m w ith a the f orm ulas u t iliz ed assu m e th at the upp er arm is

L ang e sk in f o ld calip er hav ing a pre ssu re o f 1 0 g /m m 2 of cy lind ric al in f orm , an assu m ptio n su b je c t to s om e in -

c on tac t surf ac e area. T h e m e asu rem en t w as tak e n ov e r accu rac y . S ec on d , the e stim ate s o f m us cle are a d o no t

th e tric e ps m us cle

h alf w ay betw ee n the e lbo w an d the tak e in to acc ou n t the hu m e ral d iam eter. an d an y v an ia-

acro m ial proce ss o f th e s cap u la. w i th the sk in f o ld paralle l tion in hum eral d iam ete r is th ere f ore no t acco un tab le .

to the lo ng itud inal ax is o f th e u pp er arm (6 ). H ow e v e r, a rad iograph ic stud y o f arm c om pos itio n o f

w h ite ch ild re n f oun d th e sam e ratio o f m us cle to bon e in

E stim a tes of/at and m u scle areas b o th s ex e s

an d b ef o re an d af ter ado lesc enc e (7 ). s ugg est-

U pp er arm area

A ),

u ppe r arm m usc le area (

M ).

in g that bon e and m u scle inc rease propo rtionate ly . Fur-

and up per arm f at area (

F

w ere de riv e d f rom m eas ure s th en , the es tim ation o f f at area d oe s n o t ad jus t f o r

o f up pe r arm c ircu m f ere nce (

C

co nv e rte d to m m

c

v ariab le sk in f o ld co mp ress ib i lity .

and trice ps sk in f o ld (

T

using the proce du res and res tric -

tions ind icated prev io us ly ( I ) .

I A

w as calcu late d b y th e R esu lts an d d isc u s sio n

c om pu t a t i on :

T ab le I g iv e s th e sam p le siz e an d th e p e r-

IT

w he r e

d

=

,

c e n tile s o f tric ep s sk in f o ld s . T ab le s 2 an d 3

A

( m m 2 )

= X d2 p re se n t th e p e rc e n tile s f o r arm c irc u m fe re n c e ,

e stim ate d arm m u s cle c irc u m f e re n c e , es ti-

2)

M

w as c alc u lated by c om pu tation as f o llow s:

m ate d arm f at, an d m u sc le area.

M ( m m 2 )

=

(C - i rT 2 A s sh o w n b y th e 5 0 th p e rc e n tile v alu e s , th e

41T

f o llo w in g p o in ts are e v id en t: 1 in b o th m ales

an d f e m ales th e in c re ase w ith ag e in u p p e r

3 F mm2 w as de riv e d as f o l low s: arm f at is m o re e v id e n t w h en e x p re sse d in

F mm2

=

A - M term s o f f at are a. Fo r e x am p le, b etw e e n 1

A ll th ese est im ates w e re c alc u lated f o r each s ub jec t . an d 3 0 y r, th e f at are a in m ales in cre ase s b y

T he reaf te r, ag e- and sex -sp ecif ic pe rcen tiles f o r arm ab o u t 9 0 an d 2 0 0 in f em ale s , w h e re as th e

m u scle an d arm f at areas w e re calcu late d . A s po in te d in c re ase in trice p s sk in f o ld am o u n ts to o n ly

T A B L E 1

Pe rce n ti les f o r tricep s s k in f o ld f o r w h ites o f the U n ited S tates

H ealth and N u trit ion E x am inat ion S u rv ey I o f 19 71 to 197 4

T ric e ps s kin fo ld p e rc e n tile s m m 2

g group

n S 0

2 5 5

7 5 9 0 9 5 n S 0

25

5 0 7 5 9 0 9 5

M ales Fem ales

1 1 9 2 2 8 6 7 8 1 0 1 2 1 4 1 6 2 0 4 6 7 8 1 0 1 2 1 4 1 6

2 2 9 2 2 3 6 7 8

1 0 1 2 1 4 1 5 2 0 8

6 8 9 1 0 1 2 1 5

1 6

3 3 9 2 2 0

6 7 8

1 0 I I 1 4 1 5 2 0 8 7

8 9 1 1 1 2 1 4

1 5

4 4 9

2 3 0 6 6 8 9 1 1

1 2 1 4 2 0 8 7 8 8 1 0

1 2 1 4 1 6

5 5 9

2 1 4 6 6 8 9 1 1 1 4 1 5 2 1 9

6 7 8 1 0 1 2 1 5 1 8

6 6 9

1 1 7 S 6 7 8 1 0 1 3

1 6 1 1 8 6

6 8 1 0 1 2 1 4 1 6

7 7 9

1 2 2 S 6 7

9 1 2 1 5 1 7 1 2 6 6 7 9 1 1

1 3 1 6 1 8

8 8 9 1 1 7

5 6 7 8 1 0 1 3

1 6 1 1 8

6 8 9 1 2

1 5 1 8 2 4

9 9 9

1 2 1 6 6 7

1 0 1 3 1 7 1 8 1 2 5 8 8

1 0 1 3 1 6 2 0 2 2

1 0 1 0 9 1 4 6 6

6 8 1 0 1 4 1 8

2 1 1 5 2 7 8

1 0 1 2 1 7 2 3 2 7

1 1 1 1 9 1 2 2 6 6

8 1 1 1 6 2 0 2 4 1 1 7

7 8 1 0 1 3 1 8 2 4 2 8

1 2 1 2 9 1 5 3

6 6 8 1 1

1 4 2 2 2 8 1 2 9 8

9 1 1 1 4 1 8

2 3 2 7

1 3 1 3 9 1 3 4 S

S 7 1 0 1 4 2 2 2 6

1 5 1 8 8 1 2 1 5

2 1 2 6 3 0

1 4 1 4 9 1 3 1 4 S

7 9 1 4 2 1

2 4 1 4 1 9

1 0 1 3 1 6 2 1 2 6 2 8

1 5 1 5 9

1 2 8 4 5 6 8 1 1 1 8 2 4 1 1 7 8 1 0 1 2 1 7 2 1 2 5 3 2

1 6 1 6 9

1 3 1 4 5 6

8 1 2 1 6 2 2

1 4 2 1 0

1 2 1 5 1 8 2 2 2 6

3 1

1 7 1 7 9

1 3 3 5 5

6 8 1 2

1 6 1 9 1 1 4 1 0

1 2 1 3 1 9

2 4 3 0 3 7

1 8 1 8 9 9 1

4 S 6 9

1 3 2 0 2 4

1 0 9 1 0 1 2

1 5 1 8 2 2 2 6

3 0

1 9 2 4 9 5 3 1

4 5 7

1 0 1 5 2 0 2 2

1 0 6 0 1 0

1 1 1 4 1 8

2 4 3 0 3 4

2 5 3 4 9 9 7 1 5

6 8 1 2

1 6 2 0 2 4

1 9 8 7 1 0 1 2 1 6 2 1

2 7 3 4

3 7

3 5 4 4 9

8 0 6 5 6

8 1 2 1 6 2 0

2 3 1 6 1 4 1 2 1 4 1 8 2 3

2 9 3 5 3 8

45 -54 .9 8 98

6 6 8 12 15

2 0 2 5 1 047

1 2 16 20 2 5

3 0 36 40

5 5 6 4 9

7 3 4 5 6 8

1 1 1 4 1 9

2 2 8 0 9

1 2 1 6 2 0 2 5

3 1 3 6

3 8

6 5 7 4 9

1 5 0 3 4

6 8 1 1 1 5

1 9 2 2 1 6 7 0

1 2 1 4

1 8 2 4 2 9 3 4

3 6


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T A B L E 2

P e r c e n t i l e s o f upp er arm c ircm f erence (m m )

an d es tim ate d u pp er

arm

m us cle c ircum f e ren ce (m m ) f or w h ite s o f th e U nite d S tates H e alth

a n d N u tritio n

E x am ination S u rv ey I o f 197 1 to 1 97 4

Arm c irc u m fe re n c e m m

Arm

m us c le c irc um fe re nc e m m

g group

S 0 2 5 5 0 7 5 9 0 9 5 5 1 0 2 5 5 0 7 5 9 0 9 5

Ma l e s

1 1 9 1 4 2 1 4 6 1 5 0 1 5 9 1 7 0 1 7 6 1 8 3 1 1 0 1 1 3 1 1 9 1 2 7 1 3 5 1 4 4 1 4 7

2 2 9 1 4 1 1 4 5 1 5 3 1 6 2

1 7 0 1 7 8 1 8 5 1 1 1 1 1 4 1 2 2 1 3 0 1 4 0 1 4 6 1 5 0

3 3 9 1 5 0

1 5 3 1 6 0 1 6 7 1 7 5 1 8 4 1 9 0 1 1 7

1 2 3 1 3 1 1 3 7 1 4 3 1 4 8 1 5 3

4 4 9 1 4 9 1 5 4 1 6 2 1 7 1

1 8 0 1 8 6 1 9 2 1 2 3 1 2 6 1 3 3 1 4 1 1 4 8

1 5 6 1 5 9

5 5 9 1 5 3 1 6 0 1 6 7 1 7 5 1 8 5

1 9 5 2 0 4 1 2 8 1 3 3 1 4 0 1 4 7 1 5 4

1 6 2 1 6 9

6 6 9 1 5 5 1 5 9 1 6 7 1 7 9

1 8 8 2 0 9 2 2 8 1 3 1 1 3 5 1 4 2 1 5 1

1 6 1 1 7 0 1 7 7

7 7 9 1 6 2 1 6 7 1 7 7 1 8 7

2 0 1 2 2 3 2 3 0 1 3 7 1 3 9 1 5 1 1 6 0 1 6 8 1 7 7

1 9 0

8 8 9 1 6 2 1 7 0 1 7 7 1 9 0 2 0 2 2 2 0 2 4 5 1 4 0

1 4 5 1 5 4 1 6 2 1 7 0 1 8 2 1 8 7

9 9 9 1 7 5 1 7 8 1 8 7 2 0 0 2 1 7 2 4 9 2 5 7 1 5 1 1 5 4 1 6 1 1 7 0 1 8 3 1 9 6

2 0 2

1 0 1 0 9 1 8 1 1 8 4 1 9 6 2 1 0 2 3 1 2 6 2 2 7 4 1 5 6 1 6 0

1 6 6 1 8 0 1 9 1 2 0 9 2 2 1

1 1 1 1 9 1 8 6 1 9 0 2 0 2 2 2 3

2 4 4 2 6 1 2 8 0 1 5 9 1 6 5 1 7 3

1 8 3 1 9 5 2 0 5 2 3 0

1 2 1 2 9 1 9 3

2 0 0 2 1 4 2 3 2 2 5 4 2 8 2 3 0 3 1 6 7 1 7 1 1 8 2

1 9 5 2 1 0 2 2 3 2 4 1

1 3 1 3 9 1 9 4 2 1 1 2 2 8

2 4 7 2 6 3 2 8 6 3 0 1 1 7 2 1 7 9

1 9 6 2 1 1 2 2 6 2 3 8 2 4 5

1 4 1 4 9 2 2 0 2 2 6 2 3 7 2 5 3 2 8 3 3 0 3 3 2 2 1 8 9 1 9 9 2 1 2 2 2 3 2 4 0 2 6 0 2 6 4

1 5 1 5 9 2 2 2

2 2 9 2 4 4 2 6 4 2 8 4 3 1 1 3 2 0 1 9 9

2 0 4 2 1 8 2 3 7 2 5 4 2 6 6 2 7 2

1 6 1 6 9 2 4 4 2 4 8 2 6 2 2 7 8 3 0 3 3 2 4 3 4 3 2 1 3 2 2 5 2 3 4 2 4 9 2 6 9

2 8 7 2 9 6

1 7 1 7 9 2 4 6 2 5 3 2 6 7 2 8 5 3 0 8 3 3 6 3 4 7 2 2 4 2 3 1 2 4 5 2 5 8 2 7 3 2 9 4 3 1 2

1 8 1 8 9 2 4 5

2 6 0 2 7 6 2 9 7 3 2 1 3 5 3 3 7 9 2 2 6 2 3 7 2 5 2 2 6 4 2 8 3

2 9 8 3 2 4

1 9 2 4 9 2 6 2

2 7 2 2 8 8 3 0 8 3 3 1 3 5 5 3 7 2 2 3 8 2 4 5 2 5 7

2 7 3 2 8 9 3 0 9 3 2 1

2 5 3 4 9 2 7 1 2 8 2 3 0 0 3 1 9

3 4 2 3 6 2 3 7 5 2 4 3 2 5 0 2 6 4 2 7 9 2 9 8 3 1 4

3 2 6

3 5 4 4 9 2 7 8 2 8 7 3 0 5 3 2 6 3 4 5 3 6 3 3 7 4 2 4 7 2 5 5 2 6 9

2 8 6 3 0 2 3 1 8 3 2 7

4 5 5 4 9 2 6 7 2 8 1 3 0 1

3 2 2 3 4 2 3 6 2 3 7 6 2 3 9 2 4 9 2 6 5 2 8 1 3 0 0 3 1 5 3 2 6

5 5 6 4 9 2 5 8 2 7 3 2 9 6 3 1 7 3 3 6 3 5 5 3 6 9 2 3 6 2 4 5 2 6 0 2 7 8

2 9 5 3 1 0 3 2 0

6 5 7 4 9 2 4 8 2 6 3 2 8 5 3 0 7 3 2 5 3 4 4

3 5 5 2 2 3 2 3 5 2 5 1 2 6 8 2 8 4 2 9 8 3 0 6

25 42 FR IS A N C H O

1-1.9

2 - 2 . 9

3 - 3 . 9

4-4.9

5 - 5 . 9

6 - 6 . 9

7 - 7 . 9

8-8.9

9-9.9

10- 10 . 9

11- 11 . 9

12- 12 . 9

1 3 1 3 9

14- 14 . 9

15- 15 . 9

16- 16 . 9

17- 17 . 9

1 8- 1 8 .9

19- 24 . 9

25- 34 . 9

3 5 4 4 9

45- 54 . 9

55- 64 . 9

65- 74 . 9

F e ma l e s

1 3 8 1 4 2 1 4 8 1 5 6 1 6 4 1 7 2 1 7 7 1 0 5

1 4 2 1 4 5 1 5 2 1 6 0 1 6 7 1 7 6 1 8 4 1 1 1

1 4 3 1 5 0 1 5 8 1 6 7 1 7 5 1 8 3 1 8 9 1 1 3

1 4 9 1 5 4 1 6 0 1 6 9 1 7 7 1 8 4 1 9 1 1 1 5

1 5 3 1 5 7 1 6 5 1 7 5 1 8 5 2 0 3 2 1 1 1 2 5

1 5 6 1 6 2 1 7 0 1 7 6 1 8 7 2 0 4 2 1 1 1 3 0

1 6 4 1 6 7 1 7 4 1 8 3 1 9 9 2 1 6 2 3 1 1 2 9

1 6 8 1 7 2 1 8 3 1 9 5 2 1 4 2 4 7 2 6 1 1 3 8

1 7 8 1 8 2 1 9 4 2 1 1 2 2 4 2 5 1 2 6 0 1 4 7

1 7 4 1 8 2 1 9 3 2 1 0 2 2 8 2 5 1 2 6 5 1 4 8

1 8 5 1 9 4 2 0 8 2 2 4 2 4 8 2 7 6 3 0 3 1 5 0

1 9 4 2 0 3 2 1 6 2 3 7 2 5 6 2 8 2 2 9 4 1 6 2

2 0 2 2 1 1 2 2 3 2 4 3 2 7 1 3 0 1 3 3 8 1 6 9

2 1 4 2 2 3 2 3 7 2 5 2 2 7 2 3 0 4 3 2 2 1 7 4

2 0 8 2 2 1 2 3 9 2 5 4 2 7 9 3 0 0 3 2 2 1 7 5

2 1 8 2 2 4 2 4 1 2 5 8 2 8 3 3 1 8 3 3 4 1 7 0

2 2 0 2 2 7 2 4 1 2 6 4 2 9 5 3 2 4 3 5 0 1 7 5

2 2 2 2 2 7 2 4 1 2 5 8 2 8 1 3 1 2 3 2 5 1 7 4

22 1 230 2 47 2 65

2 9 0

31 9 34 5 1 79

2 3 3 2 4 0 2 5 6 2 7 7 3 0 4 3 4 2 3 6 8 1 8 3

2 4 1 2 5 1 2 6 7 2 9 0 3 1 7 3 5 6 3 7 8 1 8 6

24 2 256 2 74 2 99 3 28 36 2 38 4 1 87

2 4 3 2 5 7 2 8 0 3 0 3 3 3 5 3 6 7 3 8 5 1 8 7

2 4 0 2 5 2 2 7 4 2 9 9 3 2 6 3 5 6 3 7 3 1 8 5

1 1 1 1 1 7 1 2 4 1 3 2 1 3 9 1 4 3

1 1 4 1 1 9 1 2 6 1 3 3 1 4 2 1 4 7

1 1 9 1 2 4 1 3 2 1 4 0 1 4 6 1 5 2

1 2 1 1 2 8 1 3 6 1 4 4 1 5 2 1 5 7

1 2 8 1 3 4 1 4 2 1 5 1 1 5 9 1 6 5

1 3 3 1 3 8 1 4 5 1 5 4 1 6 6 1 7 1

1 3 5 1 4 2 1 5 1 1 6 0 1 7 1 1 7 6

1 4 0 1 5 1 1 6 0 1 7 1 1 8 3 1 9 4

1 5 0 1 5 8 1 6 7 1 8 0 1 9 4 1 9 8

15 0 15 9 17 0 18 0 190 1 97

1 5 8 1 7 1 1 8 1 1 9 6 2 1 7 2 2 3

1 6 6 1 8 0 1 9 1 2 0 1 2 1 4 2 2 0

1 7 5 1 8 3 1 9 8 2 1 1 2 2 6 2 4 0

17 9 19 0 20 1 21 6 2 32 2 47

1 7 8 1 8 9 2 0 2 2 1 5 2 2 8 2 4 4

1 8 0 1 9 0 2 0 2 2 1 6 2 3 4 2 4 9

1 8 3 1 9 4 2 0 5 2 2 1 2 3 9 2 5 7

1 7 9 1 9 1 2 0 2 2 1 5 2 3 7 2 4 5

1 8 5 1 9 5 2 0 7 2 2 1 2 3 6 2 4 9

1 8 8 1 9 9 2 1 2 2 2 8 2 4 6 2 6 4

1 9 2 2 0 5 2 1 8 2 3 6 2 5 7 2 7 2

1 9 3 2 0 6 2 2 0 2 3 8 2 6 0 2 7 4

19 6 2 09 22 5 2 44 2 66 2 80

19 5 2 08 225 2 44 2 64 2 79

. 2 0 in m ales an d 1 0 0 in f em ale s .

In b o th d c circ u m f e re n c e in c rease s b y ab o u t 1 2 0 in

m ales an d f e m ale s , th e in cre ase w ith ag e in m ale s an d b y ab o u t 7 1 in f e m ale s . In co n -

m u sc le circ u m f e re n c e is le ss m ark e d th an th e trast, th e m u sc le are a w ith in th e sam e ag e

in cre as es o b se rv e d in m u sc le are a. T h e m u s - in te rv al in c rease s m o re th an 3 5 0 in m ale s


4/6

T A B L E 3

Percent i les fo r e stim a te s o f u pp er arm fa t area (m m 2) an d u p p e r a rm m us c le a re a m m 2 fo r w h ite s o f th e U nited

S tates H ealth E x am inat ion S u rv e y I o f 197 1 to 1 97 4

Arm m us cle a re a

p erc en tile s m m2

Arm fa t a re a p erc en tile s

m m 2

g group

5 0 2 5 5 0

75 9 0 9 5 5 1 0 2 5

5 0 7 5 9 0 9 5

M al e s

1 1 9 9 5 6 1 0 1 4 1 1 3 3 1 2 7 8 1 4 4 7 1 6 4 4 1 7 2 0 4 5 2 4 8 6 5 9 0 7 4 1 8 9 5 1 0 3 6 1 1 7 6

2 2 9 9 7 3 1 0 4 0 1 1 9 0 1 3 4 5 1 5 5 7 1 6 9 0 1 7 8 7 4 3 4

5 0 4 5 7 8 7 3 7 8 7 1 1 0 4 4 1 1 4 8

3 3 9 1 0 9 5 1 2 0 1 1 3 5 7 1 4 8 4 1 6 1 8 1 7 5 0 1 8 5 3

4 6 4 5 1 9 5 9 0 7 3 6 8 6 8 1 0 7 1 1 1 5 1

4 4 9 1 2 0 7 1 2 6 4 1 4 0 8 1 5 7 9

1 7 4 7 1 9 2 6 2 0 0 8 4 2 8 4 9 4 5 9 8 7 2 2 8 5 9 9 8 9 1 0 8 5

5 5 9 1 2 9 8 1 4 1 1 1 5 5 0 1 7 2 0 1 8 8 4

2 0 8 9 2 2 8 5 4 4 6 4 8 8 5 8 2 7 1 3 9 1 4 1 1 7 6 1 2 9 9

6 6 9 1 3 6 0 1 4 4 7 1 6 0 5 1 8 1 5 2 0 5 6

2 2 9 7 2 4 9 3 3 7 1 4 4 6 5 3 9 6 7 8 8 9 6 1 1 1 5 1 5 1 9

7 7 9 1 4 9 7 1 5 4 8 1 8 0 8 2 0 2 7 2 2 4 6 2 4 9 4 2 8 8 6 4 2 3 4 7 3 5 7 4 7 5 8 1 0 1 1

1 3 9 3 1 5 1 1

8 8 9 1 5 5 0 1 6 6 4 1 8 9 5 2 0 8 9 2 2 9 6 2 6 2 8

2 7 8 8 4 1 0 4 6 0 5 8 8 7 2 5 1 0 0 3 1 2 4 8 1 5 5 8

9 9 9 1 8 1 1 1 8 8 4 2 0 6 7 2 2 8 8 2 6 5 7

3 0 5 3 3 2 5 7 4 8 5 5 2 7 6 3 5 8 5 9 1 2 5 2 1 8 6 4 2 0 8 1

1 0 1 0 9 1 9 3 0 2 0 2 7 2 1 8 2 2 5 7 5 2 9 0 3 3 4 8 6 3 8 8 2 5 2 3 5 4 3 7 3 8 9 8 2 1 3 7 6 1 9 0 6 2 6 0 9

1 1 1 1 9 2 0 1 6 2 1 5 6 2 3 8 2 2 6 7 0 3 0 2 2 3 3 5 9 4 2 2 6 5 3 6 5 9 5 7 5 4 1 1 4 8 1 7 1 0 2 3 4 8 2 5 7 4

1 2 1 2 9 2 2 1 6 2 3 3 9 2 6 4 9 3 0 2 2

3 4 9 6 3 9 6 8 4 6 4 0 5 5 4 6 5 0 8 7 4 1 1 7 2 1 5 5 8 2 5 3 6 3 5 8 0

1 3 1 3 9 2 3 6 3 2 5 4 6 3 0 4 4 3 5 5 3 4 0 8 1 4 5 0 2 4 7 9 4 4 7 5 5 7 0 8 1 2 1 0 9 6 1 7 0 2 2 7 4 4 3 3 2 2

1 4 1 4 9 2 8 3 0 3 1 4 7 3 5 8 6 3 9 6 3 4 5 7 5 5 3 6 8 5 5 3 0 4 5 3 5 6 3 7 8 6 1 0 8 2 1 6 0 8 2 7 4 6 3 5 0 8

1 5 1 5 9 3 1 3 8 3 3 1 7 3 7 8 8 4 4 8 1 5 1 3 4 5 6 3 1 5 9 0 0 5 2 1 5 9 5 6 9 0 9 3 1 1 4 2 3 2 4 3 4 3 1 0 0

1 6 1 6 9 3 6 2 5 4 0 4 4 4 3 5 2 4 9 5 1 5 7 5 3 6 5 7 6 6 9 8 0 5 4 2 5 9 3 8 4 4 1 0 7 8 1 7 4 6 2 2 8 0 3 0 4 1

1 7 1 7 9 3 9 9 8 4 2 5 2 4 7 7 7 5 2 8 6 5 9 5 0 6 8 8 6 7 7 2 6 5 9 8 6 9 8

8 2 7 1 0 9 6 1 6 3 6 2 4 0 7 2 8 8 8

1 8 1 8 9 4 0 7 0 4 4 8 1 5 0 6 6 5 5 5 2 6 3 7 4 7 0 6 7 8 3 5 5 5 6 0 6 6 5 8 6 0 1 2 6 4 1 9 4 7 3 3 0 2 3 9 2 8

1 9 2 4 9 4 5 0 8 4 7 7 7 5 2 7 4 5 9 1 3 6 6 6 0 7 6 0 6 8 2 0 0 5 9 4 7 4 3 9 6 3 1 4 0 6

2 2 3 1 3 0 9 8 3 6 5 2

2 5 3 4 9 4 6 9 4 4 9 6 3 5 5 4 1 6 2 1 4 7 0 6 7 7 8 4 7 8 4 3 6 6 7 5 8 3 1 1 1 7 4 1 7 5 2 2 4 5 9 3 2 4 6 3 7 8 6

3 5 4 4 9 4 8 4 4 5 1 8 1 5 7 4 0 6 4 9 0 7 2 6 5 8 0 3 4 8 4 8 8 7 0 3 8 5 1 1 3 1 0 1 7 9 2 2 4 6 3 3 0 9 8

3 6 2 4

4 5 5 4 9 4 5 4 6 4 9 4 6 5 5 8 9 6 2 9 7 7 1 4 2 7 9 1 8 8 4 5 8 7 4 9 9 2 2 1 2 5 4

1 7 4 1 2 3 5 9 3 2 4 5 3 9 2 8

5 5 6 4 9 4 4 2 2 4 7 8 3 5 3 8 1 6 1 4 4 6 9 1 9 7 6 7 0 8 1 4 9 6 5 8 8 3 9 1 1 6 6 1 6 4 5 2 2 3 6 2 9 7 6 3 4 6 6

6 5 7 4 9 3 9 7 3 4 4 1 1 5 0 3 1 5 7 1 6 6 4 3 2 7 0 7 4 7 4 5 3 5 7 3 7 5 3 1 1 2 2 1 6 2 1 2 1 9 9 2 8 7 6 3 3 2 7

F e m a l e s

1 1 9 8 8 5 9 7 3 1 0 8 4 1 2 2 1 1 3 7 8 1 5 3 5 1 6 2 1 4 0 1 4 6 6

5 7 8 7 0 6 8 4 7 1 0 2 2 1 1 4 0

2 2 9 9 7 3 1 0 2 9 1 1 1 9 1 2 6 9 1 4 0 5 1 5 9 5 1 7 2 7 4 6 9 5 2 6 6 4 2 7 4 7

8 9 4 1 0 6 1 1 1 7 3

3 3 9 1 0 1 4 1 1 3 3 1 2 2 7

1 3 9 6 1 5 6 3 1 6 9 0 1 8 4 6 4 7 3 5 2 9 6 5 6 8 2 2 9 6 7

1 1 0 6 1 1 5 8

4 4 9 1 0 5 8 1 1 7 1 1 3 1 3 1 4 7 5 1 6 4 4 1 8 3 2 1 9 5 8 4 9 0 5 4 1 6 5 4

7 6 6 9 0 7 1 1 0 9 1 2 3 6

5 5 9 1 2 3 8 1 3 0 1 1 4 2 3 1 5 9 8 1 8 2 5 2 0 1 2 2 1 5 9 4 7 0 5 2 9 6 4 7

8 1 2 9 9 1 1 3 3 0 1 5 3 6

6 6 9 1 3 5 4 1 4 1 4 1 5 1 3 1 6 8 3 1 8 7 7 2 1 8 2 2 3 2 3 4 6 4 5 0 8 6 3 8 8 2 7 1 0 0 9 1 2 6 3 1 4 3 6

7 7 9 1 3 3 0 1 4 4 1 1 6 0 2 1 8 1 5 2 0 4 5 2 3 3 2 2 4 6 9 4 9 1

5 6 0 7 0 6 9 2 0 1 1 3 5 1 4 0 7 1 6 4 4

8 8 9 1 5 1 3 1 5 6 6 1 8 0 8 2 0 3 4 2 3 2 7 2 6 5 7 2 9 9 6 5 2 7 6 3 4 7 6 9

1 0 4 2 1 3 8 3 1 8 7 2 2 4 8 2

9 9 9 1 7 2 3 1 7 8 8 1 9 7 6 2 2 2 7 2 5 7 1 2 9 8 7 3 1 1 2 6 4 2 6 9 0 9 3 3 1 2 1 9 1 5 8 4 2 1 7 1 2 5 2 4

1 0 1 0 9 1 7 4 0 1 7 8 4 2 0 1 9 2 2 9 6 2 5 8 3 2 8 7 3 3 0 9 3 6 1 6 7 0 2 8 4 2 1 1 4 1 1 6 0 8

2 5 0 0 3 0 0 5

1 1 1 1 9 1 7 8 4 1 9 8 7 2 3 1 6

2 6 1 2 3 0 7 1 3 7 3 9 3 9 5 3 7 0 7 8 0 2 1 0 1 5 1 3 0 1 1 9 4 2 2 7 3 0 3 6 9 0

1 2 1 2 9 2 0 9 2

2 1 8 2 2 5 7 9 2 9 0 4 3 2 2 5 3 6 5 5 3 8 4 7 7 8 2 8 5 4 1 0 9 0 1 5 1 1

2 0 5 6 2 6 6 6 3 3 6 9

1 3 1 3 9 2 2 6 9 2 4 2 6 2 6 5 7 3 1 3 0

3 5 2 9 4 0 8 1 4 5 6 8 7 2 6 8 3 8

1 2 1 9 1 6 2 5 2 3 7 4 3 2 7 2 4 1 5 0

1 4 1 4 9 2 4 1 8 2 5 6 2 2 8 7 4

3 2 2 0 3 7 0 4 4 2 9 4 4 8 5 0 9 8 1 1 0 4 3 1 4 2 3 1 8 1 8 2 4 0 3 3 2 5 0 3 7 6 5

1 5 1 5 9 2 4 2 6 2 5 1 8 2 8 4 7 3 2 4 8 3 6 8 9 4 1 2 3 4 7 5 6 8 3 9 1 1 2 6 1 3 9 6

1 8 8 6 2 5 4 4 3 0 9 3 4 1 9 5

1 6 1 6 9 2 3 0 8 2 5 6 7

2 8 6 5 3 2 4 8 3 7 1 8 4 3 5 3 4 9 4 6 1 1 2 6 1 3 5 1 1 6 6 3 2 0 0 6 2 5 9 8 3 3 7 4 4 2 3 6

1 7 1 7 9 2 4 4 2 2 6 7 4 2 9 9 6 3 3 3 6 3 8 8 3

4 5 5 2 5 2 5 1 1 0 4 2 1 2 6 7 1 4 6 3 2 1 0 4 2 9 7 7 3 8 6 4 5 1 5 9

1 8 1 8 9 2 3 9 8 2 5 3 8 2 9 1 7 3 2 4 3

3 6 9 4 4 4 6 1 4 7 6 7 1 0 0 3 1 2 3 0 1 6 1 6 2 1 0 4 2 6 1 7 3 5 0 8 3 7 3 3

1 9 2 4 9 2 5 3 8 2 7 2 8 3 0 2 6 3 4 0 6

3 8 7 7 4 4 3 9 4 9 4 0 1 0 4 6 1 1 9 8

1 5 9 6 2 1 6 6 2 9 5 9 4 0 5 0 4 8 9 6

2 5 3 4 9 2 6 6 1

2 8 2 6 3 1 4 8 3 5 7 3 4 1 3 8 4 8 0 6 5 5 4 1 1 1 7 3 1 3 9 9

1 8 4 1 2 5 4 8 3 5 1 2 4 6 9 0 5 5 6 0

3 5 4 4 9 2 7 5 0 2 9 4 8

3 3 5 9 3 7 8 3 4 4 2 8 5 2 4 0 5 8 7 7 1 3 3 6 1 6 1 9 2 1 5 8 2 8 9 8 3 9 3 2 5 0 9 3 5 8 4 7

4 5 5 4 9 2 7 8 4 2 9 5 6

3 3 7 8 3 8 5 8 4 5 2 0 5 3 7 5 5 9 6 4 1 4 5 9 1 8 0 3

2 4 4 7 3 2 4 4 4 2 2 9 5 4 1 6 6 1 4 0

5 5 6 4 9 2 7 8 4 3 0 6 3 3 4 7 7 4 0 4 5 4 7 5 0 5 6 3 2 6 2 4 7 1 3 4 5 1 8 7 9 2 5 2 0

3 3 6 9 4 3 6 0 5 2 7 6 6 1 5 2

6 5 7 4 9 2 7 3 7 3 0 1 8 3 4 4 4 4 0 1 9

4 7 3 9 5 5 6 6 6 2 1 4 1 3 6 3 1 6 8 1 2 2 6 6

3 0 6 3 3 9 4 3 4 9 1 4 5 5 3 0

U PPE R A R M FA T A N D M U S C L E A R E A S T A N D A R D S

2543

an d ab o u t 1 9 0 in f e m ales . In o th er w o rd s,

b o th th e tric ep s s k in f o ld th ic k n e ss an d esti-

m ate s o f m u sc le circ u m f e re n c e u n d ere stim ate

th e m ag n itu d e o f th e tissu e c h an g e s in th e

u p p e r arm . T h is f in d in g is n o t su rp ris in g in

v ie w o f th e f act th at it tak e s m o re f at to c o v e r

a larg e r lim b w ith a g iv e n th ic k n e ss o f s u b -

cu tan e o u s f at th an it d o e s to c o v e r a s m aller

lim b w ith a c o m p arab le th ic k n es s . A c c o rd -

in g ly , tw o in d iv id u als w ith th e sam e tric ep s


5/6

2 5 4 4

F R I SA NCHO

sk in fo ld th ickn ess b u t d iffe ren t a rm c ircum -

fe ren ce m ay d iffer d ra stica lly in th e a rea o f

fa t an d m u sc le. F o r exam ple , a 6 -y r-o ld boy

w ith a triceps sk in fo ld th ickn es s o f4 m m and

a rm c ircum fe ren ce o f 15 0 m m w ould b e b e-

low th e 5 th p e rcen tile fo r sk in fo ld th ickn es s

an d a rm m usc le c ircum ference. H ow ev e r, if

h is a rm circum ference equa led ab ou t 180 m m

50 th p ercen tile , h e w ou ld have abou t 40 0

m m 2 of fa t a rea and 2100 m m 2 o f m uscle

a rea , w h ich w ou ld p lace h im be tw een the 5 th

and 10 th p ercen tile fo r fa t a rea an d b etw een

the 7 5 th and 90 th pe rcen tile fo r m usc le a rea .

B ased on th e triceps sk in fo ld alo ne , a ch ild

cou ld be c la ssif ied as seve re ly dep le ted o f

calo rie rese rves, w hen in fact he has ad equa te

re se rv es o f bo th ca lo r ie s and pro te ins . It is

ev iden t tha t the se p rob lem s can b e avo id ed

by co nve rting the tr iceps sk in fo ld th ickn es s

and arm c ircum fe ren ce in to fat and m uscle

a rea s. P re sen t s tud ie s in ch ild ren and adu lts

ind ica te th a t fa t a rea s a re system a tically b et-

te r e stim a to rs o f w eig h t o f fa t th an sk in fo ld

th ickn es s 8 . P rev iou s resea rch ind ica te s th at

d iffe ren ces in fa t an d m usc le a rea s are as so -

c iated w ith p ren ata l an d po stna ta l g row th

d ifferences

2 , 9 , 10 .

For these rea son s, it is

recom m ended tha t asses sm en t o f nu tritio na l

sta tu s du rin g grow th an d ad u ltho od be m ade

w ith re fe ren ce to fat and m u sc le a rea s. N ow

tha t hand calcu la to rs a re read ily av ailab le ,

the calcu la tion o f fat an d m u sc le a rea a re

easily pe rfo rm ed . T hey can a lso be o b ta ined

by in te rpo la tion from pub lished nom ogram s

1 1 .

T he p ercen tiles fo r tric eps sk in fo lds and

m u sc le area o f th e p re sen t s tudy a re sy stem -

a tically g rea ter than those g iven in the T en-

S ta te N u tr ition Su rvey 1 . S ince the p resen t

stu dy is based upon a la rge and rep re sen ta tiv e

A m erican sam ple an d since the use fu lness

and v alid ity o f th e an th rop om etr ic a sse ss-

m en t dep en ds o n th e use o f ap pro priate stan -

d ards, it is recom m ended tha t th ese m ore

approp ria te new norm s rep lace those cu r-

ren tly in use 1 . T hese new norm s shou ld be

u sed in con junc tion w ith the n ew w eig h t-fo r-

he igh t pe rcen tile s fo r ch ild ren and adu lts

pu b lish ed in the U nited S ta te s N a tion al

H ea lth S ta tis tic s 1 2 , 1 3 . S ince th ese tw o

no rm s are based on the sam e sam ples and

use the sam e age and pe rcen tile g rou ps, they

prov id e the in vestiga to r w ith a un ifo rm re f-

e rence upon w hich to d iagno se nu tr itiona l

sta tu s du ring grow th and ad u ltho od , an d

avo id cu rren t d iagno stic p rob lem s asso cia ted

w ith the u se o f d iffe ren t se ts o f an th ro pom e t-

ric s tan da rd s 1 4 -16 . O f cou rse , the va lid ity

o f any an th ro pom e tric stan da rd d ep en ds o n

the use to w hich it is g iven , bu t in gene ral

they sho u ld b e rela ted to a func tio na l ou t-

com e such as m orta lity if it is to be o f p ub lic

hea lth v alu e. A fina l cavea t is tha t th e p re sen t

no rm s sh ou ld n o t b e u sed to asse ss ag in g

trend s in m uscle size . Th is is due to the fac t

tha t a fte r the age o f 4 0 yr , the com pressib ility

o f fa t in m a le s an d fem ale s inc rea se s d isp ro -

po rtion ate ly w h ich resu lts in an o ve re stim a-

tion of m usc le an d an unde re stim atio n of fa t

a r ea .

R e fe r en ces

1 . F ris ancho AR . T ric eps sk in fo ld an d upper arm m u s-

dc s ize n orm s for assessm ent o f n u tr itio nal sta tu s.

J C lin N u tr 197 4:2 7 :1 05 2-7 .

2 . F n isancho A R . Ro le of calorie an d pro tein rese rve s

o n hum an g row th du ring ch ildho od and ado lesc enc e

in a M est izo P eru v ian p opula tion . In : G reene LS .

Joh nsto n FE . ed s. S ocial and bio log ical p red icto rs o f

n u tr itio nal sta tus , phy sic al g row th and behav ioral

d ev elopm ent. N ew Yo rk : A cadem ic P ress, 1 980 :49 -

58 .

3 . G arn SM , C lark D . G uire K E . G row th , b od y com -

posi tion and developm en t o f ob ese and le an ch il-

d ren . In : W in ick M , ed . Childh ood obe sity . N ew

Y ork : Jo hn W iley an d S on s, 197 5:2 3-4 6 .

4 . J elli ffe D B . T he a sse ssm en t of the nu trit ion al sta tus

o f th e com m unity . W H O M onog rap h no . 53 . G e -

n eva : W HO , 1966 .

5 . B istn ian BR , B lackb urn GL , S crim sh aw NS . F la tt

JP . C e llu lar im m unity in sem ista rved sta tes in ho s-

p ita l ized adu lts . Am J C lin N utn 1975:28 : 1 148-55 .

6 . N ation al C enter fo r H eal th S tat istics. P rel im inary

fin d in gs of the f irst he alth and nutritio n exam ina tio n

surv ey . U nited S tates, 1 971 -19 72 : an thropom e tn ic

an d clin ic al fin d in gs. R o ck ville , M D : N a tio nal C en-

te n for H eal th S tatistic s, 197 5 . Se ries : U n ite d S tates

D epar tm ent o f H eal th , E du cation an d W elfare .

ID HE W publicat ion no . H RA 75-1219-2 .]

7 . M a lin a R M , Jo hns ton FE . R e lations b etw een bone,

m u scle an d fat w id th s in th e u ppe r arm s and ca lve s

of bo ys and g irls stu d ied cross -sec tio nal ly a t age s 6-

1 6 y ea r s Hu m B i o l 1 9 6 7 : 3 9 : 2 1 1 2 3

8 . H im es JH , R och e A F , W ebb P . Fa t are as a s esti -

m ate s of to ta l bo dy fa t. A m J C lin N u tr 198 0:3 3 :

2093-100 .

9 . Fn isan ch o A R , K laym an JE , M a tos J. In flu enc e o f

m a ternal n u tr itio na l sta tus of prena tal g row th in a

P eru v ian urban p opu lat ion . Am J P hys A nthro p

1977:46 :265-74 .

1 0 . F n isan cho A R , K laym an JE , M atos J. N ew born

body com pos itio n and its re la tio nsh ip to line ar


6/6

U PPE R A R M FA T A N D M U S C L E A R E A S T A N D A R D S

5 5

gr ow t h . m J C lin N u tr l97 7;3 0:7 04 -1 1 .

1 1 . G u rne y JM , Je llif f e D B . A rm an th rop om etry in

nu trit ion al as ses sm en t: N o m o gram f o r rap id calcu -

lat ion o f m u scle c ircu m f e ren ce and cro ss- sec tio nal

m u sc le and f at areas. A m J C lin N u tr 19 73:26:912 -

15 .

1 2 . N atio nal C e n te r f or H eal th S tatis tics . N C H S g row th

c urv es f o r ch ild ren b irth - 1 8 y e ars . U n ited S tates.

R o ck v ille , M D : N ation al C e n te r f or H e alth S tatis -

tic s, 19 77 . (V ital and h eal th statistics S eries 1 1 : D ata

f ro m the N ation al H eal th S urv ey . no . 16 5) ID H E W

pu b lic ation n o . (PH S ) 78 -16 50 .]

13 . N at ion al C en ter f o r H eat lh S tatis tics . W eig h t by

h eig ht a nd a ge fo r a du lts 18 -74 y e ars : U n ited S tate s,

19 71-197 4 . R oc k v ille , M D : N ational C e n te r f o r

H e alth S tat istics, 19 79 . (V ital an d he alth s tatistic s.

S eries 1 1 : D ata f ro m the N atio nal H eal th S urv ey .

no . 2 08 ) [D H E W p ub licatio n no . (PH S ) 7 9-1 656 .]

1 4 . B urgert S I, A nd ers on C F. A n ev alu atio n o f up per

arm m easurem en ts u sed in nu trit ion al asse ssm en t.

m J C lin N utr 19 79:32:213 6-42 .

15 . G ray G E . G ray L K . V al id i ty o f an thro pom etn ic

nor m s

used

in the ass ess m en t

of

hos p italiz ed p a-

tie n ts . JPE N 1 97 9:3 :36 6-8 .

1 6 . B is tn ian B R , B lack b urn G L , V itale J, C oc hran D ,

N ay lo r J.

Prevalence ofm alnutnition

in g en eral m c d-

ical patie n ts . JA M A 197 6:2 3 1 S 6 7-7 0 .

Am J Clin Nutr 1981 Frisancho 2540 5

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