New norms of upper limb fat and muscle

for assessment
of nutritional
status1
A

Roberto

Frisancho,2

Ph.D.

ABSTRACT
ence

ofa

States

areas

Based

on

cross-sectional

Health

and

measurements

sample

of triceps

of 19,097

Nutritional

white

Examination

Survey

arm muscle area. and arm fat area were calculated.

all three

estimates

of upper

it is recommended

that
rather

than

that

norms

should

new

tissues

assessments

areas ofmuscle
these

arm
direct

were

replace

those

Thereafter,
Based

currently

the

arm

upper

arm

arm
from

muscle

age- and sex-specific

on empirical

be made

and

and

1 to 74 yr. derived

197 1 to 1974,

status

thickness

thickness

aged

of

obtained.

of nutritional
skinfold

skinfold

subjects

and

on

the

in use.

Am.

J. Clin.

United

circumference,
percentiles

theoretical

basis

circumference.

circumferthe

for

evidence.

of areas

of fat

It is also

recommended

Nutr.

34: 2540-2545,

and

KEY

WORDS

Growth,

standards,

nutritional

Introduction

The

American

Journal

ofClinical

Nutrition

arm

fat

areas.

arm

muscle

areas

States,
collected
during
197 1 and
1974.
Therefore,
the purpose
of the present
study
is
to provide
new percentiles
for triceps
skinfolds,
and estimates
of upper
arm
fat and
muscle
area
derived
from
anthropometric
measurements
of white
samples
of HANES
I.

In recent
years anthropometric
evaluations
of the upper
limb
have
become
valuable
in
the assessment
of nutritional
status
of children and adults.
This is based on the evidence
that
the organism,
when
faced
with
nutritional
restriction,
utilizes
its nutritional
reserves
stored
in the form
of skeletal
muscle
protein,
visceral
protein,
and fat. It is assumed
that the triceps
skinfold
thickness
indicates
the calorie
reserves
stored
in the form of fat
(1-4),
and the arm
muscle
size reflects
the
reserves
of muscle
protein
( 1 , 2, 4),
while the
levels of circulating
protein,
such as transferrin or albumin
indicate
the visceral
protein
status
(5). In a previous
study,
we have published
percentiles
for triceps
skinfolds
and
estimates
of muscle
area
for whites
derived
from the Ten-State
Nutrition
Survey
(1). Although
this survey
included
individuals
from
middle
and upper
income
levels,
the sample
was heavily
weighted
toward
the lower
income
groups
in each state
(1). Hence,
it did
not constitute
a national
population
sample.
Furthermore,
this study
did not give information
for subjects
older
than 44 yr, and its
applicability
to older
subjects
is limited.
For
this reason,
and in view of the wide
spread
use of these norms,
we have decided
to derive
new and more
applicable
standards
from the
data
sets of the Health
and Nutritional
Examination
Survey
I (HANES
I) ofthe
United
2540

status,

Materials

and

methods

Sample
This study
is based
upon
a cross-sectional
sample
of
19.097 white
subjects
aged
1 to 74. of whom
8.204 were
males
and 10.893 were females
derived
from the Health
and Nutritional
Examination
Survey
I data
sets.
The
data were collected
during April
1971 and June
1974
and the sample
was selected
from
the National
Probability sample
that represented
the civilian
noninstitutionalized
population
of whites.
The sample
size for blacks
was too small to be included
as part ofthe
present
norms.
The mean
values
for triceps
skinfold
of ages 1 to 17 for
the yr of 1971 to 1972 have been previously
published
(6). However,
neither
the data for triceps
skinfolds
after
17 yr old nor any triceps
skinfold
measurements
for any
ages during
the yr 1973 to 1974 have
been
published.
Similarly.
none of the data for upper
arm circumference
has been published
before.
Measurements

Upper
nearest

ment

cm

From

the

and

the

of Michigan,
2

34:

arm circumference
(cm) was measured
with a steel tape with the night arm

Research

NOVEMBER

Center

for

Department
Ann Arbor,
Scientist.

1981,

1981 American

Human

Growth

and

of Anthropology.
MI 48109.

pp.

2540-2545.
Printed
Society
for Clinical

to the
hanging

DevelopUniversity

in U.S.A.
Nutrition

Downloaded from www.ajcn.org by guest on April 11, 2011

1981.

UPPER

ARM

FAT

AND

MUSCLE

of/at

and

muscle

areas

Upper
arm area
(A ), upper
arm
muscle
area
( M ).
and upper
arm fat area ( F) were derived
from measures
of upper
arm circumference
( C) converted
to mm (c)
and triceps
skinfold
( T) using the procedures
and restrictions indicated
previously
( I ). I ) A was calculated
by the
computation:

, where

IT

A (mm2)
calculated

by computation

M(mm2)

(C

41T

3) F(mm2)

was

derived

as follows:

F(mm2)
All these
Thereafter,
muscle
and

skinfold
for whites
Examination
Survey

Table
centiles
present

I gives the sample

size and the perof triceps
skinfolds.
Tables
2 and 3
the percentiles
for arm circumference,

terms

discussion

muscle
circumference,
and muscle
area.

esti-

of the United
I of 1971 to

of

fat

area.

For

example,

between

and 30 yr, the fat area in males

increases
by
about
90 and 200% in females,
whereas
the
increase
in triceps
skinfold
amounts
to only

estimates
were calculated
for each subject.
ageand
sex-specific
percentiles
for arm
arm
fat areas
were
calculated.
As pointed

TABLE
1
Percentiles
for triceps
Health
and Nutrition

and

As shown
by the 50th percentile
values,
the
following
points
are evident:
1) in both males
and females
the increase
with age in upper
arm fat is more
evident
when
expressed
in

irT)2

Furfor

Results

estimated
arm
mated
arm fat,

as follows:

proportionately.
does
not
adjust

States
1974

Triceps

skinfold

90

95

percentiles

(mm2)

Age group
n

25

50

75

Males
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
13-13.9
14-14.9
15-15.9
16-16.9
17-17.9
18-18.9
19-24.9
25-34.9
35-44.9
45-54.9
55-64.9
65-74.9

228
223
220
230
214
117
122
117
121
146
122
153
134
131
128
131
133
91
531
971
806
898
734
1503

6
6
6
6
6
S
S
5
6
6
6
6
S
4
4
4
5
4
4
5
5
6
5
4

7
7
7
6
6
6
6
6
6
6
6
6
S
S
5
5
5
S
5
6
6
6
6
6

8
8
8
8
8
7
7
7
7
8
8
8
7
7
6
6
6
6
7
8
8
8
8
8

25

50

75

90

95

10
10
11
10
10
10
11
12
13
12
13
14
15
16
17
18
19
18
18
21
23
25
25
24

12
12
12
12
12
12
13
15
16
17
18
18
21
21
21
22
24
22
24
27
29
30
31
29

14
15
14
14
15
14
16
18
20
23
24
23
26
26
25
26
30
26
30
34
35
36
36
34

16
16
15
16
18
16
18
24
22
27
28
27
30
28
32
31
37
30
34
37
38
40
38
36

Females
10
10
10
9
9
8
9
8
10
10
11
11
10
9
8
8
8
9
10
12
12
12
11
11

12
12
II
11
11
10
12
10
13
14
16
14
14
14
11
12
12
13
15
16
16
15
14
15

14
14
14
12
14
13
15
13
17
18
20
22
22
21
18
16
16
20
20
20
20
20
19
19

16
15
15
14
15
16
17
16
18
21
24
28
26
24
24
22
19
24
22
24
23
25
22
22

204
208
208
208
219
118
126
118
125
152
117
129
151
141
117
142
114
109
1060
1987
1614
1047
809
1670

6
6
7
7
6
6
6
6
8
7
7
8
8
9
8
10
10
10
10
10
12
12
12
12

7
8
8
8
7
6
7
8
8
8
8
9
8
10
10
12
12
12
11
12
14
16
16
14

8
9
9
8
8
8
9
9
10
10
10
11
12
13
12
15
13
15
14
16
18
20
20
18

Downloaded from www.ajcn.org by guest on April 11, 2011

2) M was

2541

ing that bone

and muscle
increase
then,
the estimation
of fat area
variable
skinfold
compressibility.

d2

STANDARDS

out in previous
publications
( I ) the calculations
of upper
arm fat and muscle
areas are only approximations.
First,
the
formulas
utilized
assume
that
the
upper
arm
is
cylindrical
in form,
an assumption
subject
to some
inaccuracy.
Second,
the estimates
of muscle
area
do not
take into account
the humeral
diameter.
and any vaniation in humeral
diameter
is therefore
not accountable.
However,
a radiographic
study
of arm composition
of
white children
found
the same ratio of muscle
to bone
in
both sexes and before
and after adolescence
(7). suggest-

relaxed.
The measurement
was taken
midway
between
the tip of the acromion
and otecranon
process.
Triceps
skinfold
(mm)
was measured
to the nearest
mm with a
Lange
skinfold
caliper
having
a pressure
of 10 g/mm2
of
contact
surface
area.
The measurement
was taken
over
the triceps muscle halfway
between
the elbow
and the
acromial
process
ofthe
scapula.
with the skinfold
parallel
to the longitudinal
axis of the upper
arm (6).
Estimates

AREA

2542

FRISANCHO

TABLE
2
Percentiles
of upper arm circmference
(mm) and estimated
muscle
circumference
(mm)
for whites
of the United
States
and Nutrition
Examination
Survey
I of 1971 to 1974
Arm

circumference

upper
Health

arm

Arm muscle

(mm)

circumference

(mm)

Age group
S

25

50

75

90

95

10

25

50

75

90

95

110
111
117
123
128
131
137
140
151
156
159
167
172
189
199
213
224
226
238
243
247
239
236
223

113
114
123
126
133
135
139
145
154
160
165
171
179
199
204
225
231
237
245
250
255
249
245
235

119
122
131
133
140
142
151
154
161
166
173
182
196
212
218
234
245
252
257
264
269
265
260
251

127
130
137
141
147
151
160
162
170
180
183
195
211
223
237
249
258
264
273
279
286
281
278
268

135
140
143
148
154
161
168
170
183
191
195
210
226
240
254
269
273
283
289
298
302
300
295
284

144
146
148
156
162
170
177
182
196
209
205
223
238
260
266
287
294
298
309
314
318
315
310
298

147
150
153
159
169
177
190
187
202
221
230
241
245
264
272
296
312
324
321
326
327
326
320
306

Males
142
141
150
149
153
162
162
175
181
186
193
194
220
222
244
246
245
262
271
278
267
258
248

146
145
153
154
160
159
167
170
178
184
190
200
211
226
229
248
253
260
272
282
287
281
273
263

150
153
160
162
167
167
177
177
187
196
202
214
228
237
244
262
267
276
288
300
305
301
296
285

159
162
167
171
175
179
187
190
200
210
223
232
247
253
264
278
285
297
308
319
326
322
317
307

170
170
175
180
185
188
201
202
217
231
244
254
263
283
284
303
308
321
331
342
345
342
336
325

176
178
184
186
195
209
223
220
249
262
261
282
286
303
311
324
336
353
355
362
363
362
355
344

183
185
190
192
204
228
230
245
257
274
280
303
301
322
320
343
347
379
372
375
374
376
369
355

6-6.9
7-7.9
8-8.9
9-9.9
10-10.9
11-11.9
12-12.9
13- 13.9

138
142
143
149
153
156
164
168
178
174
185
194
202

142
145
150
154
157
162
167
172
182
182
194
203
211

148
152
158
160
165
170
174
183
194
193
208
216
223

156
160
167
169
175
176
183
195
211
210
224
237
243

164
167
175
177
185
187
199
214
224
228
248
256
271

172
176
183
184
203
204
216
247
251
251
276
282
301

177
184
189
191
211
211
231
261
260
265
303
294
338

105
111
113
115
125
130
129
138
147
148
150
162
169

111
114
119
121
128
133
135
140
150
150
158
166
175

117
119
124
128
134
138
142
151
158
159
171
180
183

124
126
132
136
142
145
151
160
167
170
181
191
198

132
133
140
144
151
154
160
171
180
180
196
201
211

139
142
146
152
159
166
171
183
194
190
217
214
226

143
147
152
157
165
171
176
194
198
197
223
220
240

14-14.9
15-15.9
16-16.9
17-17.9
18- 18.9
19-24.9
25-34.9
35-44.9

214
208
218
220
222
221
233
241

223
221
224
227
227
230
240
251

237
239
241
241
241
247
256
267

252
254
258
264
258
265
277
290

272
279
283
295
281
290
304
317

304
300
318
324
312
319
342
356

322
322
334
350
325
345
368
378

174
175
170
175
174
179
183
186

179
178
180
183
179
185
188
192

190
189
190
194
191
195
199
205

201
202
202
205
202
207
212
218

216
215
216
221
215
221
228
236

232
228
234
239
237
236
246
257

247
244
249
257
245
249
264
272

45-54.9
55-64.9
65-74.9

242
243
240

256
257
252

274
280
274

299
303
299

328
335
326

362
367
356

384
385
373

187
187
185

193
196
195

206
209
208

220
225
225

238
244
244

260
266
264

274
280
279

155

Females
1-1.9
2-2.9
3-3.9
4-4.9
5-5.9

20% in males
and
males
and females,
muscle
circumference
increases
observed

100% in females.
2) In both
the increase
with age in
is less marked
than the
in muscle
area. The mus-

dc circumference
increases
by about
120% in
males
and by about
7 1% in females.
In contrast,
the muscle
area
within
the same
age
interval
increases
more
than
350% in males

Downloaded from www.ajcn.org by guest on April 11, 2011

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
13-13.9
14-14.9
15-15.9
16-16.9
17-17.9
18-18.9
19-24.9
25-34.9
35-44.9
45-54.9
55-64.9
65-74.9

UPPER
TABLE
3
Percentiles
for estimates
States
Health
Examination
Arm

ARM

of upper

AND

arm fat area (mm2)

I of 1971 to 1974

Survey
muscle

FAT

area

percentiles

MUSCLE

and

upper

AREA

2543

STANDARDS

arm muscle area (mm2) for whites

Arm

(mm2)

fat area

of the

United

percentiles

(mm2)

50

75

90

95

Age group
5

25

50

75

90

95

10

25

Males
956
973
1095
1207
1298
1360
1497
1550
1811
1930
2016
2216
2363
2830
3138
3625
3998
4070
4508
4694
4844
4546
4422
3973

1014
1040
1201
1264
1411
1447
1548
1664
1884
2027
2156
2339
2546
3147
3317
4044
4252
4481
4777
4963
5181
4946
4783
4411

1133
1190
1357
1408
1550
1605
1808
1895
2067
2182
2382
2649
3044
3586
3788
4352
4777
5066
5274
5541
5740
5589
5381
5031

1278
1345
1484
1579
1720
1815
2027
2089
2288
2575
2670
3022
3553
3963
4481
4951
5286
5552
5913
6214
6490
6297
6144
5716

1447
1557
1618
1747
1884
2056
2246
2296
2657
2903
3022
3496
4081
4575
5134
5753
5950
6374
6660
7067
7265
7142
6919
6432

1644
1690
1750
1926
2089
2297
2494
2628
3053
3486
3359
3968
4502
5368
5631
6576
6886
7067
7606
7847
8034
7918
7670
7074

1720
1787
1853
2008
2285
2493
2886
2788
3257
3882
4226
4640
4794
5530
5900
6980
7726
8355
8200
8436
8488
8458
8149
7453

452
434
464
428
446
371
423
410
485
523
536
554
475
453
521
542
598
560
594
675
703
749
658
573

486
504
519
494
488
446
473
460
527
543
595
650
570
563
595
593
698
665
743
831
851
922
839
753

590
578
590
598
582
539
574
588
635
738
754
874
812
786
690
844
827
860
963
1174
1310
1254
1166
1122

741
737
736
722
713
678
758
725
859
982
1148
1172
1096
1082
931
1078
1096
1264
1406
1752
1792
1741
1645
1621

895
871
868
859
914
896
1011
1003
1252
1376
1710
1558
1702
1608
1423
1746
1636
1947
2231
2459
2463
2359
2236
2199

1036
1044
1071
989
1176
1115
1393
1248
1864
1906
2348
2536
2744
2746
2434
2280
2407
3302
3098
3246
3098
3245
2976
2876

1176
1148
1151
1085
1299
1519
1511
1558
2081
2609
2574
3580
3322
3508
3100
3041
2888
3928
3652
3786
3624
3928
3466
3327

466
526
529
541
529
508
560
634
690
702
802
854
838
1043
1126
1351
1267
1230
1198
1399
1619
1803
1879
1681

578
642
656
654
647
638
706
769
933
842
1015
1090
1219
1423
1396
1663
1463
1616
1596
1841
2158
2447
2520
2266

706
747
822
766
812
827
920
1042
1219
1141
1301
1511
1625
1818
1886
2006
2104
2104
2166
2548
2898
3244
3369
3063

847
894
967
907
991
1009
1135
1383
1584
1608
1942
2056
2374
2403
2544
2598
2977
2617
2959
3512
3932
4229
4360
3943

1022
1061
1106
1109
1330
1263
1407
1872
2171
2500
2730
2666
3272
3250
3093
3374
3864
3508
4050
4690
5093
5416
5276
4914

1140
1173
1158
1236
1536
1436
1644
2482
2524
3005
3690
3369
4150
3765
4195
4236
5159
3733
4896
5560
5847
6140
6152
5530

Females
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
13-13.9
14-14.9
15-15.9
16-16.9
17-17.9
18-18.9
19-24.9
25-34.9
35-44.9
45-54.9
55-64.9
65-74.9

885
973
1014
1058
1238
1354
1330
1513
1723
1740
1784
2092
2269
2418
2426
2308
2442
2398
2538
2661
2750
2784
2784
2737

973
1029
1133
1171
1301
1414
1441
1566
1788
1784
1987
2182
2426
2562
2518
2567
2674
2538
2728
2826
2948
2956
3063
3018

1084
1119
1227
1313
1423
1513
1602
1808
1976
2019
2316
2579
2657
2874
2847
2865
2996
2917
3026
3148
3359
3378
3477
3444

1221
1269
1396
1475
1598
1683
1815
2034
2227
2296
2612
2904
3130
3220
3248
3248
3336
3243
3406
3573
3783
3858
4045
4019

1378
1405
1563
1644
1825
1877
2045
2327
2571
2583
3071
3225
3529
3704
3689
3718
3883
3694
3877
4138
4428
4520
4750
4739

1535
1595
1690
1832
2012
2182
2332
2657
2987
2873
3739
3655
4081
4294
4123
4353
4552
4461
4439
4806
5240
5375
5632
5566

1621
1727
1846
1958
2159
2323
2469
2996
3112
3093
3953
3847
4568
4850
4756
4946
5251
4767
4940
5541
5877
5964
6247
6214

and about
190% in females.
In other
words,
both
the triceps
skinfold
thickness
and estimates of muscle
circumference
underestimate
the magnitude
of the tissue
changes
in the
upper
arm. This finding
is not surprising
in

401
469
473
490
470
464
491
527
642
616
707
782
726
981
839
1126
1042
1003
1046
1173
1336
1459
1345
1363

view of the fact that it takes more fat to cover

a larger
limb with a given
thickness
of subcutaneous
fat than it does to cover
a smaller
limb
with
a comparable
thickness.
Accordingly,
two individuals
with the same
triceps

Downloaded from www.ajcn.org by guest on April 11, 2011

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
13-13.9
14-14.9
15-15.9
16-16.9
17-17.9
18-18.9
19-24.9
25-34.9
35-44.9
45-54.9
55-64.9
65-74.9

2544

FRISANCHO

erence
upon
which
to diagnose
nutritional
status
during
growth
and
adulthood,
and
avoid
current
diagnostic
problems
associated
with the use of different
sets of anthropometric standards
(14-16).
Of course,
the validity
of any anthropometric
standard
depends
on
the use to which
it is given,
but in general
they should
be related
to a functional
outcome such as mortality
if it is to be of public
health
value.
A final caveat
is that the present
norms
should
not be used
to assess
aging
trends
in muscle
size. This is due to the fact
that after the age of 40 yr, the compressibility
of fat in males
and females
increases
disproportionately
which
results
in an overestimation of muscle
and an underestimation
of fat
area.
References
1. Frisancho
AR. Triceps
skinfold
and upper
arm musdc
size norms
for assessment
of nutritional
status.
Am J Clin Nutr 1974:27:1052-7.
2. Fnisancho
AR. Role of calorie
and protein
reserves
on human
growth
during
childhood
and adolescence
in a Mestizo
Peruvian
population.
In: Greene
LS.
Johnston
FE. eds. Social
and biological
predictors
of
nutritional
status,
physical
growth
and
behavioral
development.
New York:
Academic
Press,
1980:4958.
3. Garn
SM, Clark
D. Guire
KE. Growth,
body composition
and development
of obese
and
lean
children.
In: Winick
M, ed. Childhood
obesity.
New
York:
John
Wiley
and Sons,
1975:23-46.
4. Jelliffe
DB. The assessment
of the nutritional
status
of the community.
WHO
Monograph
no. 53. Geneva: WHO,
1966.
5. Bistnian
BR, Blackburn
GL,
Scrimshaw
NS. Flatt
JP. Cellular
immunity
in semistarved
states
in hospitalized
adults.
Am J Clin Nutn
1975:28:
1 148-55.
6. National
Center
for Health
Statistics.
Preliminary
findings
ofthe
first health
and nutrition
examination
survey.
United
States,
1971-1972:
anthropometnic
and clinical
findings.
Rockville,
MD: National
Centen for Health
Statistics,
1975. Series:
United
States
Department
of Health,
Education
and
Welfare.
IDHEW
publication
no. (HRA)
75-1219-2.]
Malina
RM, Johnston
FE. Relations
between
bone,
muscle
and fat widths
in the upper
arms and calves
of boys and girls studied
cross-sectionally
at ages 616 years. Hum
Biol 1967:39:211-23.
8. Himes
JH, Roche
AF, Webb
P. Fat areas
as estimates
of total
body
fat. Am J Clin
Nutr
1980:33:
2093-100.
9. Fnisancho
AR, Klayman
JE, Matos
J. Influence
of
maternal
nutritional
status
of prenatal
growth
in a
Peruvian
urban
population.
Am
J Phys
Anthrop
1977:46:265-74.
10. Fnisancho
AR,
Klayman
JE,
Matos
J. Newborn
body
composition
and
its relationship
to linear
7.

Downloaded from www.ajcn.org by guest on April 11, 2011

skinfold
thickness
but different
arm circumference
may differ
drastically
in the area of
fat and muscle.
For example,
a 6-yr-old
boy
with a triceps
skinfold
thickness
of4 mm and
arm circumference
of 150 mm would
be below the 5th percentile
for skinfold
thickness
and arm muscle
circumference.
However,
if
his arm circumference
equaled
about
180 mm
(50th
percentile),
he would
have
about
400
mm2 of fat area
and
2100
mm2 of muscle
area, which
would
place him between
the 5th
and 10th percentile
for fat area and between
the 75th and 90th percentile
for muscle
area.
Based
on the triceps
skinfold
alone,
a child
could
be classified
as severely
depleted
of
calorie
reserves,
when in fact he has adequate
reserves
of both
calories
and proteins.
It is
evident
that these
problems
can be avoided
by converting
the triceps
skinfold
thickness
and arm circumference
into fat and muscle
areas.
Present
studies
in children
and adults
indicate
that fat areas
are systematically
better estimators
of weight
of fat than skinfold
thickness
(8). Previous
research
indicates
that
differences
in fat and muscle
areas
are associated
with
prenatal
and
postnatal
growth
differences
(2, 9, 10). For these
reasons,
it is
recommended
that assessment
of nutritional
status
during
growth
and adulthood
be made
with reference
to fat and muscle
areas.
Now
that
hand
calculators
are readily
available,
the calculation
of fat and
muscle
area
are
easily
performed.
They
can also be obtained
by interpolation
from published
nomograms
(1 1).
The
percentiles
for triceps
skinfolds
and
muscle
area of the present
study
are systematically
greater
than those
given
in the TenState
Nutrition
Survey
(1). Since
the present
study is based
upon a large and representative
American
sample
and
since
the usefulness
and
validity
of the anthropometric
assessment depends
on the use of appropriate
standards,
it is recommended
that
these
more
appropriate
new
norms
replace
those
currently
in use ( 1 ). These
new norms
should
be
used in conjunction
with the new weight-forheight
percentiles
for children
and
adults
published
in the
United
States
National
Health
Statistics
(12,
13). Since
these
two
norms
are based
on the same
samples
and
use the same
age and percentile
groups,
they
provide
the investigator
with a uniform
ref-

UPPER

ARM

FAT

AND

growth.
Am J Clin Nutr l977;30:704-1
1.
1 1. Gurney
JM,
Jelliffe
DB.
Arm
anthropometry
in
nutritional
assessment:
Nomogram
for rapid
calculation
of muscle
circumference
and cross-sectional
muscle
and fat areas.
Am J Clin Nutr
1973:26:91215.
12. National
Center
for Health
Statistics.
NCHS
growth
curves
for children
birth1 8 years.
United
States.
Rockville,
MD:
National
Center
for Health
Statistics, 1977. (Vital
and health
statistics.
Series
1 1: Data
from the National
Health
Survey.
no. 165) IDHEW
publication
no. (PHS)
78-1650.]
13. National
Center
for Heatlh
Statistics.
Weight
by
height and age for adults 18-74 years: United
States,

MUSCLE

AREA
1971-1974.

14.

15.

16.

STANDARDS
Rockville,

2545
MD:

National

Center

for

Health
Statistics,
1979. (Vital
and
health
statistics.
Series
1 1 : Data
from
the National
Health
Survey.
no. 208) [DHEW
publication
no. (PHS)
79-1656.]
Burgert
SI, Anderson
CF. An evaluation
of upper
arm
measurements
used
in nutritional
assessment.
Am J Clin Nutr
1979:32:2136-42.
Gray
GE.
Gray
LK.
Validity
of anthropometnic
norms
used in the assessment
of hospitalized
patients.
JPEN
1979:3:366-8.
Bistnian
BR, Blackburn
GL,
Vitale
J, Cochran
D,
Naylor
J. Prevalence
ofmalnutnition
in general
mcdical patients.
JAMA
1976:23:1S67-70.

Downloaded from www.ajcn.org by guest on April 11, 2011