ANTHROPOMETRIC MEASUREMENTS

Anthropometric measurements give you an assessment of the patient's fatness or leanness

and body fat distribution. Does the patient appear fat, thin or wasted? Flabby or
muscular? Could the patient be described as more 'pear-shaped' or more 'apple shaped'
(i.e excess abdominal fat). The methods used to answer these questions are described
below (Body Mass Index, Skinfold thicknesses, Upper arm muscle circumference, waist
to hip circumference). These measures provide additional guides to a patient's adiposity
or 'leanness', and can be used as baseline measures for assessing improvement. They can
be particularly useful if your patient takes up exercise. In this situation total body weight
may not change or may increase due to increased muscle mass, where as fat mass may
have decreased. A change in fat mass due to exercise is often not detected by measuring
weight alone (since muscle is much heavier than fat); measurement of skinfold
thicknesses will be more sensitive to changes in fat mass.

BODY MASS INDEX

The Body Mass Index (BMI) provides a simple, yet accurate method of assessing
whether a patient is at risk from either over-or-underweight. However, a proportionally
greater lean body mass and/or skeletal frame size can contribute to apparent excess body
weight. Many athletes, for example would be considered 'overweight', yet skin-fold tests
show a sub-normal amount of adipose tissue. It can easily be calculated by dividing the
patient's weight (kg) by the square of their height (metres) i.e

BMI = weight (kg)

[(height (m)]2

Many studies have shown that both men and women from 18 years onwards with a BMI between 20-25
have the least risk of morbidity and mortality. The BMI figure more closely reflects adiposity than any
other single weight-for-height relationship.
BMI CLASSIFICATION
Over 30 Obese
25-30 Overweight
20-25 Healthy weight range
20-18 Underweight
<18 Very Underweight

For children and adolescents, special growth charts need to be used.

 Tables of acceptable weight for height for Australians (NHMRC, 1984)
Height cm Body weight kg* Height cm Body weight kg*
(without shoes) (in light clothing & (without shoes) (in light clothing &
without shoes) without shoes)
140 39-49 172 59-74
142 40-50 174 61-76
144 41-52 176 62-77
146 43-53 178 63-79
148 44-55 180 65-81
150 45-56 182 66-83
152 46-58 184 68-85
154 47-59 186 69-86
156 49-61 188 71-88
158 50-62 190 72-90
160 51-64 192 74-92
162 52-66 194 75-94
164 54-67 196 77-96
166 55-69 198 78-98
168 56-71 200 80-100
170 58-72
* Based on a body mass index of 20-25 and applicable to men and women aged 18 years and
over. Body mass index is calculated from weight and height as follows:
Body mass index = Weight in kg/height in m2 rounded to the nearest whole number

Please note: There is emerging evidence from recent migrant groups in Australia (1) that low
death rates from CVD can occur even though there is unexpectedly high prevalences of identified
CVD risk factors (e.g obesity, diabetes, hyperlipidaemia, inactivity, smoking). It may be possible
to develop a more 'benign' form of diabetes or obesity, or it may be possible to counteract other
CVD risk factors, depending upon the kind of foods consumed. For example, becoming
overweight on a traditional Mediterranean diet rich in antioxidants and protective foods (e.g
cereals, pulses, nuts, herbs, fish, fruit, wine and vegetables stewed in olive oil) may not be the
same as becoming overweight on a typical high saturated fat Western diet.
A common misconception is that thin people are necessarily healthier than overweight people yet
the former may have got that way by eating an inadequate diet and/or by smoking excessively. All
sedentary obese patients tend to be regarded equally with respect to morbidity and mortality;
however, dietary pathways to achieve current weight may also need to be considered.
(1) Kouris-Blazos A, Wahlqvist M, Wattanapenpaiboon N. 'Morbidity mortality paradox' of Greek-born
Australians: possible dietary contributors. Aust J Nutr Diet 1999; 56 (2) : 97-107
SKINFOLD THICKNESS

Measurement of skinfold thicknesses is particularly relevant if your patient has a large muscle
mass (e.g body builders) or if the patient has a changing proportion of muscle mass to fat mass
(e.g if exercising). In these situations, BMI (which relies on weight) will not adequately assess
body fat, since muscle is much heavier than fat. Although there are more complicated methods of
measuring body fat, measurements of skin-fold thickness using skin callipers provide a
satisfactory index of adipose tissue.
All skinfold measurements (i.e triceps, biceps, suprailiac, subscapular) should be picked up
between the thumb and forefinger; pinch the skin and pull it away from the underlying muscle;
apply callipers 1cm from the ridge of skin thus formed; take reading 3 seconds after application
of the callipers, to standardise any effects produced by deformation of tissue; do not remove your
hold of the skinfold while callipers are applied; record the average of 3 readings.

a) Triceps skinfold
Many general practitioners use the TRICEPS skinfold as a measure of adiposity. The triceps
skinfold is measured at the back of the left arm, midway between the acromial process of the
scapula and the olecranon process of the ulna. For adults, the standard normal values for triceps
skinfolds are (see TableH): 2.5mm (men) or about 20% fat; 18.0mm (women) or about 30% fat.
Measurement half, or less, of these values represent about the 15th percentile and can be
considered as either borderline, or fat depleted. Values over 20mm (men) and 30mm (women)
represent about the 85th percentile, and can be considered as obese.

b) Four skinfolds
The triceps skinfold does not adequately represent total body fat distribution, as some patients
may be inclined to deposit fat on their upper body compared to their hips and thus may have
deceivingly high triceps skinfolds but may not be overly fat. Ideally four skinfold thicknesses
should be measured - triceps, biceps, subscapular and suprailiac, which provide a more adequate
coverage of the body fat distribution. A recent study has demonstrated a clear positive correlation
between the subscapular skinfold measurement and cardiovascular illness.
The BICEPS SKINFOLD is picked up at the same mark as the triceps skinfold; however, rotated
around along the biceps branchi, with the arm resting relaxed and supine.
The SUPRAILIAC SKINFOLD is measured just above the iliac crest on the mid-auxiliary line
(over the wing of the left scapula, in plane of dermatome).
The SUBSCAPULAR SKINFOLD is picked up just under the lower angle of the scapular
(10mm above the left superior iliac crest in the midaxillary line and along the horizontal plane).
The fold should be taken at a 45o angle in the natural cleavage of the skin. The 4 skinfolds are
summed and the % body fat obtained from the Durnin & Womersley tables (see Table I below).
 Table H
% BODY FAT
(Table formulated by Body Composition laboratory at Monash Medical Centre
using the Durnin & Womesley equation)
TRICEPS SKINFOLD ONLY
Skinfold MEN (age in years) WOMEN (age in years)
17-19 20-29 30-39 40-49 50+ 17-19 20-29 30-39 40-49 50+
5 7.7 10.0 17.8 16.3 18.6 12.4 9.3 12.8 15.3 15.8
7 11.6 13.3 20.1 20.2 22.9 16.5 14.2 17.1 19.8 20.7
9 14.5 15.9 21.9 23.2 26.2 19.6 17.9 20.5 23.2 24.5
11 16.9 17.9 23.3 25.7 28.8 22.1 20.9 23.2 25.9 27.5
13 18.9 19.6 24.5 27.7 31.1 24.3 23.5 25.4 28.2 30.2
15 20.7 21.1 25.5 29.4 33.0 26.1 25.7 27.4 30.2 32.3
17 22.2 22.4 26.4 31.0 34.7 27.7 27.6 29.1 32.0 34.2
19 23.5 23.5 27.2 32.4 36.2 29.2 29.3 30.6 33.5 36.0
21 24.8 24.6 28.0 33.6 37.6 30.5 30.9 32.0 34.9 37.6
23 25.9 25.5 28.6 34.7 38.9 31.7 32.3 33.3 36.2 39.5
25 27.0 26.4 29.2 35.8 40.0 32.8 33.7 34.5 37.4 40.4
27 27.9 27.2 29.8 36.8 41.1 33.8 34.9 35.6 38.6 41.0
29 28.8 28.0 30.3 37.7 42.1 34.8 36.0 36.6 39.6 42.8
31 29.7 28.7 30.8 38.5 43.0 35.6 37.1 37.5 40.6 43.0
33 30.4 29.4 31.2 39.3 43.9 36.5 38.1 38.4 41.5 44.0
35 31.2 30.0 31.7 40.1 44.8 37.3 39.1 39.3 42.3 45.0
37 31.9 30.6 32.1 40.8 45.6 38.0 40.0 40.1 43.2 46.0
Durnin JVGA & Womersley J, Br J Nutr 1974; 32: 77-79
 TABLE I
THE SUM OF 4 SKINFOLDS
(biceps, triceps, subscapular, suprailiac)
DURNIN & WOMERSLEY TABLES
% BODY FAT
MEN (age in years) WOMEN (age in years)
Skinfold
17-29 30-39 40-49 50+ 17-29 30-39 40-49 50+
15 4.8 10.5
20 8.1 12.2 12.2 12.6 14.1 17.0 19.8 21.4
25 10.5 14.2 15.0 15.6 16.8 19.4 22.2 24.0
30 12.9 16.2 17.7 18.6 19.5 21.8 24.5 26.6
35 14.7 17.7 19.6 20.8 21.5 23.7 26.4 28.5
40 16.4 19.2 21.4 22.9 23.4 25.5 28.2 30.3
45 17.7 20.4 23.0 24.7 25.0 26.9 29.6 31.9
50 19.0 21.5 24.6 26.5 26.5 28.2 31.0 33.4
55 20.1 22.5 25.9 27.9 27.8 29.4 32.1 34.6
60 21.2 23.5 27.1 29.2 29.1 30.6 33.2 35.7
65 22.2 24.3 28.2 30.4 30.2 31.6 34.1 36.7
70 23.1 25.1 29.3 31.6 31.2 32.5 35.0 37.7
75 24.0 25.9 30.3 32.7 32.2 33.4 35.9 38.7
80 24.8 26.6 31.2 33.8 33.1 34.3 36.7 39.6
85 25.5 27.2 32.1 34.8 34.0 35.1 37.5 40.4
90 26.2 27.8 33.0 35.8 34.8 35.8 38.3 41.2
95 26.9 28.4 33.7 36.6 35.6 36.5 39.0 41.9q
100 27.6 29.0 34.4 37.4 36.4 37.2 39.7 42.6
105 28.2 29.6 35.1 38.2 37.1 37.9 40.4 43.3
110 28.8 30.1 35.8 39.0 37.8 38.6 41.0 43.9
115 29.4 30.6 36.4 39.7 38.4 39.1 41.5 44.5
120 30.0 31.1 37.0 40.4 39.0 39.6 42.0 45.1
125 30.5 31.5 37.6 41.1 39.6 40.1 42.5 45.7
130 31.0 31.9 38.2 41.8 40.2 40.6 43.0 46.2
135 31.5 32.3 38.7 42.4 40.8 41.1 43.5 46.7
140 32.0 32.7 39.2 43.0 41.3 41.6 44.0 47.2
145 32.5 33.1 39.7 43.6 41.8 42.1 44.5 47.7
150 32.9 33.5 40.2 44.1 42.3 42.6 45.0 48.2
155 33.3 33.9 40.7 44.6 42.8 43.1 45.4 48.7
160 33.7 34.3 41.2 45.1 43.3 43.6 45.8 49.2
165 34.1 34.6 41.6 45.6 43.7 44.0 46.2 49.6
170 34.5 34.8 42.0 46.1 44.1 44.4 46.6 50.0
175 34.9 - - - - 44.8 47.0 50.4
180 35.3 - - - - 45.2 47.4 50.8
185 35.6 - - - - 45.6 47.8 51.2
190 35.9 - - - - 45.9 48.2 51.6
195 - - - - - 46.2 48.5 52.0
200 - - - - - 46.5 48.8 52.4
205 - - - - - - 49.1 52.7
210 - - - - - - 49.4 53.0
Durnin JVGA & Womersley J, Br J Nutr 1974; 32: 77-79
MID ARM MUSCLE CIRCUMFERENCE

The mid arm muscle circumference (MAMC) is a measure of somatic protein or muscle
mass. It is calculated by taking a measurement of the total mid arm circumference (MAC)
and deducting an amount for the layer of adipose tissue based on the triceps skin-fold
(TSF). The calculation uses the formula:
MAMC = MAC (cm) - 3.14 x TSF (cm)

To measure the MAC, locate the midpoint of the upper arm, at the same site as the TSF,
using an inelastic tape measure. Make sure the tape is kept in a horizontal plane, with the
left arm hanging relaxed at the subject's side, palm facing upward. Do not indent the skin
with the tape. Use the average of 3 readings, recorded to the nearest 0.1cm.

Mid arm circumference

AGE PERCENTILE
(years)
50th 15th 5th
Men Women Men Women Men Women
18-19 30.1 26.2 27.4 23.2 25.3 22.1
20-24 31.0 26.5 27.7 23.6 26.1 22.2
25-34 32.0 27.8 28.9 24.8 27.0 23.3
34-44 32.7 29.2 29.6 25.8 27.8 24.1
45-54 32.1 30.3 28.9 26.6 26.7 24.3
55-64 31.7 30.2 28.1 26.1 25.6 23.9
65-74 30.7 29.9 27.3 26.2 25.3 23.8

Using the MAC measurement obtained, together with the TSF, the MAMC can now be
calculated using the formula shown above.
For adults, the standard normal values for MAMC are:
28.0cm (men)
23.0cm (women)
Measurements less than 23cm (men) and 18cm (women) are indicative of either
borderline or depleted muscle mass.

Mid arm muscle circumference (cm)

AGE (yrs) PERCENTILE
50th 15th 5th
Men Women Men Women Men Women
18-19 27.4 20.7 25.5 19.4 23.9 19.3
20-24 27.9 20.8 25.8 19.8 24.8 19.1
25-34 28.2 21.2 27.0 20.6 25.6 20.0
34-44 28.9 22.0 27.4 20.8 26.2 20.3
45-54 28.7 22.5 26.7 21.3 25.1 20.2
55-64 28.3 22.4 26.2 21.1 24.0 20.5
65-74 27.2 22.7 25.3 21.2 23.9 20.2
WAIST AND HIP CIRCUMFERENCES

Although obesity is generally considered a health hazard, results from several prospective
and metabolic studies have shown that it is not the absolute excess of adipose tissue that
is associated with an increased prevalence of diabetes, hypertension, hyperlipidaemia and
cardiovascular disease, but rather the regional distribution of body fat. Abdominal
fatness, irrespective of body size, will predispose to such conditions (see Table J). The
WHR is not closely related to total body fat (r=0.39) but it has fairly close relationships
with the amount of visceral adipose tissue in men (r=0.5 to 0.8).

Health risks and body fat distribution

least risk lean (no pot belly)
moderate risk overweight, pear shaped (no pot belly)
moderate-high risk lean, apple shaped (pot belly)
high risk overweight,apple shaped (pot belly)

The simplest measure which reflects body type is waist to hip ratio (WHR), which is
calculated by dividing the waist/abdominal circumference by the hip circumference
(greatest gluteal protuberance). WHR has been measured differently by various
researchers, but they have all been found to have similar predictive strength in relation to
lipid and carbohydrate metabolism:
 minimal waist & maximal hip
 maximal umbilical & greater trochanter
 abdominal (midway between iliac crest/hip bone and lowest rib margin) maximal hip
circumference (greatest gluteal protuberance)

The maximal umbilical and greater trochanter have been used successfully in many
populations (including Chinese, Greek, Indian, Anglo-Celtic elderly) by researchers in
the Department of Medicine at Monash University to describe abdominal obesity. The
last measure (also known as the abdominal hip ratio) has been recommended recently by
the World Health Organisation in order to standardise all future measurements. WHR
greater than 0.9 for men and 0.8 for women indicates central or android fat distribution. If
the WHR is accompanied by a high body mass index (>25) this will compound the risk
for morbidity and mortality. Umbilical circumference alone (ideal <100cm men, <90cm
women) is now also thought to be a powerful measure of abdominal obesity and health
risk in Caucasians. In ethnic groups where the build is slight, such as in many Asian
countries, a lesser degree of abdominal fatness may still put the person at risk of
developing chronic diseases.