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    2000 Kuczmarski Descriptive Anthropometric Reference Data For Older Americans PDF

    Uploaded by

    Alejandro E.

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    © All Rights Reserved
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    Descriptive anthropometric reference data for older Americans MARIE FANELLI KUCZMARSKI, PhD, RD; ROBERT J. KUCZMARSKI, DrPH, RD; MATTHEW NAJJAR SSTRACT Objective To present selected anthropometric data derived from adults aged 60 vears and older examined in the third National Health and Nutrition Examination Survey (NHANES, HD, Design NHANES Ill used a complex, stratified, multistage, probability cluster sample design to obtain a nationally representative sample of the US civilian, noninstitutionalized population. Persons aged 60 years and older, Mexican- Americans, and African-Americans were oversampled to produce more reliable estimates for these groups, Trained technicians measured height, weight, skinfold thickness, and circumferences using standardized procedures. Subjects A total of 5,700 persons aged 60 years and older, and 1,861 persons aged 50 to 59 years. Statistical analyses performed Mean and selected percentiles for body weight, body mass index, triceps skinfold thickness, mid upper arm circumference, and arm muscle circumference were calculated by gender, race/ ethnicity, and 8 age categories. Weight (Ib) per height (in) tables were generated for men and women by age group. Results Mean body weight was lowest for persons aged 80 years and older. A decline in body mass index occurred that paralleled the direction and magnitude of the progressive decrease observed in weight. Muscle loss with increasing ade, as indicated by arm muscle circumference, appeared to be greater among men than women. Applications/conclusions In addition to being relatively simple, quick, and inexpensive, anthropometry is the most reliable and specific indicator of malnutrition in the older adult population. The cross-sectional reference data provided can be used by dietitians to interpret anthropomet- rie measurements of persons aged 60 years and older. J Arm Diet Assoc. 2000; 100:59-66. Ider adults, classified as persons aged 60 years and older, are one of the fastest-growing segments of the population in the United States and throughout. the ‘world, This group is heterogeneous. Interindividual bio- logical variation is large because of variable rates of aging from, person to person and from one physiological system to another within the same person. Thus, a healthy 80-year-old differs from a healthy 60-year-old ‘Toaccurately evaluate the nutritional status of older adults, age- and gender-specific data are required forall of the assess- ment components (ie, anthropometric, biochemical, clinical, and dietary). Such data may be derived as references or ag, standards. References are data that present cross-sectional descriptions of a well-defined population. Typically, such data are presented as observed range values for distributions of selected variables according to characteristics such as age and gender categories. Standards describe desirable values to be attained for selected variables. In a clinical sense, standards may be thought of as target values to be achieved. Standards are usually arrived at through studies of values for variables that are associated with optimal health and minimal morbidity or mortality outcomes. Despite recognition of the need for age- and gender-specific anthropometric reference values for nutritional status assess- ment of older adults, existing reference data, especially for the very old, are limited for the US population (1,2). The reliability of existing references has been questioned because data col: lection was not standardized, the informations dated and may not reflect the current generation of Americans, sample sizes ‘were limited in number and were not nationally representative, and the data do not reflect the current racial/ethnic mix in the United States, Sources of weight-for-height reference data for older adults in the United States, along with the limitations of the data, are provided in Table 1 (3-10), ‘The worldwide variation in older adult populations reflects lifestyle differences over the life span, environmental influ- fences that affect genetic potential, and differences in health status (11,12). The Expert Committee of the World Health Organization recognized the need for reference data for older M. F. Kucemarski is a professor in the Department of Nutrition and Dietetics, University of Delaware, Newark. RJ. Kucemarski is a nutritionist and M. Najjar is a statistician with the National Center for Health Statistics, Hyattsville, Md. Address correspondence to: Marie Fanelli Kucemarski, PhD, RD, Department of Nutrition and Dietetics, University of Delaware, 226 Alison Hall, Newark, DE 19716. Journal of THE AMERICAN DIETETIC ASSOCIATION / 89, Table 1 ‘Anthropometric references for older adits in the United States, 1959-1988 Database Yeardata Age (y) Gender Race §—N——Paramotors Limitations (otro) collected ede records a) Bele 10596560 Mt Weis 888 Hoght waaht roe. Wete 682 ‘comenience samp 779M Wate 521, soe. Wate 377 ese Wnte 319 soe Wate 2 95-108 Write 2s eo F Wate gat nF Wnts 68 oF Wnte 453 ea Wnte 336 eseo Write 2s oes Wnite 320 95-108 White 26 ‘Wezopatan Lis abies) 1979 Boay Fagh weah Semple consis oie raurarce ula Suey pavoynldere up to age 89) WegoaMANESimnd —Wariiera,-Se7a a “Riraoss 4540 Haigh waght sand Sample only neludos poople up NHANES IP (67), aretob0 Ser ‘Alrgces 5009 thekness:viceps, 1074 yo; suveys 00 Fol Subsespular sma Felco a large sample of rmuccle area Hispanics TRANES Teoidemoioge Teenie ae7a 4 Wie 1314 Haight waane Waighs per pon ahah folowp study @) o74 0M Black "272 resented fr ages 68-04) by orm F White 1403 Fry interal oa sample Sze eer Bisck 200 ‘wae 9.805 persone: nga height usec near repression ‘Modes were used to abst or eral sampe size, Timea Baio 19852 Wits 179 leigh, waght mee Ferbulatory readers oh F Wnts 150 height ieops ana insitutons i Ono subscapular sxe nowepresentave sarple ‘tenes, mis rm Scuntorence, rid ar muscle area Ghomnal Anivopomeria Sefer 1908] Vike 6 cepa santo ‘Sample not raionaly ‘Survey forthe Ben (1), mre Wate 115 exnass, mig arm representative soso M 48 Gkeumlerence, mid oe F White 146 Uppar arm muscle 773 F Wits 239 Gheumlerence, mic upper sess F white it amuses wea ‘Feet and ascend National Healh and Nation Examination Sunes adults but did not recommend the use of universal data from a single source (13). The committee recommended that refer- ence data be presented in gender-specific 10-year age groups, ‘with means and percentiles available for each anthropometric index and age group, and that data for people older than 80 years be included. Few reference data exist for older adult populations in developing countries. The committee also rec- ommended that for countries without local data or the re- sources to develop them, data fron the third National Health and Nutrition Examination Survey (NHANES II; 1988-1994) could be used for comparisons (13). Our study provides descriptive reference values forselected, anthropometric measures derived from a nationally represen- 60 / January 2000 Volume 100 Number 1 tative sample ofnoninstitutionalized older US adults examined in NHANES IIL. These most recent cross-sectional reference data can be used by dietitians and primary care providers to facilitate the interpretation of anthropometric measurements of older adults in the United States. METHODS: Survey Design NHANES [used a complex, stratified, multistage, probability cluster sample design to obtain a nationally representative sample ofthe United tates civilian, noninstitutionalized popu- Tation aged 2 months and older (14). The survey was designed Table 2 Werght for men and women examined in the thicd National Health and Nuteion Examination Survey (1988-1994) by race/ethnicity and age aa Cheracteratic a Mean:estanderd error Men Av etriciioe 5059 ss 2602000 720 eat 1007 e068) i 8512065, or? 24 984 r7y ars yaosort 42 73 835 eory 700 792078 Sa 8 Bat INow-Fispan white 5058 y aa 97 12082 736 02.1 6089 y 510 eagsa7e 690 988 7.78) 52H 78-005" 855 ee. ary 50 52055" 598 BAS, Nor-Figpanie Black s0s9y an asz14 wos S083) 2a aps toe 383 7o70y ‘87 T3219 319 ary 53 sr ne ess Torcan-american 5059 78 ez ais or 5088) 3a 646. 773 920 ro79y 18 qatar 50. tar Bio Bory 63 653162 sre 58 rast Women At etictios S050 1.006 52 ns ore 60.88 y ni yage071 sa 38 350 To785 ona aracors 529 6 eat ery 790 ea5s068 a9 537 723 owhispant whe 5059 y vet 7432099 82 na on e088 sot 555 659. a8 770) ea 80 eta 31 ary 2 a9 £37 72 Non Hapanis back 5058) 25 625 793 10 eee y 200 818 yea 251 7.70y 12 reset 87" 580 78 935 ary 8 6.12166: 504 ais. 802 TereanAmercan Sosay 198, 79120 sa 70 eat e080 se 72000 588 ers 23 ra73y wr 6372138 517, 816 748 ary 59 Sspet7a" 08 Bar ba ‘Figure dose not veal sandard of resabaly reSsIon. hin age calogoy, mean weights ws he sao superscript are significant ciferet (P05) Neen ee ee eee a ne ee EEE! as a 6-year project carried out in 2 consecutive phases. Phase 1 was conducted from 1988 to 1991; phase 2 was conducted from 1991 to 1994, NHANES Ill was designed to oversample persons aged 60 years and older, Mexican-Americans, and African-Americans to produce more reliable estimates for these groups. The NHANES protocol begins with in-home interviews, which are followed by a multicomponent health ‘exarnination condueted ina specially designed Mobile Exami- nation Center (MEC), In NHANESIII, modified home examina- tion, consisting of a subset of MEC procedures, was offered to a limited number of older adults who could not or would not come to te MBC for the more comprehensive examination a4). Anthropometric Measurements Comprehensive anthropometric measurements were obtained for most survey participants and recorded by trained health technicians in the MEC. For older adults examined in thelr homes, technicians took a subset of body measures (height, weight, triceps skinfold thickness, arm circumference, and knee height) with portable equipment. All health technicians received standardized training, subsequent. periodic quality checks by siandardized trainers, and retraining as necessary. Height, weight, skinfold thickness, and circumferences were measured using procedures that closely followed techniques described in the anthropometric. standardization reference ‘manual for NHANES Ill (15).’The NHANES Il anthropomettie Journal of THE AMERICAN DIETETIC ASSOCLATION J 61 Table 3 Weight by height for all men aged 50 years and older examined in tng the Natal Healt and Rar Examination Survey (1966 Height (s)by on ___porcontio ‘590 group iam oth on mosoy > Tora 955 cory weir za8 85 73 wos 1505 7s 6 58 me 1704 250° 86 92 sas Vea 985 e ne 1564 ws aro 68 100 1082 1917 258 i @ en teat 2e80 cc 115 oo 1963 2a) n & 180" 900 Doe 72 and over 108 78s 2088 28 eoeey Tein urs vas wen 264 <5 04 338 1359 ins 65 ne 138.1 ere 450 ee 345 ae sos 914 o ae i395 mar sr7 6 13 ier 1234 2107 8 10 1596 1922 220 2 16 tere 1050 bao m 73 sere 2083 207 72 and over 8s 1780 2030 bao To7ey Tota 275 ia m3 2087 205 169 toa 133 vei? 65 8 1935, 23 1801 66 135 1363 1593 1902 er mn 1502 ve. tee? es 120 van? s09 ane 69 % i515, sai9 Bue 170 and over 160 1608 7008 203 aay Tote 08 104 1559 S65 1 naz. 08 6 2 es je es 10 1397 se10 7 ea Iss 1602 ee es 158 sent & et 1368" Wea To and over a wai8 ms soay ‘otain 190 sra3 m4 205 rans, SIT a2 65 1345 1570 1862 8 1420 1655 1953 er Mie 1703 wou es waa 762 2108 69 1542 era 2ise a 29 180? yeas 2230 n 25 1658 2001 28 72.na over 150 tee? 190.7 265 "Figure does not moe! Sandard of iabity or pedson due 1 ama SATE measurement procedures have been documented in a detailed video presentation (16). In the MEC, height was measured with a fixed stadiometer, The measurement was recorded to the nearest millimeter from a photograph of the measuring tape. Body weight was measured with an electronic-load cell, seale in kilograms to 2 decimals, Adults wore underpants, a disposable paper examination gown, paper pants, and foam 62 January 2000 Volume 100 Number 1 rubber slippers. No adjustment was made for clothing weight (approximately 0.1 to 0.2 kg) in the data analysis. Skinfold thickness was measured to 0.1 mm with a skinfold caliper (Holtain Ltd Crymeh, United Kingdom). Circumferences were measured with a steel tape measure (Lufkin Thinline Bxeeu- tive, Apex, NC), All equipment was checked at regular inter vals with standardized calibration devices. ‘Body mass index (BMI) was calculated as weight in kilograms, dividedy heightin meters squared. Arm muscle circumference (AMC) was calculated using the following formula: AMC (em) = MAC-1

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