Evaluating CMR

Indices of Total Adiposity - Skinfolds

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Figure 1: Example of a skinfold caliper and of a skinfold measurement (biceps)

Figure 1: Example of a skinfold caliper and of a skinfold measurement (biceps)

Skinfold measures are commonly used to assess total and regional subcutaneous adiposity. Skinfold measures are useful for estimating total adiposity, but are unable to measure intra-abdominal fat directly. Skinfold calipers (Figure 1) are used to measure the thickness of a double layer of folded skin and fat at common landmarks, such as the biceps, triceps, chest, subscapular, iliac crest, abdomen, anterior thigh, and medial calf (27-30). These skinfold thicknesses can be entered into one of several equations (31, 32) that use various skinfold combinations to estimate total body fat with accuracies ranging from moderate to good (Standard Error of Estimate (SEE): 3 to 11%) (28). However, many of the common skinfold equations tend to overestimate body fat in lean individuals and underestimate body fat in obese individuals (33, 34). Furthermore, it requires a fair amount of expertise to accurately and reliably measure skinfold thicknesses, as they are subject to higher inter- and intra-observer error than circumferences (35). It is also unclear whether skinfold measures offer any clear advantage over simpler measures such as BMI and waist circumference in predicting health risk (36-39).

Reference

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27. Lohman TG, Roche AF and Martello R. Anthropometric Standardization Reference Manual. 1988.

28. Wang J, Thornton JC, Kolesnik S, et al. Anthropometry in body composition. An overview. Ann N Y Acad Sci 2000; 904: 317-26.

29. Heymsfield SB, Lohman TG, Wang Z, et al. Human Body Composition. 2005.

30. Bray GA, Bouchard C and James WPT. Handbook of Obesity. 1998.

31. Pollock ML, Hickman T, Kendrick Z, et al. Prediction of body density in young and middle-aged men. J Appl Physiol 1976; 40: 300-4.

32. van der Ploeg GE, Gunn SM, Withers RT, et al. Use of anthropometric variables to predict relative body fat determined by a four-compartment body composition model. Eur J Clin Nutr 2003; 57: 1009-16.

33. Peterson MJ, Czerwinski SA and Siervogel RM. Development and validation of skinfold-thickness prediction equations with a 4-compartment model. Am J Clin Nutr 2003; 77: 1186-91.

34. Fogelholm GM, Sievanen HT, van Marken Lichtenbelt WD, et al. Assessment of fat-mass loss during weight reduction in obese women. Metabolism 1997; 46: 968-75.

35. Mueller WH and Malina RM. Relative reliability of circumferences and skinfolds as measures of body fat distribution. Am J Phys Anthropol 1987; 72: 437-9.

36. Steinberger J, Jacobs DR, Jr, Raatz S, et al. Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents. Int J Obes 2005; 29: 1346-52.

37. Kim J, Meade T and Haines A. Skinfold thickness, body mass index, and fatal coronary heart disease: 30 year follow up of the Northwick Park heart study. J Epidemiol Community Health 2006; 60: 275-9.

38. Yarnell JW, Patterson CC, Thomas HF, et al. Central obesity: predictive value of skinfold measurements for subsequent ischaemic heart disease at 14 years follow-up in the Caerphilly Study. Int J Obes Relat Metab Disord 2001; 25: 1546-9.

39. Kalmijn S, Curb JD, Rodriguez BL, et al. The association of body weight and anthropometry with mortality in elderly men: the Honolulu Heart Program. Int J Obes Relat Metab Disord 1999; 23: 395-402.

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