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Anthropometry and body composition in the perspective of nutritional status in the elderly.

Understanding normal changes in the body's composition with old age and their health and nutritional implications is important in determining the nutritional status of the elderly. Suitable reference data for anthropometry and body composition obtained from large representative samples of black, white, Hispanic, and Asian elderly persons are needed to improve their nutritional health and care. Distribution statistics for body measurements of persons 65 to 80 years of age are available from national health and nutrition surveys, but for persons older than 80 years, there is little information. Recumbent anthropometric techniques have been developed that are applicable. Underwater weighing continues to be a gold standard for determining body composition in the elderly, but a four-compartment model would improve estimates of body composition in the elderly because of changes in the density of the fat-free mass with old age. Noninvasive methods such as anthropometry and bioelectric impedance could be used to predict body composition if they were validated against direct methods and if appropriate equations become available.

Aged↗

Potential use of bioelectrical impedance of the 'whole body' and of body segments for the assessment of body composition: comparison with densitometry and anthropometry.

The value of 'whole body' and segmental impedance measurements, and of simple anthropometric methods for predicting body composition was assessed in 24 normal (14m, 10f) subjects (BMI, 18.3-28.6), using densitometry as the reference method. The contribution of segmental impedance was assessed in a separate group of 24 normal (12m, 12f) subjects (BMI, 19.8-28.8) at two frequencies (1 kHz and 50 kHz). Estimates of specific resistivities of certain individual segments (upper arm, forearm, upper leg, and lower leg) were also made in this group, and compared to those obtained from a group of 7 obese female subjects (BMI, 32.6-56.1). The bias and 95 per cent limits of agreement between densitometrically determined body composition (fat and fat-free mass, and total body water) and the alternative methods were found to vary considerably, depending on the technique and/or equations employed. Estimates of whole body composition based on impedance or resistance measurements were found to be associated with only slightly smaller limits of agreement than those made by anthropometry. The upper limb was found to have the greatest influence on whole body impedance measurements. Indeed, the forearm, which accounts for 1.3 per cent of body weight contributes 25.0 per cent to 'whole body' impedance. The estimated specific resistivities of segments were found to be considerably greater in the obese individuals than in normal female subjects (for example, 75 per cent higher for the upper arm, P less than 0.001). The results suggest that: (a) there may be a systematic, population-related, error in predicting densitometric estimates of body composition with the use of standard equations, which incorporate variables such as weight, height, skinfold thicknesses, and impedance/resistance measurements; (b) in this population, impedance or resistance measurements confer only a small advantage over simple anthropometry for predicting body composition; (c) the impedance of the arm or leg may provide a simple alternative method for assessing the composition of the whole body; and (d) the estimated specific resistivity of individual body segments may be useful for assessing the composition of those segments.

Adult↗

The use of anthropometry to assess nutritional status.

Anthropometry (the use of body measurements to assess nutritional status) is a practical and immediately applicable technique for assessing children's development patterns during the first years of life. An evaluation of their growth also provides useful insights into the nutrition and health situation of entire population groups. Anthropometric indicators are less accurate than clinical and biochemical techniques when it comes to assessing individual nutritional status. In many field situations where resources are severely limited, however, anthropometry can be used as a screening device to identify individuals at risk of undernutrition, followed by a more elaborate investigation using other techniques. Similarly, growth monitoring permits the detection of individuals with faltering growth, who can then be appropriately referred to specialized care. Thanks to the standardization that has taken place in recent years, changes in trends over time with respect to the nutritional situation can be evaluated in countries where national food and nutrition surveillance systems have been developed, or where nationally representative cross-sectional surveys have been conducted some years apart using identical, or nearly identical, methodologies. Although data that can be used to evaluate trends are limited, some insight can be gained into the nutritional situation and changes occurring over time in a number of countries. Prevalence figures for underweight (low weight-for-age) have been prepared using standard methods of data collection, analysis and presentation, for several countries in Africa, the Americas and Asia. As such, they fail to differentiate between wasting and stunting, or to evaluate differences between age groups. Also, they do not necessarily reflect trends in other countries in the same or other regions. Still, it is interesting, if not statistically significant, that there has been a general improvement in the nutritional status of preschool children. Intercountry trend comparisons are difficult for two main reasons. Firstly, the time between surveys is occasionally different and, secondly, despite efforts to standardize data analysis and presentation, different cut-off points have been used to calculate prevalence figures and estimate the extent of undernutrition. However, the use of identical cut-off points is not essential for making intercountry trend analyses since it is the general trends in growth deficit and nutritional status over time which are being evaluated.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗

Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables.

Length, height, weight and mid-upper arm circumference (MUAC) were measured in 4320 children aged between 0 and 59 months, and their socio-economic status was assessed, in 31 villages in Southwest Uganda during March-April 1988. A follow-up survey assessed the mortality of the children during the 12 months following anthropometry. Mortality rates were higher in those with low anthropometric indices at the first survey. MUAC was the most sensitive predictor of mortality followed by weight-for-age, height-for-age and weight-for-height. MUAC increased the predictive power of other parameters whereas the other parameters did not increase the predictive power of MUAC. MUAC below 12.5, 11.5 and 10.5 cm predicted 10.9%, 18.7% and 36.5% of the deaths respectively. Nutritional status was worse in the low socio-economic group but the predictive power of anthropometry for mortality was not influenced by socio-economic status. This suggests that nutrition per se has an influence on mortality which is independent of socio-economic status.

Age Factors↗

Issues in the assessment of nutritional status using anthropometry.

Four issues in the use and interpretation of anthropometry are discussed at the level of the population and of the individual. The first issue is the index or indices of choice: weight-for-height versus height-for-age versus weight-for-age. The selection of an index or indices depends upon many factors, and no one index is completely adequate in all situations. Proposed criteria are provided to assess the severity of low anthropometry within populations. The second issue is the scale of the index: z-scores (or standard deviations) versus percentiles versus percent-of-median. z-Scores have several properties that make them superior to the other two scales. A third issue deals with limitations in the current growth reference; one of these is the disjunction between the growth curves at 2 years of age, resulting from the use of two different populations in the reference. It is important that this disjunction be recognized by researchers so that the anthropometric findings are interpreted correctly for this age range. Lastly, some issues to do with the collection of single versus multiple anthropometric measurements on children are discussed.

Anthropometry↗

Measurement of abdominal and intra-abdominal fat in postmenopausal women by dual energy X-ray absorptiometry and anthropometry: comparison with computerized tomography.

The aim was to develop a model for prediction of intraabdominal adipose tissue (AT) with combined dual energy X-ray absorptiometry (DXA) and anthropometry in postmenopausal women. Intra-abdominal and subcutaneous AT from the 1st to the 4th lumbar intervertebral disk was measured by computerized tomography (CT) (as a reference method) in 25 postmenopausal women (BMI 19.9-35.1 kg/m2). Fat was measured in the corresponding region by DXA. Abdominal sagittal diameters, skinfold thicknesses, and circumferences were also measured. Measurements of abdominal fat by CT and DXA were valid (r = 0.9, s.e.e.%: 7%). Measurement of abdominal fat by DXA explained about 80% of the variation in the intra-abdominal AT (by CT), whereas the waist to hip ratio was the only variable that correlated significantly with the intra-abdominal to subcutaneous AT ratio. Abdominal fat measured by DXA, the waist to hip ratio, and the sum of trunk skinfold thicknesses could in combination accurately predict the intra-abdominal AT measured by CT (r2 = 0.91, s.e.e.% = 15%). The sagittal diameter, measured either anthropometrically or by CT, was not a superior predictor of the intra-abdominal AT. We conclude that the intra-abdominal AT can be predicted in postmenopausal women by DXA combined with anthropometry.

Abdomen↗

Longitudinal study on the effect of treatment on body composition and anthropometry of celiac disease patients.

OBJECTIVES: This prospective study was designed to assess the nutritional changes associated with the long-term treatment of celiac disease. In addition, we analyzed whether these changes were related to the degree of compliance with a gluten-free diet. METHODS: We studied nutritional parameters and body composition in 25 newly diagnosed celiac patients after a mean period of 37 months (range 25-49 months) on a gluten-free diet. Body composition parameters (fat, lean tissue, and bone masses) were measured by dual energy x-ray absorptiometry. Anthropometry was measured according to conventional formulas. RESULTS: At diagnosis, fat (-49%), lean tissue (-12%), and bone (-24%) compartments were reduced, compared with that of sex- and age-matched controls. After treatment, we noted a significant increase in body weight (p < 0.0001), fat mass (p < 0.0005), bone mass (p < 0.002), and body mass index (p < 0.005). In contrast, we did not observe a significant increase in lean-tissue mass or muscle mass. Patients who adhered strictly to a gluten-free diet experienced a greater, though nonsignificant improvement in fat mass, body weight, and body mass index than patients whose compliance had been partial. Mean caloric intake at the end of the study was significantly lower among those patients who had adhered strictly to a gluten-free diet, compared with those who had complied only partially with the diet (p < 0.05). CONCLUSIONS: This study shows that the institution of a gluten-free diet in celiac disease patients results in a significant improvement in nutritional parameters, as measured by anthropometry and/or body composition. This effect was more pronounced in patients who followed strict gluten restriction and was related mainly to changes in fat and bone compartments.

Adult↗

Random errors in anthropometry.

In order to present basic information on the magnitude of and variance due to the random error in anthropometry, 219 measurement items were taken on 12 subjects twice by the same observer. The precision (i.e., consistency between the repeated measurements) was investigated for these measurement items. The reliability was quantified using mean absolute difference (MAD), technical error of measurement (TEM), and reliability coefficient (R). MAD and TEM are highly correlated with each other and both represent the magnitude of error. They are not correlated with R, which represents the proportion of error-free variance. Larger measurements tend to have absolutely larger but relatively smaller random errors and higher reliability in the size range of 1-10 cm. Imprecision is inherent in anthropometry of the living because of the fact that the human body is not rigid. This may be responsible for the above tendency. Relatively large MAD and low R may be due to small absolute size, landmarks difficult to locate precisely, soft tissue deformation, and the inconsistency of the posture of the subject.

Adult↗

Leptin concentrations in maternal serum and cord blood: relationship to maternal anthropometry and fetal growth.

OBJECTIVE: To determine 1. the relationship between maternal serum leptin concentrations and maternal anthropometry and 2. the relationship between cord serum leptin concentrations at birth and neonatal anthropometry. DESIGN: Prospective cohort study of fetal growth in low-risk pregnancies. SETTING: University teaching hospital. SAMPLE: Thirty-nine women and their babies taking part in a fetal growth study. METHODS: Blood was taken from the women between 10-20 weeks of gestation and from the umbilical cord of their babies at delivery. Serum leptin was measured by radio-immunoassay. Maternal anthropometric measurements were recorded at booking. Neonatal anthropometric measurements were recorded within 48 hours after delivery. Linear regression analysis was used to explore the relationship between serum leptin concentrations and anthropometric measures and multiple regression analysis then applied to determine which variables remained independently associated with leptin. RESULTS: The median (range) leptin concentration in maternal serum was 11.8 ng/mL (1.7-39.7) and in cord blood was 4.2 ng/mL (0.6-21.4). Maternal leptin levels correlated with maternal weight, body mass index, midarm circumference and skinfold thickness, but not with birthweight, placental weight or maternal height. Body mass index and midarm circumference remained significant after multiple regression analysis. Cord leptin levels correlated with birthweight, birthlength, placental weight and skinfold thickness but not with ponderal index. Birthweight and subscapular skinfold thickness remained significant after multiple regression analysis. Cord leptin concentrations did not correlate with maternal leptin concentrations. CONCLUSIONS: We suggest that there are very strong associations between maternal leptin and maternal adiposity in pregnancy, and between cord leptin at delivery and birthweight, as well as other anthropometric markers of fetal growth.

Adult↗

Anthropometry, glucose tolerance, and insulin concentrations in Indian children: relationships to maternal glucose and insulin concentrations during pregnancy.

OBJECTIVE: The purpose of this study was to test the hypothesis that the environment experienced by fetuses of mothers with gestational diabetes mellitus (GDM) and mothers with higher glucose concentrations that are in the normal range causes increased adiposity and altered glucose/insulin metabolism in childhood. RESEARCH DESIGN AND METHODS: Children (n = 630) whose mothers were tested for glucose tolerance during pregnancy had detailed anthropometry performed at birth and annually thereafter. At 5 years, plasma glucose and insulin concentrations were measured in the children (2-h oral glucose tolerance test) and their fathers (fasting samples only). RESULTS: Newborns of diabetic mothers (n = 41) were larger in all body measurements than control newborns (babies with nondiabetic parents). At 1 year, these differences had diminished and were not statistically significant. At 5 years, female offspring of diabetic mothers had larger subscapular and triceps skinfold thicknesses (P = 0.01) and higher 30- and 120-min insulin concentrations (P < 0.05) than control children. Offspring of diabetic fathers (n = 41) were lighter at birth than control children (P < 0.001); they showed no differences in anthropometry at 5 years. In control children, skinfold thickness and 30-min insulin concentrations were positively related to maternal insulin area under the curve, and skinfold thicknesses were related to paternal fasting insulin concentrations independently of the parents' skinfold thickness and socioeconomic status. CONCLUSIONS: Maternal GDM is associated with adiposity and higher glucose and insulin concentrations in female offspring at 5 years. The absence of similar associations in offspring of diabetic fathers suggests a programming effect in the diabetic intrauterine environment. More research is needed to determine whether higher maternal glucose concentrations in the nondiabetic range have similar effects.

Adult↗

Deaths from ischemic disease, anthropometry and cardiac biometry.

INTRODUCTION: The relation between body mass index (BMI)/obesity and left ventricular hypertrophy (LVH) in ischemic heart disease (IHD) has not been completely established, based on postmortem studies. OBJECTIVE: To study necropsy data of deaths from cardiac ischemia and its relation to macroscopic data of the heart and anthropometry. METHOD: Retrospective study of necropsies conducted by the medical legal services of Porto in 2002-03, with a final diagnosis of "myocardial infarction" or "chronic ischemic heart disease" or with more than 50% obstructive coronary disease. An observation grid was compiled from the necropsy data, with emphasis on anthropometry and cardiac exam. Descriptive and inferential methods (Pearson's correlation, the chi-square test and stepwise multiple regression) were used for the statistical analysis (alpha = 0.05). RESULTS: Of the 231 selected cases, 75.3% were men, of whom 53.7% were diagnosed with myocardial infarction and 46.3% with IHD, with BMI of 26.9 +/- 5.1, body weight of 74.7 +/- 19.9 kg, left ventricular thickness of 16.9 +/- 4.7 mm, and cardiac weight of 517 +/- 163 g. Significant negative correlations (p < 0.001) were found between age, body weight (-0.33), height (-0.33), and BMI (-0.21) and positive correlations between cardiac weight, body weight (0.35), height (0.24), BMI (0.26), and LVH (0.29). Significant differences were found between genders with regard to age, weight, height and heart weight, but no differences in terms of years of education, BMI or left ventricular thickness. Stepwise regression found two predictive variables for heart weight: body weight, accounting for 12.1%, with age increasing this to 15.4%. CONCLUSION: These results seem to confirm objectively by postmortem examination that high values of BMI and body weight, left ventricular hypertrophy and cardiac weight correlate with IHD, with important gender differences to be taken into consideration. Body weight and age are major predictive variables for heart weight. These findings have important public health implications in the prevention of overweight and ischemic heart disease.

Adult↗

[Body mass index in a group of Venezuelan pregnant women and its relationship with the newborns' anthropometry].

To assess the relationship between maternal body mass index (BMI) at early gestation and the newborns' anthropometry, 105 mother-infant dyads from a public Maternity Hospital in Valencia Venezuela, were studied during 1998-2000. Weight and height of adult women between 10 and 15 weeks of gestation were used to calculate BMI according to Atalah's reference (Low weight, Normal, Over weight). Term newborns were assessed using gestational age calculated according to the Capurro method. Their weight, height, and head circumference were recorded, and were characterized using a Venezuelan reference. Newborns whose birth weight (BW) was pound 10th percentile were considered "small for gestational age" (SGA), and those with BW (3) 90th percentile as "large for gestational age" (LGA). One-way ANOVA and Tukey's Post Hoc test were used for group comparisons. There were 41.9% of "low weight" mothers, and 13.4% of SGA newborns. There were differences in the newborns' weight and height according to "Low weight" maternal BMI with "Normal" and "Over weight" maternal BMI (p < 0.05). A high prevalence of nutritional deficit was observed from the beginning of the gestational period, as well as a relationship between maternal BMI and the newborn's anthropometry.

Adult↗

Estimation of lean body mass by bioelectrical impedance analysis compared to skinfold anthropometry.

Estimation of lean body mass (LBM) is an important procedure in nutritional assessment and the availability of a rapid, portable and reproducible method would be desirable for this purpose. At present, only bioelectrical impedance analysis (BIA) and skinfold anthropometry are applicable for clinical use. We compared the prediction of LBM by these two methods in 80 subjects stratified into four subgroups by body mass index (BMI): lean, normal, obese and super-obese. Highly significant correlation coefficients (r greater than 0.92, P less than 0.001) were seen for all subgroups with a mean difference between techniques LBManthro-LBMBIA/LBManthro X 100) of less than 1 kg or 1 per cent error. A greater s.d. and error was noted in the super-obese (BMI greater than or equal to 40.0). Fifteen subjects had measurements repeated after a mean weight loss of 10 per cent. Although mean difference between methods was not statistically significant, there was a large individual variation. It is concluded that there is an excellent agreement between the estimation of LBM by bioelectrical impedance and skinfold anthropometry in the weight-stable subject.

Adult↗

Four-site skinfold anthropometry (FSA) versus body impedance analysis (BIA) in assessing nutritional status of patients on maintenance hemodialysis: which method is to be preferred in routine patient care?

BACKGROUND: Both four-site skinfold anthropometry (FSA) and bioelectrical impedance analysis (BIA) claim to be useful in routine clinical practice of maintenance dialysis as easy methods to assess nutritional status. The purpose of this study was to investigate which of these two methods is to be preferred. METHODS: Both before and after dialysis nutritional and hydration status were evaluated by BIA in 20 stable hemodialysis patients. Variables of nutritional status as lean body mass (LBM) and body fat (BF) were assessed by four-site skinfold anthropometry (LBM-FSA and BF-FSA) and BIA (LBM-BIA and BF-BIA). Variables of hydration status were total body water (TBW), its distribution into intracellular and extracellular compartments (ICW and ECW, respectively) and ICW/ECW. RESULTS: Weight loss during dialysis correlated with a change of LBM-FSA (r = 0.75, p <0.005) and also with that of LBM-BIA (r = 0.69, p < 0.005). To promote reliability of follow-up measurements in intervention studies it is warranted to evaluate nutritional status in an unchanged hydration status. The highly significant correlation (r = 0.93, p < 0.005) between the two techniques and the comparability between means and SD indicate that both techniques were almost equivalent to each other, although, compared to LBM-BIA, LBM-FSA was less affected by changes in fluid status. The sam held true for BF-BIA and BF-FSA. BF-FSA correlated significantly with BF-BIA (r = 0.65, p <0.005), whereas no difference of mean +/- SD was found between BF-FSA and BF-BIA. CONCLUSION: FSA and BIA are almost comparable techniques to assess both LBM and BF, although FSA is less affected by changes in fluid status. However, assessing LBM in normohydration is mandatory. Compared with FSA, BIA is able to establish hydration status and lacks depency on operator interpretation. Therefore, in routine patient care the BIA technique is the one to be preferred.

Body Composition↗

Use of serial ultrasound to identify periods of fetal growth restriction in relation to neonatal anthropometry.

The developmental origins of the health and disease hypothesis suggests that fetal growth restriction (FGR) is a risk factor for several chronic diseases of adulthood. However, most supporting studies use birth weight as a proxy measure of FGR. To examine the relationship between birth weight and FGR, the present study used serial prenatal ultrasound to identify periods of FGR during gestation, and related these periods to birth size and shape. The data in this study included serial prenatal ultrasounds performed on 1,349 high-risk Scandinavian women enrolled in the National Institute of Child Health and Human Development Study of Successive Small for Gestational Age Births. Fetal growth velocity between ultrasounds was used to identify periods of isolated FGR, and these were studied in relation to anthropometry at birth. FGR was identified in 184 subjects. A control group of 384 subjects without FGR was also identified. Infants with first-trimester FGR (n = 20) had the highest birth weight, ponderal index, and subscapular skinfold thickness. Infants with second-trimester FGR (n = 37) had the highest arm fat percentage. Infants with early third-trimester FGR (n = 55) had the lowest mean birth weight and ponderal index. When infant gender, gestational age, maternal body mass index, and smoking were controlled, birth weight was predicted only by third-trimester FGR (not first- or second-trimester FGR), and arm fat percent was predicted only by second-trimester FGR. These results suggest that birth weight is not a valid indicator of FGR occurring before the third trimester. Body composition may be a more sensitive marker of early FGR.

Anthropometry↗

Anthropological studies among Libyans. Erythrocyte genetic factors, serum haptoglobin phenotypes and anthropometry.

Anthropological studies were done on 1276 Libyans from the Mediterranean cities of Tripoli and Benghazi, and from Sabha southward in The Sahara. The incidences of hemoglobin (Hb)-S and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency were low in the coastal areas and significantly high in Sabha. Hb-C occurred sporadically in Tripoli and Sabha, and was absent from Benghazi in the east. One case of Hb-J Benghazi was noted. There were no sigificant differences in the ABO blood group and Rh0 (D) type distributions in the three localities. G-6-PD gene GdAfrequency was significantly high in Sabha. The lowest value of 6-phosphogluconate dehydrogenase (6-PGD) gene PGDA frequency and highest value of the gene PGDC were in Sabha. Adenylate kinase (AK) gene AK2 was only detectable in Tripoli. Acid phosphatase (AP) gene Pa frequency in Sabha was more than twice that in Tripoli and Benghazi, while pc was distinctly lower in Sabha than in the northern cities. Haptoglobin gene Hp1 frequency was almost identical in all areas. Anthropometric measurements revealed overall homogeneity of the three samples, closer similarity in the coastal region to adjacent North African populations, and Negroid influence in the Sahara Libyans. Anthropometry substantiated findings from blood markers.

ABO Blood-Group System↗

Anthropometry and numerical taxonomy in clinical genetics: an example of applied biological anthropology.

Biological anthropologists can contribute a unique perspective as well as technical expertise to the diagnosis and classification of genetic disorders. Anthropometry has been used with increasing frequency to characterize syndromes and to establish ranges of variation within syndromes. The specific anthropometric-radiologic technique of metacarpophalangeal pattern profile analysis has proven useful in discriminating individuals with the Prader-Labhart-Willi (PLW) syndrome from unaffected persons. Analysis of these data also indicate a negative correlation between age and Z-score transformations of individual hand bone lengths. These findings sound a cautionary note to clinical investigators who would use the Z-score transformation to standardize for age and sex. Problems encountered in the classification of genetic syndromes afford many parallels with those faced by anthropologists in the classification of living and fossil populations. The reliance on "key" traits and the necessity of focusing on pedigree analysis results in a deemphasis of the total range of variation and typological thinking. Application of numerical taxonomic techniques to the classification of the heterogeneous connective tissue disease osteogenesis imperfecta (OI) illustrates the heuristic value of this technique and points out the need to consider phenotypic overlap when defining typologies. Clinical genetics affords just one example of an area in medicine where the unique training and generalist perspective of the biological anthropologist is in demand. The decline in the availability of positions in the traditional academic habitat for biological anthropologists makes it imperative that graduate students be aware of alternatives and that they obtain training in the practical skills which such alternatives will demand.

Anthropology↗

Brief communication: measurement size, precision, and reliability in craniofacial anthropometry: bigger is better.

In this paper we examine the results of an intraobserver measurement error study involving 49 craniofacial variables that ranged in size from less than 1 cm to approximately 20 cm. Repeat measurements were taken on 10 male and 10 female adult subjects (19-59 years old). Our focus is on the relationship between measurement size and measurement error across the 49 variables. We found that the size of the variable showed no relationship with the magnitude of the error as measured by the technical error of measurement. When the error was expressed as a coefficient of relative variation (Malina et al.: Vital and Health Statistics, Series 11, No. 23. Washington, DC: US Department of Health and Human Services, 1973), this quantity was negatively associated with the size of the measurement. Conversely, reliability (Fleiss: The Design and Analysis of Experiments. New York: John Wiley & Sons, 1986) was positively correlated with measurement size. We did not find effects of scale (Marks et al.: Am. J. Epidemiol. 130:578-587, 1989) within the individual measurements. Thus, for the range of size of the craniofacial measurements in this study, measurement size must be added to the list of factors such as ease of locating landmarks, measurement technique, and systematic bias in the application of the technique that can affect precision and reliability in anthropometry.

Adult↗