The American Journal ofClinical Nutrition 34: NOVEM BER 1981, pp. 2540-2545. Printed in U.S.A.

1981 American Society for Clinical Nutrition

New norms of upper limb fat and muscle areas
for assessment of nutritional status1
A . Roberto Frisancho,2 Ph.D.
ABSTRACT Based on measurements of triceps skinfold thickness and upper arm circumfer-
ence ofa cross-sectional sample of 19,097 white subjects aged 1 to 74 yr. derived from the United
States Health and Nutritional Examination Survey of 197 1 to 1974, the arm muscle circumference,
arm muscle area. and arm fat area were calculated. Thereafter, age- and sex-specific percentiles for
all three estimates of upper arm tissues were obtained. Based on empirical and theoretical evidence.
it is recommended that assessments of nutritional status be made on the basis of areas of fat and
areas ofmuscle rather than direct skinfold thickness and arm circumference. It is also recommended
that these new norms should replace those currently in use. Am. J. Clin. Nutr. 34: 2540-2545,
1981.
KEY W ORDS Growth, standards, nutritional status, arm fat areas. arm muscle areas
Introduction
In recent years anthropometric evaluations
of the upper limb have become valuable in
the assessment of nutritional status of chil-
dren and adults. This is based on the evidence
that the organism, when faced with nutri-
tional restriction, utilizes its nutritional re-
serves 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 transfer-
rin or albumin indicate the visceral protein
status (5). In a previous study, we have pub-
lished percentiles for triceps skinfolds and
estimates of muscle area for whites derived
from the Ten-State Nutrition Survey (1). Al-
though this survey included individuals from
middle and upper income levels, the sample
was heavily weighted toward the lower in-
come groups in each state (1). Hence, it did
not constitute a national population sample.
Furthermore, this study did not give infor-
mation 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 Ex-
amination Survey I (HANES I) ofthe United
2540
States, collected during 197 1 and 1974.
Therefore, the purpose of the present study is
to provide new percentiles for triceps skin-
folds, and estimates of upper arm fat and
muscle area derived from anthropometric
measurements of white samples of HANES
I.
M aterials 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 Proba-
bility sample that represented the civilian noninstitution-
alized 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 arm circumference (cm) was measured to the
nearest cm with a steel tape with the night arm hanging
I From the Center for Human Growth and Develop-
ment and the Department of Anthropology. University
of Michigan, Ann Arbor, M I 48109.
2 Research Scientist.

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UPPER A R M FA T A N D M US CL E A R EA S T A N DA R DS 2541
relax ed. T he m easurem ent w as tak en m idw ay betw een out in p re vio u s publications ( I ) the calculations of upper
the tip of the acrom ion and otecranon process. T riceps arm f at and m uscle areas are only approx im ations. First,
sk inf old (m m ) w as m easured to the nearest m m w ith a the f orm ulas utiliz ed assum e that the upper arm is
L ange sk inf old caliper hav ing a pressure of 10 g/m m 2 of cy lindrical in f orm , an assum ption subject to som e in-
contact surf ace area. T he m easurem ent w as tak en ov er accuracy . S econd, the estim ates of m uscle area do not
th e tric e p s m u s c le half w ay betw een the elbow and the tak e into account the hum eral diam eter. and any v ania-
acrom ial process of the scapula. w ith the sk inf old parallel tion in hum eral diam eter is theref ore not accountable.
to the longitudinal ax is of the upper arm (6). How ev er, a radiographic study of arm com position of
w hite children f ound the sam e ratio of m uscle to bone in
E stim ates of/at and m uscle areas b o th s e xe s and bef ore and af ter adolescence (7). suggest-
Upper arm area (A ), upper arm m uscle area ( M ). ing that bone and m uscle increase proportionately . Fur-
and upper arm f at area ( F) w ere deriv ed f rom m easures then, the estim ation of f at area does not adjust f or
of upper arm circum f erence ( C) conv erted to m m (c) v ariable sk inf old com pressibility .
and triceps sk inf old ( T) using the procedures and restric-
tions indicated prev iously ( I ). I ) A w as calculated by the R esults and discussion
com putation:
T able I giv es the sam ple siz e and the per-
IT , w here d = : , centiles of triceps sk inf olds. T ables 2 and 3
A (m m 2) = X d2 present the percentiles f or arm circum f erence,
estim ated arm m uscle circum f erence, esti-
2) M w as calculated by com putation as f ollow s:
m ated arm f at, and m uscle area.
M (m m 2) = (C - irT)2 A s show n by the 50th percentile v alues, the
41T f ollow ing points are ev ident: 1) in both m ales
and f em ales the increase w ith age in upper
3) F(mm2) w as deriv ed as f ollow s: arm f at is m ore ev ident w hen ex pressed in
F(mm2) = A - M term s of f at area. For ex am ple, betw een 1
A ll these estim ates w ere calculated f or each subject. and 30 y r, the f at area in m ales increases by
T hereaf ter, age- and sex -specif ic percentiles f or arm about 90 and 200% in f em ales, w hereas the
m uscle and arm f at areas w ere calculated. A s pointed increase in triceps sk inf old am ounts to only
T A B L E 1
Percentiles f or triceps sk inf old f or w hites of the United S tates
Health and N utrition Ex am ination S urv ey I of 1971 to 1974
Tric e p s s kin fo ld p e rc e n tile s (m m 2 )
A ge group
n S 0 2 5 5 0 7 5 9 0 9 5 n S 0 2 5 5 0 7 5 9 0 9 5
M ales Fem ales
1 - 1 . 9 2 2 8 6 7 8 1 0 1 2 1 4 1 6 2 0 4 6 7 8 1 0 1 2 1 4 1 6
2 - 2 . 9 2 2 3 6 7 8 1 0 1 2 1 4 1 5 2 0 8 6 8 9 1 0 1 2 1 5 1 6
3 - 3 . 9 2 2 0 6 7 8 1 0 I I 1 4 1 5 2 0 8 7 8 9 1 1 1 2 1 4 1 5
4 - 4 . 9 2 3 0 6 6 8 9 1 1 1 2 1 4 2 0 8 7 8 8 1 0 1 2 1 4 1 6
5 - 5 . 9 2 1 4 6 6 8 9 1 1 1 4 1 5 2 1 9 6 7 8 1 0 1 2 1 5 1 8
6 - 6 . 9 1 1 7 S 6 7 8 1 0 1 3 1 6 1 1 8 6 6 8 1 0 1 2 1 4 1 6
7 - 7 . 9 1 2 2 S 6 7 9 1 2 1 5 1 7 1 2 6 6 7 9 1 1 1 3 1 6 1 8
8 - 8 . 9 1 1 7 5 6 7 8 1 0 1 3 1 6 1 1 8 6 8 9 1 2 1 5 1 8 2 4
9 - 9 . 9 1 2 1 6 6 7 1 0 1 3 1 7 1 8 1 2 5 8 8 1 0 1 3 1 6 2 0 2 2
1 0 - 1 0 . 9 1 4 6 6 6 8 1 0 1 4 1 8 2 1 1 5 2 7 8 1 0 1 2 1 7 2 3 2 7
1 1 - 1 1 . 9 1 2 2 6 6 8 1 1 1 6 2 0 2 4 1 1 7 7 8 1 0 1 3 1 8 2 4 2 8
1 2 - 1 2 . 9 1 5 3 6 6 8 1 1 1 4 2 2 2 8 1 2 9 8 9 1 1 1 4 1 8 2 3 2 7
1 3 - 1 3 . 9 1 3 4 S S 7 1 0 1 4 2 2 2 6 1 5 1 8 8 1 2 1 5 2 1 2 6 3 0
1 4 - 1 4 . 9 1 3 1 4 S 7 9 1 4 2 1 2 4 1 4 1 9 1 0 1 3 1 6 2 1 2 6 2 8
1 5 - 1 5 . 9 1 2 8 4 5 6 8 1 1 1 8 2 4 1 1 7 8 1 0 1 2 1 7 2 1 2 5 3 2
1 6 - 1 6 . 9 1 3 1 4 5 6 8 1 2 1 6 2 2 1 4 2 1 0 1 2 1 5 1 8 2 2 2 6 3 1
1 7 - 1 7 . 9 1 3 3 5 5 6 8 1 2 1 6 1 9 1 1 4 1 0 1 2 1 3 1 9 2 4 3 0 3 7
1 8 - 1 8 . 9 9 1 4 S 6 9 1 3 2 0 2 4 1 0 9 1 0 1 2 1 5 1 8 2 2 2 6 3 0
1 9 - 2 4 . 9 5 3 1 4 5 7 1 0 1 5 2 0 2 2 1 0 6 0 1 0 1 1 1 4 1 8 2 4 3 0 3 4
2 5 - 3 4 . 9 9 7 1 5 6 8 1 2 1 6 2 0 2 4 1 9 8 7 1 0 1 2 1 6 2 1 2 7 3 4 3 7
3 5 - 4 4 . 9 8 0 6 5 6 8 1 2 1 6 2 0 2 3 1 6 1 4 1 2 1 4 1 8 2 3 2 9 3 5 3 8
45-54.9 898 6 6 8 12 15 20 25 1047 12 16 20 25 30 36 40
5 5 - 6 4 . 9 7 3 4 5 6 8 1 1 1 4 1 9 2 2 8 0 9 1 2 1 6 2 0 2 5 3 1 3 6 3 8
6 5 - 7 4 . 9 1 5 0 3 4 6 8 1 1 1 5 1 9 2 2 1 6 7 0 1 2 1 4 1 8 2 4 2 9 3 4 3 6

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T A B L E 2
P e rc e n tile s of upper arm circm f erence (m m ) and estim ated upper arm
m uscle circum f erence (m m ) f or w hites of the United S tates Health
a n d Nu tritio n Ex am ination S urv ey I of 1971 to 1974
Arm c irc u m fe re n c e (m m ) Arm m u s c le c irc u m fe re n c e (m m )
A ge group
S 0 2 5 5 0 7 5 9 0 9 5 5 1 0 2 5 5 0 7 5 9 0 9 5
Ma l e s
1 - 1 . 9 1 4 2 1 4 6 1 5 0 1 5 9 1 7 0 1 7 6 1 8 3 1 1 0 1 1 3 1 1 9 1 2 7 1 3 5 1 4 4 1 4 7
2 - 2 . 9 1 4 1 1 4 5 1 5 3 1 6 2 1 7 0 1 7 8 1 8 5 1 1 1 1 1 4 1 2 2 1 3 0 1 4 0 1 4 6 1 5 0
3 - 3 . 9 1 5 0 1 5 3 1 6 0 1 6 7 1 7 5 1 8 4 1 9 0 1 1 7 1 2 3 1 3 1 1 3 7 1 4 3 1 4 8 1 5 3
4 - 4 . 9 1 4 9 1 5 4 1 6 2 1 7 1 1 8 0 1 8 6 1 9 2 1 2 3 1 2 6 1 3 3 1 4 1 1 4 8 1 5 6 1 5 9
5 - 5 . 9 1 5 3 1 6 0 1 6 7 1 7 5 1 8 5 1 9 5 2 0 4 1 2 8 1 3 3 1 4 0 1 4 7 1 5 4 1 6 2 1 6 9
6 - 6 . 9 1 5 5 1 5 9 1 6 7 1 7 9 1 8 8 2 0 9 2 2 8 1 3 1 1 3 5 1 4 2 1 5 1 1 6 1 1 7 0 1 7 7
7 - 7 . 9 1 6 2 1 6 7 1 7 7 1 8 7 2 0 1 2 2 3 2 3 0 1 3 7 1 3 9 1 5 1 1 6 0 1 6 8 1 7 7 1 9 0
8 - 8 . 9 1 6 2 1 7 0 1 7 7 1 9 0 2 0 2 2 2 0 2 4 5 1 4 0 1 4 5 1 5 4 1 6 2 1 7 0 1 8 2 1 8 7
9 - 9 . 9 1 7 5 1 7 8 1 8 7 2 0 0 2 1 7 2 4 9 2 5 7 1 5 1 1 5 4 1 6 1 1 7 0 1 8 3 1 9 6 2 0 2
1 0 - 1 0 . 9 1 8 1 1 8 4 1 9 6 2 1 0 2 3 1 2 6 2 2 7 4 1 5 6 1 6 0 1 6 6 1 8 0 1 9 1 2 0 9 2 2 1
1 1 - 1 1 . 9 1 8 6 1 9 0 2 0 2 2 2 3 2 4 4 2 6 1 2 8 0 1 5 9 1 6 5 1 7 3 1 8 3 1 9 5 2 0 5 2 3 0
1 2 - 1 2 . 9 1 9 3 2 0 0 2 1 4 2 3 2 2 5 4 2 8 2 3 0 3 1 6 7 1 7 1 1 8 2 1 9 5 2 1 0 2 2 3 2 4 1
1 3 - 1 3 . 9 1 9 4 2 1 1 2 2 8 2 4 7 2 6 3 2 8 6 3 0 1 1 7 2 1 7 9 1 9 6 2 1 1 2 2 6 2 3 8 2 4 5
1 4 - 1 4 . 9 2 2 0 2 2 6 2 3 7 2 5 3 2 8 3 3 0 3 3 2 2 1 8 9 1 9 9 2 1 2 2 2 3 2 4 0 2 6 0 2 6 4
1 5 - 1 5 . 9 2 2 2 2 2 9 2 4 4 2 6 4 2 8 4 3 1 1 3 2 0 1 9 9 2 0 4 2 1 8 2 3 7 2 5 4 2 6 6 2 7 2
1 6 - 1 6 . 9 2 4 4 2 4 8 2 6 2 2 7 8 3 0 3 3 2 4 3 4 3 2 1 3 2 2 5 2 3 4 2 4 9 2 6 9 2 8 7 2 9 6
1 7 - 1 7 . 9 2 4 6 2 5 3 2 6 7 2 8 5 3 0 8 3 3 6 3 4 7 2 2 4 2 3 1 2 4 5 2 5 8 2 7 3 2 9 4 3 1 2
1 8 - 1 8 . 9 2 4 5 2 6 0 2 7 6 2 9 7 3 2 1 3 5 3 3 7 9 2 2 6 2 3 7 2 5 2 2 6 4 2 8 3 2 9 8 3 2 4
1 9 - 2 4 . 9 2 6 2 2 7 2 2 8 8 3 0 8 3 3 1 3 5 5 3 7 2 2 3 8 2 4 5 2 5 7 2 7 3 2 8 9 3 0 9 3 2 1
2 5 - 3 4 . 9 2 7 1 2 8 2 3 0 0 3 1 9 3 4 2 3 6 2 3 7 5 2 4 3 2 5 0 2 6 4 2 7 9 2 9 8 3 1 4 3 2 6
3 5 - 4 4 . 9 2 7 8 2 8 7 3 0 5 3 2 6 3 4 5 3 6 3 3 7 4 2 4 7 2 5 5 2 6 9 2 8 6 3 0 2 3 1 8 3 2 7
4 5 - 5 4 . 9 2 6 7 2 8 1 3 0 1 3 2 2 3 4 2 3 6 2 3 7 6 2 3 9 2 4 9 2 6 5 2 8 1 3 0 0 3 1 5 3 2 6
5 5 - 6 4 . 9 2 5 8 2 7 3 2 9 6 3 1 7 3 3 6 3 5 5 3 6 9 2 3 6 2 4 5 2 6 0 2 7 8 2 9 5 3 1 0 3 2 0
6 5 - 7 4 . 9 2 4 8 2 6 3 2 8 5 3 0 7 3 2 5 3 4 4 3 5 5 2 2 3 2 3 5 2 5 1 2 6 8 2 8 4 2 9 8 3 0 6
2542 FR IS A N CHO
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
1 3 - 1 3 . 9
14-14.9
15-15.9
16-16.9
17-17.9
18- 18.9
19-24.9
25-34.9
3 5 - 4 4 . 9
45-54.9
55-64.9
65-74.9
Fe ma l e s
1 3 8 1 4 2 1 4 8 1 5 6 1 6 4 1 7 2 1 7 7 1 0 5
1 4 2 1 4 5 1 5 2 1 6 0 1 6 7 1 7 6 1 8 4 1 1 1
1 4 3 1 5 0 1 5 8 1 6 7 1 7 5 1 8 3 1 8 9 1 1 3
1 4 9 1 5 4 1 6 0 1 6 9 1 7 7 1 8 4 1 9 1 1 1 5
1 5 3 1 5 7 1 6 5 1 7 5 1 8 5 2 0 3 2 1 1 1 2 5
1 5 6 1 6 2 1 7 0 1 7 6 1 8 7 2 0 4 2 1 1 1 3 0
1 6 4 1 6 7 1 7 4 1 8 3 1 9 9 2 1 6 2 3 1 1 2 9
1 6 8 1 7 2 1 8 3 1 9 5 2 1 4 2 4 7 2 6 1 1 3 8
1 7 8 1 8 2 1 9 4 2 1 1 2 2 4 2 5 1 2 6 0 1 4 7
1 7 4 1 8 2 1 9 3 2 1 0 2 2 8 2 5 1 2 6 5 1 4 8
1 8 5 1 9 4 2 0 8 2 2 4 2 4 8 2 7 6 3 0 3 1 5 0
1 9 4 2 0 3 2 1 6 2 3 7 2 5 6 2 8 2 2 9 4 1 6 2
2 0 2 2 1 1 2 2 3 2 4 3 2 7 1 3 0 1 3 3 8 1 6 9
2 1 4 2 2 3 2 3 7 2 5 2 2 7 2 3 0 4 3 2 2 1 7 4
2 0 8 2 2 1 2 3 9 2 5 4 2 7 9 3 0 0 3 2 2 1 7 5
2 1 8 2 2 4 2 4 1 2 5 8 2 8 3 3 1 8 3 3 4 1 7 0
2 2 0 2 2 7 2 4 1 2 6 4 2 9 5 3 2 4 3 5 0 1 7 5
2 2 2 2 2 7 2 4 1 2 5 8 2 8 1 3 1 2 3 2 5 1 7 4
221 230 247 265 2 9 0 319 345 179
2 3 3 2 4 0 2 5 6 2 7 7 3 0 4 3 4 2 3 6 8 1 8 3
2 4 1 2 5 1 2 6 7 2 9 0 3 1 7 3 5 6 3 7 8 1 8 6
242 256 274 299 328 362 384 187
2 4 3 2 5 7 2 8 0 3 0 3 3 3 5 3 6 7 3 8 5 1 8 7
2 4 0 2 5 2 2 7 4 2 9 9 3 2 6 3 5 6 3 7 3 1 8 5
1 1 1 1 1 7 1 2 4 1 3 2 1 3 9 1 4 3
1 1 4 1 1 9 1 2 6 1 3 3 1 4 2 1 4 7
1 1 9 1 2 4 1 3 2 1 4 0 1 4 6 1 5 2
1 2 1 1 2 8 1 3 6 1 4 4 1 5 2 1 5 7
1 2 8 1 3 4 1 4 2 1 5 1 1 5 9 1 6 5
1 3 3 1 3 8 1 4 5 1 5 4 1 6 6 1 7 1
1 3 5 1 4 2 1 5 1 1 6 0 1 7 1 1 7 6
1 4 0 1 5 1 1 6 0 1 7 1 1 8 3 1 9 4
1 5 0 1 5 8 1 6 7 1 8 0 1 9 4 1 9 8
150 159 170 180 190 197
1 5 8 1 7 1 1 8 1 1 9 6 2 1 7 2 2 3
1 6 6 1 8 0 1 9 1 2 0 1 2 1 4 2 2 0
1 7 5 1 8 3 1 9 8 2 1 1 2 2 6 2 4 0
179 190 201 216 232 247
1 7 8 1 8 9 2 0 2 2 1 5 2 2 8 2 4 4
1 8 0 1 9 0 2 0 2 2 1 6 2 3 4 2 4 9
1 8 3 1 9 4 2 0 5 2 2 1 2 3 9 2 5 7
1 7 9 1 9 1 2 0 2 2 1 5 2 3 7 2 4 5
1 8 5 1 9 5 2 0 7 2 2 1 2 3 6 2 4 9
1 8 8 1 9 9 2 1 2 2 2 8 2 4 6 2 6 4
1 9 2 2 0 5 2 1 8 2 3 6 2 5 7 2 7 2
1 9 3 2 0 6 2 2 0 2 3 8 2 6 0 2 7 4
196 209 225 244 266 280
195 208 225 244 264 279
. 20% in m ales and 100% in f em ales. 2) In both dc circum f erence increases by about 120% in
m ales and f em ales, the increase w ith age in m ales and by about 7 1% in f em ales. In con-
m uscle circum f erence is less m ark ed than the trast, the m uscle area w ithin the sam e age
increases observ ed in m uscle area. T he m us- interv al increases m ore than 350% in m ales

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T A B L E 3
Percentiles fo r e s tim a te s o f upper arm fa t area (m m 2) and u p p e r a rm m u s c le a re a (m m 2 ) fo r wh ite s of the United
S tates Health Ex am ination S urv ey I of 1971 to 1974
Arm m u s c le a re a p e rc e n tile s (m m 2 ) Arm fa t a re a p e rc e n tile s (m m 2 )
A ge group
5 0 2 5 5 0 7 5 9 0 9 5 5 1 0 2 5 5 0 7 5 9 0 9 5
M ales
1 - 1 . 9 9 5 6 1 0 1 4 1 1 3 3 1 2 7 8 1 4 4 7 1 6 4 4 1 7 2 0 4 5 2 4 8 6 5 9 0 7 4 1 8 9 5 1 0 3 6 1 1 7 6
2 - 2 . 9 9 7 3 1 0 4 0 1 1 9 0 1 3 4 5 1 5 5 7 1 6 9 0 1 7 8 7 4 3 4 5 0 4 5 7 8 7 3 7 8 7 1 1 0 4 4 1 1 4 8
3 - 3 . 9 1 0 9 5 1 2 0 1 1 3 5 7 1 4 8 4 1 6 1 8 1 7 5 0 1 8 5 3 4 6 4 5 1 9 5 9 0 7 3 6 8 6 8 1 0 7 1 1 1 5 1
4 - 4 . 9 1 2 0 7 1 2 6 4 1 4 0 8 1 5 7 9 1 7 4 7 1 9 2 6 2 0 0 8 4 2 8 4 9 4 5 9 8 7 2 2 8 5 9 9 8 9 1 0 8 5
5 - 5 . 9 1 2 9 8 1 4 1 1 1 5 5 0 1 7 2 0 1 8 8 4 2 0 8 9 2 2 8 5 4 4 6 4 8 8 5 8 2 7 1 3 9 1 4 1 1 7 6 1 2 9 9
6 - 6 . 9 1 3 6 0 1 4 4 7 1 6 0 5 1 8 1 5 2 0 5 6 2 2 9 7 2 4 9 3 3 7 1 4 4 6 5 3 9 6 7 8 8 9 6 1 1 1 5 1 5 1 9
7 - 7 . 9 1 4 9 7 1 5 4 8 1 8 0 8 2 0 2 7 2 2 4 6 2 4 9 4 2 8 8 6 4 2 3 4 7 3 5 7 4 7 5 8 1 0 1 1 1 3 9 3 1 5 1 1
8 - 8 . 9 1 5 5 0 1 6 6 4 1 8 9 5 2 0 8 9 2 2 9 6 2 6 2 8 2 7 8 8 4 1 0 4 6 0 5 8 8 7 2 5 1 0 0 3 1 2 4 8 1 5 5 8
9 - 9 . 9 1 8 1 1 1 8 8 4 2 0 6 7 2 2 8 8 2 6 5 7 3 0 5 3 3 2 5 7 4 8 5 5 2 7 6 3 5 8 5 9 1 2 5 2 1 8 6 4 2 0 8 1
1 0 - 1 0 . 9 1 9 3 0 2 0 2 7 2 1 8 2 2 5 7 5 2 9 0 3 3 4 8 6 3 8 8 2 5 2 3 5 4 3 7 3 8 9 8 2 1 3 7 6 1 9 0 6 2 6 0 9
1 1 - 1 1 . 9 2 0 1 6 2 1 5 6 2 3 8 2 2 6 7 0 3 0 2 2 3 3 5 9 4 2 2 6 5 3 6 5 9 5 7 5 4 1 1 4 8 1 7 1 0 2 3 4 8 2 5 7 4
1 2 - 1 2 . 9 2 2 1 6 2 3 3 9 2 6 4 9 3 0 2 2 3 4 9 6 3 9 6 8 4 6 4 0 5 5 4 6 5 0 8 7 4 1 1 7 2 1 5 5 8 2 5 3 6 3 5 8 0
1 3 - 1 3 . 9 2 3 6 3 2 5 4 6 3 0 4 4 3 5 5 3 4 0 8 1 4 5 0 2 4 7 9 4 4 7 5 5 7 0 8 1 2 1 0 9 6 1 7 0 2 2 7 4 4 3 3 2 2
1 4 - 1 4 . 9 2 8 3 0 3 1 4 7 3 5 8 6 3 9 6 3 4 5 7 5 5 3 6 8 5 5 3 0 4 5 3 5 6 3 7 8 6 1 0 8 2 1 6 0 8 2 7 4 6 3 5 0 8
1 5 - 1 5 . 9 3 1 3 8 3 3 1 7 3 7 8 8 4 4 8 1 5 1 3 4 5 6 3 1 5 9 0 0 5 2 1 5 9 5 6 9 0 9 3 1 1 4 2 3 2 4 3 4 3 1 0 0
1 6 - 1 6 . 9 3 6 2 5 4 0 4 4 4 3 5 2 4 9 5 1 5 7 5 3 6 5 7 6 6 9 8 0 5 4 2 5 9 3 8 4 4 1 0 7 8 1 7 4 6 2 2 8 0 3 0 4 1
1 7 - 1 7 . 9 3 9 9 8 4 2 5 2 4 7 7 7 5 2 8 6 5 9 5 0 6 8 8 6 7 7 2 6 5 9 8 6 9 8 8 2 7 1 0 9 6 1 6 3 6 2 4 0 7 2 8 8 8
1 8 - 1 8 . 9 4 0 7 0 4 4 8 1 5 0 6 6 5 5 5 2 6 3 7 4 7 0 6 7 8 3 5 5 5 6 0 6 6 5 8 6 0 1 2 6 4 1 9 4 7 3 3 0 2 3 9 2 8
1 9 - 2 4 . 9 4 5 0 8 4 7 7 7 5 2 7 4 5 9 1 3 6 6 6 0 7 6 0 6 8 2 0 0 5 9 4 7 4 3 9 6 3 1 4 0 6 2 2 3 1 3 0 9 8 3 6 5 2
2 5 - 3 4 . 9 4 6 9 4 4 9 6 3 5 5 4 1 6 2 1 4 7 0 6 7 7 8 4 7 8 4 3 6 6 7 5 8 3 1 1 1 7 4 1 7 5 2 2 4 5 9 3 2 4 6 3 7 8 6
3 5 - 4 4 . 9 4 8 4 4 5 1 8 1 5 7 4 0 6 4 9 0 7 2 6 5 8 0 3 4 8 4 8 8 7 0 3 8 5 1 1 3 1 0 1 7 9 2 2 4 6 3 3 0 9 8 3 6 2 4
4 5 - 5 4 . 9 4 5 4 6 4 9 4 6 5 5 8 9 6 2 9 7 7 1 4 2 7 9 1 8 8 4 5 8 7 4 9 9 2 2 1 2 5 4 1 7 4 1 2 3 5 9 3 2 4 5 3 9 2 8
5 5 - 6 4 . 9 4 4 2 2 4 7 8 3 5 3 8 1 6 1 4 4 6 9 1 9 7 6 7 0 8 1 4 9 6 5 8 8 3 9 1 1 6 6 1 6 4 5 2 2 3 6 2 9 7 6 3 4 6 6
6 5 - 7 4 . 9 3 9 7 3 4 4 1 1 5 0 3 1 5 7 1 6 6 4 3 2 7 0 7 4 7 4 5 3 5 7 3 7 5 3 1 1 2 2 1 6 2 1 2 1 9 9 2 8 7 6 3 3 2 7
F e m a le s
1 - 1 . 9 8 8 5 9 7 3 1 0 8 4 1 2 2 1 1 3 7 8 1 5 3 5 1 6 2 1 4 0 1 4 6 6 5 7 8 7 0 6 8 4 7 1 0 2 2 1 1 4 0
2 - 2 . 9 9 7 3 1 0 2 9 1 1 1 9 1 2 6 9 1 4 0 5 1 5 9 5 1 7 2 7 4 6 9 5 2 6 6 4 2 7 4 7 8 9 4 1 0 6 1 1 1 7 3
3 - 3 . 9 1 0 1 4 1 1 3 3 1 2 2 7 1 3 9 6 1 5 6 3 1 6 9 0 1 8 4 6 4 7 3 5 2 9 6 5 6 8 2 2 9 6 7 1 1 0 6 1 1 5 8
4 - 4 . 9 1 0 5 8 1 1 7 1 1 3 1 3 1 4 7 5 1 6 4 4 1 8 3 2 1 9 5 8 4 9 0 5 4 1 6 5 4 7 6 6 9 0 7 1 1 0 9 1 2 3 6
5 - 5 . 9 1 2 3 8 1 3 0 1 1 4 2 3 1 5 9 8 1 8 2 5 2 0 1 2 2 1 5 9 4 7 0 5 2 9 6 4 7 8 1 2 9 9 1 1 3 3 0 1 5 3 6
6 - 6 . 9 1 3 5 4 1 4 1 4 1 5 1 3 1 6 8 3 1 8 7 7 2 1 8 2 2 3 2 3 4 6 4 5 0 8 6 3 8 8 2 7 1 0 0 9 1 2 6 3 1 4 3 6
7 - 7 . 9 1 3 3 0 1 4 4 1 1 6 0 2 1 8 1 5 2 0 4 5 2 3 3 2 2 4 6 9 4 9 1 5 6 0 7 0 6 9 2 0 1 1 3 5 1 4 0 7 1 6 4 4
8 - 8 . 9 1 5 1 3 1 5 6 6 1 8 0 8 2 0 3 4 2 3 2 7 2 6 5 7 2 9 9 6 5 2 7 6 3 4 7 6 9 1 0 4 2 1 3 8 3 1 8 7 2 2 4 8 2
9 - 9 . 9 1 7 2 3 1 7 8 8 1 9 7 6 2 2 2 7 2 5 7 1 2 9 8 7 3 1 1 2 6 4 2 6 9 0 9 3 3 1 2 1 9 1 5 8 4 2 1 7 1 2 5 2 4
1 0 - 1 0 . 9 1 7 4 0 1 7 8 4 2 0 1 9 2 2 9 6 2 5 8 3 2 8 7 3 3 0 9 3 6 1 6 7 0 2 8 4 2 1 1 4 1 1 6 0 8 2 5 0 0 3 0 0 5
1 1 - 1 1 . 9 1 7 8 4 1 9 8 7 2 3 1 6 2 6 1 2 3 0 7 1 3 7 3 9 3 9 5 3 7 0 7 8 0 2 1 0 1 5 1 3 0 1 1 9 4 2 2 7 3 0 3 6 9 0
1 2 - 1 2 . 9 2 0 9 2 2 1 8 2 2 5 7 9 2 9 0 4 3 2 2 5 3 6 5 5 3 8 4 7 7 8 2 8 5 4 1 0 9 0 1 5 1 1 2 0 5 6 2 6 6 6 3 3 6 9
1 3 - 1 3 . 9 2 2 6 9 2 4 2 6 2 6 5 7 3 1 3 0 3 5 2 9 4 0 8 1 4 5 6 8 7 2 6 8 3 8 1 2 1 9 1 6 2 5 2 3 7 4 3 2 7 2 4 1 5 0
1 4 - 1 4 . 9 2 4 1 8 2 5 6 2 2 8 7 4 3 2 2 0 3 7 0 4 4 2 9 4 4 8 5 0 9 8 1 1 0 4 3 1 4 2 3 1 8 1 8 2 4 0 3 3 2 5 0 3 7 6 5
1 5 - 1 5 . 9 2 4 2 6 2 5 1 8 2 8 4 7 3 2 4 8 3 6 8 9 4 1 2 3 4 7 5 6 8 3 9 1 1 2 6 1 3 9 6 1 8 8 6 2 5 4 4 3 0 9 3 4 1 9 5
1 6 - 1 6 . 9 2 3 0 8 2 5 6 7 2 8 6 5 3 2 4 8 3 7 1 8 4 3 5 3 4 9 4 6 1 1 2 6 1 3 5 1 1 6 6 3 2 0 0 6 2 5 9 8 3 3 7 4 4 2 3 6
1 7 - 1 7 . 9 2 4 4 2 2 6 7 4 2 9 9 6 3 3 3 6 3 8 8 3 4 5 5 2 5 2 5 1 1 0 4 2 1 2 6 7 1 4 6 3 2 1 0 4 2 9 7 7 3 8 6 4 5 1 5 9
1 8 - 1 8 . 9 2 3 9 8 2 5 3 8 2 9 1 7 3 2 4 3 3 6 9 4 4 4 6 1 4 7 6 7 1 0 0 3 1 2 3 0 1 6 1 6 2 1 0 4 2 6 1 7 3 5 0 8 3 7 3 3
1 9 - 2 4 . 9 2 5 3 8 2 7 2 8 3 0 2 6 3 4 0 6 3 8 7 7 4 4 3 9 4 9 4 0 1 0 4 6 1 1 9 8 1 5 9 6 2 1 6 6 2 9 5 9 4 0 5 0 4 8 9 6
2 5 - 3 4 . 9 2 6 6 1 2 8 2 6 3 1 4 8 3 5 7 3 4 1 3 8 4 8 0 6 5 5 4 1 1 1 7 3 1 3 9 9 1 8 4 1 2 5 4 8 3 5 1 2 4 6 9 0 5 5 6 0
3 5 - 4 4 . 9 2 7 5 0 2 9 4 8 3 3 5 9 3 7 8 3 4 4 2 8 5 2 4 0 5 8 7 7 1 3 3 6 1 6 1 9 2 1 5 8 2 8 9 8 3 9 3 2 5 0 9 3 5 8 4 7
4 5 - 5 4 . 9 2 7 8 4 2 9 5 6 3 3 7 8 3 8 5 8 4 5 2 0 5 3 7 5 5 9 6 4 1 4 5 9 1 8 0 3 2 4 4 7 3 2 4 4 4 2 2 9 5 4 1 6 6 1 4 0
5 5 - 6 4 . 9 2 7 8 4 3 0 6 3 3 4 7 7 4 0 4 5 4 7 5 0 5 6 3 2 6 2 4 7 1 3 4 5 1 8 7 9 2 5 2 0 3 3 6 9 4 3 6 0 5 2 7 6 6 1 5 2
6 5 - 7 4 . 9 2 7 3 7 3 0 1 8 3 4 4 4 4 0 1 9 4 7 3 9 5 5 6 6 6 2 1 4 1 3 6 3 1 6 8 1 2 2 6 6 3 0 6 3 3 9 4 3 4 9 1 4 5 5 3 0
UPPER A R M FA T A N D M US CL E A R EA S T A N DA R DS
2543
and about 190% in f em ales. In other w ords,
both the triceps sk inf old thick ness and esti-
m ates of m uscle circum f erence underestim ate
the m agnitude of the tissue changes in the
upper arm . T his f inding is not surprising in
v iew of the f act that it tak es m ore f at to cov er
a larger lim b w ith a giv en thick ness of sub-
cutaneous f at than it does to cov er a sm aller
lim b w ith a com parable thick ness. A ccord-
ingly , tw o indiv iduals w ith the sam e triceps

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2 5 4 4 FRI S ANCHO
skinfold thickness but different arm circum-
ference 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 be-
low 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 bet-
ter estimators of weight of fat than skinfold
thickness (8). Previous research indicates that
differences in fat and muscle areas are asso-
ciated 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 system-
atically greater than those given in the Ten-
State 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 assess-
ment depends on the use of appropriate stan-
dards, it is recommended that these more
appropriate new norms replace those cur-
rently in use ( 1 ). These new norms should be
used in conjunction with the new weight-for-
height 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-
erence upon which to diagnose nutritional
status during growth and adulthood, and
avoid current diagnostic problems associated
with the use of different sets of anthropomet-
ric 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 out-
come 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 dispro-
portionately which results in an overestima-
tion of muscle and an underestimation of fat
area.
References
1. Frisancho AR. Triceps skinfold and upper arm mus-
dc 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 M estizo Peruvian population. In: Greene LS.
Johnston FE. eds. Social and biological predictors of
nutritional status, physical growth and behavioral
development. New York: Academic Press, 1980:49-
58.
3. Garn SM , Clark D. Guire KE. Growth, body com-
position and development of obese and lean chil-
dren. In: W inick M , ed. Childhood obesity. New
York: John W iley and Sons, 1975:23-46.
4. Jelliffe DB. The assessment of the nutritional status
of the community. W HO M onograph no. 53. Ge-
neva: W HO, 1966.
5. Bistnian BR, Blackburn GL, Scrimshaw NS. Flatt
JP. Cellular immunity in semistarved states in hos-
pitalized 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, M D: National Cen-
ten for Health Statistics, 1975. Series: United States
Department of Health, Education and W elfare.
IDHEW publication no. (HRA) 75-1219-2.]
7. M alina 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 6-
1 6 y e a r s . Hu m Bi o l 1 9 6 7 : 3 9 : 2 1 1 - 2 3 .
8. Himes JH, Roche AF, W ebb P. Fat areas as esti-
mates of total body fat. Am J Clin Nutr 1980:33:
2093-100.
9. Fnisancho AR, Klayman JE, M atos 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, M atos J. Newborn
body composition and its relationship to linear

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grow th. A m J Clin N utr l977;30:704-1 1.
1 1. Gurney JM , Jellif f e DB . A rm anthropom etry in
nutritional assessm ent: N om ogram f or rapid calcu-
lation of m uscle circum f erence and cross-sectional
m uscle and f at areas. A m J Clin N utr 1973:26:912-
15.
12. N ational Center f or Health S tatistics. N CHS grow th
curv es f or children birth- 1 8 y ears. United S tates.
R ock v ille, M D: N ational Center f or Health S tatis-
tics, 1977. (V ital and health statistics. S eries 1 1: Data
f rom the N ational Health S urv ey . no. 165) IDHEW
publication no. (PHS ) 78-1650.]
13. N ational Center f or Heatlh S tatistics. W eight by
height and age for adults 18-74 y ears: United S tates,
1971-1974. R ock v ille, M D: N ational Center f or
Health S tatistics, 1979. (V ital and health statistics.
S eries 1 1 : Data f rom the N ational Health S urv ey .
no. 208) [DHEW publication no. (PHS ) 79-1656.]
14. B urgert S I, A nderson CF. A n ev aluation of upper
arm m easurem ents used in nutritional assessm ent.
A m J Clin N utr 1979:32:2136-42.
15. Gray GE. Gray L K . V alidity of anthropom etnic
norm s used in the assessm ent of hospitaliz ed pa-
tients. JPEN 1979:3:366-8.
16. B istnian B R , B lack burn GL , V itale J, Cochran D,
N ay lor J. P revalence ofm alnutnition in general m cd-
ical patients. JA M A 1976:23 :1S 67-70.

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