Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Body composition, energy expenditure and physical activity

Comparability of skinfold thickness to DXA whole-body total fat in their associations with serum triglycerides in youths

Abstract

Objective:

To determine the comparability of triceps and subscapular skinfold thicknesses with dual X-ray absorptiometry (DXA) whole-body total fat (kg) in relation to serum triglyceride (TG) levels and increased risk of elevated TG levels, and identified optimum skinfold cutoffs for screening purposes in US adolescents.

Subjects/Methods:

Data from triceps and subscapular skinfold thickness, DXA whole-body total fat and serum TGs were obtained from 1505 US adolescents ages 12.00–17.99 years, who participated in two continuous National Health and Nutrition Examination Survey (NHANES) cycles 2001–2004. Study associations were examined with linear and logistic models, and ROC (receiver operating characteristic) analyses were used to derive skinfold cutoffs for identifying the risk of elevated TG levels.

Results:

Using area under the curves (AUCs) as metrics of prediction accuracy (with bootstrapped 95% CIs), no significant differences were found between skinfolds and DXA logistic models for predicting elevated TG levels. Similarly, skinfold and DXA models had comparable precision in predicting continuous serum TG from bootstrapped root mean squared errors for both sexes. Population-adjusted marginal mean estimates indicated that youths whose skinfolds are in the top quartile had TG levels within 83–108 mg/dl. Skinfold cutoffs for predicting elevated estimated TG using ROC analyses showed that cutoffs decreased with age and ranged from 13 to 30 mm for ages 12–17, in yearly intervals.

Conclusion:

Skinfold thicknesses were comparable to DXA whole-body total fat in predicting serum TG levels. These skinfold cutoffs could be used in practical settings as a first pass screener for identifying US adolescents at risk of elevated serum TGs.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Goran MI, Malina RM . Fat distribution during childhood and adolescence: implications for later health outcomes. Am J Hum Biol 1999; 11, 187–188.

    Article  Google Scholar 

  2. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS . The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 1999; 103 (6 Pt 1), 1175–1182.

    Article  CAS  Google Scholar 

  3. Srinivasan SR, Myers L, Berenson GS . Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study. Diabetes 2002; 51, 204–209.

    Article  CAS  Google Scholar 

  4. Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119, 628–647.

    Article  Google Scholar 

  5. Cali AM, Caprio S . Obesity in children and adolescents. J Clin Endocrinol Metab 2008; 93 (11 Suppl 1), S31–S36.

    Article  CAS  Google Scholar 

  6. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM . Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006; 295, 1549–1555.

    Article  CAS  Google Scholar 

  7. Broyles S, Katzmarzyk PT, Srinivasan SR, Chen W, Bouchard C, Freedman DS et al. The pediatric obesity epidemic continues unabated in Bogalusa, Louisiana. Pediatrics 2010; 125, 900–905.

    Article  Google Scholar 

  8. Daniels SR, Greer FR . Lipid screening and cardiovascular health in childhood. Pediatrics 2008; 122, 198–208.

    Article  Google Scholar 

  9. Freedman DS, Wang J, Ogden CL, Thornton JC, Mei Z, Pierson RN et al. The prediction of body fatness by BMI and skinfold thicknesses among children and adolescents. Ann Hum Biol 2007; 34, 183–194.

    Article  Google Scholar 

  10. Steinberger J, Jacobs DR, Raatz S, Moran A, Hong CP, Sinaiko AR . 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, 1346–1352.

    Article  CAS  Google Scholar 

  11. Garn S . Implications and applications of subcutaneous fat measurement to nutritional assessment and health risk evaluation. In: Himes JH (ed). Anthropometric Assessment of Nutritional Status. Wiley-Liss: New York, 1991, pp 123–150.

    Google Scholar 

  12. CDC/NCHS. The National Health and Nutrition Examination Survey, 2007; Available at: http://www.cdc.gov/nchs/nhanes.htm. Accessed August 2011.

  13. CDC/NCHS. Survey Design Factors. 2010; Available at: http://www.cdc.gov/nchs/tutorials/nhanes/SurveyDesign/intro.htm. Accessed 3 November 2011.

  14. NCHC/CDC. MEC Laboratory Component: Triglycerides and LDL-Cholesterol, 2008; Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/l13am_c.pdf.Accessed 31 August 2011.

  15. Lohman T, Roche AF, Martorell R (eds). Anthropometric Standardization Reference Manual. Human Kinetics Europe Ltd: Champaign, IL, USA, 1988.

    Google Scholar 

  16. Marks GC, Habicht JP, Mueller WH . Reliability, dependability, and precision of anthropometric measurements. The Second National Health and Nutrition Examination Survey 1976–1980. Am J Epidemiol 1989; 130, 578–587.

    Article  CAS  Google Scholar 

  17. Tukey J . Exploratory Data Analysis. Addison-Wesley Publishing Company: Reading, MA, 1977.

    Google Scholar 

  18. Korn EL, Graubard BI . Epidemiologic studies utilizing surveys: accounting for the sampling design. Am J Public Health 1991; 81, 1166–1173.

    Article  CAS  Google Scholar 

  19. Steyerberg EW . Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating. Springer: New York, NY, 2009.

    Book  Google Scholar 

  20. Effron B, Tibshirani R . An Introduction to the Bootstrap. Chapman & Hall/CRC: New York, NY, USA, 1993.

    Book  Google Scholar 

  21. Rubin D . Multiple Imputation for Nonresponse in Surveys. John Wiley & Sons, Inc.: New York, NY, USA, 1987.

    Book  Google Scholar 

  22. Freedman DS, Katzmarzyk PT, Dietz WH, Srinivasan SR, Berenson GS . Relation of body mass index and skinfold thicknesses to cardiovascular disease risk factors in children: the Bogalusa Heart Study. Am J Clin Nutr 2009; 90, 210–216.

    Article  CAS  Google Scholar 

  23. Freedman DS, Bowman BA, Otvos JD, Srinivasan SR, Berenson GS . Differences in the relation of obesity to serum triacylglycerol and VLDL subclass concentrations between black and white children: the Bogalusa Heart Study. Am J Clin Nutr 2002; 75, 827–833.

    Article  CAS  Google Scholar 

  24. Despres JP, Couillard C, Gagnon J, Bergeron J, Leon AS, Rao DC et al. Race, visceral adipose tissue, plasma lipids, and lipoprotein lipase activity in men and women: the Health, Risk Factors, Exercise Training, and Genetics (HERITAGE) family study. Arterioscler Thromb Vasc Biol 2000; 20, 1932–1938.

    Article  CAS  Google Scholar 

  25. Addo OY, Himes JH . Reference curves for triceps and subscapular skinfold thicknesses in US children and adolescents. Am J Clin Nutr 2010; 91, 635–642.

    Article  CAS  Google Scholar 

  26. Zillikens MC, Conway JM . Anthropometry in blacks: applicability of generalized skinfold equations and differences in fat patterning between blacks and whites. Am J Clin Nutr 1990; 52, 45–51.

    Article  CAS  Google Scholar 

  27. Cronk CE, Roche AF . Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/stature. Am J Clin Nutr 1982; 35, 347–354.

    Article  CAS  Google Scholar 

  28. Tresaco B, Moreno LA, Ruiz JR, Ortega FB, Bueno G, Gonzalez-Gross M et al. Truncal and abdominal fat as determinants of high triglycerides and low HDL-cholesterol in adolescents. Obesity 2009; 17, 1086–1091.

    Article  CAS  Google Scholar 

  29. Huang TT, Johnson MS, Figueroa-Colon R, Dwyer JH, Goran MI . Growth of visceral fat, subcutaneous abdominal fat, and total body fat in children. Obes Res 2001; 9, 283–289.

    Article  CAS  Google Scholar 

  30. Mamalakis G, Kafatos A, Manios Y, Kalogeropoulos N, Andrikopoulos N . Abdominal vs buttock adipose fat: relationships with children′s serum lipid levels. Eur J Clin Nutr 2002; 56, 1081–1086.

    Article  CAS  Google Scholar 

  31. Goodpaster BH, Thaete FL, Simoneau JA, Kelley DE . Subcutaneous abdominal fat and thigh muscle composition predict insulin sensitivity independently of visceral fat. Diabetes 1997; 46, 1579–1585.

    Article  CAS  Google Scholar 

  32. Teixeira PJ, Sardinha LB, Going SB, Lohman TG . Total and regional fat and serum cardiovascular disease risk factors in lean and obese children and adolescents. Obes Res 2001; 9, 432–442.

    Article  CAS  Google Scholar 

  33. Flodmark CE, Sveger T, Nilsson-Ehle P . Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12–14-year-old children. Acta Paediatr 1994; 83, 941–945.

    Article  CAS  Google Scholar 

  34. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M . Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr 2002; 91, 1307–1312.

    Article  CAS  Google Scholar 

  35. Li S, Liu X, Okada T, Iwata F, Hara M, Harada K . Serum lipid profile in obese children in China. Pediatr Int 2004; 46, 425–428.

    Article  CAS  Google Scholar 

  36. Hajnis K, Parizkova J, Petrasek R . Development of centrality indices of subcutaneous fat during growth. Coll Antropol 2003; 27, 563–571.

    PubMed  Google Scholar 

  37. Stomfai S, Ahrens W, Bammann K, Kovacs E, Marild S, Michels N et al. Intra- and inter-observer reliability in anthropometric measurements in children. Int J Obes 2011; 35 (Suppl 1): S45–S51.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to O Y Addo.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Contributors: OYA and JHH developed the research idea and design; OYA performed statistical analyses and prepared the original manuscript draft. Results interpretation was carried out by OYA and JHH. Editing was done and intellectual content was prepared by OYA, JHH and MAP. Research supervision was done by JHH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Addo, O., Pereira, M. & Himes, J. Comparability of skinfold thickness to DXA whole-body total fat in their associations with serum triglycerides in youths. Eur J Clin Nutr 66, 989–993 (2012). https://doi.org/10.1038/ejcn.2012.22

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2012.22

Keywords

This article is cited by

Search

Quick links