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Intra- and inter-observer reliability in anthropometric measurements in children



Studies such as IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) seek to compare data across several different countries. Therefore, it is important to confirm that body composition indices, which are subject to intra- and inter-individual variation, are measured using a standardised protocol that maximises their reliability and reduces error in analyses.


To describe the standardisation and reliability of anthropometric measurements. Both intra- and inter-observer variability of skinfold thickness (triceps, subscapular, biceps, suprailiac) and circumference (neck, arm, waist, hip) measurements were investigated in five different countries.


Central training for fieldwork personnel was carried out, followed by local training in each centre involving the whole survey staff. All technical devices and procedures were standardised. As part of the standardisation process, at least 20 children participated in the intra- and inter-observer reliability test in each centre. A total of 125 children 2–5 years of age and 164 children 6–9 years of age took part in this study, with a mean age of 5.4 (±1.2) years.


The intra-observer technical error of measurement (TEM) was between 0.12 and 0.47 mm for skinfold thickness and between 0.09 and 1.24 cm for circumference measurements. Intra-observer reliability was 97.7% for skinfold thickness (triceps, subscapular, biceps, suprailiac) and 94.7% for circumferences (neck, arm, waist, hip). Inter-observer TEMs for skinfold thicknesses were between 0.13 and 0.97 mm and for circumferences between 0.18 and 1.01 cm. Inter-observer agreement as assessed by the coefficient of reliability for repeated measurements of skinfold thickness and circumferences was above 88% in all countries.


In epidemiological surveys it is essential to standardise the methodology and train the participating staff in order to decrease measurement error. In the framework of the IDEFICS study, acceptable intra- and inter-observer agreement was achieved for all the measurements.

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We thank all the children who took part in the survey and all the centres that provided data. This study was conducted as part of the IDEFICS study ( We gratefully acknowledge the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD) and the grant support from the EU for the IDEFICS study. We thank the IDEFICS children for their participation in this extensive examination. The information in this document reflects the author's view and is provided as it is.

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Correspondence to S Stomfai.

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Statement of ethics

We certify that all applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during this research. Approval by the appropriate ethical committees was obtained by each of the eight centres engaged in the fieldwork. Participants were not subjected to any study procedure before both the children and their parents gave their consent for examinations, collection of samples, subsequent analysis and storage of personal data and collected samples. The participating children and their parents could consent to single components of the study while refraining from others.

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

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