International Journal of Obesity (2011) 35, S45–S51

& 2011 Macmillan Publishers Limited All rights reserved 0307-0565/11

www.nature.com/ijo

ORIGINAL ARTICLE
Intra- and inter-observer reliability in anthropometric
measurements in children
S Stomfai1, W Ahrens2, K Bammann2, É Kovács1, S Mårild3, N Michels4, LA Moreno5, H Pohlabeln2,
A Siani6, M Tornaritis7, T Veidebaum8 and D Molnár1, on behalf of the IDEFICS Consortium
1
Department of Paediatrics, Medical Faculty, University of Pecs, Pécs, Hungary; 2Bremen Institute for Prevention Research
and Social Medicine, University of Bremen, Bremen, Germany; 3Department of Paediatrics, The Queen Silvia Children’s
Hospital, University of Gothenburg, Gothenburg, Sweden; 4Department of Public Health/Department of Movement and Sport
Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; 5Growth, exercise, Nutrition and
Development Research Group, EU Ciencias de la Salud, University of Zaragoza, Zaragoza, Spain; 6Unit of Epidemiology and
Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy; 7Research and Education Institute
of Child Health, Strovolos, Cyprus and 8National Institute for Health Development, Tervise Arengu Instituut, Tallinn,
Estonia

Introduction: 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.
Objective: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
International Journal of Obesity (2011) 35, S45–S51; doi:10.1038/ijo.2011.34

Keywords: anthropometric methods; skinfold thickness; circumference; technical error of measurement; reliability

Introduction development of chronic illnesses, properly standardised

anthropometric measurements are needed. As body mass
Obese children and adolescents are at risk for health index is not accurate enough to determine total body fat
problems during their youth and as adults if obesity persists. and its distribution, other measures should be included to
To clarify the interrelations between genetic and environ- determine body composition. It should also be considered that
mental factors, and nutritional status and their effect on the body mass index is not only related to body fat but also with
fat-free mass, and this is especially relevant during growth.1
Total body fat distribution is a major risk factor for chronic
Correspondence: Dr S Stomfai, Department of Paediatrics, Medical Faculty,
University of Pecs, Jozsef Attila Street 7, Pécs, 7623, Hungary. diseases in adults and children.2 There is also a strong
E-mail: [email protected] correlation between central obesity and cardiovascular
 Reliability of anthropometric measurements
S Stomfai et al
S46
diseases. Current epidemiological evidence suggests that Anthropometric methods
waist circumference and waist–height ratio, as indicators The measurement of weight was carried out using an
of abdominal adiposity, are positively related to coronary electronic scale (Tanita BC 420 SMA, Tanita Europe GmbH,
heart disease independently of body mass index and other Sindelfingen, Germany) to the nearest 0.1 kg. The children
risk factors for coronary heart disease.3 wore only underwear and a T-shirt. Height was measured,
There is a need to find an adequate method for the with the children as barefoot, using a telescopic height-
determination of body composition and fat distribution. measuring instrument (Seca 225 stadiometer, Birmingham,
There are several sophisticated methods to determine UK) to the nearest 0.1 cm. Skinfold thickness (mm)
body composition and fat-free mass, such as dual X-ray was measured twice on the right side of the body to
absorptiometry,4 air-displacement plethysmography, com- the nearest 0.2 mm with a skinfold calliper (Holtain, Holtain
puter tomography, nuclear magnetic resonance5 and under- Ltd, Pembrokeshire, UK, range 0–40 mm). Skinfold measure-
water weighing.6 These methods are complicated, difficult ments were taken at the following sites: (1) triceps, halfway
to perform and expensive, and are not suitable for large- between the acromion and the olecranon process at the back
scale epidemiological studies.2 In such studies, the most of the arm; (2) biceps, at the same level as the triceps skinfold,
frequently used techniques are measurements of height, directly above the centre of the cubital fossa; (3) subscapular,
weight, body circumference and skinfold thickness. To about 20 mm below the tip of the scapula, at an angle of 451
obtain reliable data, the standardisation of measurements is to the lateral side of the body; (4) suprailiac, about 20 mm
essential and the intra- and inter-observer errors should be above the iliac crest and 20 mm towards the medial line. In
kept as low as possible. the survey, taking measurements of subcutaneous tissue at
The 5-year multicentre IDEFICS (Identification and the triceps and suscapular site was compulsory, that of biceps
prevention of dietary- and lifestyle-induced health effects and suprailiac was optional. Biceps and suprailiac skinfolds
in children and infants) study investigates the aetiology of were only included in the reliability tests in centres taking
diet- and lifestyle-related diseases and disorders with a strong these measurements in the survey. Circumference (cm) was
focus on overweight and obesity in children 2–8 years of measured once with an inelastic tape (Seca 200), precision
age. The baseline survey will provide data on total body fat 0.1 cm, range 0–150 cm, with the subject in a standing
percentage and anthropometric parameters of body fat position. Circumference measurements were taken at four
distribution of European children. sites: arm, waist, hip and neck.7–10
Because of the multicentric design of the study, the risk for
systematic observer effects due to variations in skills and
adherence to the study protocol between members of the Table 1 The total number and age of children participating in the intra-
field staff is increased. For this reason, major emphasis was observer study
laid on the standardisation of anthropometric measurements
N Age (in years)
to decrease measurement error.
The purpose of the present paper is to describe the 2–5 years 6–9 years All Mean s.t.d.
standardisation process and the inter- and intra-observer
Estonia 20 24 44 5.8 2.3
reliability of the anthropometric measurements used in the
Germany 9 24 33 5.8 1.2
IDEFICS study. Hungary 40 38 78 5.9 2.4
Italy 10 19 29 5.7 1.1
Spain 27 26 53 5.7 1.6
Materials and Methods Sweden 46 59 105 5.4 2.1
All 152 190 342 5.7 2.0

The IDEFICS study started in 2006 and baseline survey

included 16 224 children in eight centres (Belgium, Cyprus,
Estonia, Germany, Hungary, Italy, Spain and Sweden). Before
Table 2 The total number and age of children participating in the inter-
baseline survey, all centres participated in central training, observer study
and local training was carried out in each country to
train the field workers and standardise the methodology. N Age (in years)
The guidelines for the conduct of each measurement were 2–5 years 6–9 years All Mean s.t.d.
laid down in standard operation procedures, which were
compiled in a fieldwork manual and provided to all staff Italy 11 11 22 5.4 1.2
Estonia 10 10 20 5.6 2.1
members. All applicable institutional and governmental
Cyprus 14 29 43 6.0 1.3
regulations regarding the ethical issues of human volunteers Sweden 5 15 20 6.4 1.9
were followed during this research. Parents were informed by Germany 15 24 39 5.6 1.3
letter about the nature and aim of the study before the Hungary 20 18 38 5.8 2.4
Spain 24 24 48 5.7 1.6
survey. Only children who provided oral assent and written
All 99 131 230 5.8 1.7
parental consent were included in the study.

International Journal of Obesity

 Reliability of anthropometric measurements
S Stomfai et al
S47
Intra-observer assessment centre, the inter-observer reliability test was dropped for
The protocol of the reliability study proposed that the this measurement. The inter-observer assessment was not
whole set of anthropometric measurements be taken in performed in Belgium, because in this centre only one
at least 20 children (10 boys and 10 girls, 10 kinder- observer was available for one measure. As a result, seven
garten-aged and 10 school-aged). The total number and centres were included in the analyses.
age of participating children are shown in Table 1. Every
observer measured each child three consecutive times
Statistical analysis
within 1 h. Intra-observer assessment was not performed
Technical error of measurement (TEM) is the most widely
in Belgium and Cyprus, leaving only six centres for analysis.
used indicator of precision.
In Germany and in Italy, the full set of measurements was
It is based on at least two measurements taken of the same
not taken.
child by the same observer (intra-observer variability), or by
at least two observers taking the same measurement on
Inter-observer assessment the same child (inter-observer variability). The calculations
A complete set of anthropometric measurements was taken for intra- and inter-observer error are broadly the same.
of at least 20 children (10 boys and 10 girls, 10 kindergarten- For intra-observer TEM for two measurements, and inter-
aged and 10 school-aged). The total number and age of observer TEM involving two observers, the equation is
participating children are shown in Table 2. All observers rffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
X  ffi
measured the same children once. The inter-observer TEM ¼ D2 =2N
reliability investigation was performed on a separate day
from the intra-observer reliability test. If for a specific where D is the difference between measurements and N is
measurement only one observer was present in a survey the number of subjects measured.11

Table 3 Intra-observer TEM, relative TEM and R% for the measurements by country

Estonia Germany Hungary Italy

N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R%

Height (m) 44 1.19 0.0019 0.159 99.99 33 1.19 0.0025 0.214 99.92 78 1.18 0.0018 0.155 99.99 29 1.18 0.0043 0.365 99.79
Weight (kg) 44 23.86 0.0718 0.300 99.99 32 22.43 0.0250 0.111 99.99 78 24.13 0.0075 0.031 100.00 15 26.00 0.2266 0.871 99.93

Skinfold thickness (mm)

Triceps 44 11.71 0.2423 2.069 99.69 40 9.56 0.3120 3.266 98.70
Subscapular 44 6.99 0.1884 2.695 99.79 40 5.85 0.2497 4.275 97.68
Biceps 44 5.73 0.2611 4.560 99.15 40 5.41 0.2106 3.894 97.91
Suprailliac 44 6.97 0.2190 3.142 99.82 40 5.09 0.3001 5.900 98.22

Circumference (cm)
Neck 44 25.97 0.0888 0.342 99.83 33 26.05 0.1845 0.708 98.08 76 26.63 0.4148 1.558 94.72 30 26.68 0.5188 1.945 96.14
Arm 76 18.86 0.1894 1.005 99.42 30 19.76 0.3069 1.553 99.19
Waist 44 54.33 0.8899 1.638 98.37 33 52.62 0.2399 0.456 99.69 76 56.67 0.7342 1.296 98.88 30 57.67 1.0826 1.877 98.83
Hip 44 63.52 0.1670 0.263 99.96 33 62.02 0.1243 0.200 99.95 76 63.24 1.2396 1.960 97.76 30 67.34 0.7391 1.098 99.47

Spaina Sweden All

N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R%

Height (m) 105 1.18 0.0015 0.128 99.99 289 1.18 0.0021 0.173 99.98
Weight (kg) 93 23.65 0.0268 0.113 99.99 262 23.75 0.0546 0.230 99.99

Skinfold thickness (mm)

Triceps 53 11.25 0.362 3.218 99.65 97 9.25 0.2008 2.172 99.19 181 9.91 0.2397 2.418 99.42
Subscapular 53 7.15 0.197 2.757 99.65 97 5.88 0.1222 2.078 99.44 181 6.14 0.1744 2.842 99.52
Biceps 53 6.39 0.1555 2.434 99.65 84 5.57 0.2384 4.277 98.91
Suprailliac 53 6.46 0.1789 2.771 99.65 84 6.07 0.2613 4.302 99.61

Circumference (cm)
Neck 53 25.42 0.1766 0.695 98.93 183 26.33 0.3228 1.226 97.33
Arm 106 19.07 0.2180 1.144 99.37
Waist 53 54.09 0.3494 0.646 98.96 106 53.33 0.2665 0.500 99.49 289 54.54 0.6042 1.108 99.02
Hip 53 62.12 0.3625 0.583 98.96 183 63.57 0.8210 1.291 98.99

Abbreviations: R, coefficient of reliability; TEM, technical errors of measurement. aOn the basis of two measurements.

International Journal of Obesity

 Reliability of anthropometric measurements
S Stomfai et al
S48

99.97
99.99

99.74
99.82
98.64
99.71

97.75
98.13
99.67
99.60
The coefficient of reliability (R) estimates the proportion of

R%
between-subject variance in a measured population that is

TEM%

0.192
0.241

1.809
1.930
4.065
2.491

0.961
1.372
0.809
0.709
free from measurement error. Measures of R can be used to
match the relative reliability of different anthropometric

0.0023
0.0561

0.2790
0.2238
0.4315
0.3976

0.0027
0.0031
0.0051
0.0052
Girls

TEM
measurements, as well as of the same measurements in
different age groups, and to estimate sample size require-

23.29

15.42
11.60

28.43

62.67
1.18

10.61
15.96

22.51

73.27
Mean
ments in anthropometric studies.12–14 R as a percentage (R%)
was calculated using the following equation:11

152
137

14
14

37
28
44
37
7
7
N
Gender
R% ¼ 1  ðtotal TEM2 =SD2 Þ

99.98
99.99

99.15
98.97
97.09
99.36

96.31
99.04
97.87
98.20
R%
TEM%

0.151
0.218

2.259
2.678
4.475
3.566

1.260
1.062
1.247
1.427
To compare TEM assessed for different measurements or for
different populations, absolute TEM was converted into

0.0018
0.0529

0.2127
0.1553
0.2223
0.1934

0.0032
0.0019
0.0067
0.0088
Boys
relative TEM (%TEM) using the following equation:

TEM

24.27

25.86
18.00
53.39
61.40
1.19

9.42
5.80
4.96
5.42
Mean
%TEM ¼ ðTEM=meanÞ100

137
125

106
106

143

204
143
47
47

76
N
where mean is the average of the actually measured
anthropometric parameters.11

99.95
99.99

99.26
99.46
99.13
99.55

96.18
99.29
98.44
98.28
R%
It is well known that the reliability of anthropometric

TEM%

0.229
0.260

2.655
3.053
3.690
4.078

1.456
1.228
1.395
1.717
measurements (especially skinfolds) is influenced by age,
gender and degree of obesity. Although the main goal of the

Obese

0.0028
0.0821

0.2851
0.1983
0.2039
0.2623

0.0037
0.0023
0.0075
0.0108
TEM
study was to investigate the reliability of the measurements
between countries, results were also analysed according to age,
Intra-observer, relative TEM and R% according to age, weight status and gender for the aggregated sample

1.23

6.49
5.52
6.43
31.52

10.73

25.72
18.71
53.81
62.78
Mean
gender and obesity prevalence. All statistical analyses were
performed using SAS 9.2, SAS Institute Inc., Cary, NC, USA.
Weight status

46
40

93
93
44
44

99
56

99
153
N

99.98
99.99

99.56
99.58
98.72
99.65

98.10
99.44
99.63
99.86
Results R%
TEM%

0.164
0.223

1.989
2.516
4.821
4.578

0.909
1.046
0.678
0.466
Non-obese

0.0019
0.0501

0.1799
0.1450
0.2712
0.2601

0.0024
0.0020
0.0038
0.0030
The main characteristics of the children participating
TEM

in the intra-observer reliability tests were the following

22.46

27.06
19.47
55.38
64.51
1.19

9.04
5.76
5.62
5.68
Mean

(mean±s.d.): weight 23.8±7.0 kg, height 118.6±13.3 cm

and age 5.4±2.0 years. The intra-observer TEMs for skinfold

Abbreviations: R, coefficient of reliability; TEM, technical errors of measurement.

217
209

136
88
88
40
40

84
50

84
N

thickness ranged between 0.12 and 0.47 mm in the case of

99.91
99.98

99.56
99.67
99.25
99.69

98.37
99.43
99.60
99.80
Belgium, Estonia, Hungary, Spain and Sweden. The TEM for
R%

circumferences was between 0.09 and 1.24 cm in Belgium,

TEM%

0.175
0.211

2.338
2.736
4.183
3.919

0.868
1.019
0.711
0.460
Estonia, Germany, Hungary, Italy and Sweden. Intra-observer
agreement as assessed by R was above 97.7% for skinfold
0.0022
0.0589

0.2376
0.1767
0.2482
0.2964

0.2365
0.2098
0.4060
0.3147
6–9

TEM

thickness and above 94.7% for circumferences in these

countries. Table 3 shows the intra-observer TEM and R of
27.80

10.16

27.25
20.58
57.09
68.38
1.28

6.46
5.93
7.56
Mean

the validity study by countries, and Table 4 demonstrates

Age (in years)

these parameters according to age, gender and body weight

164
153

103
103

104

166
104
42
42

56
N

for the pooled sample. TEM% provides comparability

99.93
99.98

99.01
98.08
97.35
97.58

91.91
98.01
94.66
93.14
R%

regarding the quality of measurements.

The main characteristics of the children participating in
TEM%

0.168
0.265

2.529
2.997
4.374
4.814

1.606
1.289
1.552
2.069

the inter-observer reliability tests were the following

(mean±s.d.): weight 22.8±6.1 kg, height 117.6±11.9 cm
0.0017
0.0476

0.2423
0.1713
0.2282
0.2200

0.4066
0.2257
0.7940
1.1870
2–5

TEM

and age 5.5±1.9 years. The inter-observer TEMs for skinfold

thickness based on the data of all participating children
1.06

9.58
5.72
5.22
4.57
17.98

25.16
17.50
51.15
57.36
Mean

ranged between 0.13 and 0.97 mm in the case of Cyprus,

(mm)
125
109

123
78
78
42
42

79
50

79

Estonia, Germany, Hungary, Italy, Spain and Sweden. The

N

Circumference (cm)
Skinfold thickness

TEM for circumferences was between 0.18 and 1.01 cm in

Subsca-pular

Supra-iliac
Weight (kg)

Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden.

Height (m)
Table 4

Triceps

Biceps

Waist
Neck

Inter-observer agreement as assessed by the R for repeated

Arm

Hip

measurements of skinfold thickness and circumference was

International Journal of Obesity

 Table 5 Inter-observer TEM, relative TEM and R% for the measurements by country

Cyprus Estonia Germany Hungary

N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R%

Height (m) 44 1.15 0.0036 0.316 99.87 20 1.18 0.0019 0.158 99.98 39 1.18 0.0026 0.225 99.92 39 1.19 0.0021 0.181 99.98
Weight (kg) 44 21.73 0.0917 0.422 99.96 20 22.68 0.0647 0.285 99.99 35 22.19 0.0644 0.290 99.98 39 23.98 0.0113 0.047 100.0

Skinfold thickness (mm)

Triceps 43 9.78 0.2768 2.830 98.38 20 10.03 0.3796 3.787 97.68 39 10.46 0.7280 6.961 94.67 38 10.74 0.9703 9.036 92.67
Subscapular 41 6.09 0.1989 3.265 98.58 20 6.36 0.1311 2.062 99.67 39 5.97 0.4585 7.682 90.22 38 6.85 0.5845 8.527 98.36
Biceps 41 5.53 0.2569 4.651 96.73 20 5.80 0.1333 2.299 99.70 38 6.06 0.6760 11.152 89.87
Suprailliac 43 5.95 0.3188 5.359 97.96 20 7.59 0.3242 4.273 99.48 38 6.77 0.6901 10.199 98.13

Circumference (cm)
Neck 44 25.50 0.3902 1.530 96.87 20 25.80 0.8266 0.320 99.80 39 25.92 0.4508 1.739 88.15 38 26.73 0.4150 1.553 94.65
Arm 38 19.01 0.2526 1.329 99.09
Waist 44 55.39 0.6344 1.145 98.49 20 53.84 0.1785 0.332 99.93 38 52.48 0.4555 0.868 98.74 38 57.11 1.0172 1.781 98.08
Hip 44 60.67 0.6660 1.098 36039 20 61.57 0.2733 0.444 99.82 39 61.48 0.5444 0.886 98.94 38 63.71 0.7467 1.172 99.22

Italy Spain Sweden All

N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R% N Mean TEM TEM% R%

Height (m) 22 1.16 0.0044 0.380 99.80 20 1.22 0.0025 0.205 99.95 184 1.17 0.0027 0.230 99.95
Weight (kg) 20 24.25 0.0570 0.235 99.98 158 22.79 0.0649 0.285 99.98
S Stomfai et al

Skinfold thickness (mm)

Triceps 22 12.36 0.5179 4.188 96.97 48 11.25 0.6652 5.912 97.08 20 9.26 0.4464 4.820 97.14 230 10.56 0.5945 5.628 96.97
Subscapular 22 8.65 0.8061 9.316 98.57 48 7.14 0.3458 4.839 98.58 20 6.45 0.4987 7.732 94.43 228 6.71 0.3940 5.875 98.36
Biceps 22 6.85 0.3659 5.340 98.48 48 6.39 0.6006 9.402 94.23 169 6.07 0.4473 7.363 96.35
Suprailliac 22 10.07 0.4770 4.766 99.55 48 6.46 0.5889 9.120 96.64 171 7.03 0.4882 6.940 98.75

Circumference (cm)
Neck 22 26.27 0.4082 1.554 35612 48 25.41 0.2473 0.973 97.82 211 25.83 0.3043 1.178 97.39
Reliability of anthropometric measurements

Arm 22 19.24 0.3119 1.621 98.97 60 19.09 0.2758 1.444 99.04

Waist 22 56.15 0.7162 1.275 99.36 48 54.09 0.4941 0.914 99.56 20 54.79 0.6561 1.197 94.67 230 54.66 0.5672 1.038 99.25
Hip 22 65.62 1.0609 1.617 98.71 48 62.12 0.5127 0.825 99.45 211 62.18 0.5689 0.915 99.32

Abbreviations: R, coefficient of reliability; TEM, technical errors of measurement.

International Journal of Obesity

S49
 Reliability of anthropometric measurements
S Stomfai et al
S50

99.88
99.99

96.81
98.10
96.53
99.56

95.43
97.64
99.48
98.19
above 88.1% in all countries. Table 5 demonstrates the

R%
inter-observer TEM and R of the validity study by country,

8.96 0.4668 5.2126

TEM%

1.23 0.0035 0.286

99.98 18 30.33 0.0359 0.118

28 14.61 0.7394 5.061

28 11.21 0.8229 7.338

22 14.30 0.5087 3.557

28.29 0.4788 1.342

22.16 0.3494 1.577
63.63 0.6493 1.020
71.96 0.9544 1.326
and Table 6 shows the same parameters according to age,
gender and body weight for the pooled sample of all

Girls

TEM
countries.

Mean

99.95 28

22

25
17
28
25
N
Gender
Discussion

95.64
94.96
96.39
97.37

96.66
98.47
98.40
99.12
R%
One of the main goals of the IDEFICS study was to obtain

TEM%

0.221
0.306

5.302
5.158
6.115
6.921

1.219
1.352
1.062
0.856
reliable and comparable data on a large sample of children
from eight European countries. To achieve this goal, a

0.0026
99.99 140 21.947 0.0672

0.5120
0.3006
0.3311
0.4210

0.3123
0.2439
0.5676
0.5196
Boys

TEM
significant effort was devoted to standardisation of anthro-
pometric measurements.

Mean

96.23 133 25.61

42 17.84
98.82 150 53.43
99.42 133 60.69
1.17

9.65
5.83
5.41
6.08
ReliabilityFmost frequently characterised by two indices,
TEM and R 11Fwas the indicator used to assess the extent to

98
99.95 152

96.26 149
96.80 147

98.34 100
N
which within-subject variability is due to components other

95.64

98.80
R%
than measurement error variance or physiological variation.
The lower the variability between repeated measurements of

TEM%

0.239
0.256

5.504
6.937
7.188
7.030

1.351
1.612
1.158
0.814
the same subject by one (intra-observer differences) or two or

0.0028
83 22.097 0.0586

0.6040
0.4752
0.4501
0.5073

0.3412
0.3027
0.6201
0.5027
more (inter-observer differences) observers, the higher the

Obese

TEM
precision. Intra- and inter-observer measurement errors are
not always analysed in epidemiological studies, although

Mean

1.16

6.85
6.26
7.22
119 10.97

25.26
18.77
53.53
61.73
other pan-European studies have provided comparative data.
Weight status
For the intra-observer reliability study, the Spanish AVENA

119

111

119
111
97

88
88

31
N
Inter-observer TEM and R% according age, weight status and gender for the aggregated sample

study with 101 Spanish adolescents indicated TEMs for

99.95
99.99

97.43
99.33
96.86
99.04

97.97
99.26
99.50
99.23
R%
skinfold thickness and circumference measurements of less
than 1 mm, and R% was above 95%.9 In the framework of the TEM%

0.221
0.301

5.777
4.342
7.571
6.836

0.983
1.254
0.905
1.011
European Healthy Lifestyle in Europe by Nutrition in
Non-obese

0.0026
75 23.549 0.0710

0.5857
0.2848
0.4457
0.4688

0.2599
0.2412
0.5119
0.6334
Adolescence study, 202 adolescents were measured in the
TEM

anthropometric intra-observer reliability study. At the time

of the first training, the results of this study indicated TEMs
Mean

97.68 111 10.14

97.10 100 26.45

29 19.44
99.19 111 55.87
99.03 100 62.66
1.19

6.56
5.89
6.86
for skinfold and circumferences below 2.9 mm and R%

Abbreviations: R, coefficient of reliability; TEM, technical errors of measurement.

98.63 109
87

81
83
greater than 69% after the first training session. However,
N

after a second training session, which resulted in much

99.89
99.98

97.24
99.10

98.89
R%

better agreement, the intra-observer TEMs for skinfold

thickness and circumferences ranged from 1 to 2 mm, and
TEM%

0.247
0.265

5.622
6.302
7.022
6.148

1.082
1.467
1.086
0.946
R% was greater than 95%.2 These results emphasised the
1.26 0.0026
89 26.79 0.0709

94.85 124 10.82 0.6084

7.23 0.4555
6.48 0.4549
8.46 0.5201

95.24 109 26.74 0.2891

29 20.67 0.3034
98.85 124 57.17 0.6209
98.60 109 66.33 0.6273
6–9

need for controlling the reliability of the measurements, in

TEM

order to complete the training if necessary.

Other studies (reviewed by Ulijaszek and Kerr11) reported
Mean

inter-observer reliability of skinfold thickness measurements

Age (in years)

99.87 101

95.86 124
85
85
N

to range from 48 to 99% for triceps and from 60 to 99% for

99.94

93.79
95.05

97.97

subscapular skinfolds. For circumferences, the inter-observer

R%

reliability was between 86 and 99% for waist and between 68

TEM%

0.210
0.327

5.785
5.202
7.949
8.320

1.267
1.404
0.963
0.851

and 99% for hip.11 In comparison with the above results, the
reliability of the anthropometric measurements of the
2–5

1.06 0.0026
59 17.52 0.0573

0.5931
0.3181
0.4532
0.4686

0.3153
0.2472
0.4966
0.4909
TEM

IDFEICS study can be considered relatively good.

In terms of differences in reliability indices according to
6.11
5.70
5.63
96 10.25

24.89
17.61
51.55
57.67
Mean

age, gender and obesity in this preadolescent sample,

Skinfold thickness (mm)

significant gender differences in measurement error were

73

Subsca-pular 94
74
76

92
31
96
92
N

Circum-ference (cm)

observed in some centres but did not reach a level that could
Supra-iliac
Weight (kg)

be regarded as clinically meaningful. The TEM differences

Height (m)
Table 6

Triceps

Biceps

Waist
Neck

between genders were 0.1% or less in total body fat content

Arm

Hip

as calculated from skinfold thickness measurements accord-

International Journal of Obesity

 Reliability of anthropometric measurements
S Stomfai et al
S51
ing to the Slaughter equations.15 Gender differences are and their parents gave their consent for examinations,
generally negligible in the prepubertal age group. Age did collection of samples, subsequent analysis and storage of
not appear to influence reliability results. personal data and collected samples. The participating
Obesity may influence the reliability of skinfold measure- children and their parents could consent to single compo-
ments, especially in those cases in which skinfold size nents of the study while refraining from others.
approaches the upper limit of the measurement range of
the calliper. The skinfold values of our subjects were far from
the upper range of the measurement limit. TEM% values
were lower and R% values were higher in obese children as References
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International Journal of Obesity