Prevalence of marked overweight and obesity in a multiethnic pediatric population: findings from the Child and Adolescent Trial for Cardiovascular Health (CATCH) study

OBJECTIVE: Determine the prevalence of marked overweight and obesity among children in the Child and Adolescent Trial for Cardiovascular Health (CATCH), identify high risk groups, and compare findings to other recent studies. DESIGN: Cohort study. SUBJECTS/SETTING: Five thousand one hundred-six school children who were participants in CATCH at baseline (age approximately 9 years) during 1991 and 4,019 of those children who had follow-up data from 1994 (age approximately 1 years) available. METHODS: Body mass index (BMI), triceps and subscapular skinfolds, subscapular to triceps skinfold (S/T) ratio, and an estimate of body fat distribution from skinfolds was calculated. Findings were compared to population-based reference data from the First National Health and Nutrition Examination Survey, 1971 to 1973 (NHANES I), to data from the Bogalusa Heart Study, and to data from the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III). RESULTS: Children in CATCH were markedly heavier and fatter than the NHANES I population and more comparable to the NHANES III population, especially those in the upper percentiles. The prevalence of obesity based on BMI and triceps skinfolds >95th percentile among CATCH children was higher in boys than in girls at both baseline (boys 9.1%, girls 8.6%) and follow-up (boys 11.7%, girls 7.2%). It was higher among African-Americans and Hispanics than whites for both sexes. S/T ratios did not differ appreciably from those observed in the NHANES I reference population, suggesting that body fat distribution was more stable over time than BMI and skinfolds. APPLICATIONS: Our findings support other recent reports that American children, especially African-American and Hispanic children, are becoming heavier and fatter. Preventive measures are warranted, especially for high-risk youth.     

Adiponectin/ACP30, a collagen-like plasma protein in relation to anthropometric measurement in Thai overweight and obese subjects

Adiponectin, anthropometric parameters including weight, height, body mass index (BMI), arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio were recorded in 48 male and 166 female overweight and obese Thai volunteers (BMI?≥?25.0 kg/m²), and in 26 male and 81 female normal subjects (BMI?=?18.5???24.9 kg/m²). Thai volunteers were investigated. Statistically significantly lower adiponectin concentrations in overweight and obese subjects were found when compared with control subjects of both sexes. Anthropometric parameters, including weight, height, BMI, arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio, except arm span, were statistically significantly higher in overweight and obese subjects than in control subjects. The overweight and obese subjects had higher glucose concentrations than the control subjects. The BMI and glucose concentrations were found to be significantly related, under these conditions, to adiponectin.     

Adiponectin/ACP30, a collagen-like plasma protein in relation to anthropometric measurement in Thai overweight and obese subjects

Adiponectin, anthropometric parameters including weight, height, body mass index (BMI), arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio were recorded in 48 male and 166 female overweight and obese Thai volunteers (BMI=25.0 kg/m(2)), and in 26 male and 81 female normal subjects (BMI=18.5-24.9 kg/m(2)). Thai volunteers were investigated. Statistically significantly lower adiponectin concentrations in overweight and obese subjects were found when compared with control subjects of both sexes. Anthropometric parameters, including weight, height, BMI, arm circumference, triceps skinfold, subscapular skinfold, waist, hip circumferences and waist/hip ratio, except arm span, were statistically significantly higher in overweight and obese subjects than in control subjects. The overweight and obese subjects had higher glucose concentrations than the control subjects. The BMI and glucose concentrations were found to be significantly related, under these conditions, to adiponectin.     

Waist circumference and cardiovascular risk factors in prepubertal children

OBJECTIVE: Intra-abdominal fat has been identified as being the most clinically relevant type of fat in humans. Therefore, an assessment of body-fat distribution could possibly identify subjects with the highest risk of adverse lipid profile and hypertension. Few data on the relationship between body-fat distribution and cardiovascular risk factors are available in children, especially before puberty. RESEARCH METHODS AND PROCEDURES: This cross-sectional study was undertaken to explore the relationship between anthropometric variables, lipid concentrations, and blood pressure (BP) in a sample of 818 prepubertal children (ages 3 to 11 years) and to assess the clinical relevance of waist circumference in identifying prepubertal children with higher cardiovascular risk. Height, weight, triceps and subscapular skinfolds, waist circumference, and BP were measured. Plasma levels for triacylglycerol, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, apolipoprotein A1 (ApoA1), and apolipoprotein B (ApoB) were determined. RESULTS: Females were fatter than males (5.8 [3.5] vs. 4.8 [3.3] kg of fat mass; p < 0.01). Males had higher HDL cholesterol and ApoA1/ApoB plasma concentrations than females (p < 0.001 and p < 0.01, respectively). Waist circumference had a higher correlation with systolic and diastolic BP (r = 0.40 and 0.29, respectively; p < 0.001) than triceps (r = 0.35 and 0.21, respectively; p < 0.001) and subscapular (r = 0.28 and 0.16, respectively; p < 0.001) skinfolds and relative body weight (0.33 and 0.23, respectively; p < 0.001). Multivariate linear model analysis showed that ApoA1/ApoB, HDL cholesterol, total cholesterol/HDL cholesterol, and systolic as well as diastolic BP were significantly associated with waist circumference and triceps and subscapular skinfolds, independently of age, gender, and body mass index. DISCUSSION: Waist circumference as well as subscapular and triceps skinfolds may be helpful parameters in identifying prepubertal children with an adverse blood-lipids profile and hypertension. However, waist circumference, which is easy to measure and more easily reproducible than skinfolds, may be considered in clinical practice. Children with a waist circumference greater than the 90th percentile are more likely to have multiple risk factors than children with a waist circumference that is less than or equal to the 90th percentile.     

The low prevalence of weight-for-height deficits in Brazilian children is related to body proportions

Compared with children from other regions, Latin American children living in poverty have much lower prevalences of weight-for-height deficits than would be expected given the observed rates of stunting. This study was aimed at investigating whether variations in body proportions, particularly abdominal circumference, could explain this paradoxical finding. In a cross-sectional study, children aged 12-35 mo (n = 197) were studied in Southern Brazil. Half of these children were from a high socioeconomic status (SES) group whose growth closely resembled that of the National Center for Health Statistics (NCHS)/WHO reference; the other half were from low income families. The following 11 anthropometric measurements were collected: weight, height, sitting height/crown-rump length, head, chest, upper arm and abdominal circumference, triceps, biceps, subscapular and suprailiac skinfolds. These measures were compared between the two groups of children and with values for North American children [mostly from Second National Health and Nutrition Examination Survey (NHANES II)]. For nearly all measures, low SES Brazilian children tended to be smaller than both high SES and North American children. However, when body proportionality was assessed by dividing the measurements by the child's height, these differences tended to disappear or even to change direction, as was the case for head, chest and abdominal circumferences. Mean abdominal circumference was virtually identical between low and high SES children, and the former had larger abdomens for a given height. Despite slight differences in measuring techniques, Brazilian children had larger abdomens than North Americans. These findings may explain in part why deprived Latin American children have higher weights for their height compared with the NCHS/WHO reference.     

Obesity: does it occur in African children in a rural community in South Africa?

BACKGROUND: Total body fatness and a centripetal fat patterning are recognized as risk indicators of cardiovascular disease in adulthood. In this study, the development of these risk factors in rural South African children during the preschool years and first years of formal schooling is explored. METHOD: The initial cross-sectional data from the Ellisras Longitudinal Investigations in Rural Community Children Project, ongoing since 1996, were used, involving 684 boys and 652 girls, aged 3-10 years, in the Ellisras rural community. Overweight was measured using the body mass index (BMI) (kg/m2). Overfatness was based on the sum of the triceps and subscapular skinfold thicknesses. A centripetal fat patterning was measured by the sum of trunk skinfolds relative to limb skinfolds and the ratio of the subscapular to triceps skinfold. Further, the ratio of the subscapular to supraspinale skinfold was used as an indicator of lower body fat patterning. The 85th percentiles of the NHANES III were used as cutoff values for overweight, overfatness and a centripetal fat patterning. RESULTS: At ages 7 and 8 years, mean BMI was statistically significantly higher in males compared to females (P < 0.05). The log transformed supraspinale skinfold thickness was larger in females compared to males at ages 4-7 years; the log transformed subscapular skinfold was larger in girls compared to boys aged 7-10 years. Less clear patterns were found for the extremity skinfolds and the skinfold ratios. Very few children (0-2.5% in males and 0-4.3% in females) had BMI values above the NHANES III 85th percentiles, indicating a very low prevalence of overweight children in the area. About 15% of the males showed overfatness at ages 3-4 years, while low prevalence was found at older ages. CONCLUSION: Few Ellisras rural children had above normal values for BMI, indicating a low prevalence of obesity in this population. In the 3- and 4-year-old group more subjects were found to have excessive fat, as indicated by the sum of the triceps and subscapular skinfold thicknesses.     

Comparison of body mass indexes and cutoff points for estimating the prevalence of overweight in Hispanic women.

The anthropometric standards used for estimating the prevalence of overweight among Hispanic groups are generally developed in other populations. Our purpose was to identify appropriate anthropometric indicators and cutoff points for Hispanic women. Data from the Hispanic Health and Nutrition Examination Survey HHANES (1982-1984) included 1,784 Mexican American, 479 Cuban American, and 750 Puerto Rico women aged 25 to 74 years. The body mass indexes examined were weight/standing height1.5, weight/standing height2, weight/sitting height1.5, and weight/sitting height2. Appropriateness was based on correlation of the index with triceps and subscapular skinfold measurements and lack of association with standing or sitting height. The most appropriate indicator was weight/standing height2. To estimate overweight, the 85th percentiles for weight/standing height2 were obtained from the 20- to 29-year-olds in HHANES and the second National Health and Nutrition Examination Survey (NHANES II). For 10-year age intervals, the differences in proportions of women above those cutoff points were compared with a modified t test. The mean estimated prevalences of overweight were significantly higher with the NHANES II standard compared with the HHANES cutoff points (P < .05) for Mexican American women (43% vs 29%) and Puerto Rican women (40% vs 28%). They were slightly lower for the Cuban American women (36% vs 39%). Cutoff points are relative, not absolute, standards that must have biologic meaning. Before our results are used for assessing populations, the cutoff points should be tested for predictive validity with chronic disease rates.     

Anthropometric indices of school children and familiar risk factors

BACKGROUND: Overweight in adolescence predicts adverse health effects in adulthood. We carried out a primary school health program and assessed children's growth and body composition. METHODS: Were screened 869 (448 M, 421 F) primary school children: height, weight, four skinfolds, and four circumferences were measured. A family-reported questionnaire was used to determine family composition, history, and lifestyle. RESULTS: Age was 118 +/- 5 months, BMI 18 +/- 3 kg/m(2). No difference by gender was observed as for BMI or blood pressure. Girls had higher skinfold thickness at the biceps (BCF), triceps (TCF), subscapular (SSF), and suprailiac (SIF) areas (P < 0.001), hip and thigh circumferences (P < 0.01), body fat percentage (P < 0.001). Boys had higher waist circumference (P < 0.01), waist/thigh ratio, and conicity index (P < 0.001). Offspring BMI was correlated with birth weight (P < 0.05), parental BMI and scholarship level (P < 0.001), children blood pressure (P < 0.001), and hours per day spent in television viewing (P < 0.01). Family history for diabetes was associated with higher BMI, SSF, waist circumference (P < 0.05), and upper thigh (P < 0.01). Family history for hypertension was associated with higher SSF/TCF ratio (P < 0.05). CONCLUSIONS: Three of 869 children had BMI >30 kg/m(2) (2 boys and 1 girl), 33 had BMI >25 kg/m(2) (17 boys and 16 girls). The percentages of children who could be considered overweight (BMI >/=95(th) percentile of age- and sex-specific NHANES I reference data) were boys, 10.0%, and girls, 9.3%. Anthropometric and anamnestic data on child and family yield more accurate estimates of risk profile: fat distribution seems relevant for metabolic and cardiovascular disorders.     

Bioelectrical impedance, anthropometry and body composition in stunted and non-stunted children

Bioelectrical impedance (BIA) and anthropometric measurements were taken of 129 stunted and 32 non-stunted children aged 9-24 months in Kingston, Jamaica. The reliability of BIA in such young children was examined and the relationships between impedance and anthropometry were determined. The stunted children had significantly lower body mass index (BMI) and smaller triceps skinfolds than the non-stunted children, suggesting differences in body composition between the groups. Resistance was significantly higher in the stunted children than the non-stunted children and nutritional group (stunted or non-stunted) contributed significantly to the variance in resistance after controlling for length, weight, mid-upper arm circumference, triceps and subscapular skinfolds, age and sex. This suggests that there were differences in body composition and/or body shape between the groups beyond that measured by the anthropometric indices used. Total body water (TBW) was estimated using an equation for Jamaican children of comparable age. As a percentage of body weight the TBW estimates were the same for the two groups, a finding which is inconsistent with the anthropometric data.     

BMI values and other anthropometric and functional measurements as predictors of obesity in a selected group of adolescents

Summary Background Obesity is well known to be a problem all over the world: WHO data report that one billion subjects are overweight and 300 million are obese. Epidemiological data (IOTF) show that prevalence rates are increasing not only in industrialized countries, but also in developing countries, especially as far as the adolescent population is concerned. Aim of the study To select adolescents at risk of obesity by BMI calculation and by other anthropometric and functional measurements in the Aosta Valley Mountain Region (Northern Italy). Methods 532 adolescents were recruited and participated in the study (254 males and 278 females, aged 15.4 ± 0.7). According to standard methods, the following parameters were measured: weight and height for BMI calculation, four skin folds (mid–triceps,mid–biceps, subscapular and supra–iliac) to compute body fat mass,waist and hip circumferences, systolic (SBP) and diastolic (DBP) blood pressure. Parental weight and height, educational and socio–economic status were requested from the parents using a questionnaire. Results Percentages of overweight and obese boys were 20.9% and 4.7% respectively, and percentages of overweight and obese girls were 14.7% and 1.1% respectively (using Cole's cut off point reference standard). Mean body fat mass percentages (males = 19.3 ± 5.6%, females 23.3 ± 4.4%) showed males at risk of obesity, as indicated by a higher prevalence rate of overweight and obesity in this gender. Positive correlations (p <0.01) were found between BMI and the following parameters: mid–triceps skinfolds, body fat mass percentage,waist and hip circumferences, but no correlation emerged with WHR; body fat mass positively correlates (p <0.01) with waist and hip circumferences; students' BMI positively correlates with blood pressure (p <0.01),with parental BMI and shows a positive trend towards parental low education and socioeconomic levels. Conclusions Overweight and obesity prevalence rates are higher in males than in females according to literature data; family influences weight condition. The correlations that emerged show that BMI is a good adiposity index also in adolescents, it acts as an indicator of cardiovascular risk condition and is influenced by parental BMI.     

Body fat distribution and osteoarthritis

The association of body fat distribution with single and combined site osteoarthritis was investigated using data from the US Health Examination Survey I, 1960-1962 (HES I) and the first National Health and Nutrition Examination Survey I, 1971-1975 (NHANES I). The study included 1,636 adults aged 35-79 years from HES I with hands and feet radiographs and four anthropometric fat distribution measures--subscapular and triceps skinfolds, waist girth, and seat breadth--and 3,885 adults aged 45-74 from NHANES I with knee radiographs and subscapular and triceps skinfold measures. Sex-specific data, adjusted for age, race, and body mass index, were analyzed using polychotomous logistic regression. There was a positive association of body mass index with knee osteoarthritis and with combined hands and feet osteoarthritis. A peripheral body girth pattern was associated with combined site osteoarthritis of the hands and feet; however, there was no consistent pattern of association of body fat distribution with knee osteoarthritis nor with osteoarthritis of the hands or feet only. These findings suggest that the central body fat pattern observed in previous studies to be associated with cardiovascular and gallbladder disease, and with diabetes, is not associated with osteoarthritis of the hands, feet, or knees.     

Comparison of body proportions of one-year-old Mexican-American and Anglo children.

The body proportions of 95 Anglo and Mexican-American children aged 48-56 weeks in the Women, Infants, and Children (WIC) Special Supplemental Food Program were determined by use of multiple anthropometric measurements. Ethnic differences were several and collectively define the Mexican-American child as being greater in weight-for-length than the Anglo child with greater chest and thigh circumferences, subscapular skinfolds, and estimated body fat.     

Preschoolers on alternate life-style diets. Associations between size and dietary indexes with diets limited in types of animal foods

One hundred nineteen vegetarian preschool children whose parents volunteered were studied in their homes. Length, weight, triceps and subscapular skinfolds, and head circumference were measured. Information on extensiveness of avoidances of animal food groups, parental dietary group, birth weight, parental heights, and the child's status with respect to breast feeding at the time of measurement was obtained by parental report. All infants under six months old were breast fed. More of the children's measurements were below the Harvard 50th percentiles for length and weight than would have been expected after six months of age, but not until then. Vegetarian children were also leaner (triceps and subscapular skinfolds) after six months of age than would be expected from Tanner-Whitehouse standards. Head circumferences were similar to standards and within normal limits at all ages. An association between smallness, lightness, and leanness was found among the vegetarians, with these characteristics being more pronounced among the older, non-breast fed, macrobiotic children on diets with limited variety in terms of animal food. While smallness and low weight-for-length were associated with leanness, largeness and high weight-for-length did not imply obesity in these subjects.     

Breast-feeding has a limited long-term effect on anthropometry and body composition of Brazilian mothers

The effect of lactation on maternal nutrition is controversial. Some studies have shown that breast-feeding reduces maternal weight, whereas some have not. All studies have been restricted to the first 2 y after delivery. We investigated the effect of lactation on maternal nutrition 5 y after delivery. All mothers giving birth in the city of Pelotas, Brazil, in 1993 were interviewed and weighed soon after delivery; information was also obtained on prepregnancy weight. In 1994, information on breast-feeding duration and pattern was collected for a 20% subsample. They were seen again in 1998, and those eligible (nonsmokers, no subsequent pregnancy, last birth weight > or = 2500 g) underwent measurements for weight, height, waist, hip and arm circumferences, triceps and subscapular skinfolds. The following indices were calculated in 312 women: body mass index, waist/hip ratio, arm fat area, the percentage of body fat assessed through skinfolds, and weight and body mass index change since before conception. The percentage of body fat was also measured through bioimpedance for half of the sample. After adjustment for confounding, all outcomes generally showed a similar pattern, i.e., mothers who breast-fed for 6-11.9 mo had lower measurements than those with shorter or longer durations. However, only the association with bioimpedance was significant (P < 0.03), and that for arm fat area tended to be significant (P = 0.06). Exclusive or predominant breastfeeding at 4 mo was associated with lower waist circumference (P = 0.05) and the percentage of body fat measured through skinfolds (P = 0.04). This study suggests that the relationship between breast-feeding and long-term changes in maternal weight is complex and, in this population, not particularly strong.     

High levels of childhood obesity observed among 3- to 7-year-old New Zealand Pacific children is a public health concern

This cross-sectional, community-based survey was designed to assess attained growth and body composition of 3- to 7-y-old Pacific children (n = 21 boys and 20 girls) living in Dunedin, New Zealand, and to examine nondietary factors associated with the percentage of body fat. Fat mass, lean tissue mass and the percentage of body fat were measured using dual energy X-ray absorptiometry. One trained anthropometrist also measured height, weight, skinfolds (triceps, subscapular) and circumferences (mid-upper arm, chest, waist, calf). Compared with the National Center for Health Statistics and National Health and Examination Surveys I and II reference data, these Pacific children were tall and heavy for their age with high arm-muscle-area-for-height. Median (quartiles) Z-scores for height and BMI-for-age and arm-muscle-area-for-height were 1.33 (0.60, 2.15), 1.20 (0.74, 4.43) and 1.09 (0.63, 1.85), respectively. Their median (quartile) percentage of body fat was 21.8% (15.0, 35.5) of which 38.5% was located in the trunk. The estimated percentage of children classified as obese ranged from 34 to 49% depending on the criterion used. Over 60% of the children had levels of trunk fat above 1 SD of reported age- and sex-specific Z-scores for New Zealand children. The nondietary factors examined (hours of television viewing and hours playing organized sports, as reported by parents) were not associated with variations in the percentage of body fat, after adjusting for age, sex and birth weight. These extremely high levels of obesity and truncal fat among very young New Zealand children will have major public health implications as these children age.     

Anthropometric and Dietary Assessment of Select Single-Living Urban Elderly

A subsample was selected from a group of single-living, subjectively healthy, urban Canadian Anglophones, 65-77 years of age, involved in a food behaviour study. Fifty persons (26 men and 24 women) participated in an anthropometric examination; three day food records were obtained from 18 men and 19 women. The anthropometric measurements included height, weight, 4 girths (midarm, waist, maximum abdomen, thigh), 6 skinfolds (triceps, biceps, subscapular, suprailiac, abdominal, anterior thigh) and the bistyloid diameter. Food intake was analysed in terms of energy and nutrients. The men had anthropometric parameters within the Canadian median. The women were comaparable in height with other studies but were slender in weight and body measurements; energy and nutrient density were adequate in their diets. Indications of less than adequate intake of energy and of calcium, vitamin A and thiamine were found for some males.     

Black/white differences in relative weight and obesity among girls: the Bogalusa Heart Study

BACKGROUND AND OBJECTIVE: Although black women have a higher prevalence of overweight and obesity than do white women, it is unclear if a similar pattern exists among youths. We therefore examined the development of black/white differences in relative weight and adiposity among 5 to 17-year-old girls. METHODS: Cross-sectional analyses of 4542 black and 4542 white girls who were examined between 1973 and 1994. Quetelet Index (kg/m(2)), Rohrer Index (kg/m;s(3)), and height-adjusted weight were used as measures of relative weight, and subscapular and triceps skinfolds as measures of adiposity. Breast development was used as an index of sexual maturation. RESULTS: On average, black girls were 1 to 3 kg heavier than were similarly aged white girls, and before adolescence, they were 2 to 3 cm taller. After adjusting for differences in height, the mean relative weight of black girls was consistently greater than that of white girls only after age 13; furthermore, sexual maturation was a stronger correlate of relative weight among black girls than among white girls. Comparable differences were seen for the subscapular skinfold thickness, but white girls consistently had a thicker mean triceps skinfold than did black girls. CONCLUSION: Sexual maturation should be considered in comparisons of relative weight and obesity among youths, and as compared with white girls, black girls do not have a higher mean relative weight until adolescence. The use of different indices of overweight and adiposity can lead to contrasting results, with simple comparisons of Quetelet Index tending to overstate the relative weights of taller children.     

Which measure of body fat distribution is best for epidemiologic research?

Multivariate associations were sought between risk factor levels (total cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, glucose, and systolic and diastolic blood pressures) and two sets of anthropometric variables (four circumferences and six skinfolds) to select a set of anthropometric indicators of body fat distribution that correlate most highly with risk of disease. Subjects were men (n = 285) and women (n = 672) from a study of gallbladder disease in a Mexican American population in Starr County, Texas, 1985-1986. The canonical correlations showed that circumferences (0.49-0.61) and skinfolds (0.42-0.60) were equally well correlated to risk factor levels independently of sex and age. Weights from the canonical analyses suggest that measurements at or above the waist and on the lower limb (thigh) are most heavily loaded toward risk (waist = highest risk; thigh = lowest risk). The simplest and most reliable index of body fat distribution for both sexes is the ratio of waist to thigh circumferences. The more commonly used waist/hip ratio proved more valid in women, but not in men. Simple skinfold indices of body fat distribution were more poorly correlated to risk factor levels than the corresponding circumference ratios. In women, body mass index and waist circumference by themselves did as well as body fat distribution indices in explaining variation in risk factors, suggesting the involvement of visceral fat in the body fat/body fat distribution disease relation.     

Improved prediction of body fat by measuring skinfold thickness, circumferences, and bone breadths

OBJECTIVE: To develop improved predictive regression equations for body fat content derived from common anthropometric measurements. RESEARCH METHODS AND PROCEDURES: 117 healthy German subjects, 46 men and 71 women, 26 to 67 years of age, from two different studies were assigned to a validation and a cross-validation group. Common anthropometric measurements and body composition by DXA were obtained. Equations using anthropometric measurements predicting body fat mass (BFM) with DXA as a reference method were developed using regression models. RESULTS: The final best predictive sex-specific equations combining skinfold thicknesses (SF), circumferences, and bone breadth measurements were as follows: BFM(New) (kg) for men = -40.750 + {(0.397 x waist circumference) + [6.568 x (log triceps SF + log subscapular SF + log abdominal SF)]} and BFM(New) (kg) for women = -75.231 + {(0.512 x hip circumference) + [8.889 x (log chin SF + log triceps SF + log subscapular SF)] + (1.905 x knee breadth)}. The estimates of BFM from both validation and cross-validation had an excellent correlation, showed excellent correspondence to the DXA estimates, and showed a negligible tendency to underestimate percent body fat in subjects with higher BFM compared with equations using a two-compartment (Durnin and Womersley) or a four-compartment (Peterson) model as the reference method. DISCUSSION: Combining skinfold thicknesses with circumference and/or bone breadth measures provide a more precise prediction of percent body fat in comparison with established SF equations. Our equations are recommended for use in clinical or epidemiological settings in populations with similar ethnic background.