Reference curves for triceps and subscapular skinfold thicknesses in US children and adolescents

Background: Skinfold thicknesses have long been considered important and valid measurements of subcutaneous fat. Nevertheless, there are no current skinfold reference data for US children and adolescents. Objective: We developed new percentile reference curves for triceps and subscapular skinfold thicknesses by using the same national samples as those included in the reference curves for body mass index (BMI) in the Centers for Disease Control and Prevention 2000 Growth Charts. Design: We included triceps and subscapular skinfold-thickness measurements for 32,783 individuals who also had complete data for BMI. The LMS method was used to derive 10 smoothed skinfold-thickness percentile reference curves and to generate the L, M, and S parameters that allow the calculation of standardized z scores. Results: The new reference curves exhibit established age-and sex-related patterns of development, including dramatic prepubescent increases in subcutaneous fatness in boys at the highest percentiles. Comparisons of smoothed medians for race-ethnicity groups confirm greater subcutaneous fatness in white children than in black age mates at the triceps site but similar median subscapular skinfold thicknesses. Median skinfold thicknesses for children considered overweight (>= 85th percentile) or obese (>= 95th percentile) on the basis of BMI cutoffs do not follow closely the skinfold percentile reference channels across age, especially in boys, which suggests a certain degree of independence between BMI and skinfold thickness at the upper extremes of the BMI distribution. Conclusions: The age-and sex-standardized skinfold percentiles and z scores will be appropriate for a wide range of research applications that consider measures of subcutaneous fat. Because they were developed by using the same children as those used for the 2000 BMI curves of the Centers for Disease Control and Prevention, they provide an important new complementary assessment tool that should be appropriate for almost all US children and adolescents. Am J Clin Nutr 2010;91:635-42.