Protocol for Anthropometric and Body Composition Assessment in Child Undernutrition: A Review and Consensus Document of The International Society for the Advancement of Kinanthropometry (ISAK)
DOI:
https://doi.org/10.34256/ijk26111Keywords:
ISAK, Children, Undernutrition, Body CompositionAbstract
Introduction: Child undernutrition is becoming a physical and mental health problem worldwide as well as an economic development one. It is characterized by wasting (low body mass for stretch stature), stunting (low stretch stature for age) or being underweight (low body mass for age), and reflects nutritional deficiencies in growth and development at critical stages of life. In accordance with the United Nations initiative to reduce malnutrition by 2030, diagnosis, treatment or prevention of any type of child malnutrition is necessary. The objective of this review and consensus document is to offer a standardized frame of measurements and adaptations to the protocol used by the International Society for the Advancement of Kinanthropometry (ISAK) to evaluate undernourished children. Methods: A systematic literature review was conducted using the PRISMA guidelines to identify the existence of different anthropometric measurements and methods to evaluate undernourished children. There are important differences in severe acute or chronic child malnutrition clinical conditions which require a different anthropometric approach. Additionally, the distinct growth and development stages of a lifespan require the adaptation of materials and methods used. Other ethical and practical recommendations are included as necessary in the evaluation of undernourished children. Results: Finally, estimation of body composition in this population must be approached with caution since clinical conditions do not always allow for the necessary measurements. Conclusion: This review can serve as a practical clinical guideline to conduct anthropometric measurements in child undernutrition.
References
Alvear-Vasquez, F., Gomez-Campos, R., Pezoa-Fuentes, P., Urra-Albornoz, C., Caceres-Bahamondes, J., Luarte-Rocha, C., Sulla-Torres, J., Cossio-Bolaños, M.A. (2020). El Flujo espiratorio Máximo y la Fuerza de prensión Manual Predicen La Salud Ósea De Niños Y Adolescentes (Maximum Expiratory Flow and Handgrip Strength Predict Bone Health in Children and Adolescents). Retos, 38: 123-128. https://doi.org/10.47197/retos.v38i38.71786
Azcorra, H., Rodríguez, L., Banik, S.D., Bogin, B., Varela-Silva, M.I., Dickinson, F. (2019). Caesarean Birth and Adiposity Parameters in 6- to 8-Year-Old Urban Maya children from Two Cities of Yucatan, Mexico. American Journal of Human Biology, 31(2): e23217. https://doi.org/https://doi.org/10.1002/ajhb.23217
Baird, J., Walker, I., Smith, C., Inskip, H. (2017). Review of Methods for Determining Pubertal Status and Age of Onset of Puberty in Cohort and Longitudinal Studies. London, UK: CLOSER.
Bakshi, A.C., Bhandari, N. R. (1977). Assessment of Nutritional Status of Pre-School Children in Bhopal. Indian Pediatrics, 14(8): 615–623. https://www.cabidigitallibrary.org/doi/full/10.5555/19771463389
Barr, R., Collins, L., Nayiager, T., Doring, N., Kennedy, C., Halton, J., Walker, S., Sala, A., Webber, C. (2011). Nutritional Status at Diagnosis in Children with Cancer. 2: An Assessment by Arm Anthropometry. Journal of Pediatric Hematology/Oncology, 33(3): e101-e104. https://doi.org/10.1097/mph.0b013e3182002a65
Basaleem, H.O., Amin, R.M. (2011). Integrated Management of Childhood Illness in Lahej, Yemen: A qualitative analysis from the perspective of health providers. Eastern Mediterranean Health Journal, 17(2): 101–108. https://iris.who.int/handle/10665/118086
Boye, K.R., Dimitriou, T., Manz, F., Schoenau, E., Neu, C., Wudy, S., Remer, T. (2002). Anthropometric assessment of muscularity during growth: estimating fat-free mass with 2 skinfold-thickness measurements is superior to measuring midupper arm muscle area in healthy prepubertal children123. The American Journal of Clinical Nutrition, 76(3): 628–632. https://doi.org/10.1093/ajcn/76.3.628
Council for International Organizations of Medical Sciences (CIOMS). (2016). International ethical guidelines for health-related research involving humans: Prepared by the Council for International Organizations of Medical Sciences (CIOMS) in collaboration with the World Health Organization (WHO). Council for International Organizations of Medical Sciences. https://doi.org/https://doi.org/10.56759/rgxl7405
De Onis, M. (2006). Reliability of anthropometric measurements in the WHO Multicentre Growth Reference Study. Acta Paediatrica, 95(S450): 38–46. https://doi.org/10.1111/j.1651-2227.2006.tb02374.x
De Onis, M., Onyango, A., Borghi, E., Siyam, A., Blössner, M., Lutter, C. (2012). Worldwide implementation of the WHO Child Growth Standards. Public Health Nutrition, 15(9): 1603–1610. https://doi.org/10.1017/S136898001200105X
eAcnur. (2020). Desnutrición infantil en el mundo. https://eacnur.org/es/actualidad/noticias/emergencias/desnutricion-infantil-en-el-mundo
Esparza-Ros, F., Vaquero-Cristóbal, R. (2023). Antropometría: Fundamentos para la aplicación e interpretación. Aula Magna, McGraw Hill. https://books.google.com.mx/books?id=K3jCEAAAQBAJ
Esparza-Ros, F., Vaquero-Cristóbal, R., Marfell-Jones, M. (2019). Protocolo Internacional Para La Valoración Antropométrica, Sociedad Internacional para el Avance de la Cineantropometría, ISAK, 2019, 154. https://books.google.com.mx/books?id=eRqfzgEACAAJ
Fenton, T.R. (2003). A New Growth Chart for Preterm Babies: Babson and Benda’s Chart Updated with Recent Data and a New Format. BMC Pediatrics, 3: 13. https://doi.org/10.1186/1471-2431-3-13
Fernández, J.R., Redden, D.T., Pietrobelli, A., Allison, D.B. (2004). Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. The Journal of Pediatrics, 145(4): 439–444. https://doi.org/10.1016/j.jpeds.2004.06.044
Freedman, D.S., Horlick, M., Berenson, G.S. (2013). A comparison of the Slaughter skinfold-thickness equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in children. The American journal of clinical nutrition, 98(6): 1417-1424.
Frisancho, A.R., Tracer, D. P. (1987). Standards of arm muscle by stature for the assessment of nutritional status of children. American Journal of Physical Anthropology, 73(4): 459–465. https://doi.org/10.1002/ajpa.1330730408
Gómez-Campos, R., Andruske, C.L., Arruda, M.D., Urra Albornoz, C., Cossio-Bolaños, M. (2017). Proposed equations and reference values for calculating bone health in children and adolescents based on age and sex. PloS one, 12(7): e0181918. https://doi.org/10.1371/journal.pone.0181918
Gupta, P.M., Wieck, E., Conkle, J., Betters, K.A., Cooley, A., Yamasaki, S., Laibhen-Parkes, N., Suchdev, P. S. (2020). Improving assessment of child growth in a pediatric hospital setting. BMC Pediatrics, 20(1): 419. https://doi.org/10.1186/s12887-020-02289-1
H Heemann, M., Kim, R., Vollmer, S., Subramanian, S.V. (2021). Assessment of undernutrition among children in 55 low-and middle-income countries using dietary and anthropometric measures. JAMA network open, 4(8): e2120627. https://doi.org/10.1001/jamanetworkopen.2021.20627
Heymsfield, S.B., McManus, C., Smith, J., Stevens, V., Nixon, D.W. (1982). Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. The American journal of clinical nutrition, 36(4): 680–690. https://doi.org/10.1093/ajcn/36.4.680
Innes, S., Schulte-Kemna, E., Cotton, M.F., Zöllner, E. W., Haubrich, R., Klinker, H., Sun, X., Jain, S., Edson, C., van Niekerk, M., Innes, E. R., Rabie, H., Browne, S.H. (2013). Biceps Skin-fold Thickness May Detect and Predict Early Lipoatrophy in HIV-infected Children. The Pediatric Infectious Disease Journal, 32(6):e254-e262. https://doi.org/10.1097/INF.0b013e3182814b30
Kiernan, B.D., Mascarenhas, M. (2023). Growth Assessment and Its Significance. In: Vachani, J.G. (eds) Failure to Thrive and Malnutrition. Springer International Publishing, Cham, 33–72. https://doi.org/10.1007/978-3-031-14164-5_3
Marrodán, M.D., González-Montero de Espinosa, M., Herráez, Á., Alfaro, E.L., Bejarano, I.F., Carmenate, M., Lomaglio, D.B., López-Ejeda, N., Martínez, A., Mesa, M.S., Pérez, B.M., Meléndez, J.M., Moreno-Romero, S., Pacheco, J.L., Vázquez, V., Dipierri, J.E. (2017). Development of subcutaneous fat in Spanish and Latin American children and adolescents: Reference values for biceps, triceps, subscapular and suprailiac skinfolds. HOMO, 68(2): 145–155. https://doi.org/10.1016/j.jchb.2017.02.003
Marshall, A. I., Lasco, G., Phaiyarom, M., Pangkariya, N., Leuangvilay, P., Sinam, P., Suphanchaimat, R., Julchoo, S., Kunpeuk, W., Zhang, Y. (2021). Evidence on Child Nutrition Recommendations and Challenges in Crisis Settings: A Scoping Review. International journal of environmental research and public health, 18(12), 6637. https://doi.org/10.3390/ijerph18126637
Mirwald, R.L., Baxter-Jones, A.D., Bailey, D.A., Beunen, G.P. (2002). An assessment of maturity from anthropometric measurements. Medicine & science in sports & exercise, 34(4), 689-694.
National Center for Health Statistics (CDC). (2024). Growth charts. https://www.cdc.gov/growthcharts/index.htm
National Center for Health Statistics (CDC). (2025). NANHES survey I. https://www.cdc.gov/nchs/nhanes/nhanes1/default.aspx
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart , L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., Moher, D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372: n71. https://doi.org/10.1136/bmj.n71
Pezzuti, I.L., Kakehasi, A.M., Filgueiras, M.T., de Guimarães, J.A., de Lacerda, I.A.C., Silva, I.N. (2017). Imaging methods for bone mass evaluation during childhood and adolescence: an update. Journal of Pediatric Endocrinology and Metabolism, 30(5): 485-497. https://doi.org/10.1515/jpem-2016-0252
Ramírez, E., Valencia, M. E., Bourges, H., Espinosa, T., Moya-Camarena, S. Y., Salazar, G., Alemán-Mateo, H. (2012). Body composition prediction equations based on deuterium oxide dilution method in Mexican children: a national study. European Journal of Clinical Nutrition, 66(10): 1099-1103.
Rocha, M.S.L. (1975). Peso ósseo do brasileiro de ambos os sexos de 17 a 25 años. Arquivos de Anatomía e Antropología, 1: 445–451.
Ross, W.D., Kerr, D.A. (1991). Fraccionamiento de la masa corporal: un nuevo método para utilizar en nutrición clínica y medicina deportiva. Apunts, 28: 175–188. https://dialnet.unirioja.es/servlet/articulo?codigo=6305062
Slaughter, M.H., LOHMAN, T.G., Boileau, R., HORSWILL, C.A., STILLMAN, R.J., Van Loan, M.D., Bemben, D.A. (1988). Skinfold equations for estimation of body fatness in children and youth. Human biology, 60(5): 709-723. https://www.jstor.org/stable/41464064
Sphere Association. (2018). The Sphere Handbook: Humanitarian charter and minimum standards in humanitarian response (4a edition). Practical Action Publishing. https://www.spherestandards.org/handbook-2018/
UNICEF - WHO. (2024). The UNICEF-WHO- World Bank Joint Child Malnutrition Estimates ( JME ) standard methodology Tracking progress on SDG Indicators, 2(1). https://www.who.int/publications/i/item/9789240100190
UNICEF, U. N. C. F. (2013). Improving child nutrition: The achievable imperative for global progress. https://data.unicef.org/resources/improving-child-nutrition-the-achievable-imperative-for-global-progress/
UNICEF, U. N. C. F. (2023). Causas de la Desnutrición infantil. https://www.unicef.es/causas/desnutricion-infantil
Vijayaraghavan, K. (1987). Anthropometry for assessment of nutritional status. The Indian Journal of Pediatrics, 54(4), 511–520. https://doi.org/10.1007/BF02749045
WHO, W. H. O. (2022). Training course on the inpatient management of severe acute malnutrition: course director’s guide (W.H.O.(WHO)(ed.)). WHO. https://www.who.int/publications/i/item/9789240029781
WHO, W.H.O. (2003). Guiding principles for feeding infants and young children during emergencies. https://iris.who.int/handle/10665/42710
WHO, W.H.O. (2025). Child growth standards. https://www.who.int/tools/child-growth-standards/standards
Zanchetta, J.R., Plotkin, H., Filgueira, M.A. (1995). Bone mass in children: normative values for the 2–20-year-old population. Bone, 16(4): S393-S399. https://doi.org/10.1016/8756-3282(95)00082-o
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Copyright (c) 2026 Lorenzo Alejandro Landa Pérez, María Dolores Cabañas Armesilla, Adán Israel Rodríguez-Hernández, Ka Yiu Lee, Irina Livier Rangel-García, Claudia Maceroni
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Articles published in the International Journal of Kinanthropometry are licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, provided appropriate credit is given to the original authors and the source.
