Protocol - Height - Standing Height
Description
Standing height is measured from the top of the participant’s head to his or her heels. This measure is taken among participants, usually older than 2 years of age, who are able to stand unassisted.
The Anthropometrics Expert Review Panel suggests that the measurements be taken to the nearest 0.1 cm.
Specific Instructions
Three measurement protocols (Standing Height, Recumbent Height, and Knee Height) accommodate various groups of participants. Self-Reported Height should be used as a last resort only. Several overarching, critical issues for high-quality data collection of anthropometric measures that optimize the data in gene-environment etiologic research include (1) the need for training (and retraining) of study staff in anthropometric data collection; (2) duplicate collection of measurements, especially under field conditions; (3) use of more than one person for proper collection of measurements where required; (4) accurate recording of the protocols and the measurement units of data collection; and (5) use of required and properly calibrated equipment.
The notion of recommending replicate measurements comes from the reduction in random errors of measurement and accompanying improved measurement reliability when the mean of multiple measurements is used rather than the a single measurement. This improvement in measurement reliability, however, depends on the reliability of a single measurement in the hands of the data collectors in a particular study (Himes, 1989). For example, if a measure such as standing height in a given study has a measurement reliability of 0.95 (expressed as an intraclass correlation coefficient), taking a second measurement and using the mean of the two measurements in analyses will improve the reliability to only 0.97, yielding only a 2% reduction in error variance for the additional effort. If, in the same study, the reliability of a single triceps skinfold measurement was 0.85, using the mean, including a replicate measurement, would raise the reliability to 0.92 and yield a 7% reduction in error variance, more than a three-fold improvement compared with recumbent length. Because the benefits of taking replicate measurements are so closely linked with the existing measurement reliability, it is recommended that as a part of the training of those who will be collecting anthropometry data, a reliability study be conducted that will yield measurement reliability estimates for the data collectors, protocols, settings, and participants involved in that particular study (Himes, 1989). If the measurement reliability for a single measurement is greater than or equal to 0.95, the recommendation is that replicate measurement are not necessary and will yield little practical benefit. If the measurement reliability is less than 0.95, the recommendation is to include replicate measurements as prescribed.
If replicate measurements are indicated because of relatively low reliability, a second measurement should be taken, including repositioning the participant. A third measurement should be taken if the first two measurements differ by more than 1.0 cm. If it is necessary to take a third measurement, the two closest measurements are averaged. Should the third measurement fall equally between the first two measurements, all three should be averaged.
Standing Height, Recumbent Length, and Knee Height protocols are part of an examination study. Self-Reported Height may be part of a personal or self-administered interview.
Note: Detailed videos illustrating the procedure can be found here: https://www.youtube.com/watch?v=jpfT7oh-z3w
Availability
Protocol
Standing Height Protocol
Standing height is an assessment of maximum vertical size. This stature measurement is collected on all SPs aged 2 years and older who are able to stand unassisted. Standing height is measured using a stadiometer with a fixed vertical backboard and an adjustable head piece.
1. Position the SP. Direct the SP to the stadiometer platform. Ask him or her to remove any hair ornaments, jewelry, buns, or braids from the top of the head. Exhibit 3-4 depicts the correct position for the measurement of standing height. First, have the SP stand up straight against the backboard with the body weight evenly distributed and both feet flat on the platform. Instruct the SP to stand with the heels together and toes apart. The toes should point slightly outward at approximately a 60ºangle. Check that the back of the head, shoulder blades, buttocks, and heels make contact with the backboard (Exhibit 1).
Note: Depending on the overall body conformation of the individual, all four contact points—head, shoulders, buttocks, and heels—may not touch the stadiometer backboard. For example, elderly SPs may frequently have kyphosis, a forward curvature of the spine that appears as a hump at the upper back. In particular, dowager’s hump is a form of kyphosis that creates a hump at the back of the neck. Additionally, some overweight SPs cannot stand straight while touching all four contact points to the backboard. In such instances it is important to obtain the best measurement possible according to the protocol. If you cannot ensure that the SP’s trunk remains vertical above the waist, the arms and shoulders are relaxed, and the head lies in the Frankfort plane, then call “NS” to the recorder who will capture the measurement and add the “Not Straight” comment beside the appropriate stature measure in ISIS.
Exhibit 1. Standing height position
2. Second, align the head in the Frankfort horizontal plane. The head is in the Frankfort plane when the horizontal line from the ear canal to the lower border of the orbit of the eye is parallel to the floor and perpendicular to the vertical backboard (Exhibit 3-5). Many people will assume this position naturally, but for some SPs the examiner may need to gently tilt the head up or down to achieve the proper alignment. Instruct the SP to look straight ahead. Next, lower the stadiometer head piece so that it rests firmly on top of the participant’s head, with sufficient pressure to compress the hair. Instruct the SP to stand as tall as possible, take a deep breath, and hold this position. The act of taking a deep breath helps straighten the spine to yield a more consistent and reproducible stature measurement. Notice that the inhalation will cause the head piece to rise slightly.
Note: Some SPs have hair styles such as a barrette, bun, or braid that will interfere with the placement of the stadiometer head piece. Other SPs may refuse to remove their shoes for the height measurement. In these cases, while the SP remains positioned on the stadiometer platform, the examiner will measure the hair piece and/or the shoe heel with the 15-cm height adjustment ruler. The recorder will enter this number in the Height Correction Above/Below Waist field on the screen. ISIS will use this correction factor to automatically calculate an adjusted height value.
3. Capture the Result. While the SP is correctly positioned and holding the breath, call “Get” to the recorder, who will click the Get button on the ISIS screen to capture the result. Tell the SP to release the breath as you hold the head piece in position. Wait for the computer to repeat the measurement aloud. After verifying the correct value, have the SP relax and step away from the stadiometer. Slide the head piece to the top of the measurement column and secure it in place with the brake lever, in preparation for the next participant.
Note: In the event of a power outage or if the stadiometer malfunctions, slide the head piece to the top of the measurement column and obtain the height using the tape measure mounted on the right side of the measurement column. Call the result to the recorder, who will manually enter this number in the appropriate ISIS field.
Exhibit 2. Frankfort horizontal plane
Personnel and Training Required
None
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Interviewer-administered questionnaire
Lifestage
Toddler, Child, Adolescent, Adult, Senior
Participants
This measure includes four protocols, and each protocol relates to the age of the participant and his or her ability to stand up straight. A fourth protocol for self-reported height is included but is considered a protocol of last resort when direct measurement of height or its proxy is not possible.
Standing Height
The standing height protocol is used for participants 2 years of age or older who can stand unassisted.
Recumbent Length
The recumbent length protocol is used for all infants and children from birth through 47 months of age.
Knee Height
The knee height protocol was used for participants 60 years of age or older or for individuals who cannot stand unassisted.
Self-Reported Height*
Study subject aged 16 years or older or by a knowledgeable adult proxy for children younger than 16 years of age.
*NOTE: Self-reported height values are considered to be less accurate and are used only when measured height cannot be obtained.
Selection Rationale
The National Health and Nutrition Examination Survey 2021-2023 protocols were selected as best practice methodology and are the most widely used protocols to assess height.
Language
Chinese, English, Spanish
While the English version of this protocol has been updated, the available translations have not and reflect a previous version. These differences may impact the compatibility between the English and Spanish/Chinese versions. It is the responsibility of the investigator to determine if the translations are sufficiently compatible with the English version for their research and subsequent analysis.
Standards
| Standard | Name | ID | Source |
|---|
Derived Variables
None
Process and Review
The PhenX Steering Committee (SC) reviewed this protocol in October 2023. Guidance from the SC includes:
- Updated protocol
Protocol Name from Source
National Health and Nutrition Examination Survey (NHANES), Anthropometry Procedures Manual, 2021-2023
Source
Centers for Disease Control and Prevention, National Center for Health Statistics. National Health and Nutritional Examination Survey (NHANES) 2021-2023. Anthropometry Procedures Manual (Section 3.4.3 - Standing Height). Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
Certification for the Spanish translation can be found here.
General References
Himes, J. H. (1989). Reliability of anthropometric methods and replicate measurements. American Journal of Physical Anthropology, 79, 77-80.
Protocol ID
20706
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX020706_Height_Standing_Height_Centimeters | ||||
| PX020706010000 | Please enter the height gathered by the more | N/A | ||
Measure Name
Height
Release Date
September 16, 2024
Definition
Height is the distance from the top of the participant’s head to the heels of his or her feet (i.e., the vertical length).
Purpose
Height or stature is used to assess body size and bone length. Recumbent length is used to measure length of infants, and knee height may be used to estimate height when stature cannot be measured in older adults.
Keywords
Anthropometrics, body mass index, BMI, stature, Waist-to-Height Ratio, WHtR, NHANES, gerontology, aging, geriatrics
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 20701 | Height - Knee Height |
| 20705 | Height - Recumbent Length |
| 20706 | Height - Standing Height |
| 20707 | Height - Self-Reported Height |
Publications
There are no publications listed for this protocol.