1. science
2. mathematics
3. algebra

The Journal of Nutrition. First published ahead of print June 16, 2010 as doi: 10.3945/jn.109.118430.
The Journal of Nutrition
Nutritional Epidemiology
Development of New Demi-Span Equations
from a Nationally Representative Sample of
Adults to Estimate Maximal Adult Height1–3
Vasant Hirani,* Faiza Tabassum, Maria Aresu, and Jennifer Mindell
Department of Epidemiology and Public Health, University College London Medical School, University College London, London,
UK WCIE 6BT
Abstract
Various measures have been used to estimate height when assessing nutritional status. Current equations to obtain demispan equivalent height (DEHBassey) are based on a small sample from a single study. The objectives of this study were to
develop more robust DEH equations from a large number of men (n = 591) and women (n = 830) aged 25–45 y from a
produced from young adults’ (aged 25–45 y) measured height and demi-span to estimate new DEH equations (DEHnew).
DEH in people aged $ 65 y was calculated using DEHnew. DEHnew estimated current height in people aged 25–45 y with a
mean difference of 0.04 in men (P = 0.80) and 20.29 in women (P = 0.05). Height, demi-span, DEHnew, and DEHBassey
declined by age group in both sexes aged $65 y (P , 0.05); DEH were larger than the measured height for all age groups
(mean difference between DEHnew and current height was 22.64 in men and 23.16 in women; both P , 0.001).
Comparisons of DEH estimates showed good agreement, but DEHnew was significantly higher than DEHBassey in each age
and sex group in older people. The new equations that are based on a large, randomly selected, nationally representative
sample of young adults are more robust for predicting current height in young adults when height measurements are
unavailable and can be used in the future to predict maximal adult height more accurately in currently young adults as they
age. J. Nutr. doi: 10.3945/jn.109.118430.
Introduction
Height and weight are important measurements used in the
calculation of BMI, an indicator of nutritional status and
predictive of future ill health (1,2). In older people, a height
measurement may not necessarily reflect maximum attained
height (3,4) because of loss of height with aging (5), as well as
inaccuracies in obtaining measurements in older people, or due
to spinal deformities such as kyphosis. Alternative height
measurements such as arm-span (6,7), knee height (8,9), and
demi-span (10–13) have been used in some epidemiological
studies among older people, for the interpretation of spirometric
data (1,6), and in people for whom a standing height measurement is not possible (14–16).
Demi-span (defined as the distance between the mid-point of
the sternal notch and the finger roots with the arm outstretched
laterally) has been included in most years of the Health Survey
1
Supported by the National Health Service (NHS) Information Centre (funded
The Health Survey for England 2007). The authors are currently funded by the
NHS Information Centre to work on subsequent Health Surveys for England. The
views expressed are those of the authors, not of the funders.
2
Author disclosures: V. Hirani, F. Tabassum, M. Aresu, and J. Mindell, no
conflicts of interest.
3
Supplemental Tables 1 and 2 are available with the online posting of this paper
at jn.nutrition.org.
* To whom correspondence should be addressed. E-mail: [email protected].
for England (HSE),4 because it can be easily measured without
causing discomfort or distress, is more reliable than other
surrogate measures in the assessment of nutritional status in
adults (8,9,17), and is considered a better measure for assessing
BMI (18). For this, a demi-span equivalent height (DEH) using
the Bassey equations (10) can be used in BMI calculation.
The Bassey equations (10) are limited in usefulness for
estimating maximal adult standing height from the demi-span
measurement, because they are derived from a small sample of
young adults (125 people). The equations were derived to be sex
specific, but not age specific. New equations have been developed (19) to predict current height in older people based on an
elderly Spanish population.
Mean height has increased by ~0.3–3.0 cm/decade over the
last century (20,21). For example, a 1-cm leg length difference
has been reported between members of the 1946 and 1958 birth
cohorts (22). This marked cohort effect means that DEH
equations need to be updated for subsequent cohorts. New
and potentially more robust equations can be derived using
height and demi-span data from a large sample of young adults
to estimate maximal height from demi-span.
4
Abbreviations used: DEH, demi-span equivalent height; DEHnew, new
demi-span equivalent height; HSE, Health Survey for England.
ã 2010 American Society for Nutrition.
Manuscript received November 5, 2009. Initial review completed December 23, 2009. Revision accepted May 24, 2010.
doi: 10.3945/jn.109.118430.
Copyright (C) 2010 by the American Society for Nutrition
1 of 6
Downloaded from jn.nutrition.org by guest on October 6, 2014
nationally representative cross-sectional sample (Health Survey for England 2007). Sex-specific regression equations were
Our aim in this paper was to derive new equations from a
large, nationally representative, randomly selected population
sample of adults aged 25–45 y, investigate how closely the
results of the new DEH compare with measured standing height,
determine whether these equations provide a better estimate of
maximal adult height, and assess whether these equations can be
used among people aged $65 y.
Methods
Ethics. Participants gave verbal consent to the interviewer and the nurse
for having measurements taken. Ethical approval for the survey was
obtained from the London Multi-center Research Ethics Committee.
Statistical analysis. Data were analyzed using SPSS v15. The normality
of the distribution for each of the measurements was confirmed by
Kolmogorov Smirnov-test, histogram, and QQ-plot. The data were
checked to ensure that there were no outliers for the demi-span and
height measurements. The data were weighted to take into account the
sampling probabilities and nonresponse in the survey (24) in line with
Men : HeightðcmÞ ¼ 57:8 þ ð1:40 3 demi-span in cmÞ
Women : HeightðcmÞ ¼ 60:1 þ ð1:35 3 demi-span in cmÞ
Results
Basic characteristics of participants. Valid height and demispan measurement were obtained at the nurse visit from 591
male and 830 female participants aged 25–45 y (59% of the
2390 of that age group interviewed). Nearly 86% of participants
were White. Demi-span measures did not differ between the
White (79.5 6 5.4) and non-White population (79.6 6 5.4).
Among those aged $65 y, valid height and demi-span measurements were obtained by the nurse from 452 men and 516 women
(60% of the 1622 of that age group that were interviewed).
Similarly, mean demi-span measures did not differ between the
White (77.3 6 5.1) and non-White (79.2 6 5.5) older population.
The following prediction equations were developed to
calculate DEHnew based on participants aged 25–45 y. The
robust SE are given in parentheses:
Men : DEHnew ðcmÞ ¼ 65:8ð4:3Þ þ 1:33ð0:05Þ 3 demi-span
Women : DEHnew ðcmÞ ¼ 64:0ð5:1Þ þ 1:31ð0:07Þ 3 demi-span:
These analyses were also repeated including respondents’ age
in the prediction equation both as a main effect and as an
Main characteristics of the study participants aged 25–45 y1
TABLE 1
Men
Age, y
25–29
30–34
35–39
40–45
Total
P-trend2
1
2
2 of 6
Measured height
DEHnew
Demi-span
n
Measured height
DEHnew
Demi-span
107
126
147
211
591
177.6 6 6.6
176.6 6 7.1
176.8 6 6.8
176.5 6 6.8
176.8 6 6.8
0.269
cm
176.9 6 5.2
176.7 6 5.5
176.9 6 4.9
176.7 6 5.6
176.8 6 5.3
0.870
83.5 6 3.9
83.3 6 4.1
83.5 6 3.7
83.4 6 4.2
83.4 6 4.0
0.870
145
198
216
271
830
164.5 6 6.4
162.7 6 6.6
163.5 6 6.6
162.3 6 6.1
163.1 6 6.4
0.008
cm
164.2 6 5.1
163.3 6 4.8
163.6 6 5.0
162.8 6 4.4
163.4 6 4.8
0.014
76.5 6 3.9
75.8 6 3.6
76.1 6 3.8
75.4 6 3.4
75.9 6 3.6
0.014
Values are means 6 SD.
Wald Test, to test for trends.
Hirani et al.
Women
n
Downloaded from jn.nutrition.org by guest on October 6, 2014
Data. The HSE is a continuous cross-sectional survey that examines the
health of people living in England that has been conducted annually since
1991. Each year, a new, representative sample of the population living in
private households is selected (23). In the multi-stage stratified sampling
process for HSE 2007, 13,680 addresses were drawn randomly from the
Postcode Address File. Up to 10 resident adults (aged $16 y) at each
selected private household address were eligible for inclusion in the
survey. Full details of the sampling method have been published
elsewhere (23).
At the interview stage, participants had height measured using a
portable stadiometer, with a sliding head plate, a base plate, and 3
connecting rods marked with a metric measuring scale. Measurements
were taken according to standardized HSE protocols. The measurement
was taken without shoes, with the participant stretching to the maximum
height and the head positioned in the Frankfort plane. The reading was
recorded to the nearest millimeter. Participants who were ill, chairbound,
or unsteady on their feet or where the nurse felt a reliable height
measurement would not be obtained were not measured (24).
At the nurse visit, demi-span was measured in participants aged 25–
45 y and also among those aged 65 y and over using standard HSE
protocols. Demi-span measurements (the distance between the mid-point
of the sternal notch and the finger roots with the right arm outstretched
laterally) were made using a metal retractable tape. The measurements
were taken to the nearest even millimeter. Measurements that the nurse
considered unreliable, e.g. due to excessive clothing, were excluded from
the analysis (23). Quality assurance techniques included field staff being
trained on how to take measurements according to a standardized
protocol (23) (taking repeated measurements on individuals during the
training days to test the repeatability of measurements, which were taken
again by the trainer to check for accuracy). Staff also had regular
refresher training annually, as well as periodically being observed in the
field by nurse supervisors, who were particularly experienced.
usual practice for government surveys since 2003 (23). To determine
DEH using data from participants aged 25–45 y, prediction equations
were developed by simple linear regression analysis and by specifying
robust SE to take into account the natural clustering of the data. The
equations were derived separately for men and women, with measured
height as the dependent variable and demi-span as the independent
variable. The following formula was used: measured height = a + b (demispan), where a represents the intercept and b the coefficient of demi-span.
Descriptive tables report the main characteristics (mean 6 SD) for
participants aged 25–45 y and $65 y, in 5-y age groups by sex. The Wald
test was used to examine any trends across the age groups.
Agreement analysis as described by Bland and Altman (25) was used
to investigate how closely the results of DEH compared with measured
standing height at an individual level. Significance was accepted at a
P-value of ,0.05. Agreement was assessed by plotting the difference
between the 2 measurements against the mean of the 2 measurements.
The limits of agreement were defined as the mean difference 6 1.96 SD.
Paired t tests were used to assess any significant differences between
measured height and the DEH, by 5-y age group, for each sex.
Measured height and DEHnew were compared with DEHBassey in the
older participants. DEHBassey was calculated using the following
equations (10):
TABLE 2
Main characteristics of the study participants aged $65 y1
Men
n Measured height
Age, y
65–69
70–74
75–79
.80
Total $65
P-trend2
1
2
166
116
96
74
452
172.6 6 7.0
171.9 6 6.3
170.8 6 7.6
169.4 6 6.1
171.5 6 6.9
,0.001
DEHnew
174.9 6 4.8
174.6 6 5.1
173.1 6 5.0
172.9 6 4.7
174.1 6 5.0
,0.001
Women
DEHBassey Demi-span n Measured height
cm
172.7 6 5.1
172.3 6 5.4
170.7 6 5.2
170.5 6 5.0
171.8 6 5.2
,0.001
82.1 6 3.6
81.8 6 3.8
80.7 6 3.7
80.5 6 3.6
81.4 6 3.8
,0.001
159.5 6 6.0
158.1 6 6.0
156.6 6 5.6
155.5 6 6.3
157.7 6 6.1
,0.001
cm
161.7 6 4.3
161.2 6 4.5
160.5 6 4.3
159.5 6 4.2
160.9 6 4.4
,0.001
DEHBassey Demi-span
160.9 6 4.5
160.2 6 4.6
159.6 6 4.5
158.6 6 4.4
160.0 6 4.6
,0.001
Differences between height and DEHnew in people aged
$65 y. The agreement analysis of measured height and DEHnew,
as a proxy for maximum adult height in people aged $65 y,
shows that for all these older age groups in men and women,
DEHnew overestimated the measured height (Table 5). For
participants $ 65 y, height was overestimated by 2.64 cm in men
and 3.16 cm in women. Furthermore, the limits of agreement
were wide for men and women, indicating poor agreement
between height and DEHnew (Fig. 1A,B).
Measured height and DEHBassey did not differ significantly in
men , 80 y, but the mean difference was significant for all ages
in women (Table 5). However, the limits of agreement for men
and women were also wide, indicating poor agreement between
height and DEHBassey among people aged 65 y (Fig. 1C,D).
Differences between DEHnew and DEHBassey in people
aged $65 y. Estimation of maximal height in older people
using DEHnew was larger than when using DEHBassey (Table 5).
The mean difference between DEHnew and DEHBassey among
men aged $65 y was 2.32 cm, while in women, the mean
difference was 0.91 cm. The limits of agreement were up to 2 cm
in men and 1 cm in women, showing good agreement between
DEHnew and DEHBassey.
Discussion
The findings from this study show a close agreement between
measured height and newly derived DEHnew in the younger
population, indicating that DEHnew can be used as a proxy for
height when a height measurement cannot be obtained. This is of
importance, for example, when screening individuals for malnutrition, e.g. on hospital admission. However, the use of the
new equations among people aged $ 65 y resulted in larger
Difference between height measurements and DEHnew of the study participants, aged 25–45 y, by sex and age group
Men
1
2
n
Mean difference:
height–DEHnew1
107
126
147
211
591
cm
0.68 6 0.3*
20.05 6 0.4
20.09 6 0.3
20.22 6 0.3
0.04 6 0.2
Women
95% CI
Limits of
agreement2
21.34, 20.03
20.67, 0.77
20.55, 0.73
20.28, 0.73
20.35, 0.27
cm
27.49, 8.85
29.12, 9.02
28.28, 8.10
28.12, 7.68
28.27, 8.35
n
Mean difference:
height–DEHnew1
95% CI
Limits of
agreement2
145
198
216
271
830
cm
0.31 6 0.4
20.59 6 0.3
20.14 6 0.3
20.51 6 0.2*
20.29 6 0.2
20.99, 0.38
20.05, 1.24
20.51, 0.79
0.05, 0.98
20.01, 0.59
cm
27.96, 8.58
29.45, 8.27
29.08, 8.80
28.11, 7.09
28.68, 8.10
Values are means of the difference 6 SE. *P , 0.05.
Limits of agreement by Bland and Altman (25).
Demi-span equations to estimate height in adults
3 of 6
Downloaded from jn.nutrition.org by guest on October 6, 2014
Differences between measured height and DEHnew in
young adults. Only men aged 25–29 y had a higher DEHnew
than height measurement (0.68 cm; P = 0.04); there were no
significant differences in either sex in any other age groups
(Table 3).
Bland-Altman analysis showed a good agreement between
measured height and DEHnew, because the limits of agreement
were not wide (Table 3); ,3% of men and women had their
height overestimated or underestimated by using DEHnew,
outside the limits of 6 1.96.
Cross-classification of participants by quintiles of measured
height and DEHnew showed that few men and women had their
measured height and DEHnew in different quintiles, e.g. 3% of
men and 1% of women whose height was in the first quintile of
measured height had their DEHnew in the 5th quintile (Table 4).
Likewise, only 1% of men and women whose height was in the
5th quintile had a DEHnew in the first or second quintile.
Age, y
25–29
30–34
35–39
40–45
Total 25–45
76.6 6 3.3
74.2 6 3.4
73.7 6 3.3
72.9 6 3.2
74.0 6 3.4
,0.001
Values are means 6 SD.
Wald Test, to test for trends.
interaction with demi-span. For both men and women, age was
non-significant and the estimates of demi-span and the constant
terms were the same as those reported in this paper without
including age.
In men aged 25–45 y, measured height, DEHnew, and demispan did not vary by age. However, in women in this age range,
measured height, DEHnew, and demi-span tended to be less with
increasing age; younger women were slightly taller and had
greater DEHnew and demi-span compared with older women
(P , 0.05 for all the measures). Men aged 25–45 y had
significantly greater height, demi-span, and DEH measurements
than women overall and in the 5-y age groups (Table 1). In both
men and women aged $65 y, height, demi-span, DEHnew, and
DEHBassey declined by age group (P , 0.05 for all the measures;
Table 2).
TABLE 3
186
144
103
83
516
DEHnew
TABLE 4
Cross-classification of participants aged 25–45 y by quintiles of DEHnew and measured
heights1
Quintiles of
measured height
Men
Q1
Q2
Q3
Q4
Q5
Total
Women
Q1
Q2
Q3
Q4
Q5
Total
Quintiles of DEHnew
Q1
Q2
Q3
Q4
(62.8)
(29.7)
(2.7)
(3.4)
(1.4)
(100)
48 (32.2)
53 (35.6)
34 (22.8)
13 (8.7)
1 (0.7)
149 (100)
n (%)
9 (6.3)
30 (21.1)
46 (32.4)
42 (29.6)
15 (10.6)
142 (100)
3 (2.0)
14 (9.3)
40 (26.5)
60 (39.7)
34 (22.5)
151 (100)
4
5
17
30
93
149
110 (67.1)
40 (24.4)
11 (6.7)
2 (1.2)
1 (0.6)
164 (100)
36 (22.4)
61 (37.9)
46 (28.6)
17 (10.6)
1 (0.6)
161 (100)
15 (9.6)
41 (26.1)
44 (28.0)
47 (29.9)
10 (6.4)
157 (100)
5 (3.2)
14 (9.0)
34 (21.9)
52 (33.5)
50 (32.3)
155 (100)
1
4
23
39
95
162
93
44
4
5
2
148
Total2
Measured height
(2.7)
(3.4)
(11.4)
(20.1)
(62.4)
(100)
157 (21.2)
146 (19.8)
141 (19.1)
150 (20.3)
145 (19.6)
739 (100)
cm
167.4 6 3.1
173.4 6 1.2
177.2 6 1.0
180.4 6 1.1
186.4 6 3.0
176.8 6 6.8
(0.6)
(2.5)
(14.2)
(24.1)
(58.6)
(100)
167 (20.9)
160 (20.0)
158 (19.8)
157 (19.6)
157 (19.6)
799 (100)
154.3
159.8
163.2
166.4
172.2
163.1
Q5
6 2.6
6 1.1
6 0.9
6 1.1
6 3.3
6 6.4
Values are mean of measured height 6 SD for each quintile of measured height. The data are weighted to take into account nonresponse;
n is also presented as weighted.
2
For each quintile of DEH new and measured height.
1
TABLE 5
Men
Age, y
65–69
70–74
75–79
.80
Total $65
Women
65–69
70–74
75–79
.80
Total $65
1
2
Difference between height measurements and DEHnew of the study participants aged $65 y, by sex and age group
n
Mean difference:
height– DEHnew1
166
116
96
74
452
cm
22.39 6 0.4*
22.71 6 0.5*
22.30 6 0.5*
23.49 6 0.5*
22.64 6 0.3*
23.22;
23.63;
23.32;
24.58;
23.11;
186
144
103
83
516
22.21 6 0.4*
23.02 6 0.4*
23.92 6 0.4*
23.98 6 0.5*
23.16 6 0.2*
22.91; 21.52
23.87; 22.16
24.68; 23.16
24.95; 23.01
23.57; 22.76
% CI
21.56
21.80
21.28
22.39
22.16
Values are means of the difference 6 SE. *P , 0.0001.
Limits of agreement by Bland and Altman (25).
4 of 6
population. The new DEH equations are based on measurements
in 1421 individuals, more than a 10-fold increase in sample size
over the currently used equations (10).
We used Bland Altman analysis, which is recommended for
use when investigating the agreement between 2 different
methods for measuring the same parameter at an individual
level (25). This method is preferred to correlation coefficient in
this context, because correlation coefficient only measures the
strength of a relationship between 2 variables, not the agreement
between them. Furthermore, a high correlation does not necessarily mean a perfect agreement between 2 methods (25).
There are some limitations in that this study is based on crosssectional data, not cohort data, so we cannot rule out the
possibility that the lower values for demi-span in older age
groups may represent decline of demi-span with age, in which
case DEH will underestimate maximal adult height. However,
the difference in demi-span with age is shown to be considerably
Hirani et al.
Limits of
agreement2
cm
211.58,
211.03,
211.22,
211.73,
211.40,
6.80
5.60
6.62
4.77
6.13
210.11, 5.68
211.35, 5.31
211.36, 3.53
212.47, 4.50
211.28, 4.95
Mean difference:
height–
DEHBassey1
% CI
Limits of
agreement2
Mean difference:
DEH newDEHBassey1
% CI
Limits of
agreement2
cm
20.11 6 0.4
20.42 6 0.4
0.07 6 0.5
21.1 0 6 0.6
20.31 6 0.2
20.94;0.71
21.34;0.50
20.94;1.08
22.20; 0
20.78; 0.11
29.27, 9.05
28.81, 7.97
28.72, 8.87
29.39, 7.20
29.06, 8.43
cm
2.28 6 0.02*
2.29 6 0.03*
2.37 6 0.03*
2.38 6 0.03*
2.32 6 0.01*
2.23;2.32
2.24;2.35
2.32;2.43
2.32;2.45
2.29;2.35
cm
1.78, 2.78
1.77, 2.82
1.86, 2.89
1.90, 2.87
1.81, 2.86
21.33 6 0.4*
22.11 6 0.4*
22.99 6 0.4*
23.03 6 0.5*
22.25 6 0.2*
22.03; 20.63
22.97; 21.26
23.76; 22.23
24.00; 22.06
22.66; 21.85
29.22, 6.56
210.46, 6.23
210.46, 4.47
211.50, 5.44
210.37, 5.86
0.88 6 0.01*
0.90 6 0.01*
0.92 6 0.01*
0.95 6 0.02*
0.91 6 0.01*
0.86;0.91
0.88;0.93
0.90;0.95
0.92;0.98
0.89;0.92
0.62, 1.14
0.64, 1.17
0.66, 1.18
0.70, 1.12
0.65, 1.17
Downloaded from jn.nutrition.org by guest on October 6, 2014
DEHnew than both the measured height and DEHBassey values in
men and women.
Because both demi-span and measured height have increased
by ~1 cm in men aged $65 y and women aged $75 y since 1994
(Supplemental Tables 1 and 2), this confirms that the regression
equations for estimating DEH need to be revised periodically to
allow for the population becoming taller. The new regression
equations based on demi-span measured in adults aged 25–45 y
in 2007 to predict maximal adult height gave significantly higher
values (DEHnew) than results using DEHBassey in every age group
in both sexes, although the changes by age were very similar. The
expected effect of osteoporosis on measured height occurring at
younger ages in women than in men was reflected in the pattern
of differences between DEHBassey and measured height in
women but not for DEHnew.
The main strengths of this study are the use of data from a
large and nationally representative sample of the general
FIGURE 1 Bland Altman plots
showing agreement between measured height and DEHnew (A,B) and
DEHBassey (C,D) in men (A,C) and
women (B,D) $ 65 y old. The mean
difference of the paired measurements is plotted against their mean.
The line represents the mean 6 1.96
SD.
Literature Cited
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Acknowledgments
V.H. and J.M. had the initial idea; V.H. designed the analyses;
F.T., V.H., and M.A. conducted the analyses; and V.H. wrote
the first draft and had responsibility in preparing the final draft
and submission. All authors were involved in interpreting the
results and redrafting the manuscript. All authors read and
approved the final version of the manuscript.
14.
15.
Allen SC. The relation between height, arm-span and forced expiratory
volume in elderly women. Age Ageing. 1989;18:113–6.
Flegal KM, Graubard BL, Williamson DF, Gail MH. Cause-specific
excess deaths associated with underweight, overweight, and obesity.
JAMA. 2007;298:2028–37.
Milne JS, Williamson J. A longitudinal study of kyphosis in older
people. Age Ageing. 1983;12:225–53.
Cline MG, Meridith KE, Boyer JT, Burrows B. Decline of height with
age in adults in a general population sample: estimating maximum
height and distinguishing birth cohort effects from actual loss of stature
with aging. Hum Biol. 1989;61:415–25.
Sorkin JD, Muller DC, Andres R. Longitudinal change in the heights of
men and women: consequential effects on body mass index. Epidemiol
Rev. 1999;21:247–60.
Aggarwal AN, Gupta D, Jindal SK. Interpreting spirometric data:
impact of substitution of arm-span for standing height in adults from
North India. Chest. 1999;115:557–62.
Jarzem PF, Gledhill RB. Predicting height from arm measurements. J
Pediatr Orthop. 1993;13:761–5.
Chumlea WC, Roche AF, Steinbearagh ML. Estimating stature from
knee height for persons 60 to 90 years of age. J Am Geriatr Soc.
1985;33:116–20.
Cockram DB, Baumgartner RN. Evaluation of the accuracy and
reliability of callipers for measuring recumbent knee-height in elderly
people. Am J Clin Nutr. 1990;52:397–400.
Bassey EJ. Demi-span as a measure of skeletal size. Ann Hum Biol.
1986;13:499–502.
Department of Health. The nutrition of elderly people. Report on health
and social subjects. Report. 43. London: HMSO; 1992.
Smith WD, Cunningham DA, Paterson DH, Koval JJ. Body mass indices
and skeletal size in 394 Canadians aged 55–86 years. Ann Hum Biol.
1995;22:305–14.
Bannerman E, Chapman N, Cowan S, Reilly J, Kirk Z, MacClennan
WJ, Pender I. Evaluation of the use of knee height to estimate stature in
non-institutionalised elderly individuals .75 years old: implications
for the determination of body mass index. Proc Nut Soc. 1997;55:
249A.
Guigoz Y. The Mini Nutritional Assessment (MNA) review of the
literature - what does it tell us? J Nutr Health Aging. 2006;10(6):466–485.
Malnutrition Universal Screening Tool (The ’MUST’). 2006 [cited 2009
Jan 10]. Available from: http://www.bapen.org.uk/the-must.htm.
Demi-span equations to estimate height in adults
5 of 6
Downloaded from jn.nutrition.org by guest on October 6, 2014
less than the height measurement as shown in cross-sectional
surveys (3,19,26), which suggests that this apparent decrease is
most likely to be a cohort effect reflecting the increasing height
of successive cohorts during the 20th century (20,21). It is
difficult to show the true difference between measurements with
this type of study design. The only way to test this is with a
cohort study, by measuring height and demi-span at 10 to 20 y
intervals throughout adult life. This has not been done; no
current cohorts have measured demi-span in middle age to allow
repeated measurement in the same individuals. Sixty percent of
the participants had both a height and demi-span measurement.
To attempt to correct for unequal sample selection and nonresponse, specific statistical weighting was included (24).
Cross classification analysis in the younger participants has
shown a close agreement in participants’ DEHnew and measured
height. We recommend that our new, more robust equations
should be used for younger people currently in their 20s–40s
when current height cannot be measured. DEHBassey should be
used to estimate maximal adult height only for people currently
aged $ 60 y, with our new, more robust equations being used for
younger people as they age.
We have derived new, more robust equations using a large
nationally representative sample of people aged 25–45 y that can
be used now as a proxy for height in people in their 20s and 40s
when a height measurement cannot be obtained. This is of
importance, e.g., when screening individuals for malnutrition,
such as on hospital admission. DEHnew can be used in the future
to predict maximal height in the current cohort of younger
adults as they age.
16. New NICE guideline will help tackle the problem of malnutrition in the
NHS [cited 2009 Sep 10]. Available from: http://www.nice.org.uk/pdf/
2006_006_nutrition_guideline_launch.pdf.
17. de Lucia E, Lemma F, Tesfaye F, Demisse T, Ismail S. The use of
armspan measurement to assess the nutritional status of adults in four
Ethiopian ethnic groups. Eur J Clin Nutr. 2002;56:91–5.
18. Hirani V, Mindell J. A comparison of measured height and demi-span
equivalent height in the assessment of body mass index among people
aged 65 years and over in England. Age Ageing. 2008;37:311–7.
19. Weinbrenner T, Vioque J, Barber X, Asensio L. Estimation of height and
body mass index from demi-span in elderly individuals. Gerontology.
2006;52:275–81.
20. Cole TJ. Secular trends in growth. Proc Nutr Soc. 2000;59:317–24.
21. Cavelaars AE, Kunst AE, Geurts JJ, Crailesi R, Gro¨tvedt L, Helmert
U, Lahelma E, Lundberg O, Mielck A, et al. Persistent variations in
average height between countries and between socioeconomic groups:
22.
23.
24.
25.
26.
an overview of 10 European countries. Ann Hum Biol. 2000;27:
407–21.
Li L, Hardy R, Kuh D, Lo Conte R, Power C. Child-to-adult body mass
index and height trajectories: a comparison of 2 British birth cohorts.
Am J Epidemiol. 2008;168:1008–15.
Craig R, Shelton N. The Health Survey for England 2007: Healthy
lifestyles: knowledge, attitudes and behavior. The Health Survey for
England series. London: The Information Centre; 2009 [cited 2009 Sept
10]. Available from: http://www.ic.nhs.uk/pubs/hse07healthylifestyles.
Craig R, Shelton N, editors. Health Survey for England 2007. 2nd vol.
Methodology and documentation. London: Information Centre; 2009.
Bland JM, Altman DG. Statistical methods for assessing agreement
between two methods of clinical measurement. Lancet. 1986;1:307–10.
Lehmann AB, Bassey EJ, Morgan K, Dallosso HM. Normal values for
weight, skeletal size and body mass indices in 890 men and women aged
over 65 years. Clin Nutr. 1991;10:18–22.
Downloaded from jn.nutrition.org by guest on October 6, 2014
6 of 6
Hirani et al.