ANTHROPOMETRIC ASSESSMENT

ANTHROPOMETRIC ASSESSMENT
  • Anthropometric measurements of human body reflect changes in morphological variation due to inappropriate food intake or malnutrition.
  • A variety of anthropometric measurements can be made either covering the whole body or parts of the body.
  • Anthropometric measurements can be taken for cross sectional and longitudinal studies.
  • The measurements to be taken for nutritional assessment includes; height, weight, fat fold thickness, circumferences like mid upper arm, waist, hip, head and chest.
  • Recorded measurements need to be compared with suitable standards. However, there is no permanent standard as there is no uniformity of growth in subsequent generation.
  • Local standards need to be developed of various ethnic groups. It is wise to compare with international standards.
  • Most commonly used and recommended is the NCHS (National center for Health Statistics) standard.
Body Weight
  • Body weight is the most widely used and the sensitive and simplest reproducible measurement for the evaluation of nutritional status of population.
  • It indicates the body mass and is a composite of all body constituents like water, mineral, fat, protein and bone. It reflects more recent nutrition than do height.
  • Serial measurements of weight, as in growth monitoring are more sensitive indicators of changes in nutritional status than a single measurement at a point of time.
  • Rapid loss of body weight in children should be considered as an indicator of potential malnutrition.
  • For measuring body weight, beam or lever actuated scales, with an accuracy of 50-100g are preferred. Bathroom scales may give errors upto 1.5 kg.
  • Beam balances are extensively used in Integrated Child Development Services projects (ICDS).
  • Periodically scales need to be calibrated for accuracy using known weights.
  • Weights should be taken with the individual under basal conditions with minimum clothing and without shoes.
  • The zero error of the weighing scale should be checked before taking the weight and corrected as and when required.
Height
  • The height of an individual is influenced both by genetics and environmental factors.
  • The maximum growth potential of an individual is decided by hereditary factors, while the environmental factors, the most important being nutrition and morbidity, determine the extent of exploitation of that genetic potential.
  • Height is affected only by long-term nutritional deprivation; it is considered an index of chronic or long duration malnutrition.
  • In children below the age of two years cannot stand properly, recumbent length (crown-heel length) should be measured with infantometer.
  • The legs need to be held straight and firm with the feet touching the sliding board.
  • In the older children and adults, heights are measured with a vertical measuring rod using anthropometer or stadiometer.
  • The subject should stand erect looking straight on a leveled surface with heels together and toes apart, without shoes.
  • The moving head piece of the anthropometer should be lowered to rest flat on the top of the head and reading should be taken.
  • Height should be read to the nearest ¼” or 0.5 cm. An average of three measurements is taken as the final measurement.
Mid-Upper Arm Circumference (MUAC)
  • Mid-upper Arm Circumference is recognized to indicate the status of muscle development.
  • It is useful not only in identifying malnutrition but also in determining the mortality risk in children.
  • It correlates well with weight, weight for height and clinical signs.
  • On the left hand, the mid-point between the tip of the acromion of scapula and tip of the olecranon of the fore-arm bone, ulna is located with the arm flexed at the elbow and marked with a marker pen.
  • Fibre glass tape is used and the reading is taken to the nearest millimeter.
Fat fold at triceps
  • By using skin-fold calipers thickness of the fat layers is measured. This is measured by picking the skin fold between the thumb and forefinger on the dorsal side at the same mid point where mid upper arm circumference is measured on the right arm.
Fat Fold at Sub-scapula
  • The fat fold is measured just below and lateral to the angle of the left scapula by picking it up with the thumb and forefinger in a line running approximately 45⁰ to the spine, in the natural line of skin cleavage.
  • The calipers used should have a standard contact surface (pinch area) of 20-40 mm and an accuracy of 0.1mm.
  • Some of the standard calipers used are Harpenden, Lange and Best. Una caliper is used in India.
Head and Chest circumferences
  • Head size relates mainly to the size of brain which increases quite rapidly during infancy.
  • The chest in a normally nourished child grows faster than head during the second and third year of life.
  • As a result, the chest circumference overtakes head circumference by about one year age.
  • In protein energy malnutrition due to poor growth of chest, the head circumference may remain to be higher than the chest even at the age of 2½ to 3 years.
  • Flexible fibre glass tape is used. The chest circumference is taken at the nipple level preferably in mid inspiration.
  • The head circumference is measured passing the tape round the head over the supra-orbital ridges of the frontal bone in front and the most protruding point of the occiput on the back of the head.
Assessment of children
Weight for age
1st Degree 80 – 70%
2nd Degree 70 – 60 %
3rd Degree 60 – 50 %
4th Degree < 50% of Expected
Gomez Classification
Grade Weight for age
Normal >90%
Grade I 75-90%
Grade II 60-75%
Grade III <60%
Most often accurate assessment of age may not be possible. Weight for height is age independent.
Mid-upper Arm Circumference for Age
  • Mid arm circumference varies little between the age of one and four years. It correlates well with weight and weight for height.
  • Use of tricolor tape (Shakir Tape), QUAC stick (arm circumference and height) and arm circumference/head circumference ratio have been suggested for assessment of nutritional status.
ASSESSMENT OF PEM in Children
    • Assessment can be made by using several indices. The following table gives commonly used indices of normal and PEM children.
Anthropometric Measurements of normal and PEM children
Measurement Normal PEM
Wt in kg
  • Rao index x100
(ht in cm)2 		>0.15 < 0.15
  • Wt/age
 Normal 80-60% kwashiorkar oedema
<60% Marasmus without oedema
  • Skin fold thickness
 >10 mm <6mm
  • Bangle test-4.0 cm diameter
 Does not pass Passes above the elbow
  • Mid arm circumference
 16 mm Mild - 12.5-13.5 cm


Moderate - 12.5-13.5 cm


Severe < 12.5 cm
  • Kanawati index: Ratio of arm circumference to head circumference

 > 0.32 Mild - 0.28-0.32
Mid arm circumference
Head circumference
Moderate - 0.25-0.28
Severe < 0.25
Chest circumference
  • Head circumference
 >1.0 <1.0

Prediction of Birth Weight of the Newborns
Maternal height and weight for height (%) are useful in predicting the birth weight of the newborn. Women with height of more than 145 cm and weight of 45 kg or more and good weight gain are found to have babies with good birth weights. Prematurity rates are very low with better stature, body weight and weight / height2.
Assessment of adults
Body Mass Index (BMI)
After the cessation of linear growth around 21 years, weight for height indicates muscle fat mass in the adult body. The ratio of Weight in kg/ height2 m is referred to as Body Mass Index.
BMI has good correlation with fatness. It may also be used as an indicator of health risk.
Table -17.1 BMI in relation to energy status
Presumptive diagonsis BMI
Chronic energy deficiency-grade III severe <16.0
Chronic energy deficiency-grade II moderate 16.0-17.0
Chronic energy deficiency –grade I mild 17-18.5
Low weight -normal 18.5-20.0
Normal 20.0-25.0
Obese grade I 25.0-30.0
Obese grade II >30

For similar BMI, Indians have a greater proportion of body fat which renders them susceptible to morbidity.
Broka’s Index
Broka’s index = Ht is cms – 100 = ideal weight in kg.
Broka’s index is simple and easy to use index for assessment of nutritional status of adults.
Broka’s index correlates with BMI and wt/ht.
Waist and Hip Circumference Ratio
Waist-to-hip ratio gives distribution of fat in the human body. A waist hip ratio greater than 1.0 in men 0.8 in women is indicative of android obesity and increase the risk of atherosclerosis.
Last modified: Monday, 18 June 2012, 8:37 AM