Anthropometry

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  • Monitoring the weight is helpful in diagnosing malnutrition at early stage
  • Used to calculate expected weight between the ages of 3 months and 12 years
  • Tragion- an anthropometric point situated in the notch just above the tragus of the ear.
  • Anthropometry

    1. 1. ANTHROPOMETRY
    2. 2. Anthropometry: Introduction •Anthropos - "man" and Metron "measurement” •A branch of anthropology that involves the quantitative  measurement of the human body. •It is the single most portable, universally applicable,  inexpensive and non-invasive technique for assessing the size,  proportions and composition of the human body. •It is used to evaluate both under & over nutrition. •The measured values reflects the current nutritional status &  don’t differentiate between acute & chronic changes 08/24/13 Anthropometry - Amarendra B. Singh 090201263 2
    3. 3. Parameters of anthropometry Age dependent factors:- a) Weight b) Height c) Head circumference d) Chest circumference Age independent factors:- a)Mid-arm circumference (1-5 years) b) Weight for height c) Skinfold thickness d) Mid upper arm/height ratio 08/24/13 Anthropometry - Amarendra B. Singh 090201263 3
    4. 4. Weight • The measurement of weight is most reliable criteria of  assessment of health and nutritional status of children. • The weight can be recorded using a :           Beam type weighing balance             Electronic weighing scales for infants and children             Bathroom type of mechanical scale (very unreliable)             Salter spring machine (in field conditions)  08/24/13 Anthropometry - Amarendra B. Singh 090201263 4
    5. 5. •The periodic recording of weight on a growth chart is essential for  monitoring the growth of under-five children. •Growth Velocity : A.0-4 months           1.0kg/month(30g/day)       5-8 months            0.75kg/month(20gm/day)       9-12 months         0.50kg/month(15g/day)       1-3 years              2.25kg/yr       4-9 years               2.75 kg/yr       10-18 years           5.0-6.0kg/yr                                     (0.5kg/month) B. Weight at 4-5 months  2 x birth weight      Weight at 1 year          3 x birth weight      Weight at 2 years        4 x birth weight      Weight at 7 years          7 x birth weight 08/24/13 Anthropometry - Amarendra B. Singh 090201263 5
    6. 6. WEECH’S FORMULA a) 3 – 12 months Expected weight(kg) = age (months) + 9 / 2 b) 1- 6 years Expected weight(kg) = age (years) x 2 + 8 c) 7 – 12 years Expected weight(kg) = age (years) x 7 - 5 / 2 08/24/13 Anthropometry - Amarendra B. Singh 090201263 6
    7. 7. Classification of Malnutrition by Indian Academy of Pediatrics Weight for age * Grade of malnutrition >80 % 71-80% 61-70% 51-60% <50% Normal Grade 1 (Mild) Grade 2 (Moderate) Grade 3 (Severe) Grade 4 (very severe) 08/24/13 Anthropometry - Amarendra B. Singh 090201263 7
    8. 8. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 8
    9. 9. Length or Height/Stature Measurement Technique • Upto  2 years of age Recumbent Length is measured with the help of an  Infantometer .  • In older children Standing Height or Stature is recorded. It is convenient to  use an Inbuilt Stadiometer affixed on the wall which provides a direct read  out of height with an accuracy of +/- 0.1cm. • Nutritional deprivation over a period of time affects the stature or linear  growth of the child .  08/24/13 Anthropometry - Amarendra B. Singh 090201263 9
    10. 10. Technique of length measurement  • The infant is placed supine on the infantometer. • Assistant or mother is asked to keep the vertex or top  of the head snugly touching the fixed vertically plank. • The leg are fully extended by pressing over the knee,  and feet are kept vertical at 90  , the movable pedal ⁰ plank of infantometer is snuggly apposed against  soles and length is read from scale.  08/24/13 Anthropometry - Amarendra B. Singh 090201263 10
    11. 11. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 11
    12. 12. Technique for height measurement • In older children who can stand , height can be measured by the rod attached to the lever type machine or by stadiometer. • Child should stand with bare feet on the flat floor against a wall with fit parallel and with heels buttocks, shoulders and occiput touching the wall. • Head should be kept in Frankfurt plane. • With the help of a wooden spatula or plastic ruler. The topmost point of the vertex is identified on the wall. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 12
    13. 13. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 13
    14. 14. Height Velocity A At birth 50cms Gain during 1st year 25cms Gain during 2nd year 12.5cms Gain during 3rd year 7.5 to 10cms Gain during 3 – 12 years 5 to 7.5cms Adolescence 8cms/yr for girls during 12 to 16 years 10cms/yr for boys during 14 to 18 years Birth to 3 months 3.5cm/month 3 – 6 months 2.0cm/month 6 – 9 months 1.5cm/month 9 – 12 months 1.3cm/month 2 – 5 years 6 – 8cm/year 5 – 12 years 5cm/year AGE Approximate rate of increase in stature 08/24/13 Anthropometry - Amarendra B. Singh 090201263 14
    15. 15. B] Expected height upto 12 yrs length or height (in cms) = age in years x 6 +77 ( wheech’s formula ) C] ] Prediction of adult height • Parental height , Tanner’s formula and Weech’s formula are used. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 15
    16. 16. HEAD CIRCUMFERENCE • Brain growth takes place 70% during fetal life, 15% during infancy and remaining 10% during pre-school years. • Head circumference are routinely recorded until 5 years of age. • If scalp edema or cranial moulding is present , measurement of scalp edema may be inaccurate until fourth or fifth day of life . •The head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 16
    17. 17. Expected head circumference in children Age Head circumference (cm) At birth 34 – 35 2 months 38 3 months 40 4 months 41 6 months 42 - 43 1 year 45 - 46 2 years 47 - 48 5 years 50 - 51 08/24/13 Anthropometry - Amarendra B. Singh 090201263 17
    18. 18. Head Circumference Growth Velocity •During first year there is 12 cm increase in head circumference , while 1 – 5 year age , only 5 cm gain occur in head size. •Adult head size is achieved between 5 to 6 years . the following formula (Dine’s formula) is used for estimating the head circumference in the first year of life : - ( length in cm + 9.5 ) ± 2.59 2 Till 3 months 2 cm/month 3 months – 1 year 2cm/3 month 1 – 3 year 1cm/ 6 month 3 – 5 year 1cm/ year 08/24/13 Anthropometry - Amarendra B. Singh 090201263 18
    19. 19. The term Macrocephaly refers to OFC of more than 2SD above the mean while Microcephaly refers to OFC more than 3SD below the mean for age , sex , height and weight. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 19
    20. 20. Chest circumference • It is usually measured at the level of nipples, preferably in mid inspiration. • Xiphisternum • In children <= 5years - lying down position > 5 years - standing position 08/24/13 Anthropometry - Amarendra B. Singh 090201263 20
    21. 21. Relationship between head size with Chest Circumference: • At birth: head circumference > chest circumference by upto 3 cms. • At around 9 months to 1 year of age: head circumference = chest circumference, • but thereafter chest grows more rapidly compared to the brain. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 21
    22. 22. • The head circumference is greater than chest circumference by more than 3 cms in : a) preterms b) small-for-date , & c) hydrocephalic infants • In malnourished children, chest size may be significantly smaller than head circumference because growth of brain is less affected by undernutrition. Therefore there will be considerable delay before chest circumference overtakes head circumference. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 22
    23. 23. AGE INDEPENDENT CRITERIA FOR ASSESSMENT OF NUTRITIONAL STATUS • Mid-upper arm circumference • Thickness of subcutaneous fat • Body ratios • Weight for height • Body mass index • Upper segment/ lower segment ratio • Arm span • Obesity 08/24/13 Anthropometry - Amarendra B. Singh 090201263 23
    24. 24. MID-UPPER ARM CIRCUMFERENCE • During 1-5 Yrs of age it remains reasonably static between 15-17cms among healthy children . • It is conventionally measured over the left upper arm , at a point marked midway between acromion (shoulder) and olecranon (elbow) with arm bent at right angle. • The child is asked to stand or sit with the arm hanging loose at the side. • MUAC is measured with a fiber glass or steel tape. • If it is less than 12.5 cm it is suggestive of severe malnutrition. • If it is between 12.5 -13.5 cm it is indicative of moderate malnutrition. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 24
    25. 25. • Bangle test – quick assessment of arm circumference. A fiber glass ring of internal diameter of 4 cm is slipped up the arm, if it passes above the elbow, it suggests that upper arm is less than 12.5 cm and child is malnourished. • Shakir tape – is a fiber-glass tape with red – less than 12.5 cm yellow – 12.5- 13.5 cm green – greater than 13.5 cm shading so that paramedical workers can assess nutritional status without having to remember the normal limits of mid arm circumference. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 25
    26. 26. • QUAC stick – Quaker Upper Arm Circumference Stick It is developed on the principle that acute starvation severely affects mid-arm circumference while height is unaffected. • It is a height measuring rod, calibrated in MAC. • Values of 80% MAC for Ht. are marked on stick at corresponding ht. levels • The malnourished child would be taller than the anticipated height derived from the mid-arm circumference MAC (cm) Ht. (cm) 16.5 133.0 13.5 103.5 12.5 70.0 08/24/13 Anthropometry - Amarendra B. Singh 090201263 26
    27. 27. Skinfold thickness • Measured with Herpenden’s caliper • Triceps or subscapular region • The skinfold with subcutaneous fat is picked up with thumb and index finger, and caliper is applied beyond the pinch. • Fat thickness >10mm - healthy children 1-6 years <6mm - is indicative of moderate to severe degree of malnutrition 08/24/13 Anthropometry - Amarendra B. Singh 090201263 27
    28. 28. Body ratios • Rao & Singh’s weight-height index: = [weight (kg) / (height)2 cms ] * 100 normal index is more than 0.15 • Kanawati index: (during 3m to 4 years) = Mid-arm circumference / Head circumference Normal 0.331 Mild 0.310 – 0.280 Modreate 0.279 – 0.250 Severe < 0.250 08/24/13 Anthropometry - Amarendra B. Singh 090201263 28
    29. 29. WEIGHT-FOR-HEIGHT Weight-for-height = Weight of the patient (kg) X 100 Weight of normal child of same height The nutritional status can be expressed as follows on the basis of weight-for-height: Weight-for-Height * Nutritional Status >90% 85-90 % 75-80 % <75 % Normal Borderline Malnutrition Moderate Malnutrition Severe Malnutrition *Reference standard NCHS data 08/24/13 Anthropometry - Amarendra B. Singh 090201263 29
    30. 30. Classification • When malnutrition has been chronic, the child is “stunted”, weight-for-age is low/normal height-for-age is low weight-for-height is normal. • In Acute malnutrition, the child is “wasted”, weight-for-age is low height-for age is normal weight-for-height is low 08/24/13 Anthropometry - Amarendra B. Singh 090201263 30
    31. 31. BODY MASS INDEX (BMI) •A BMI-for-age of > 85th percentile is suggestive of Overweight. •A BMI-for-age of > 95th percentile is or when it is associated with triceps or skinfold thickness-for-age of > 90th percentile, it is diagnostic of Obesity. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 31
    32. 32. • Ponderal index : - it is another parameter which is similar to BMI and is used for defining newborn babies with intrauterine growth retardation. PI = (Body weight in grams) × 100 length (cm)³ • In malnourished small-for-date babies (asymmetric IUGR), ponderal index is <2, while it is usually more than 2.5 in term appropriate-for-gestation babies and hypoplastic small-for-date babies. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 32
    33. 33. PROPORTIONAL TRUNK AND LIMB GROWTH •The mid-point of the body in newborn is at umbilicus whereas in an adult the mid-point shifts to the symphysis pubis due to greater growth of limbs than trunk. •The UPPER SEGMENT (vertex to upper edge of symphysis pubis) to LOWER SEGMENT (symphysis pubis to heels) ratio at birth is 1.7 to 1.0 . •This gradually becomes 1.0 to 1.1 in healthy adults. • In infants upper segment (crown to symphysis pubis) can be measured by using infantometer. • The lower segment is obtained by subtracting the upper segment from total length.08/24/13 Anthropometry - Amarendra B. Singh 090201263 33
    34. 34. • Infantile upper segment to lower segment ratio (trunk abnormally large or limbs abnormally small) is seen in : 1.Achondroplasia 2.Cretinism 3.Short limbed dwarfism 4.Sexual precocity 5.Bowed legs 08/24/13 Anthropometry - Amarendra B. Singh 090201263 34
    35. 35. • Advanced upper segment to lower segment ratio (trunk abnormally short or limb abnormally long) is seen in: 1. Arachnodactyly 2.Hypogonadism 3.Eunuchoidism 4.Turner Syndrome 5.Klinefelter’s Syndrome 6.Chondrodystrophy 7.Spinal deformities (rickets, pott’s spine) 08/24/13 Anthropometry - Amarendra B. Singh 090201263 35
    36. 36. ARM SPAN •It is the distance between the tips of middle fingers of both arms outstretched at right angles to the body, measured across the back of the child. •In under-5 children , arm span is 1 to 2 cm smaller than body length. •During 10-12 years of age , arm span = height. •In adults arm span is more in adults by 2 cm. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 36
    37. 37. •Abnormally large arm span is seen in patients with 1)Arachnodactyly (Marfan syndrome) 2)Eunuchoidism 3)Klinefelter’s Syndrome 4)Coarctation of aorta •Arm span is short compared to height in patients with : 1)Short limbed dwarfism 2)Cretinism 3)Achondroplasia 08/24/13 Anthropometry - Amarendra B. Singh 090201263 37
    38. 38. ADVANTAGES OF ANTHROPOMETRY • Less expensive & need minimal training • Readings are reproducible. • Objective with high specificity & sensitivity • Measures many variables of nutritional significance (Ht, Wt, MAC, HC, skin fold thickness, waist & hip ratio & BMI). • Readings are numerical & gradable on standard growth charts
    39. 39. Limitations of Anthropometry Inter-observers errors in measurement Limited nutritional diagnosis Problems with reference standards, i.e. local versus international standards. Arbitrary statistical cut-off levels for what considered as abnormal values. 08/24/13 Anthropometry - Amarendra B. Singh 090201263 39
    40. 40. Thank you 08/24/13 Anthropometry - Amarendra B. Singh 090201263 40

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