This document provides an overview of nutritional anthropometry. It begins by defining anthropometry as the quantitative measurement of the human body. It then discusses various anthropometric measurements that can be taken including weight, height, waist-to-hip ratio, mid-upper arm circumference, skin folds, head circumference, and chest circumference. The document provides details on techniques for accurately measuring each indicator. It explains how anthropometric data can be used at both individual and population levels. Key advantages and disadvantages of anthropometry are also summarized.
2. WHAT IS INSIDE !!!
What is Anthropometry
Anthropometric measurements
Indices
References used
Classification
Results of different National Surveys
Conclusion
3. INTRODUCTION
• Anthropos
- "man" and Metron "measurement”
• A branch
of anthropology that involves the quantitative measurement of
the human body.
Nutritional Anthropometry
“Measurement of the variations of the physical Dimensions & the gross
composition of the human body at different age levels and degrees of
nutrition”
- Jellife (1966)
• It
is used to evaluate both under & over nutrition.
• The measured values reflects the current nutritional status & don’t differentiate
between acute & chronic changes
3
4. USE OF ANTHROPOMETRY
Individual Level
SCREENING: ONE TIME ASSESSMENT
to immediately decrease case fatality (emergency situations)
in non-emergency situations
GROWTH MONITORING: TREND ASSESSMENT
Population Level
ONE TIME ASSESSMENT
under circumstances of food crisis
for long-term planning
NUTRITIONAL SURVEILLANCE: TREND ASSESSMENT
for long-term planning
for timely warning
for programme management
4
5. SIGNIFICANCE OF ANTHROPOMETRY
Primary measures of past or current nutritional status in
children.
Distinguish between stunting & wasting
Identify PEM & obesity
Monitor changes after nutrition intervention
In clinical settings- identify, hospital patients with CED or over
nutrition.
5
Public Health screening
6. Advantages
• Simple & Safe procedures
• Inexpensive, portable, durable
equipment
• Little training
• Precise & accurate methods
• Info generated on past longtime nutritional history, not
possible with other tech. with
equal confidence.
Disadvantages
• Relatively insensitive method &
can’t detect disturbances in
nutritional status over short period
of time or identify specific nutrient
deficiency.
• Unable to distinguish disturbances
in growth or body composition
induced by nutrient(Zn) def. from
those caused by imbalances in
P&E intake.
6
8. Nutritional Anthropometry
Weight :
- Total Body mass
- Simple, widely used
- Sensitive to small changes in nutrition
Height :
- Genetically Determined
- Environmentally influenced
- Stunting Reflects chronic undernutrition
MUAC :
- Reflects muscle/fat
- Easy to measure, used for quick screening
- Independent of age (1-5 years)
FFT:
- Measures body fat
- Correlates well with total body fat
8
9. ANTHROPOMETRIC MEASUREMENTS
( For New Born & Young Children)
Weight
Recumbent length
Head Circumference
Chest Circumference
Mid Upper Arm Circumference (MUAC)
9
10. ANTHROPOMETRIC MEASUREMENTS
( For Adults )
Weight (in Kg)
Hip Circumference (in cm)
Height (in cm)
Fat fold thickness (in mm)
Mid Upper Arm Circumference
(MUAC) (in cm)
Triceps
Biceps
Supra-Iliac
Sub-scapular
Waist Circumference (in cm)
10
11. REQUIREMENTS FOR NUTRITIONAL
ANTHROPOMETRY
Standard equipment:
- Accuracy / Consistency,
Appropriate techniques:
- Training & Standardization
Correct assessment of age:
Reference values:
- For comparison and computation of indices
Classification:
- For grading nutritional status
11
12. 1. WEIGHT OR BODY MASS
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)
12
13. INDICATION
Sensitive indicator of current nutritional
status.
Deficit in weight indicates short term under
nutrition which can be easily reversed.
PEM is best indentified by weight
deficiency in all groups
13
14. MEASURING CHILD’S WEIGHT USING THE SALTER SCALE.
(SOURCE: UNICEF, 1986)
Adjust the pointer of the scale
to zero level.
Take off the child’s heavy
clothes and shoes.
Hold the child’s legs through
the leg holes (arrow 1).
Hold the child’s feet (arrow
2).
Hang the child on the Salter
Scale (arrow 3).
Read the scale at eye level to
the nearest 0.1 kg (arrow 5).
Remove the child slowly and
safely.
14
15. MEASURING WEIGHT OF ADULTS USING THE
BEAM BALANCE SCALE .
Participants are asked to remove
their heavy outer garments
(jacket, coat, trousers, skirts, etc.)
and shoes. If subjects refuse to
remove trousers or skirt, at least
make them empty their pockets and
record the fact in the data collection
form
The participant stands in the centre
of the platform, weight distributed
evenly to both feet. Standing offcentre may affect measurement.
The weights are moved until the
beam balances (the arrows are
aligned).
The weight is recorded to the
resolution of the scale (the nearest
0.1 kg or 0.2 kg).
15
18. WEIGHT
Sensitive
to changes
Changes in two directions up and down
Fast change
Usually easy to collect
Standardisation of scales needed, calibration
Small changes are difficult to measure: food
intake of the child, urine, dehydration, temp, etc:
not very specific
community aversion: connotations
can be difficult: co-operation of children
to nearest 100 gr.
18
19. 2. HEIGHT OR LENGTH
Height
vertical distance measured from crown of head to bottom of feet
(heels) for children 2 yr of age or older.
Recumbent Length:
distance measured from crown of head to bottom of feet (heels) while
child(< 2 yr of age) is measured supine.
Indication
Infantometer
Gives a picture of past
nutritional status
Deficit inheight
indicates chronic &
prolonged under
nutrition resulting often
in permanently stunted
physical staus
19
Stadiometer
20. 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 90⁰ , the movable pedal
plank of infantometer is snuggly apposed against
20
soles and length is read from scale.
22. 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.
•
Person 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.
22
24. HEIGHT
Difficult
to measure, accuracy, large variations
Differences are small: 24 cm increment in the first
year of life, 11 cm second year, 8 third
Low sensitivity
Large measurement errors
Measure to the nearest mm
Below 2 y recumbent, above standing
24
25. 3. WAIST-TO-HIP CIRCUMFERENCE RATIO
MEASUREMENT TECHNIQUE
Waist circumference
A good quality non-stretchable
measuring tape should be used.
View the patient from the front.
Locate the narrowest point
between ribs and iliac crests.
Ensure that the tape measure is at
the same height around the waist.
Measure and state the
measurement correctly to the
nearest centimetre.
≥102cm (adult male) & ≥88 cm (adult female) considered having abdominal
obesity
25
26. WAIST-TO-HIP CIRCUMFERENCE RATIO
Hip circumference
View the person from the front.
Hip measurement is taken at
the widest lateral extension of
the hips.
Ensure that the tape measure is
horizontal.
Measure and state the
measurement correctly to the
nearest centimetre.
Calculate Waist/Hip Ratio to 2
decimal places.
26
27. MEASURES OF BODY COMPOSITION
Weight loss, per se, does not provide the nutritionist
with an indication of type of tissue lost (i.e. weight loss
due to loss of adipose tissue or loss of muscle tissue).
Measurements of skin-folds, mid-arm circumference
and mid-arm muscle circumference therefore provide a
more comprehensive picture of body composition/
changes.
27
28. MID-ARM CIRCUMFERENCE (MAC)
Locate the midpoint of the arm.
Non-dominant arm elbow flexed at 90deg
with palm facing upwards
Measurer stands behind the subject & locates
the lateral tip of the acromion and the most
distal point on the olecranon
process
Place a tape measure so that it passes between
these 2 landmarks and mark the
midpoint
Measure the midarm circumference
The subject stands erect with arms hanging
freely at the sides and the palms facing the
thighs
Place the tape measure perpendicular to the
long axis of the arm at the marked midpoint
& measure the circumference to the nearest
mm. (e.g. 18.1 cm)
Provide the actual MAC in cm.
28
32. SKIN-FOLD MEASUREMENTS
Approximately half of the total
amount of fat tissue in the human
body is located below the surface of
the skin.
In general, when measuring skin-fold
thickness,
This makes it possible to predict
total body fat from skin-fold
thicknesses with a relative high
degree of accuracy using a simple
two-compartmental method.
This accuracy is confirmed by CT
scan as well as ultrasonic and
radiographic techniques used to
measure subcut.fat.
The assessor, using the forefinger and the
thumb, grasps and lifts the subcut. tissue
and skin from the underlying muscle.
Places the pincers of the skin-fold
caliper, applying a constant
pressure, 2cm below the fingers at a
depth of 1cm.
Holds this position for 3-4seconds.
Takes three measurements for accuracy.
32
Provides the actual skin-fold thickness in
mm.
33. DIFFERENT TYPES OF SKIN FOLD CALLIPERS
Holtain
Sanny Professional
Skin fold Caliper
Defender Body
Fat Caliper
Cescorf
Body Caliper
Lange Fat Caliper
Warrior Digital
Body Mass Calliper
Accu-Measure
33
Personal Body Fat Tester
Harpenden Caliper
Lafayette
34. TRICEPS SKIN-FOLD (TSF)
A measure of subcutaneous fat stores taken at the
midpoint of the posterior aspect of the humerus.
Correlates closely with percentage of body fat and
with total body fat.
Triceps skin-fold thickness varies between
6 -12mm in lean individuals and between
40 - 50mm in obese individuals.
34
35. TRICEPS SKIN-FOLD MEASUREMENT TECHNIQUE
Subject should be standing with arms hanging
loosely at the sides.
Assessor to be positioned behind the subject.
To locate the triceps skin-fold site, locate the site
previously marked for the midarm
circumference measurement (MAC).
The triceps skin-fold site is on the posterior surface
of the arm, midway between the shoulder and the
elbow.
Using the forefinger and the thumb the assessor
grasps and lifts the subcut. tissue and skin 2cm
above TSF site.
Place the pincers of the skin-fold caliper at the
TSF point at a depth of 1cm.
Hold this position for 3-4seconds.
Take three measurements for accuracy.
Provide the actual skin-fold thickness in mm.
35
36. BICEPS SKIN-FOLD MEASUREMENT
Locate the biceps skin-fold site:
The assessor positioned in front of
the subject.
Subject should be standing erect
with arms hanging loosely at their
sides.
To locate the biceps skin-fold
site, locate the level previously
marked for the mid-arm
circumference measurement.
The biceps skin-fold site is on the
anterior surface of the
arm, midway between the shoulder
and elbow.
36
37. SUBSCAPULAR SKIN-FOLD MEASUREMENT
TECHNIQUE
The assessor is positioned behind the
subject.
The subscapular skin-fold site is located 1cm
below the inferior angle of the scapula.
The assessor grasps and lifts the subcut.
tissue and skin at a downward angle of
approximately 45 towards the lateral
aspect of the body.
Place the pincers of the skin-fold caliper at
a depth of 1cm.
Hold this position for 3 to 4
seconds.
Take three measurements for accuracy
(answer in mm).
Provide the actual skin-fold thickness in mm.
37
38. SUPRA-ILIAC SKIN-FOLD MEASUREMENT
TECHNIQUE
The assessor to be positioned in front
of the subject.
The supra-iliac site is located 5cm
above the anterior superior iliac spine.
The assessor grasps and lifts the
subcut. tissue and skin at a downward
angle of 45 towards the medial aspect
of the body.
Place the pincers of the skin-fold
caliper at a depth of 1cm.
Hold this position for 3 to 4
seconds.
Take three measurements for accuracy
(answer in mm).
Provide the actual skin-fold thickness in
mm.
38
39. 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.
39
40. EXPECTED HEAD
CIRCUMFERENCE IN CHILDREN
Age
Head
circumference
(cm)
At birth
41
6 months
42 - 43
1 year
45 - 46
2 years
Adult head size is achieved
between 5 to 6 years .
40
4 months
38
3 months
During first year there is 12 cm
increase in head circumference ,
while 1 – 5 year age , only 5 cm
gain occur in head size.
34 – 35
2 months
47 - 48
40
5 years
50 - 51
41. 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.
41
42. 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
42
43. RELATIONSHIP BETWEEN HEAD SIZE WITH
CHEST CIRCUMFERENCE:
At birth:
head circumference > chest circumference by up to 3 cm.
At around 9 months to 1 year of age:
head circumference = chest circumference,
but thereafter chest grows more rapidly compared to the brain.
43
44. Summary
Measurements
Advantage
Disadvantage
Common in use
Weight
Age
groups
Difficult in field;
Can’t tell body
composition;
need accurate age;
Need proper scale
Differs by day time:
Other factors play a
role
all
Height
all
Common in use
Simple to do in field
Head
Circumference
0-4 yr
simple
Other factors play a
role
all
Simple; age dependent; child
need not to be denuded;
suitable for rapid survey
No limits for over
nutrition & no
standard for adults
All
Measure body composition;
Detect obesity in adults
Need expensive
callipers; difficult with
the child & in the field
44
1-2 yr
Simple; age independent
For limited age; no
classification method
MUAC
Skin-fold
thickness
Chest –head
ratio
45. AGE
Usually
the most difficult and inaccurate
measurement
Less of a problem if a trend in the same child is
measured, the mistake is repeated every time and
thus cancels out
45
46. INDICES
Relation between two measurements
weight for age W/A general appreciation of nutritional status
combined measurement
NO individual diagnosis but trend assessment
For growth monitoring
height for age H/A measure of linear growth deficit or STUNTING
not sensitive to change
slow progress
Community diagnosis
weight for height/length W/H measure of weight deficit according to
length WASTING
Individual diagnosis
Community diagnosis
Sensitive to change
46
47. THE REFERENCE
One
reference for all?
Reference or standard?
International
Standards used:
Harvard standards
NCHS(U.S. National Centre for Health Sciences)
WHO standards
47
48. COMMON ERRORS
First
year of life is up to 11.9 months of age and
not O-12
Length and height; change technique at 24 mo
Lack of distinction between descriptive use and
operational use
No use of statistics: Confidence intervals and tests
to compare prevalence and averages
Undernutrition
Wasting
Stunting
48
49. CLASSIFICATION OF NUTRITIONAL STATUS
By SD
By % deviation from the Median of Standard
e.g. Gomez classification
Using percentiles
Velocity of growth
Distance Charts
Birth weight( normal is ≥2.5Kg)
Weight for Age:
Gomez Classification
IAP Classification
Jelliffe Classification
Wellcome Classification
Height for Age
49
50. Weight/Height ratios
Relative weight/indices
Power type indices
Quetelet’s index = Wt(in Kg)/Ht(m2)
pondreal index = Wt. / Ht.
Weight/Height Ratio = Wt (in gm)/ Ht (cm2)
Wt/Ht2 x 100 = > 0.15 indicates PEM
Wt/Ht % classification = <80 Under Nutrition
80-120 Normal
120-130 over nutrition
>130 obese
50
51. NUTRITIONAL GRADING /
CLASSIFICATIONS
Preschool Children:
GOMEZ CLASSIFICATION
WEIGHT FOR AGE
(% of NCHS
Standards)
90
NUTRITIONAL GRADE
Normal
75 – 89.9
Grade I (Mild Undernutrition)
60 – 74.9
Grade II (Moderate Undernutrition)
< 60
Grade III (Severe Undernutrition)
51
52. IAP CLASSIFICATION
(INDIAN ACADEMY OF PAEDIATRICS)
WEIGHT FOR AGE
(% of Harvard
Standard)
80
NUTRITIONAL GRADE
Normal
70 – 89.9
Grade I (Mild Undernutrition)
60 – 69.9
Grade II (Moderate Undernutrition)
50 – 59.9
Grade III (Severe Undernutrition)
< 50
Grade IV (Severe Undernutrition)
52
54. STANDARD NORMAL DISTRIBUTION
“Measuring Changes in Nutritional Status”
(WHO, Geneva 1983).
Normal
2%
-3.0 -2.0
14%
-1.0
34%
34%
0.0
1.0
SD Score
( 2SD = 96 %)
14%
2.0
2%
3.0
54
55. STANDARD DEVIATION (SD) CLASSIFICATION
NUTRITIONAL GRADE
CUT-OFF LEVEL
Median – 2 SD
WEIGHT FOR
AGE
HEIGHT FOR WEIGHT FOR
AGE
HEIGHT
Normal
Normal
Normal
Median – 3 SD to
Median – 2 SD
Moderate
Underweight
Moderate
Stunting
Moderate
Wasting
< Median – 3 SD
Severe
Underweight
Severe
Stunting
Severe
Wasting
55
56. Classification
BMI(kg/m2)
<18.50
<18.50
Severe
thinness
<16.00
<16.00
16.00 - 16.99
16.00 - 16.99
Mild thinness
Body Mass Index (BMI)
Additional cut-off
points
Moderate
thinness
Nutritional gradation
based on BMI (adult)
Principal cut-off
points
17.00 - 18.49
17.00 - 18.49
Underweight
Normal range
Overweight
=
Weight in kg / height in meter sq.
Pre-obese
Obese
18.50 - 24.99
18.50 - 22.99
23.00 - 24.99
≥25.00
25.00 - 29.99
≥25.00
25.00 - 27.49
27.50 - 29.99
≥30.00
Obese
class I
30.00 - 34-99
Obese
class II
35.00 - 39.99
Obese
class III
≥30.00
30.00 - 32.49
≥40.00
32.50 - 34.99
35.00 - 37.49
37.50 - 39.99
≥40.00
56
Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004
61. BROKA’S INDEX
Height (in cm) ─ 100 = IBW
Persons with IBW
Nutritional Status
10-20% more
mildly Overweight
20-30% more
Overweight
30-40% more
Obese
40% +
severly Obese
20-30% lower
Underweight
30-40% lower
Severly Underweight
Between 80-120%
normal
61
63. UNDERWEIGHT CHILDREN < 5 YEARS
(PROFILE OF STATES/ UTS)
The 2011 census estimates the population of children below 6 years at 158.8 million.
Nearly 40 % undernourished ( >63 million)
The proportion of children <5years who are underweight was lowest in Sikkim
(19.7%) followed by Mizoram (19.9%).
>50 % children <5years of age underweight are in M.P (60%), Jharkhand (56.5%)
& Bihar (55.9%).
Other states where more than 40 percent and upto 50% of children are underweight are
Meghalaya, Chhattisgarh, Gujarat, Uttar Pradesh, and Orissa.
Although the prevalence of underweight is relatively low in Mizoram, Sikkim, and
Manipur, even in those states more than 1/3 of children are stunted.
Stunting was more prevalent in Uttar Pradesh (56.8%), Bihar (55.6%), and
Meghalaya (55.1%).
63
Wasting is most common in Madhya Pradesh (35%), Jharkhand (32%), and
Meghalaya (31%).
64. TRENDS IN CHILD NUTRITIONAL STATUS
Percent of children age under 3 years
NFHS-3
NFHS-2
51
43
20
Stunted
(Low height
for age)
40
23
Wasted
(Low weight
for height)
Underweight
(Low weight
for age)
NFHS-3, India, 2005-06
45
66. Child nutrition: Status of achieving Millennium Development Goals
The MDG1 is ‘Eradicate extreme poverty and Hunger’ Under Goal 1, target 2
states, ‘halve, between 1990 and 2015, the proportion of people who suffer from
hunger’ with the indicator ‘Prevalence of underweight children<3 years of age’.
India is therefore, committed to halving the prevalence of underweight children by
2015..
66
67. (Each of these indices is expressed in standard deviation units SD, from the median
of the 2006 WHO international reference population)
Higher is the percentage of underweight female children
(< 5 years) than male children, whereas females are in a slightly
better position compared to male children (< 5 years) while
considering stunting and wasting.
67
70. NUTRITIONAL STATUS OF ADULTS
Percent of women and men age 15-49
36
Men
55
NFHS-3, India, 2005-06
Women
34
24
13
9
BMI below normal Overweight/ Obese
Anaemic
71. MALNUTRITION OF WOMEN BY
RESIDENCE AND EDUCATION
Percent of women age 15-49
7
7
14
13
13
14
11
24
36
42
41
42
35
35
36
3535
36
25
25
Ru
ra
ed
uc l
at
i
<8 on
ye
8- ars
9
ye
10 ars
+
ye
ar
s
25
No
25
21
Underweight
Underweight
to
ta
l
41
11
21
NF
HS
-2
24
13
To
ta
l
Ur
ba
n
50
13
45
40
35
30
25
36
20
15
10
5
0
7
7
Overweight
Overweight
NFHS-3, India, 2005-06
50
45
40
35
30
25
20
15
10
5
0
72. MALNUTRITION OF MEN BY
RESIDENCE AND EDUCATION
Percent of men age 15-49
50
50
45
45
35
35
8
8
66
55
14
14
14
14
30
30
25
25
20
20
15
15
40
40
38
38
34
34
40
40
38
38
Overweight
Overweight
27
27
25
25
10
10
5
5
N
o
s
ar
ye
10
+
ye
9
8-
ye
<8
ar
ar
s
s
n
io
at
ed
uc
R
ur
al
0
0
To
ta
l
U
rb
an
NFHS-3, India, 2005-06
40
40
33
55
Underweight
Underweight
76. 76
The increase in fat fold thickness over the last three decades begins in childhood and
increases with age in both males and females. The increase is more in women.
77. DATA FROM NNMB SURVEYS IN URBAN
SLUMS
Data from NNMB surveys in urban slums on time trends in
weight; mid-upper arm circumference and fat fold thickness at
triceps are shown in Figure 7.2.10, 7.2.11, 7.2.12 and 7.2.13.
Mean body weight, mid upper arm circumference and fat fold
thickness at triceps are higher in all age groups in 1993 - 94.
The increase in body weight is mainly due to increase fat as
shown by rising fat fold thickness.
Data from NNMB reports shows that both in men and women
over years, there have been an increase in body weight and fat
fold thickness.
The increase in body weight and fat fold is greater in urban slum
77
dwellers.
83. REFERENCES
Yasoda Devi. P, Uma Maheshwari. K ; Manual on Nutritional
Anthropometry; PG&RC, ANRAU
Rosalind S. Gibson ;1990, Principles of Nutritional Assessment; Oxford
University Press
National Family Health Survey 3 (2005-2006)
CHILDREN IN INDIA 2012 - A Statistical Appraisal ; Ministry of statistics
and Programme Implementation Government of India
NNMB surveys Report (1975 -2005) ; DIETARY INTAKES AND
NUTRITIONAL STATUS
http://wcd.nic.in/research/nti1947/7.2%20dietary%20intakes%20pr%204.2.
83
pdf
www.pediatrics.about.com
Editor's Notes
Monitoring the weight is helpful in diagnosing malnutrition at early stage