Assessment of nutritional status especially in vulnerable population is important for taking prompt action. young children are the most affected proportion of the population in the world.In community settings, rapid methods of assessment are important tools to identify children suffering from both macro and micro deficiencies .This is pictorial presentation showing various methods as well as pictures of deficiencies

1. Assessment of
Nutritional Status
Dr. Harivansh Chopra,
DCH, MD
Professor,
Community Medicine,
LLRM Medical College, Meerut.
harichop@gmail.com
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2. DR.HARIVANSH CHOPRA
Objectives
1. To learn the various methods used for
assessing the nutritional status.
2. To learn the Normal Growth pattern of
children.
3. To learn the age independent parameters
and indices utilised in the community.
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3. DR.HARIVANSH CHOPRA
Methods of Nutritional Assessment in
Natural History of Disease
Prepathogenic period Period of Pathogenesis
Diminishing
Reserves
Physiological
& Metabolic
alterations
Reserves
Exhausted
Non-specific
Signs and
symptoms
D
E
A
T
H
Food Balance Sheets
Dietary Surveys
Mortality Data
Clinical Signs & Mortality
Anthropometric Studies
Biochemical Studies
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4. DR.HARIVANSH CHOPRA
Assessment of Nutritional Status
1. Clinical Examination.
2. Anthropometry.
3. Biochemical evaluation.
4. Functional assessment.
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5. DR.HARIVANSH CHOPRA
Assessment of Nutritional Status
5. Assessment of dietary intake.
6. Vital and Health statistics.
7. Ecological studies
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6. DR.HARIVANSH CHOPRA
1. Clinical Assessment
1. General
Appearance:
Thin built
Sickly
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7. DR.HARIVANSH CHOPRA
1. Clinical Assessment
2. Hair :
Lack of lusture
Dyspigmented
Thin and Sparse
Easily pluckable
Flag sign
(Kwashiorkar)
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8. DR.HARIVANSH CHOPRA
1. Clinical Assessment
3. Head:
Craniotabes,
Frontal bossing,
Parietal bossing,
Caput quadratum,
Delayed closure AF
(Vit. D deficiency)
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1. Clinical Assessment
CRANIO TABES

10. DR.HARIVANSH CHOPRA
1. Clinical Assessment
4. Face :
Diffuse pigmentation,
Nasolabial dyssebacea
(Vitamin B12 deficiency),
Moon face
(Kwashiorkar).
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11. DR.HARIVANSH CHOPRA
1. Clinical Assessment
5. Eyes :
i. Conjunctiva – Dryness, Bitot’s
Spot (Vit. A def.), Pale
Conjunctiva (Fe def.)
ii. Cornea – Dryness, Haziness or
Opacity (Vit. A def.), Corneal
vascularisation (Riboflavin def.)
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12. DR.HARIVANSH CHOPRA
1. Clinical Assessment
6. Lips :
Angular Stomatitis,
Cheilosis (Vit. B12
& Folate
deficiency)
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13. DR.HARIVANSH CHOPRA
1. Clinical Assessment
7. Tongue :
Pale & Flabby, Red
& Raw, Fissured,
Geographic (Vit. B-
complex def.)
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14. DR.HARIVANSH CHOPRA
1. Clinical Assessment
8. Teeth :
Mottled Enamel,
Caries, Attrition,
Delayed and
irregular eruptions
(Vit. D def.)
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15. DR.HARIVANSH CHOPRA
1. Clinical Assessment
9. Gums :
Spongy, Bleeding
(Vit. C deficiency)
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16. DR.HARIVANSH CHOPRA
1. Clinical Assessment
10. Glands :
Thyroid
enlargement
(Iodine deficiency)
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17. DR.HARIVANSH CHOPRA
1. Clinical Assessment
11. Neck :
Casal necklace
(Niacin def.)
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18. DR.HARIVANSH CHOPRA
1. Clinical Assessment
12. Chest:
Pigeon Chest, Beading of
ribs (Vit. D def.),
Rachitic rosary, Scorbutic
rosary (Vit. C def.),
Cardiomegaly, Tachycardia
(Thiamine Def.)
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19. DR.HARIVANSH CHOPRA
1. Clinical Assessment
13. Abdomen:
Harrison’s sulcus,
Pot belly (Vit. D def.)
Hepatomegaly
(PEM)
Scrotal and Vulval
dermatosis
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20. DR.HARIVANSH CHOPRA
1. Clinical Assessment
13. Abdomen:
Harrison’s sulcus,
Pot belly (Vit. D def.)
Hepatomegaly
(PEM)
Scrotal and Vulval
dermatosis
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21. DR.HARIVANSH CHOPRA
1. Clinical Assessment
14. Spine:
Kyphosis, Scoliosis,
Rachitic pelvis (Vit.
D def.)
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22. DR.HARIVANSH CHOPRA
1. Clinical Assessment
15. Limbs:
Oedema, Epiphyseal enlargement,
Knock Knee or Bow Legs (Vit. D def.),
Muscle wasting, Oedema (PEM)
Motor weakness, Calf tenderness
(Thiamine def.)
Frog leg position (Vit. C def.)
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23. DR.HARIVANSH CHOPRA
1. Clinical Assessment
15. Limbs:
Oedema, Epiphyseal enlargement,
Knock Knee or Bow Legs (Vit. D def.),
Muscle wasting, Oedema (PEM)
Motor weakness, Calf tenderness
(Thiamine def.)
Frog leg position (Vit. C def.)
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24. DR.HARIVANSH CHOPRA
1. Clinical Assessment
16. Skin :
Dry & Scaly, Follicular
hyperkeratosis, Flaky Paint
Dermatosis (PEM)
Petechiae (Vit. C def.)
Pellagrous Dermatosis (Niacin
def.) Acrodermatitis (Zn def.)
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25. DR.HARIVANSH CHOPRA
1. Clinical Assessment
17. Nails :
Koilonychias (Fe def.)
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26. DR.HARIVANSH CHOPRA
2. Anthropometry
 Terminology –
1. Measurements : Age, Weight,
Height/Length/Stature.
2. Indices : Weight for Height, Height for Age,
BMI, etc.
3. Indicator : Cut-off points, Standards.
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27. DR.HARIVANSH CHOPRA
2. Anthropometry
1. Most commonly used Anthropometric
Indices are age dependent.
2. For making comparisons, Normal growth
may be obtained from International
Reference Population data, or by various
formulae.
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28. DR.HARIVANSH CHOPRA
2A. Anthropometry –
International Reference Population
1. Harvard Growth Curves – 1966.
2. National Centre for Health Statistics –
1970. Current usage.
3. W H O CHILD GROWTH STANDARDS
These are based on multicentre growth reference study done in
Brazil,Ghana,India,Norway,Oman and USA between 1997-2003
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29. DR.HARIVANSH CHOPRA
NORMAL GROWTH
 Normal Growth may be defined as the level
of growth which is (and can be) attained by
the child when its innate genetic potential
for growth finds full expression – in a
situation wherein dietary and environmental
constrains on growth are eliminated.
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30. DR.HARIVANSH CHOPRA
2B. Anthropometry –
Growth in Childhood
Growth velocity
 Growth Velocity is maximum in the first year of
life.
 Even in the first year Growth Velocity is
maximum in first 4 months.
384
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31. DR.HARIVANSH CHOPRA
2B. Anthropometry –
Weight Gain in Childhood
1. From 1 – 6 years, the weight gain (in kg.) can
be calculated by the formula
(Age in years X 2) + 8.
2. From 7 – 12 yrs, the formula is
(Age in years X 7) – 5
2
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32. DR.HARIVANSH CHOPRA
2B. Anthropometry –
Gain in Height / Length
1. Length at birth = 50 cm.
2. Length at 1 year = 75 cm.
3. Length at 2 years = 87 cm.
4. Height gain (in cm.) during
2 – 12 yrs. of life
= (Age in years X 6) + 77.
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33. DR.HARIVANSH CHOPRA
2B. Anthropometry –
Head Circumference
1. At birth = 34 cm.
2. At 3 months =
40 cm.
3. At 12 months =
47 cm.
4. At 2 years =
49 cm.
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34. DR.HARIVANSH CHOPRA
2B. Anthropometry –
Chest Circumference
1. At birth it is 3 cm. less
than head circumference.
2. Equals head
circumference at 1 year.
3. Exceeds head
circumference after 2
years of life.
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35. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Knowing the Age of child
1. Documentary evidence like “Birth
Certificate”, “Clinic care”, or “Horoscope”,
etc. (if available).
2. Ask from mother (Cross-checking is
necessary as errors in recall is common).
3. Age recorded up to the nearest month or
year.
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36. 8/9/2020 DR.HARIVANSH CHOPRA 36
Types of weighing machines

37. Types of weighing machines
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38. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Weight of child
1. For measuring weight of infants and
young children, pan type weighing scale
should be used.
2. A beam scale with non-detachable
weights may be used.
3. Alternatively, a Salter Scale or a Uniscale
may be used.
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39. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Weight of child
1. Use of a Salter Scale
for measuring weight.
2. Requires a Measurer
and an Assistant
(better if the mother).
3. Measure weight upto
the nearest 0.1 kg.
Method and Correct use of a Salter Scale http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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40. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Weight of child
1. Reduce the clothing
of child to minimum.
2. Measure weight of
mother + child, and
then mother alone.
The difference gives
the weight of child.
3. Calculate to nearest
0.1 kg.
Method and Correct use of a UNISCALE http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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41. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Weight of child Tare scale
1. Reduce the clothing
of child to minimum.
2. Measure weight of
mother + child, and
then mother alone.
The difference gives
the weight of child.
3. Calculate to nearest
0.1 kg.
Method and Correct use of a UNISCALE http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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42. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Length of child
1. Use of a measuring
board for child 0 – 23
months of age.
2. Requires a Measurer
and an Assistant.
3. length recorded upto the
nearest 0.1 cm.
Method and Correct use of a measuring board http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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43. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Height of child
1. Use of a measuring
board for child >24
months of age.
2. Requires a Measurer
and an Assistant.
3. Height recorded upto the
nearest 0.1 cm.
Method and Correct use of a measuring board http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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44. Dr. Harivansh Chopra
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45. Dr. Harivansh Chopra
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46. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Chest circumference
1. Horizontal girth of trunk
measured at arms eye
height, passing just
above the level of
nipples on anterior
chest.
2. Measuring tape is used.
3. The measurement made
up to the nearest 0.1 cm.
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47. DR.HARIVANSH CHOPRA
2C. Anthropometry –
Head Circumference of child
Lower edge of the measuring tape
just above the child's
eyebrows, above the ears and
around the occipital
prominence at the back of the
head.
Pull the tape to compress the hair.
The objective is to measure
the maximal head
circumference.
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48. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Age independent Anthropometry
1. In field conditions, it is very difficult to
know the exact age of the children,
especially if the parents are illiterate.
2. To overcome this, Age Independent
Parameters and Indices are utilised.
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49. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Mid-Upper Arm
Circumference
1. Used for children 1 – 5
years of age.
2. Measured in left arm
with arms hanging by
side.
Measuring the MUAC of child using Insertion Tape http://www.fantaproject.org/downloads/pdfs/anthro_5.pdf
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50. DR.HARIVANSH CHOPRA
2D. Anthropometry – (MUAC)
Applicable for 1 – 5 years age group.
1. Normal : > 13.5 cm.
2. Boderline Malnutrition : 12.5 – 13.5 cm.
3. Malnutrition : < 12.5 cm.
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51. DR.HARIVANSH CHOPRA
2D. Anthropometry –
(MUAC) – Shakir Tape Method
 Shakir & Morley Tape
12.5 cm 13.5 cm
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52. DR.HARIVANSH CHOPRA
2D. Anthropometry –
(MUAC) – Bangle Method
Bangle Test
4 cm
If bangle crosses the elbow,
the child is malnourished.
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53. DR.HARIVANSH CHOPRA
2D. Anthropometry –
MUAC – Quac-Stick Method
Simple, Easy, Inexpensive, yet Reliable
method for detecting Early Malnutrition of
Acute Onset.
Qu : Quacker.
A : Arm.
C : Circumference.
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54. DR.HARIVANSH CHOPRA
 Maximum left arm circumference – the arm
hanging by the side of body – is recorded.
 QUAC stick consists of a stick graduated
with figures for MUAC in relation to height.
2D. Anthropometry –
MUAC – Quac-Stick Method
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55. DR.HARIVANSH CHOPRA
 The child is made to
stand in front of the
QUAC stick. From the
graduations in the stick,
his nutritional status in
terms of 50, 60, 70 or
80% of the standard
can be easily read.
14.0
13.9
13.8
13.7
13.6
13.5
12.8
12.7
12.6
12.5
12.3
12.2
12.1
12.0
11.8
11.7
11.5
11.3
11.1
10.9
15.2
14.9
14.5
14.4
14.2
14.1
13.8
13.6
13.0
12.9
12.8
12.7
12.6
12.5
12.4
12.2
12.0
15.2
15.0
14.8
14.7
14.5
14.4
14.3
14.2
14.0
13.9
13.7
13.6
13.5
13.4
13.1
12.8
15.5
15.4
15.3
15.2
15.1
15.0
14.9
14.8
14.7
14.6
14.5
14.4
14.3
13.9
13.7
13.5
120
115
110
105
100
95
90
85
80
75
70
80%
70%
60%
50%
2D. Anthropometry –
MUAC – Quac-Stick Method
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56. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Triceps skin fold thickness
Measured by a standard caliper (Lange or
Herpenden).
Used for children 1 – 6 years of age.
1. Normal Child: > 10 mm.
2. Mild Malnutrition: 6 – 10 mm.
3. Moderate to gross Malnutrition: < 6
mm.
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57. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Rao and Singh’s Index
1. Relationship between height and weight.
2. Given by formula:
Weight (in kg) x 100
Height (in cm2)
3. Normal range is 0.14 – 0.16.
4. Gross malnutrition < 0.14.
5. Reliable indicator.
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58. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Quetelet Index
1. Relationship between height and weight.
2. Given by formula:
Weight (in kg)
Height (in m2)
3. Normal range is 3rd to 85th Percentile
4. malnutrition < 3rd percentile.
5. As per WHO BMI Charts.
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61. DR.HARIVANSH CHOPRA
2D. Anthropometry –
Dugdale Index
1. Based on relationship
between weight and height.
2. Given by the formula:
Weight (in kg)
Height (in cm)1.6
3. Normal value is between 0.88 & 0.79.
4. Value < 0.79 is suggestive of malnutrition.
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62. DR.HARIVANSH CHOPRA
3. Biochemical Tests
1. Laboratory Tests:
1. Hemoglobin – Reflects overall state of Nutrition.
2. Stools and Urine – Intestinal parasites, Urine
albumin and sugar.
2. Biochemical Tests:
1. Measurement of individual Nutrient.
2. Detection of abnormal Metabolites.
3. Measurement of Enzymes.
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63. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
Weighing of Raw foods
1. Duration of survey may range from 1 – 21
days, but commonly employs 7 days
which is called “one dietary cycle”.
2. Involves weighing of all foods going to be
cooked.
3. Widely practised in India, Practical, and
fairly accurate.
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64. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
Weighing of Cooked foods
1. Analysis of food in the
form in which they are
consumed.
2. Not easily acceptable
among people.
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65. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
Oral questionnaire method
1. Useful for dietary survey in
large population in short time.
2. Retrospective enquiries made
about the nature and quantity
of food eaten during previous
24 – 48 hrs.
3. Gives reliable results.
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66. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
Stock inventory method
1. Measurement of total
stock of food.
2. Weight of the total stock
and the time in which it is
consumed by a definite
number of people gives
the approximate
consumption
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67. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
the calculation
1. Data collected is translated into mean
intake (grams) of food in terms of cereals,
pulses, vegetables, fruits, milk, meat, fish
and eggs.
2. Mean intake of food per adult man value,
or “consumption unit” is calculated.
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68. DR.HARIVANSH CHOPRA
5. Assessment of Dietary Intake –
Uses
1. Provides information about dietary intake
patterns, & estimated nutrient intakes.
2. Indicates relative dietary inadequacies as
per present standards.
3. Valuable for planning health education
activities.
4. Allows an assessment of changes needed
in agriculture and food production
industries.
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Consumption unit
Adult male sedentry 1
moderate 1.2
heavy 1.6
Adult female sedentry .8
moderate .9
heavy 1.2
Child 0-1 Nil
1-3 .4
3-5 .5
5-7 .6
7-9 .7
9-12 .8
12 – 21 ( Adolescent) 1

70. DR.HARIVANSH CHOPRA
1. Writer
2. Typist
3. Teacher
4. Peon
5. Postman
6. Barber
7. Executive

71. DR.HARIVANSH CHOPRA
1. Carpenter
2. Shoemaker
3. Potter
4. Goldsmith
5. Rickshaw puller
6. Driver
7. Weaver

72. DR.HARIVANSH CHOPRA
1. Woodcutter
2. Stone cutter
3. Blacksmith
4. Mineworker

73. DR.HARIVANSH CHOPRA
6. Vital Statistics
1. Morbidity data:
i. Rate of low birth weight babies.
ii. Data on PEM, Anemia, Xerophthalmia,
other vitamin deficiencies, Endemic goitre,
Diarrhoea, Measles, & Parasitic
infestations
Through hospital data, community health
data, or morbidity surveys.
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74. DR.HARIVANSH CHOPRA
6. Vital Statistics
2. Mortality data:
i. Mortality in 1 – 4 years age group.
ii. Infant mortality rate.
iii. Second year mortality rate.
Mortality data, however, do not provide a
satisfactory picture of nutritional status of
population.
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75. DR.HARIVANSH CHOPRA
6. Vital Statistics – Uses
1. Identify the groups at high risk.
2. Indicate the extent of risk to the
community.
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76. DR.HARIVANSH CHOPRA
7. Ecological Factors –
Food balance sheet
1. Indirect method of assessing
food consumption.
2. Supplies are related to census
population to derive levels of
food consumption in terms of per
capita supply availability.
3. Estimate refers to country as a
whole.
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77. DR.HARIVANSH CHOPRA
7. Ecological Factors –
Food balance sheet
Disadvantage:
 Conceals differences occurring between
regions, among economic, age & sex groups.
Advantage:
 Cheap.
 Simple.
 Gives indication of general food consumption in
country.
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78. DR.HARIVANSH CHOPRA
7. Ecological Factors –
Socio-economic factors
Food consumption
pattern varies with
Family size,
Occupation, Income,
Education, Customs,
Cultural patterns, etc.
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79. DR.HARIVANSH CHOPRA
7. Ecological Factors –
Health and Educational Services
1. Primary Health
Care Services.
2. Feeding
Programmes.
3. Immunization
Programmes.
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80. DR.HARIVANSH CHOPRA
7. Ecological Factors –
Conditioning Influences
1. Parasitic, Bacterial and Viral infections
which precipitate Malnutrition.
2. Necessity to make an “Ecological
Diagnosis” of various factors influencing
nutrition in community before it is possible
to put into effect measures for prevention
and control of malnutrition.
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81. DR.HARIVANSH CHOPRA
Conclusion
1. Out of the seven methods of assessment,
only three i.e. Clinical Assessment,
Anthropometry, and Dietary Survey are
useful in community settings.
2. Age independent anthropometric
measurements are most rapid and useful
methods of assessment.
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82. DR.HARIVANSH CHOPRA8/9/2020 90

83. DR.HARIVANSH CHOPRA
MCQ
1. Which of the following is most useful
method of nutritional assessment in
community settings –
1. Biochemical estimation.
2. Dietary survey.
3. Anthropometry.
4. Age-independent Anthropometry.
Answer – 4.
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84. DR.HARIVANSH CHOPRA
MCQ
2. Attainment of Normal growth in children is
dependent upon –
1. Genetic potential.
2. Environmental factors.
3. Child rearing practices.
4. All of the above.
Answer – 4.
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85. DR.HARIVANSH CHOPRA
MCQ
3. Which type of malnutrition can be
assessed by Quac-stick method –
1. Acute malnutrition.
2. Chronic malnutrition.
3. Acute-on-chronic malnutrition.
4. None of the above.
Answer – 1.
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86. DR.HARIVANSH CHOPRA
MCQ
4. Casal Necklace is a feature of –
1. Thiamine deficiency.
2. Niacin deficiency.
3. Vitamin A deficiency.
4. Vitamin D deficiency.
Answer – 2.
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87. DR.HARIVANSH CHOPRA
MCQ
4. Single “dietary cycle” consists of –
1. 2 days.
2. 7 days.
3. 2 weeks.
4. 1 month.
Answer – 2.
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