The document describes various methods for assessing malnutrition in children, including midarm circumference (MAC), weight for height, and several indices like Quetlet's index and BMI. It explains how these measurements can distinguish between different types of malnutrition, such as acute versus chronic. Additionally, several tools and ratios, such as the quackstick and midarm/head circumference ratio, are discussed for practical evaluation in field studies.

2. AGE INDEPENDENT ANTHROPOMETRY
• MIDARM CIRCUMFERENCE (MAC)
• WEIGHT FOR HEIGHT
• QUACKSTICK
• MIDARM/HEAD CIRCUMFERENCE RATIO
• QUETLET’S INDEX
• MID-UPPER ARM/HEIGHT RATIO
• BODY MASS INDEX (BMI)
• PONDERAL INDEX (PI)

3. MIDARM CIRCUMFERENCE (MAC)
• AS THE MIDARM CIRCUMFERENCE IS RELATIVELY CONSTANT BETWEEN 16.5 CM TO 17.5
CM IN 1 TO 5 YEARS OF AGE, THIS MEASUREMENT MAY BE CONSIDERED AS AN AGE
INDEPENDENT VARIABLE UP TO 5 YEARS OF AGE. ANY CHILD WHOSE MAC IS LESS THAN
12.5 CM UP TO 5 YEARS OF AGE, IS CONSIDERED MALNOURISHED. SHAKIR’S TAPE ALSO
MEASURES THE MAC. A BANGLE OF 4 CM IN DIAMETER, USED IN FIELD STUDIES IS NOT A
RELIABLE METHOD (BANGLE TEST).

4. WEIGHT FOR HEIGHT
• THE DEGREE OF WASTING CAN BE MEASURED BY COMPARING THE CHILD’S WEIGHT WITH EXPECTED WEIGHT
FOR A HEALTHY CHILD OF THE SAME HEIGHT. COMBINATIONS OF THESE MEASUREMENTS HAVE BEEN USED TO
DISTINGUISH DIFFERENT TYPES OF MALNUTRITION. WATER LOW SUGGESTED THAT WEIGHT FOR HEIGHT CAN BE
USED TO DISTINGUISH BETWEEN MALNUTRITION OF RECENT ORIGIN, I.E. WASTING AND MALNUTRITION DUE TO
A CONSIDERABLE PERIOD OF MONTHS. IN CHRONIC MALNUTRITION THE CHILD IS STUNTED WITH THE WEIGHT
FOR AGE AND HEIGHT FOR AGE BEING LOW. IN ACUTE MALNUTRITION, HEIGHT FOR AGE IS NORMAL BUT
WEIGHT FOR AGE IS LOW (WASTING). THUS, THE WEIGHT AND HEIGHT MEASUREMENTS TOGETHER ARE USEFUL
IN UNDERSTANDING THE DYNAMICS OF MALNUTRITION. IN NUTRITIONAL SHORT STATURE THE WEIGHT/HEIGHT
IS EQUAL; THE CHILD MAY PASS OFF AS A NORMAL CHILD OF LOWER AGE IF THE CHRONOLOGICAL AGE IS NOT
KNOWN. THESE HAVE BEEN DISCUSSED IN THE CHAPTER ON ‘PROTEIN-ENERGY MALNUTRITION’.

5. QUACKSTICK
• QUAKER’S MIDARM CIRCUMFERENCE MEASURING STICK IS A HEIGHT
MEASURING ROD, CALIBRATED IN MAC RATHER THAN HEIGHT; VALUES OF 80
PERCENT MAC FOR HEIGHT ARE MARKED ON THE STICK AT CORRESPONDING
HEIGHT LEVELS. IF A CHILD IS FOUND TALLER THAN HIS/HER ARM
CIRCUMFERENCE LEVEL ON THE STICK, HE/SHE IS CONSIDERED
MALNOURISHED. THE QUACKSTICK WAS DEVISED IN MEXICO AND HAS SINCE
BEEN ADAPTED IN AFRICA AND INDIA.

6. MIDARM/HEAD CIRCUMFERENCE RATIO
• IT IS A SIMPLE AND USEFUL CRITERION FOR DETECTION OF MALNUTRITION. A
RATIO 0.280 TO 0.314 INDICATES EARLY MALNUTRITION, 0.250 TO 0.279
MODERATE, AND LESS THAN 0.249 DENOTES SEVERE MALNUTRITION

7. QUETLET’S INDEX
• IT IS BASED ON THE RELATIONSHIP BETWEEN WEIGHT AND HEIGHT AND IS
EXPRESSED AS WEIGHT (KG)/HEIGHT (CM) × 100. NORMAL VALUE VARIES FROM
0.14 TO 0.16. IN GROSS MALNUTRITION, IT IS LESS THAN 0.14. IT IS A QUITE
RELIABLE RATIO FOR ASSESSING MALNUTRITION.

8. MID-UPPER ARM/HEIGHT RATIO
It is also a very good indicator of nutritional status. A ratio of less than 0.29 indicates
gross malnutrition, while the normal value ranges from 0.32 to 0.33.

9. BODY MASS INDEX (BMI)
• 𝐵𝑀𝐼 =
𝑤𝑒𝑖𝑔ℎ𝑡 𝑘𝑔
ℎ𝑒𝑖𝑔ℎ𝑡2(𝑚2)
• THIS IS SIMILAR TO QUETLET’S INDEX EXCEPT THAT THE VALUES ARE IN SI
UNITS. BMI VALUES CAN BE USED TO DRAW STANDARDIZED PERCENTILE
CURVES IN CHILDREN AND ADOLESCENTS. IT IS ESPECIALLY USEFUL FOR
DEFINING OBESITY. BMI VALUES ABOVE 95TH PERCENTILE FOR AGE ARE
USUALLY USED TO DEFINE OBESITY.

10. PONDERAL INDEX (PI)
• 𝑃𝐼 =
ℎ𝑒𝑖𝑔ℎ𝑡 𝑚
𝑐𝑢𝑏𝑒 𝑟𝑜𝑜𝑡 𝑜𝑓 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡(𝑘𝑔)
• THIS IS ANOTHER INDEX SIMILAR TO BMI AND IS OFTEN USED IN DEFINING NEWBORN WITH
INTRAUTERINE GROWTH RETARDATION (IUGR).