This document provides an overview of anthropometric assessments. It defines anthropometry as the measurement of human physical dimensions and composition. It discusses various anthropometric measurements including height, weight, mid-upper arm circumference, and skin folds that are used to assess growth in children and body composition in adults. It also describes how indices like weight-for-age, height-for-age, and body mass index are derived from these measurements and used to classify nutritional status. Quality control measures for anthropometric surveys are also outlined to ensure accurate data collection.

1. Chapter2:
ANTHROPOMETRIC ASSESSMENTS
1
NUTRITION ASSESSMENT 2022
Abdulkadir M. Nuh (BSc, MSc in Human Nutrition)
Gmail: abdulkadirnuh91@gmail.com Tell: +252 634101918
Faculty of health sciences
Department of Nutrition

2. Faculty of health sciences
Department of Nutrition

3. Learning Objectives
By the end of the chapter you will be able to:
 Define anthropometric measurement
 Differentiate anthropometric measurements of growth
and body composition
 Generate an index and an indicator from measurements
of nutritional status
 Be able to identify different measurements for different
demographic groups

4. • Anthropometry comes from two Greek words:
Anthropo = Human, and Metry/metron =
measurement.
• Definition: - Anthropometry refers to
measurement of variations of physical dimension
and gross composition of human body at
different levels and degrees of nutrition
ANTHROPOMETRIC ASSESSMENTS

5. Anthropometric measurements could be used both in the
clinical and field set-ups.
In the clinical set-ups they are used to assess the
nutritional status of:
Post-operative patient,
Post traumatic patient (after acute trauma or surgery),
Chronically sick medical patient,
Patient preparing for operation,
Severely malnourished patient to assess the impact
of nutritional intervention.
ANTHROPOMETRIC ASSESSMENTS………

6. • In community setups
• Anthropometric measurements are performed
with two major purposes in mind:
• IN CHILDREN: to assess physical growth
• IN ADULTS: to assess changes in body
composition or weight
Purposes of Anthropometric measurements

7. • Growth performance of children is an excellent
reflection of their underlying nutritional status
• Children adapt to the chronic nutritional insult
by either reducing their rate of growth or by
totally failing to grow.
Anthropometric Measurement of growth

8.  Growing child is healthy child.
 Optimal growth occurs only with adequate food,
absence of illness, caring and nurturing, social
environment
 Most rapid in first year of life
8
Measurement of Child Growth

9.  Common anthropometric measurements are weight,
height/length, MUAC, head circumference
 Most accurate and sensitive method of
measuring growth is weight gain
 Weight gain can be measured by regularly
weighing
9
How to measure growth ?

10.  Assessment of growth performance of children is one
very important purpose of anthropometric measurements.
 The following body measurements are good indicators of
growth performance of children at different ages when
combined with the cut-off points
10
ANTHROPOMETRIC MEASUREMENTS OF GROWTH

11.  Measured using flexible measuring tape around 0.6cm
wide to the nearest 1mm.
 It is the circumference of the head along the supra orbital
ridge anteriorly and occipital prominence posteriorly.
 HC is useful in assessing chronic nutritional problems in
under two children.
 But after 2 years as the growth of the brain is sluggish HC
is not useful indicator any more.
11
1. HEAD CIRCUMFERENCE (HC):

12. 12
1. HEAD CIRCUMFERENCE (HC)…..

13. • A wooden measuring board (also called sliding board) is
used for measuring length.
• It is measured in recumbent position in children <2 yrs
old to the nearest1mm.
• It is always > height by 1-2cm.
• One assistant is needed in
taking the measurement
• Measurement is read to the nearest mm
13
2. LENGTH

14. 2. LENGTH

15.  Is measured in children > 2 yrs and a adults in standing position to
the nearest 0.1 cm.
 The head should be in the Frankfurt plane during measurement,
knees should be straight and the
1. Heels
2. Calf muscle
3. buttocks and
4. the shoulders blades, should touch the vertical surface of the
Stadiometer (anthropometer) or wall.
 Stadiometer or portable anthropometer can be used for measuring.
 There is also a plastic instrument called acustat Stadiometer that is
cheaper than the conventional Stadiometer. 15
3. HEIGHT

17.  Weighing sling (spring balance) also called salter scale is used for
measurement of weight in children < 2 years.
 in children the measurement is performed to the nearest 10g.
 In adults and children >2 years, beam balance is used and the
measurement is performed to the nearest 0.1 kg.
 For both digital (electronic) scales can be used and are very
accurate.
 UNICEF Mother- Infant scale can also be used
17
4. WEIGHT

18. Weight…
Salter
Scale

19. Improvising Weight
measurement…

20. • What is an index?
• It is a combination of two measurements or a
measurement plus age.
The following are few of them: -
 Head circumference-for age
 Weight -for-age
 Height-for age
 Weight for height 20
INDICES DERIVED FROM THESE
MEASUREMENTS

21. Meanings Of The Indices Derived From Growth
Measurements
W eight for A ge = x 100
Weight of the child
Weight the normal child of the same age
Weigh for height Weight of the child
Weight the normal child of the same height
Height for age X 100
= H e i g h t o f t h e c h i l d
H e i g h t o f t h e n o r m a l c h i l d o f t h e s a m e
a g e
x 100

22.  Both weigh for age and weight for height are indices sensitive to
acute changes to nutritional status
 Height for age of children in a given population indicates their
nutritional status in the long run.
 The best example is change in the average height of children in the
industrialized countries towards higher values following
improvements in nutrition, control of infectious problems etc.
 This is called Secular change in Height
22

23. An indicator is an index + a cut-off point.
• E.g.
• W F A < 60% = is indicator of severe
malnutrition
• HFA < 85%= indicator of severe stunting
• W F H < 70% = is indicator of severe wasting
23
Indicator

24. Various Indices And Cut-off Points For Defining
Malnutrition And Their Relationships:
“Moderate” malnutrition classified as the percent falling between
– 2 to – 3 SD and “severe” as the percent falls below – 3 SD
Measurements Indices Indicators Cut-off points for the deferent ways defining
Malnutrition
Percentile of
the reference
median
Percent of the
reference
median
Z score Or SD
Weight and Height
Weight for
Height(WFH)
Wasting 3rd 80 <-2
Height and age Height for age Stunting 3rd 90 <-2
Weight and age
Weight for
age
Under weight 3rd 80 <-2
Weight , height and
age
BMI for age Thinness - - <-2

25.  Percentiles are not recommended for evaluating anthropometric
measurements from less developed countries when reference
data from industrialized countries such as NCHS are used
 Because many of the study population may have indices
below the extreme percentiles of the reference population
making it difficult for accurately classifying large number of
individuals
Using appropriate methods for different setups

26. ■ Standard deviation score is recommended by waterlow
et al(1977) for evaluating anthropometric data from less
industrialized countries.
■ This is because the deviations scores can be defined
beyond the limits of original reference data.
■ This allows accurate classification of individuals below
the extreme percentiles of the reference data.
26
Using appropriate methods for different setups…….

27. Comparison of the characteristic of three measures of scale
Characteristic Z score Percentile Percent of
median
Adherence to reference
population
Yes Yes No
Summary statistics
Possible
Yes No Yes
Uniform Criteria across
indices
Yes Yes No
Useful for detecting
changes at extreme
of distribution
Yes No Yes

28. 28
CLASSIFICATION OF
NUTRITIONAL STATUS
BASED ANTHROPOMETRIC
INDICES

30. Hamse Khalif (MSc in Human Nutrition, Bsc,
RN)
30

31. • The cut off point 90% may be too high as many
well-nourished children are below this value.
• Edema is ignored and yet it
contributes to weight and
• It does not indicate the duration of malnutrition
• Age is difficult to know in developing countries
(agrarian society).
• It does not also differentiate between
kwashiorkor and marasmus
31
Disadvantages of Gomez classification

33. This method does not differentiate :
• Acute malnutrition (for emergency planning)
• Chronic malnutrition( for food security planning)
• Depends on knowledge of the child’s age
• Does not take height differences in to
account
33
Disadvantages

34. Waterlow Classification
( Waterlow JC,1972)
Currently we use water low classification for diagnosing
acute malnutrition both clinical and community setups.

35. 35
Anthropometric
Measurements of
Body composition

36.  Linear growth ceases at around the age of 25-30
years.
 Therefore, the main purpose of nutritional
assessment of adults using Anthropometry is
determination of the changes of body weight
and body composition
36
ASSESSMENT BODY COMPOSITION

37. 1. Atomic level(C, H, N, P, Ca, O)
2. Molecular level(fat, Water, protein)
3. Cellular level(body cell mass, intra/extra
cellular water, intracellular solids)
4. Tissue level(adipose tissue, muscle, bone)
5. Whole body level (Weight, height, skin folds
37
Five levels of body composition Assessment

38. Some Of The Main Components At The first Four
Body Composition Levels

39. • Whole body level assessment is used
• In assessing body composition we consider
the body to made up of two compartments:
• The fat mass and the fat free mass
• TOTAL BODY MASS = FAT MASS + FAT
FREE MASS
• Therefore different measurements are used
to assess these two compartments:
39
ASSESSMENT BODY OF COMPOSITION
Using Anthropometry

40.  Mid upper arm circumference
1. Mid upper arm Muscle area
2. Mid thigh circumference
3. Mid thigh muscle area
4. Mid calf circumference
5. Mid calf muscle area
40
MEASUREMENT OF FAT FREE
MASS

42. It is a sensitive indicator of risk of mortality
Useful for screening of children for community
based nutrition interventions
 Useful for the assessment of nutritional status
of pregnant women
42
MUAC…

43. Why is MUC useful to screen children?
MUAC stays the same during the first 5 years
43

44. MUAC and RUAC have a similar trend of
increase with age in both sexes in the
different places of residences
44
Does looking for the mid point of the
Upper arm matter?
MUAC vs RUAC

45. MUAC..

46. MUAC..

47. Measurements Used to Assess Fat Mass:
• Weight & height ( body mass index)
• Waist circumference
• Waist to height ratio
• Waist to h ip circumference ratio
• Skin fold thickness
47
MEASUREMENT OF FAT MASS

48. Indices derived from height and weight
measurements
 Different indices could be derived by measuring the
weight and height of an adult
 Body mass index (Quetelet’s index) = Wt/(Height in
meters)2
 Weight/height ratio (Benn’s index)P
 Ponderal index = Wt/ (ht)3

49. • Body mass index the best method for
assessing adult nutritional status as the
index is not affected by the height of the
person
• Therefore, it is most frequently used for
assessing adult nutritional status
49
Body mass Index(BMI)

52. When it is not possible to measure height as in
the case of :
• Elderly people
• Kiphosis / Scoliosis
• People unable to assume erect position
Height can be estimated from arm span or demi-
span 52
BMI for Situations where Height
measurements is Impossible

53. Arm-span is the distance between the tips of
the tallest fingers while arms are starched on
straight line(180 degrees).
Demi span (Half arm span)- the distance
from sternal notch to the tallest finger on the
left side with the arm stretches on straight.
53
Arm Span

55. ■ Measures double thickness of skin and
subcutaneous fat
Advantages:
–inexpensive
–fast
–portable
–large database
55
Skinfold Thickness

57. 11/8/2023 57
Hamse Khalif (MSc in Human Nutrition, Bsc,
RN)

58. ■ Limitations
■ Technician error
■ Skinfold thickness affected by factors other than amount
of fat
– exercise increases skin thickness
– dehydration reduces skin thickness
– edema increases skin thickness
– dermatitis increases skin thickness
■ Poorly predicts visceral fat
58
SkinfoldThickness

59. ■ It is the circumference of the waist measured
mid-way between the lowest rib cage at the
mid-clavicular line and anterior superior iliac
spine divided by the circumference of the hip
measured at the level of the greater
trochanter off the fumer (widest Area) (both
are measured to the nearest 0.1cm)
59
WAIST TO HIPCIRCUMFERENCE RATIO

61. Cut-off for percentage of body fat
Description Women Men
Essential fat 10–13% 2–5%
Athletes 14–20% 6–13%
Fitness 21–24% 14–17%
"Average" 25–31% 18–24%
Obese
32%+
>35%(WHO)
25%+
Source: American Council on Exercise

62. ■ The following issues need to be considered in carrying out
anthropometric surveys to ensure the quality of data
 Calibration of the instrument after each measurement and
after moving the instrument from one room to another.
 Standardization of procedures.
 Making subjects wear a uniform gown before measuring
weight or measuring their weight nude if they are children.
62
Quality control measures in anthropometric
surveys

63. Advantages And Disadvantages Of
Anthropometric Measurements
ADVANTAGES
 Quick
 Cheap
 Objective
 Gives Gradable
Results
 More Accepted By The
Community
 Non Invasive
DISADVANTAGES
 Difficulty Of Selecting Appropriate
Cut-Off Points
 Have Limited Diagnostic
Relevance (Only For Diagnosing
PEM)
 Need Reasonably Precise Age In
Children
 Error is very likely

64. 1. Describe the limitations of anthropometry.
2. Outline the sources of errors when taking weight.
3. Write down the procedure when measuring height.
4. State four source of errors when taking MUAC.
5. Tabulate the classes of oedema.
SELF TEST QUESTIONS
NUTRITION ASSESSMENT, 2022

65. THE END
Thank You
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