This document discusses various methods for assessing nutritional status in individuals, families, and communities. It outlines expected competencies in understanding nutritional assessment concepts and identifying nutritional health problems. The main assessment methods covered are clinical examination, anthropometry, biochemical evaluation, functional assessment, diet surveys, health statistics, and ecological studies. Considerable detail is provided on anthropometric assessment parameters and techniques for measuring weight, height, head circumference, chest circumference, mid-upper arm circumference, and interpreting growth charts. Clinical signs of malnutrition and the advantages and limitations of clinical and dietary assessment methods are also summarized.

1. CM.5.2.1-METHODS OF
ASSESSMENT OF NUTRITIONAL
STATUS IN INDIVIDUAL, FAMILIES
AND COMMUNITIES
Dr. Hitesh Deka
Assistant Professor
Department of Community Medicine

2. Expected competency..
• Understand the concepts of Nutritional Assessment .
• Will be able to discuss various methods of nutritional
assessment.
• Will be able to identify and demonstrate proper use of
anthropometric tools for nutritional assessment.
• Interpret assessment data for identifying nutritional health
problems.

6. Assessment Methods in use..
A. Clinical examination.
B. Anthropometry
C. Biochemical evaluation
D. Functional assessment
E. Diet survey
F. Health statistics.
G. Ecological studies.

9. Anthropometric Assessment
•

13. 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

16. WEECH’S formula for Wt. measurement
• For 3 – 12 months
- Expected weight(kg) = age (months) + 9 / 2
• For 1- 6 years
-Expected weight(kg) = age (years) x 2 + 8
• For 7 – 12 years
-Expected weight(kg)= age (years) x 7 - 5 / 2

18. Technique of length measurement in
infant
• 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 soles and length
is read from scale.

20. 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.

24. Height Velocity contd..
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.

25. 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
protuberance at the back and just over the supraorbital
ridge front. over the occipital and the glabella in

26. Head circumference measurement
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

30. Chest circumference
•It is usually measured at the level of
the nipple preferably in mid inspiration.
•Measurement in children
<= 5years - lying down position
> 5 years - standing position

32. Q. Why Head : Chest ?
•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.

33. AGE INDEPENDENT NUTRITIONALASSESSMENT
CRITERIA
•Mid-upper arm circumference
•Thickness of subcutaneous fat
•Body ratios
•Weight for height
•Body mass index
• Upper segment/ lower segment ratio
•Arm span
•Obesity

34. MUAC
• 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.

35. MUAC contd…
• Bangle test –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,s tape – It is a fiber-glass tape with shading so that
paramedical workers can assess nutritional status without
having to remember the normal limits of mid arm
circumference
Red – less than 12.5 cm
Yellow – 12.5- 13.5 cm
Green – greater than 13.5 cm.

36. MUAC technique…

39. WEIGHT-FOR-HEIGHT
Weight of the patient (kg)
Weight of normal child of same height
Weight-for-Height Nutritional Status *Reference
standard NCHS data
>90% Normal
85-90 % Borderline Malnutrition
75-80 % Moderate Malnutrition
<75 % Severe Malnutrition
X 100

41. Growth Chart/Curve

59. Clinical Assessment

60. Clinical Assessment…

62. Clinical assessment
Advantage:
• Fast and easy to perform.
• Inexpensive.
• Non-invasive
Disadvantage-
• Did not detect early cases.

67. Dietary Assessment

68. Dietary Assessment…

77. Bio-chemical Assessment

78. Laboratory Assessment…

82. Thank you