This presentation was prepared by PhD Scholar Savitesh Kushwaha for 1st Public Health Nutrition Workshop conducted in PGIMER, Chandigarh

1. ANTHROPOMETRIC
MEASUREMENTS
By: Dr. Poonam Khanna,
Dr. Rachana Srivastava,
Dr. Savitesh Kushwaha
School of Public Health, PGIMER, Chandigarh, India
Methods
Goals
Introduction Objectives

2. Introduction
Nutritional status refers to the state of the health of any individual, it is affected by
the intake and utilization of nutrients.
Nutritional assessment assesses the severity and magnitude of nutritional
problems prevalent in communities due to faulty intake or utilisation of
nutrients.
•It is influenced by food intake, quantity & the quality & physical health.
The spectrum of nutritional status spreads from obesity to severe malnutrition.
Methods
Objectives
Introduction Goals

3. Introduction Methods
Objectives
Goals
Goals
1
• To discover facts about
the nutritional situation
and guide action to
improve nutrition and
health.
• To determine the
specific nutritional
component which is
causing the adverse
health effects in an
individual and
population.
2
• Factual evidence of the
exact magnitude of
nutritional problems is
essential to sensitise
administrators and
politicians to obtain the
allocation of material
and human resources
and plan appropriate
intervention strategies.
3
• In formulating a public
health strategy to
combat malnutrition, an
assessment of the
nutritional status of the
community is the first
step.

4. Introduction Methods
Objectives
Goals
• What Type?
• Screening (the numbers affected)
• Distribution (where?)
• Identify the at-risk groups (Who?)
• Determine the contributory factors (Why?)
Objectives

5. Introduction Methods
Objectives
Goals Methods
Methods of Nutritional
Assessment
Indirect
Ecological Factors
Health Stats
Economic Factors
Direct
Clinical
Dietary
Physical
Anthropometry
Laboratory
Body Composition

6. Introduction Methods
Objectives
Goals Methods
Length
Weight
MUAC
Head Circumference
Chest Circumference
Height
Weight
Bicep Skinfold thickness
Hip Circumference
Waist Circumference
Triceps Skinfold Thickness
Subscapular Skinfold Thickness
Children
Adults
Both
A
N
T
H
R
O
P
O
M
E
T
R
Y

7. Introduction Methods
Objectives
Goals Methods
Frankfurt/Eye-
ear/auriculo-orbital plane
It was decided that a plane passing through
the inferior margin of the left orbit (the
point called the left orbitale) and the upper
margin of each ear canal or external
auditory meatus, a point called the porion,
was most nearly parallel to the surface of
the earth, and also close to the position the
head is normally carried in the living
subject.
Frankfurt, Germany 1884 (World Congress of Anthropology)

8. Introduction Methods
Objectives
Goals Methods
LENGHT
Length assesses the maximum vertical size of an infant <2 years.
Equipment:
1. Height Board.
2. Alcohol swabs to clean the board.
Procedure:
1. Measuring board lying on a flat surface should be used for children.
2. Explain to the mother the reason for taking the length measurement. Explain that you
will need their assistance in taking this measure and how they can help.
3. Wipe the height board with an antibacterial surface wipe before taking the
measurements.
4. Place the child on the bed of the measuring board with his/her crown touching the
headpiece and the mother standing at the head.
5. Straighten the infant’s legs by holding the legs by the ankles and applying gentle
downward pressure over the legs with the other hand.
6. Move the infant’s head into the Frankfurt Plane position and ask the mother to hold it
and ensure their head is in contact with the headpiece.
7. Releasing your hand from the baby’s ankles, move the footrest on which the
measurement reader is mounted to touch the soles of the child’s feet; toes should be
pointing directly upwards.
8. Height/length should be recorded in cms to the nearest mm.

9. Introduction Methods
Objectives
Goals Methods
LENGHT

10. Introduction Methods
Objectives
Goals Methods
LENGHT

11. Introduction Methods
Objectives
Goals Methods
WEIGHT
Equipment:
1. Child weighing machine or weighing balance.
2. Alcohol swabs to clean the weighing machine.
Procedure:
1. If the child is less than two years old, use the lying scales.
2. Ask the mother to remove all clothing from the child (including their nappy). To
avoid the child moving too much, ask the mother to help distract the child while
you take the weight measurement.
3. The reading from the weight scale should be obtained when the reading becomes
stable.
We can use the Tare method if the child is scared of both scales.
1. Weigh the mother on the adult weighing scales.
2. Record the weight of the mother.
3. Then ask the mother to repeat the measurement by carrying the child.
4. Record this combined weight.
5. Now we can subtract the mother’s weight with combined weight to get the weight
of the child.

12. Introduction Methods
Objectives
Goals Methods
WEIGHT

13. Introduction Methods
Objectives
Goals Methods
MUAC (Mid-upper arm circumference)

14. Introduction Methods
Objectives
Goals Methods
MUAC (Mid-upper arm circumference)
Mid-upper arm circumference is an anthropometric measure providing
information on muscle mass and subcutaneous fat.
Equipment:
1. UNICEF/WHO MUAC measuring tape.
2. White eyeliner pencil (to mark the measuring position on the infant’s arm)
3. Alcohol swabs to clean the tape.
Procedure:
1. Explain the procedure to the mother.
2. The baby must have a bare arm and shoulder for this measurement.
3. Position the baby in a sitting position on the mother’s lap so you can easily access the left arm. The
baby will need to have their elbow bent at a right angle.
4. The mother should hold the left hand to prevent the baby from pulling their arm away.
5. Identify the process of the Acromion (this is the end of the shoulder bone and the tip of the elbow
(olecranon process).
6. Using the measuring tape, measure the distance between these points. Divide this measurement in
half; this is the mid-point of the upper arm; mark this mid-point with the white eyeliner pen.
7. Pass the tape over the baby’s hand and slip it up the baby’s arm to the mid-point you have marked.
8. Read the measurement to the nearest 0.1cm. Loosen and then reposition the tape, and repeat the
measurement two more times.

15. Introduction Methods
Objectives
Goals Methods
MUAC (Mid-upper arm circumference)

16. Introduction Methods
Objectives
Goals Methods
Head circumference

17. Introduction Methods
Objectives
Goals Methods
Head circumference
Head circumference measurement is a routine part of a child’s nutritional
assessment because it provides important information about growth and
development.
Equipment:
1. Fibreglass tape/head circumference tape
2. Alcohol swabs to clean the tape.
Procedure:
1. Explain the procedure to the mother.
2. Ask the mother to remove hair clips, bobbles, hair bands or hats from the child’s
hair/head.
3. Place the measuring tape around the child’s head at its largest diameter midway
between the eyebrows and the hairline at the front, above the ears and around the
occipital prominence at the back of the head.
4. Aim always to measure the largest circumference possible.
5. Pull the tape snugly to compress the hair. Make sure that the tape passes the
occipitofrontal plane (as described above) and does not slip when getting the reading.
It may be helpful to ask the mother to hold the tape on the back of the head with a
finger.
6. Read the measurement to the nearest 0.1 cm.

18. Introduction Methods
Objectives
Goals Methods
Available for birth to 5 years

19. Introduction Methods
Objectives
Goals Methods
Chest circumference
Axilla
Axial Skeleton
Sternum

20. Introduction Methods
Objectives
Goals Methods
Chest circumference
Chest circumference measurement is part of a child’s nutritional assessment
because it provides information on low birth weight whenever weighing
newborns is not feasible.
Equipment:
1. Fibreglass tape.
2. Alcohol swabs to clean the tape.
Procedure:
1. Explain the procedure to the mother and remove the clothing.
2. Whilst the child is standing, feel for the xiphisternum where the ribs meet the sternum
and mark with a short horizontal line.
3. The tape was wrapped around the head midway on the occipital bone, and for HC, the
tape was wrapped under the axillary area around the back to meet at the mid-sternal
area at the nipple level.
4. Make sure the tape is level and is not pulled too tight.
5. Take the reading at the end of expiration.
6. Read the measurement to the nearest 0.1 cm.
7. Record three measurements and calculate the mean.
<30.5cm (low risk for LBW)
<29.5cm (high risk for LBW)
>=30.5 (Normal)
For new born only

21. Introduction Methods
Objectives
Goals Methods
Length
Weight
MUAC
Head Circumference
Chest Circumference
Height
Weight
Bicep Skinfold thickness
Hip Circumference
Waist Circumference
Triceps Skinfold Thickness
Subscapular Skinfold Thickness
Children
Adults
Both
A
N
T
H
R
O
P
O
M
E
T
R
Y

22. Introduction Methods
Objectives
Goals Methods
HEIGHT
Standing height is an assessment of maximum vertical size.
Equipment:
1. Height Board.
Procedure:
1. Ask the person to remove hair ornaments, jewellery, buns, or braids from the
top of the head.
2. Direct the person to the stadiometer platform.
3. Instruct the person to stand with the heels together and toes apart. The toes
should point slightly outward at approximately a 60ºangle.
4. Check that the back of the head, shoulder blades, buttocks, and heels contact
the board.
5. Align the head in the Frankfort horizontal plane. The head is in the Frankfort
plane when the horizontal line from the ear canal to the lower border of the
orbit of the eye is parallel to the floor and perpendicular to the vertical
backboard.
6. Instruct the person to stand as tall as possible, take a deep breath, and hold
this position.
*The instructor should always be taller than the participant.

23. Introduction Methods
Objectives
Goals Methods
WEIGHT
Equipment:
1. Weighing machine
Procedure:
1. Participant will be weighed in kilograms using a digital/analogue weight scale.
2. The participants will be asked to remove their shoes, ornaments, wallets etc. and
to have minimal clothing.
3. The participant should be directed to step on and stand in the centre of the scale
platform facing the recorder, hands at the sides, and looking straight ahead
(Frankfurt plane).
4. The reading from the weight scale should be obtained when the reading becomes
stable.

24. Introduction Methods
Objectives
Goals Methods
Biceps Skinfold Thickness
Do not take a skinfold measurement reading if you cannot
construct a fold with two skin thicknesses and underlying fat.
Repeatedly pressing of skinfold may dilate the fats and leads to
inaccurate measurements.

25. Introduction Methods
Objectives
Goals Methods
Biceps Skinfold Thickness
The biceps skinfold provides information about the body, and the calculated muscle
mass provides information on the protein reserves.
Equipment:
1. Skinfold Caliper.
2. Alcohol swabs to clean the calliper.
Procedure:
1. Ask the person to remove excess clothes from the upper body and have visible arms.
2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders
relaxed, and the arms hanging loosely at the sides.
3. Flexing or tightening the arm muscles will yield an inaccurate measurement.
4. Using your thumb and index finger, grasp a fold of skin and subcutaneous adipose tissue
approximately 2.0 cm above the mid-arm circumference mark and anterior surface of the arm.
5. Holding the skinfold 2.0 cm above the circumference mark, place the tips of the calliper jaws over the
complete skinfold.
6. Ensure that the mark remains centred between the tips and that the jaws sit perpendicular to the length
of the skinfold.
7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the
caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.

26. Introduction Methods
Objectives
Goals Methods
Hip Circumference
Data from most of the cross‐sectional studies suggested that waist
circumference or waist-hip ratio are better indicators than BMI of
the risk of diabetes.
Equipment:
1. Fibreglass tape.
2. Alcohol swabs to clean the tape (if measurement is taken on the skin).
Procedure:
1. Ask the person to remove excess clothes from the upper and lower body.
2. The participant should be made to stand straight; the head should be in the eye-
ear plane and 60-degree angle between the toes.
3. Measure the hip circumference at a level parallel to the floor, at the largest
circumference of the buttocks.
4. Ensure that the skin is not pressed too much or loose, and the tape should be in
the horizontal plane.
5. Read the measurement to the nearest 0.1 cm from the sides.
Cutoffs for Adults WHRs (ADA)
Male: ≥0.88
Female: ≥0.81
https://doi.org/10.2337/diacare.26.5.1380

27. Introduction Methods
Objectives
Goals Methods
Length
Weight
MUAC
Head Circumference
Chest Circumference
Height
Weight
Bicep Skinfold thickness
Hip Circumference
Waist Circumference
Triceps Skinfold Thickness
Subscapular Skinfold Thickness
Children
Adults
Both
A
N
T
H
R
O
P
O
M
E
T
R
Y

28. Introduction Methods
Objectives
Goals Methods
Waist Circumference
WHO Guideline to
measure the waist
circumference.

29. Introduction Methods
Objectives
Goals Methods
Waist Circumference
Waist circumference can be used as a screening tool but is not
diagnostic of an individual’s body fatness or health.
Equipment:
1. Fibreglass tape.
2. Alcohol swabs to clean the tape (if measurement is taken on the skin).
Procedure: (WHO)
1. Ask the person to remove excess clothes from the upper body.
2. The participant should be made to stand straight; the head should be in the eye-
ear plane and 60-degree angle between the toes.
3. Locate the iliac crest and the lower rib of the participant.
4. Mark a mid-point between the iliac crest and the lower rib.
5. Measure the horizontal plane midway between the lowest rib and the iliac crest
at normal expiration.
6. Ensure that the skin is not pressed too much or loose, and the tape should be in
the horizontal plane.
7. Read the measurement to the nearest 0.1 cm from the sides.

30. Introduction Methods
Objectives
Goals Methods
Waist Circumference
Cutoffs for Adults (IDF) Cutoffs for Adults (ADA)
Male: ≥85cm
Female: ≥80cm

31. Introduction Methods
Objectives
Goals Methods
Waist Circumference
WC>90th Percentile will be considered central obesity (CNNS) (Sarna et al., 2020)
Cutoffs for Children and Adolescents

32. Introduction Methods
Objectives
Goals Methods
Triceps Skinfold Thickness (TSFT)
The triceps skinfold provides information about the body, and the calculated muscle
mass provides information on the protein reserves.
Equipment:
1. Skinfold Caliper.
2. Alcohol swabs to clean the calliper.
Procedure:
1. Ask the person to remove excess clothes from the upper body and have visible arms.
2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders
relaxed, and the arms hanging loosely at the sides.
3. Flexing or tightening the arm muscles will yield an inaccurate measurement.
4. Using your thumb and index finger, grasp a fold of skin and subcutaneous adipose tissue
approximately 2.0 cm above the mid-arm circumference mark.
5. Holding the skinfold 2.0 cm above the circumference mark, place the tips of the calliper jaws over the
complete skinfold.
6. Ensure that the mark remains centred between the tips and that the jaws sit perpendicular to the length
of the skinfold.
7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the
caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.

33. Introduction Methods
Objectives
Goals Methods

34. Introduction Methods
Objectives
Goals Methods
Subscapular Skinfold Thickness (TSFT)
The skinfold provides information about the body, and the calculated muscle mass
provides information on the protein reserves.
Equipment:
1. Skinfold Caliper.
2. Alcohol swabs to clean the calliper.
Procedure:
1. Ask the person to remove excess clothes from the upper body and have visible scapula.
2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders
relaxed, and the arms hanging loosely at the sides.
3. Open the back of the gown and palpate for the inferior angle, or triangle portion, of the right scapula.
4. Make the first line at 45 degrees to the spine and cross this with a line that bisects the inferior angle of
the scapula.
5. Using your thumb and index finger, grasp a fold so that the index finger remains situated roughly 2.0
cm above and medial to the inferior angle of the scapula.
6. Position the tips of the caliper jaws over the complete skinfold perpendicular to the length of the fold
and roughly 2.0 cm lateral to the fingers
7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the
caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.

35. Introduction Methods
Objectives
Goals Methods

36. Introduction Methods
Objectives
Goals Methods
Body Fat % Formulas

37. Introduction Methods
Objectives
Goals Methods
https://dapa-toolkit.mrc.ac.uk/anthropometry/objective-methods/simple-measures-skinfolds
Body Fat % Formulas

38. Introduction Methods
Objectives
Goals Methods
BMI
BMI=Kg/m2
WHO 2022
The Lancet 2004

39. Introduction Methods
Objectives
Goals Methods
BMR (Basal Metabolic Rate)
Basal Metabolic Rate (BMR) is the number of calories you burn as your body
performs basic (basal) life-sustaining functions.
Sex
Age (years)
Prediction equation proposed by
FAO/WHO/UNU
Consultation (2004)
Males
18-30 15.1xB.W.(kg)+692.2
30-60 11.5xB.W.(kg)+873
>60 11.7xB.W.(kg)+587.7
Females
18-30 14.8xB.W.(kg)+486.6
30-60 8.1xB.W.(kg)+845.6
>60 9.1xB.W.(kg)+658.5
B.W.= Body Weight
For a 60 kg adult (20 y)
inactive male.
BMR of Indians is 10% and 9% lower for males and females, respectively, than the international values (FAO/WHO/UNU, 2004).
For a 60 kg adult (20 y) male, the BMR equation used is (15.1xB.W.(kg)+692.2), and the resultant value is multiplied by 0.90 to
obtain the BMR of 1438 kcal/d.

40. Introduction Methods
Objectives
Goals Methods
PAL (Physical Activity Level)
The PAL, also achievement conversion, describes the amount of energy that is needed in addition to the
metabolic rate in order to achieve physical performance.
Physical activity level or energy requirement expressed as a multiple of 24-hour BMR.
Level of activity
ICMR
2020
FAO/WHO/UNU
2004
Sedentary Work 1.40 1.40-1.69
Moderate Work 1.80 1.70 – 1.99
Heavy Work 2.30 2.00 – 2.40*
*PAL Value > 2.40 is difficult to maintain over a prolonged period.
Physical Activity Level (PAL)/ Physical activity Factor (PAF)
Men Women
BMR x 1.4 inactive BMR x 1.4 inactive
BMR x 1.7 moderately active BMR x 1.6 moderately active
BMR x 1.9 very active BMR x 1.8 very active
TEE=1438*1.4
TEE=2013.2 kcal/day
Moderate BMR*PAL factor = TEE
Sedentary BMR*PAL = kcal