Amyanthropometry 130824161551 Phpapp02

ANTHROPOMETRY
Anthropometry: Introduction
A branch of anthropology that involves the
quantitative measurement of the human body.
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Anthropometry - Amarendra B. Singh

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Anthropometric Methods
Anthropometry is the measurement
of body height, weight & proportions.
It is an essential component of
clinical examination of infants,
children & pregnant women.
It is used to evaluate both under &
over nutrition.
The measured values reflects the
current nutritional status & dont
differentiate between acute &
chronic changes .
Classification of age
Neonates= birth to 28 days

Infant= till one year of age
Toddler= 1-3 years
Pre-schoolar= 4-6 years
Schoolar= 6-12 years
Adolescents=13-19years
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Anthropometric Measurements
Height, weight
Mid-arm circumference(1-5years)
Head circumference
chest circumference
Skin fold thickness
Hip/waist ratio
Anthropometry for children
Weight
The measurement of weight is most reliable criteria of
assessment of health and nutritional status of children.
The weight can be recorded using a :
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Beam type weighing balance

Electronic weighing scales for infants and children
Bathroom type of mechanical scale (very unreliable)
Salter spring machine (in field conditions)

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The periodic recording of weight on a growth chart is essential for

monitoring the growth of under-five children.
Growth Velocity :
A.0-4 months
5-8 months
9-12 months
1-3 years
4-9 years
10-18 years
1.0kg/month(30g/day)
0.75kg/month(20gm/day)
0.50kg/month(15g/day)
2.25kg/yr
2.75 kg/yr
5.0-6.0kg/yr
(0.5kg/month)
B. Weight at 4-5 months

Weight at 1 year
Weight at 2 years
Weight at 7 years
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2 x birth weight
3 x birth weight
4 x birth weight
7 x birth weight

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Length or Height/Stature
Measurement Technique
Upto 2 years of age Recumbent Length is measured with the help of an

Infantometer .
In older children Standing Height or Stature is recorded. It is convenient to

use an Inbuilt Stadiometer affixed on the wall which provides a direct read
out of height with an accuracy of +/- 0.1cm.
Nutritional deprivation over a period of time affects the stature or linear

growth of the child.
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Technique of length
measurement
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 90 , the movable pedal
plank of infantometer is snuggly apposed against
soles and length is read from scale.
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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.
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Height Velocity
AGE
Birth to 3 months
Approximate rate of increase

in stature
3.5cm/month
3 6 months
2.0cm/month
6 9 months
1.5cm/month
9 12 months
1.3cm/month
2 5 years
6 8cm/year
5 12 years
At birth
5cm/year
50cms
Gain during 1st year
25cms
Gain during 2nd year
12.5cms
Gain during 3rd year
7.5 to 10cms
Gain during 3 12 years
5 to 7.5cms
Adolescence
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8cms/yr for girls during 12 to 16

years
10cms/yr for boys during 14 to 16
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18 years
Degree of malnutrition
Expected weight
______________ x 100
Actual weight(kg)
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WEECHS FORMULA
a) 3 12 months
Expected weight(kg) = age (months) + 9 /
2
b) 1- 6 years
Expected weight(kg) = age (years) x 2 + 8
c) 7 12 years
Expected weight(kg) = age (years) x 7 5/2
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Classification of Malnutrition by Indian

Academy of Pediatrics
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Weight for age *
Grade of malnutrition
>80 %
71-80%
61-70%
51-60%
<50%
Normal
Grade 1
Grade 2
Grade 3
Grade 4
(Mild)
(Moderate)
(Severe)
(very severe)

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B] Expected height upto 12 yrs

length or height (in cms) = age in years x 6 +77 ( wheechs
formula )
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WEIGHT-FOR-HEIGHT
Weight-for-height =
Weight of the patient (kg)

X 100
Weight of normal child of same height
The nutritional status can be expressed as follows on the basis of weight-for-height:

Weight-for-Height *
Nutritional Status
>90%
85-90 %
75-80 %
<75 %
Normal
Borderline Malnutrition
Moderate Malnutrition
Severe Malnutrition
*Reference standard NCHS data
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The term Macrocephaly refers to OFC of more than 2SD above

the mean while Microcephaly refers to OFC more than 3SD below
the mean for age , sex , height and weight.
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Video
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Chest circumference
It is usually measured at the level of nipples,
preferably in mid inspiration.
Xiphisternum
In children
<= 5years - lying down position
> 5 years - standing position
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Relationship between head

size with Chest
At birth: head circumference > chest
Circumference:
circumference by upto 3 cms.
At around 9 months to 1 year of age: head

circumference = chest circumference,
but thereafter chest grows more rapidly
compared to the brain.
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The head circumference is greater than chest

circumference by more than 3 cms in :
a) preterms
b) small-for-date , &
c) hydrocephalic infants
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.
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AGE INDEPENDENT CRITERIA FOR

ASSESSMENT OF NUTRITIONAL STATUS
Mid-upper arm circumference

Thickness of subcutaneous fat
Body ratios
Weight for height
Body mass index
Upper segment/ lower segment ratio
Arm span
Obesity
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MID-UPPER ARM
CIRCUMFERENCE
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.
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Bangle test quick assessment of arm circumference. 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 tape is a fiber-glass tape with

red less than 12.5 cm
yellow 12.5- 13.5 cm
green greater than 13.5 cm
shading so that paramedical workers can assess nutritional status
without having to remember the normal limits of mid arm
circumference.
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QUAC stick Quaker Upper Arm Circumference Stick

It is developed on the principle that acute starvation severely affects
mid-arm circumference while height is unaffected.
It is a height measuring rod, calibrated in MAC.

Values of 80% MAC for Ht. are marked on stick at
corresponding ht. levels
The malnourished child would be taller than the
anticipated height derived from the mid-arm
circumference
MAC (cm)
Ht. (cm)
16.5
133.0
13.5
103.5
12.5
70.0
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Skinfold thickness
Measured with Herpendens caliper
Triceps or subscapular region
The skinfold with subcutaneous fat is picked
up with thumb and index finger, and caliper
is applied beyond the pinch.
Fat thickness
>10mm - healthy children 1-6 years
<6mm - is indicative of moderate to
severe degree of malnutrition
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Body ratios
Rao & Singhs weight-height index:
= [weight (kg) / (height)2 cms ] * 100
normal index is more than 0.15
Kanawati index: (during 3m to 4 years)
= Mid-arm circumference / Head circumference
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Normal
0.331
Mild
0.310 0.280
Modreate
0.279 0.250
Severe
< 0.250
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Classification
When malnutrition has been chronic, the child is stunted,

weight-for-age is low/normal
height-for-age is low
weight-for-height is normal.
In Acute malnutrition, the child is wasted,

weight-for-age is low
height-for age is normal
weight-for-height is low
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BODY MASS INDEX (BMI)
A BMI-for-age of > 85th percentile is suggestive of Overweight.

A BMI-for-age of > 95th percentile is or when it is associated
with triceps or skinfold thickness-for-age of > 90th percentile, it
is diagnostic of Obesity.
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Measurements for adults

Height:
The subject stands erect & bare
footed on a stadiometer with a
movable head piece. The head
piece is leveled with skull vault
& height is recorded to the
nearest 0.5 cm.
WEIGHT MEASUREMENT
Use a regularly calibrated
electronic or balanced-beam scale.
Spring scales are less reliable.
Weigh in light clothes, no shoes
Read to the nearest 100 gm (0.1kg)
Nutritional Indices in Adults

The international standard for assessing
body size in adults is the body mass index
(BMI).
BMI is computed using the following formula:
BMI = Weight (kg)/ Height (m)
Evidence shows that high BMI (obesity level)
is associated with type 2 diabetes & high risk
of cardiovascular morbidity & mortality
BMI (WHO Classification)

BMI < 18.5 = Under Weight
BMI 18.5-24.5= Healthy weight range
BMI 25-30 = Overweight (grade 1
obesity)
BMI >30-40 = Obese (grade 2
obesity)
BMI >40
=Very obese (morbid or
grade 3 obesity)
Waist/Hip Ratio
Waist circumference is measured
at the level of the umbilicus to
the nearest 0.5 cm.
The subject stands erect with
relaxed abdominal muscles, arms
at the side, and feet together.
The measurement should be
taken at the end of a normal
expiration.
Waist circumference
Waist circumference predicts mortality better
than any other anthropometric measurement.
It has been proposed that waist
measurement alone can be used to assess
obesity, and two levels of risk have been
identified
MALES
FEMALE
LEVEL 1
LEVEL2
> 94cm
> 102cm
>
>
80cm
88cm
Waist circumference/2
Level 1 is the maximum acceptable
waist circumference irrespective of
the adult age and there should be
no further weight gain.
Level 2 denotes obesity and
requires weight management to
reduce the risk of type 2 diabetes &
CVS complications.
Hip Circumference
Is measured at the point of greatest
circumference around hips & buttocks to
the nearest 0.5 cm.
The subject should be standing and the
measurer should squat beside him.
Both measurement should taken with a
flexible, non-stretchable tape in close
contact with the skin, but without
indenting the soft tissue.
Interpretation of WHR
High risk WHR= >0.80 for females &
>0.95 for males i.e. waist
measurement >80% of hip
measurement for women and >95%
for men indicates central (upper
body) obesity and is considered high
risk for diabetes & CVS disorders.
A WHR below these cut-off levels is
considered low risk.
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 over the occipital
protuberance at the back and just over the supraorbital ridge and the glabella in
front.
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Expected head circumference

in children
Age
Head circumference
(cm)
At birth
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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
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Head Circumference Growth Velocity

Till 3 months
2 cm/month
3 months 1 year
2cm/3 month
1 3 year
1cm/ 6 month
3 5 year
1cm/ year
During first year there is 12 cm increase in head circumference ,

while 1 5 year age , only 5 cm gain occur in head size.
Adult head size is achieved between 5 to 6 years .
the following formula (Dines formula) is used for estimating the
head circumference in the first year of life : ( length in cm + 9.5 ) 2.59
2
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Ponderal index : - it is another parameter
which is similar to BMI and is used for defining

newborn babies with intrauterine growth retardation.
PI =
(Body weight in grams) 100

length (cm)
In malnourished small-for-date babies (asymmetric

IUGR), ponderal index is <2, while it is usually more
than 2.5 in term appropriate-for-gestation babies and
hypoplastic small-for-date babies.
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PROPORTIONAL TRUNK AND

GROWTH
LIMB
The mid-point
of the body in newborn is at umbilicus whereas in an
adult the mid-point shifts to the symphysis pubis due to greater
growth of limbs than trunk.
The UPPER SEGMENT (vertex to upper edge of symphysis pubis)
to LOWER SEGMENT (symphysis pubis to heels) ratio at birth is
1.7 to 1.0 .
This gradually becomes 1.0 to 1.1 in healthy adults.
In infants upper segment (crown to symphysis pubis) can be
measured by using infantometer.
The lower segment is obtained by subtracting the upper segment
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from
total length.
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Clinical signs of nutritional

deficiency
HAIR
Spare & thin
Protein, zinc, biotin

deficiency
Easy to pull out
Protein deficiency
Corkscrew
Coiled hair
Vit C & Vit A

deficiency

deficiency
MOUTH
Glossitis
Riboflavin, niacin, folic acid,

B12 , pr.
Bleeding & spongy gums
Vit. C,A, K, folic acid & niacin
Angular stomatitis,
cheilosis & fissured
tongue
B 2,6,& niacin
leukoplakia
Vit.A,B12, B-complex, folic

acid & niacin
Sore mouth & tongue
Vit B12,6,c, niacin ,folic acid

& iron

deficiency
EYES
Night blindness,
exophthalmia
Vitamin A
deficiency
Photophobiablurring,
conjunctival
inflammation
Vit B2 & vit A

deficiencies

deficiency
NAILS
Spooning
Iron deficiency
Transverse lines Protein

deficiency

deficiency
SKIN
Pallor
Follicular
hyperkeratosis
Flaking
dermatitis
Pigmentation,
desquamation
Bruising, purpura
Folic acid, iron, B12

Vitamin B & Vitamin
C
PEM, Vit B2, Vitamin
A, Zinc & Niacin
Niacin & PEM
Vit K ,Vit C & folic
acid

deficiency
Thyroid gland
in
mountainous
areas and far
from sea places
Goiter is a
reliable sign of
iodine
deficiency.

deficiency
Joins & bones
Help
detect signs
of vitamin D
deficiency
(Rickets) &
vitamin C
deficiency
(Scurvy)
Infantile upper segment to lower segment ratio

(trunk abnormally large or limbs abnormally
small) is seen in :
1. Achondroplasia
2. Cretinism
3. Short limbed dwarfism
4. Sexual precocity
5. Bowed legs
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Advanced upper segment to lower segment ratio (trunk abnormally

short or limb abnormally long) is seen in:
1. Arachnodactyly
2.Hypogonadism
3.Eunuchoidism
4.Turner Syndrome
5.Klinefelters Syndrome
6.Chondrodystrophy
7.Spinal deformities (rickets, potts spine)
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ARM SPAN
It is the distance between the tips of middle fingers of both arms outstretched at
right angles to the body, measured across the back of the child.
In under-5 children , arm span is 1 to 2 cm smaller than body length.
During 10-12 years of age , arm span = height.
In adults arm span is more in adults by 2 cm.
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Abnormally large arm span is seen in patients with

1)Arachnodactyly (Marfan syndrome)
2)Eunuchoidism
3)Klinefelters Syndrome
4)Coarctation of aorta
Arm span is short compared to height in patients with :

1)Short limbed dwarfism
2)Cretinism
3)Achondroplasia
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ADVANTAGES OF
ANTHROPOMETRY
Less expensive & need minimal training

Readings are reproducible.
Objective with high specificity &
sensitivity
Measures many variables of nutritional
significance (Ht, Wt, MAC, HC, skin fold
thickness, waist & hip ratio & BMI).
Readings are numerical & gradable on
Limitations of
Anthropometry
Inter-observers errors in measurement

Limited nutritional diagnosis
Problems with reference standards, i.e.
local versus international standards.
Arbitrary statistical cut-off levels for
what considered as abnormal values.
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Thank you
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ANTHROPOMETRY

Anthropometry - Amarendra B. Singh

Neonates= birth to 28 days

Anthropometry - Amarendra B. Singh

Anthropometry for children

Beam type weighing balance

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

The periodic recording of weight on a growth chart is essential for

B. Weight at 4-5 months

Anthropometry - Amarendra B. Singh

Upto 2 years of age Recumbent Length is measured with the help of an

In older children Standing Height or Stature is recorded. It is convenient to

Nutritional deprivation over a period of time affects the stature or linear

Anthropometry - Amarendra B. Singh

The infant is placed supine on the infantometer.

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Technique for height

In older children who can stand , height can be

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Approximate rate of increase

Gain during 1st year

Gain during 2nd year

Gain during 3rd year

Gain during 3 12 years

8cms/yr for girls during 12 to 16

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Classification of Malnutrition by Indian

Weight for age *

Anthropometry - Amarendra B. Singh

B] Expected height upto 12 yrs

Anthropometry - Amarendra B. Singh

Weight of the patient (kg)

The nutritional status can be expressed as follows on the basis of weight-for-height:

*Reference standard NCHS data

Anthropometry - Amarendra B. Singh

The term Macrocephaly refers to OFC of more than 2SD above

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Relationship between head

At around 9 months to 1 year of age: head

Anthropometry - Amarendra B. Singh

The head circumference is greater than chest

In malnourished children, chest size may be

Anthropometry - Amarendra B. Singh

AGE INDEPENDENT CRITERIA FOR

Mid-upper arm circumference

Anthropometry - Amarendra B. Singh

During 1-5 Yrs of age it remains reasonably static between 15-17cms

Anthropometry - Amarendra B. Singh

Anthropometry - Amarendra B. Singh

Bangle test quick assessment of arm circumference. A

Shakir tape is a fiber-glass tape with

Anthropometry - Amarendra B. Singh

QUAC stick Quaker Upper Arm Circumference Stick

It is a height measuring rod, calibrated in MAC.