Anthropometric
Methods
www.hu.edu.et 1
Session objectives
• Define anthropometry
• Describe the purpose of anthropometric measurements
• Explain different methods to determine
body size and composition
www.hu.edu.et 2
• 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
www.hu.edu.et 3
Purposes of Anthropometric
measurements
• Anthropometric measurements are performed with two major
purposes in mind:
• IN CHILDREN: to : assess physical growth
• IN ADULTSIN ADULTS: : to assess changes in body composition or weight
composition
www.hu.edu.et 4
Measurement of Body Size
• 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
• Of the various measurements of body size, head
circumference is important because it is closely
related to brain size.
• Height is measured in older children and adults
www.hu.edu.et 5
Length
• Recumbent length is measured in infants and children < 2 y.
• A wooden measuring board (also called sliding board) is used for
measuring the length of children under two years old to the nearest
millimetre
• Measuring the child lying down always gives readings greater than the
child’s actual height by 1-2 cm.
www.hu.edu.et 6
Height
• This is measured with the child or adult in a standing position (usually
children who are two years old or more).
• The head should be in the Frankfurt position (a position where the
line passing from the external ear hole to the lower eye lid is parallel
to the floor) during measurement, and the shoulders, buttocks and
the heels should touch the vertical stand.
• Either a stadiometer or a portable anthropometer can be used for
measuring. Measurements are recorded to the nearest millimetre.
www.hu.edu.et 7
Weight
• A weighing sling (spring balance), also called the ‘Salter Scale’
is used for measuring the weight of children under two years
old, to the nearest 0.1 kg.
• In adults and children over two years a beam balance is used
and the measurement is also to the nearest 0.1 kg.
• In both cases a digital electronic scale can be used if you have
one available.
• Do not forget to re-adjust the scale to zero before each
weighing.
• you also need to check whether your scale is measuring
correctly by weighing an object of known weight.
www.hu.edu.et 8
Head circumference
• The head circumference (HC) is the measurement of the head along the supra
orbital ridge (forehead) anteriorly and occipital prominence (the prominent area
on the back part of the head) posteriorly.
• It is measured to the nearest millimetre using flexible, non-stretchable measuring
tape around 0.6cm wide.
• HC is useful in assessing chronic nutritional problems in children under two years
old as the brain grows faster during the first two years of life. But after two years
the growth of the brain is more sluggish and HC is not useful.
• In Ethiopia, HC is measured at birth for all newborn babies.
www.hu.edu.et 9
Abnormal size of a baby could be:
• Hydrocephalus: A build-up of fluid in the cavities deep within the
brain. Characterized by head enlargement in infants
• Microcephaly: a very small head size of a baby due to abnormal
development of the brain.
www.hu.edu.et 10
www.hu.edu.et 11
Converting measurements to
indices
• Index: An index is a combination of two measurements or one
measurement plus the person’s age.
• Weight-for-age is an index used in growth monitoring for assessing
children who may be underweight.
• Height-for age is an index used for assessing stunting (chronic
malnutrition in children).
www.hu.edu.et 12
• Stunting is defined as a low height for age of the child compared to
the standard child of the same age. Stunted children have decreased
mental and physical productivity capacity.
• Weight-for-height is an index used for assessing wasting
(acute malnutrition).
• Wasting is defined as a low weight for the height of the child
compared to the standard child of the same height. Wasted children
are vulnerable to infection and stand a greater chance of dying.
www.hu.edu.et 13
• Body mass index is the weight of a child or adult in kg divided by their
height in metres squared: Weight (kg)/(Height in metres)2
• Here is how to calculate each index for children in your community.
• Birth weight is weight of the child at birth and is classified as follows:
• 2500 grams and above =normal birth weight
• 1500–2499 grams=low birth weight
• less than 1500 grams=very low birth weight
www.hu.edu.et 14
MEANINGS OF THE INDICES DERIVED FROM GROWTH
MEASUREMENTSGROWTH MEASUREMENTS
www.hu.edu.et 15
Indicator
• An indicator is an index (for example, a scale showing weight for age,
or weight for height) combined with specific cut-off values
• An indicator is an index + a cut-off point
Eg. A 3 year old boy was measured to be 63 cm in height and falls less
than -3SD on the growth chart
• Index _________
• Indicator _______
• Nutritional problem _________
www.hu.edu.et 16
Expressing Anthropometric
measurements
Z-score is the deviation from the mean value in terms of standard deviation
units; the term is used in analysing variables such as heights and weights of a
sample.
In the reference population, all the children of the same height are distributed
around the median weight, some having a superior weight, and others with an
inferior one.
What is standard Deviation?
A measure of the dispersion of a data set, around the mean.
Generally, the larger the distribution of the values around the average, the higher the
standard deviation.
www.hu.edu.et 17
www.hu.edu.et 18
• What are these terms
• Cut off?
• Standard deviations
• Percentiles
• Oedema
www.hu.edu.et 19
www.hu.edu.et 20
www.hu.edu.et 21
www.hu.edu.et 22
www.hu.edu.et 23
Measuring fat-free mass
(muscle mass): MUAC
• An accurate way to measure fat-free mass is to measure the Mid
Upper Arm Circumference (MUAC).
• The MUAC is the circumference of the upper arm at the midway
between the shoulder tip and the elbow tip on the left arm.
• The mid-arm point is determined by measuring the distance from the
shoulder tip to the elbow and dividing it by two.
• A low reading indicates a loss of muscle mass.
www.hu.edu.et 24
www.hu.edu.et 25
• MUAC is a good screening tool in determining the risk of mortality
among children, and people living with HIV/AIDS.
• MUAC is the only anthropometric measure for assessing nutritional
status among pregnant women.
• It is also very simple for use in screening a large number of people,
especially during community level screening for community-based
nutrition interventions or during emergency situations
www.hu.edu.et 26
• MUAC is a good screening tool in determining the risk of
mortality among children, and people living with HIV/AIDS.
• MUAC is the only anthropometric measure for assessing
nutritional status among pregnant women.
• MUAC is therefore used as a screening tool for community
based nutrition programmes such as an outpatient therapeutic
programme (OTP), for community-based interventions,
supplementary feeding programmes and enhanced outreach
programmes throughout Ethiopia.
• MUAC is also used for screening target children and pregnant
women for severe acute malnutrition (SAM) and moderate
acute malnutrition (MAM).
www.hu.edu.et 27
Cut-off points for screening in the community for
SAM and MAM using MUAC
www.hu.edu.et 28
The correct interpretation of anthropometric
Growth• indices
measurements requires the use of anthropometric
indices
• They are usually calculated from two or more raw
anthropometric measurements.
• In the simplest case the indices are numerical ratios
such as weight/(height)2 (kg/m2).
• Combinations such as weight-for-age, height-forage,
and weight-for-height are more complex
• These latter indices are not ratios and, to avoid
confusion with numeri cal ratios, should not be
written as "wt/age,“ "ht/age," and "wt/height."
www.hu.edu.et 29
• Combinations such as weight-for-age are expressed, instead, as Z -
scores, percentiles, or percentage of the median, relative to
appropriate reference data.
• They can then be used to compare an individual or a group with a
reference population
Existing Indices
• Head circumference-for-age
• Weight-for-age
• Weight-for-height
• Height-for-age
www.hu.edu.et 30
Head circumference-for-age
• Head circumference-for-age can be used as an index of chronic
protein-energy deficiency for children < 2 y.
• Chronic malnutrition during the first few months of life, or
intrauterine growth retardation, may hinder brain development and
result in an abnormally low head circumference.
• Beyond 2 y, growth in head circumference is slow and its
measurement is no longer useful
• Head circumference-for-age is not sensitive to less extreme
malnutrition
www.hu.edu.et 31
www.hu.edu.et 32
Weight-for-age
• Weight-for-age reflects body mass relative to chronological age.
• Low weight-for-age is described as "lightness" and reflects a
pathological process referred to as "underweight,“ arising from
gaining insufficient weight relative to age, or losing weight
• Because of its simplicity and the availability of scales in most health
centers in low-income countries, weight-for-age is widely used in
children from 6 mo to 7 y to assess under- and overnutrition.
www.hu.edu.et 33
• A major limitation of weight-for-age is that it reflects
both weight-for-height and height for-age.
• It fails to distinguish tall, thin children from those
who are short with adequate weight.
• Thus, children with a low weight-forage may be
genetically short, or their low weight-for-age may
result from "stunting“ or nutritional growth failure.
• This condition is characterized by low height-for-age
but a weight appropriate to their short stature.
• Consequently, the prevalence of undernutrition in
small children may be overestimated if only weight-
for-age is used.
www.hu.edu.et 34
• To interpret any single measurement of either weight or height in
relation to the reference data, the exact age of the child at the date of
the measurement must be calculated from the date of birth
• Software, such as EpiInfo 2004, can calculate exact ages in decimal
fractions of a year, from birth and visit dates.
www.hu.edu.et 35
Weight-for-height
• Weight-for-height measures body weight relative to height.
• Low weight-for-height in children is described as "thinness" and
reflects a pathological process referred to as "wasting." It arises from
a failure to gain sufficient weight relative to height or from losing
weight.
• In stunted children, weight may be appropriate for length or height
(i.e., stature), whereas in wasting, weight is very low for stature as a
result of marked deficits in both tissue and fat mass.
www.hu.edu.et 36
• In many of the industrialized countries, overweight in young children,
defined by weight-for-height > 2 Z-scores, is becoming increasingly
common.
www.hu.edu.et 37
Height-for-age
• Height-for-age is a measure of achieved linear growth that can be
used as an index of past nutritional or health status.
• Low height-for-age is defined as "shortness" and reflects either a
normal variation or a pathological process involving failure to reach
linear growth potential.
• The outcome of the latter process is termed "stunting," or the gaining
of insufficient height relative to age
www.hu.edu.et 38
• Stunting results from extended periods of inadequate food intake,
poor dietary quality, increased morbidity, or a combination of these
factors.
• It is generally found in countries where economic conditions are poor.
www.hu.edu.et 39
Selecting the appropriate
growth indices
• The choice of index depends on whether the information is required
for diagnosing malnutrition at the individual or the population level
the study objectives.
• At the individual level, weight-for-height is the index of choice when
the main objective is to identify and treat wasted children, whereas
for stunted children stature-for-age is more appropriate.
www.hu.edu.et 40
• At the population level, a combination of weight-for-stature and
stature-for-age is preferred for identifying subgroups with a high
prevalence of wasting (low weight-for stature) and stunting (low
stature-for-age), enabling necessary resources to be targeted to
combat the problem.
• Additional factors that must be considered when selecting an index or
combination of indices, include the availability of accurate measuring
equipment, the training of examiners to collect accurate information
and to interpret the results correctly, and the time required to take
the measurements.
www.hu.edu.et 41
www.hu.edu.et 42
Body mass index in adults
• Weight to height ratios indicate body weight in relation to height and
are particularly useful for providing a measure of overweight and
obesity in adult populations.
• Hence these ratios are sometimes referred to as obesity indices.
• Body mass index is relatively unbiased by height and appears to
correlate reasonably well with laboratory-based measures of
adiposity in most younger and older adults
www.hu.edu.et 43
• At the present time, the ratio most commonly used in this way is the
body mass index (BM1) (also termed Quetelet's index), calculated as
weight (kg) / height (m)2.
• Body mass index is used in preference to other weight/height indices,
including the weight/height ratio, the Ponderal index, and Benn's
index.
• It is now used extensively internationally to classify overweight and
obesity in adults.
www.hu.edu.et 44
www.hu.edu.et 45
• Hence, when practical, it is often better to include a more direct
measure of obesity, such as skinfold thickness measurements, with
the BMI
• Waist circumference can also be used as a surrogate estimate of
abdominal fat and is used to predict risk of cardiovascular disease.
• A high skinfold thickness or waist circumference would suggest that
an elevated BMI is indeed from excessive adiposity.
www.hu.edu.et 46
Relationship b/n BMI and the relative
risk of mortality.
www.hu.edu.et 47
www.hu.edu.et 48
BMI in children and adolescents
• Body mass index is now also the internationally recommended
indicator of overweight and obesity in both children and adolescents
• Strong positive correlations between BMI
• and body fatness (measured in children by densitometry, magnetic
resonance imaging, or DXA)
• Associations between BMI or changes in BMI in children and several
major risk factors for subsequent heart disease and other chronic
diseases; risk factors include increased blood pressure, adverse
lipoprotein profiles
www.hu.edu.et 49
www.hu.edu.et 50
www.hu.edu.et 51
Anthropometric
assessment
of body composition
www.hu.edu.et 52
Body composition measurements
• Body fat(Skin fold thickness and waist)
• Adipose tissue
• Fat free mass(Bio electrical Impedance Densitometry)
www.hu.edu.et 53
Measurements used to assess body composition
• In assessing body composition (fat content) the body is considered to be made up
of two compartments: the fat mass and the fat free mass.
• Therefore different measurements are used to assess these two compartments.
www.hu.edu.et 54
Regional Fat Deposition
• Abdominal body fat poses greater health risks than
fat stored in other areas
• Males store more fat
centrally and have
increased health
risks associated
with body fatness Male (apple) Female (pear)
Higher health risk Lower health risk
55 Concepts of Physical Fitness 12e
• Anthropometric techniques can indirectly assess fat
and the fat-free mass, and variations in their amount
and proportion can be used as indices of nutritional
status.
• For example, fat is the main storage form of energy in
the body and is sensitive to acute malnutrition.
• Thus, alterations in body fat content provide indirect
estimates of changes in energy balance.
www.hu.edu.et 56
• Body muscle, composed largely of protein, is a major component of
the fat-free mass and serves as an index of the protein reserves of the
body; these reserves become depleted during chronic undernutrition,
resulting in muscle wasting.
• The body fat content is the most variable component of the body,
differing among individuals of the same sex, height, and weight.
• On average, the fat content of women is higher than that of men,
representing 26.9% of their total body weight compared with 14.7%
for men.
www.hu.edu.et 57
Fat and Fat free mass
www.hu.edu.et 58
• Body fat is deposited in two major types of sites: one for
essential lipids, and the other for storage of fat.
• Essential lipids are found in the bone marrow, central nervous
system, mammary glands, and other organs and are required
for normal physiological functioning; fat from these sites
makes up about 12% of body weight in reference woman and
3% in reference man.
• Storage fat consists of inter- and intramuscular fat, fat
surrounding the organs and gastrointestinal tract, and
subcutaneous fat
• The proportion of storage fat in males and females is relatively
constant, averaging 12% of total body weight in males and 15%
in females.
www.hu.edu.et 59
www.hu.edu.et 60
www.hu.edu.et 61
Skin fold Technique
Layers of subcutaneous
fat are measured at
different sites of body
to estimate total body
fat levels
Cross sectional view
62 Concepts of Physical Fitness 12e
Skin fold thickness
www.hu.edu.et 63
www.hu.edu.et 64
Waist-Hip Ratio
www.hu.edu.et 65
Waist to Hip Ratio is an effective
way to examine regional fat
distribution.
www.hu.edu.et 66
Anthropometric assessment of body
size
• head circumference
• Recumbent length
• Height
• Knee height (knemometry)
• Arm span
• Weight
• Elbow breadth
Anthropometric assessment
of body composition
• Skin fold measurements
• Waist circumference (WC)
• Waist to hip ratio (WHR)
• Waist to height ratio (WHtR)
