ANTRHROPOMETRIC METHODS

Anthropometry
– are the objective measurements of body muscle
and fat

– this measurements are compared to the reference

data of the same age/height and sex group to
evaluate the Growth pattern (nutritional status) of
the individual
 Cont’d
• Height
• weight
• Mid-upper arm circumference(MUAC)
• Skin fold thickness
• Head circumference
• Head/chest ratio
• Hip/Waist ratio
 Height/length measurement
– Height is affected less immediately by diet than
weight

– Height-for-age is a relative indicator of chronic food

deficiency

– The subject stands erect and bare footed on a

measuring board with a movable head piece

– The head piece is leveled with the skull vault and the
height is recorded
 Cont’d
– for infants and children ≤ 85cm/ <2 years,
recumbent length is measured

– two examiners are usually required

– place the subject face upward

– put the head to wards the fixed end of the board

and the body parallel to the board’s axis
Cont’d
 Height for age interpretation (percentile)

>95 Normal

87.5-95 Mild stunting

80-87.5 Moderate stunting

<80 Severe stunting

 Cont’d
– Low height for age, stunting

– Stunting results from

• extended periods of inadequate food intake
• poor dietary quality
• morbidity or
• a combination of these factors
 Weight measurement
• infants and children <2 yrs
– suspended scale
– weighing sling
– pediatric scale with pan
– Taring (What is it?)

• naked or with minimum of clothing

• the mother and the child can be weighed

together, then the mother alone
 Cont’d
• Older children and adults
– measurement should preferably be after empting
the bladder and before meal
 Weight for age
Is used to get insight how near the child is to
the standard weight for his age

Compares the weight of the child with the

weight of a healthy reference child of the
same age
Wchild
WFA  *100%
Wreference
 Interpretation
>110 Overweight

90-110 Normal

75-89 Mild wasting

60-74 Moderate wasting

<60 Severe wasting

Eg. A child of 27 month weighing 8.9kg, while the reference

weight-for-age at 27 month=12.7kg, so her WFA=8.9/12.7 x
100%=70%(moderate wasting)
 Weight-for-height
– compares the weight of a child with the weight of
a healthy reference children of the same age, sex
and height

– used when the age of the child is not known

– between 1 and approximately 10y, however,

weight-for-height is relatively independent of age,
enhancing its usefulness in areas where the ages
of the children are uncertain
 Cont’d
– However, during adolescence, the relationship
between WFH changes dramatically with age and
maturation status. Thus is extended only to 145cm
for boys and 137cm for girls

– Eg. A child of 75cm if healthy should weigh 10kg.

On weighing 7 kg would be only 75% of the
expected weight for his height and would be
classified as a thin child showing evidence of
moderate under nutrition
 Interpretation
>90 Normal

80-90 Mild wasting

70-80 Moderate wasting

<70 Severe wasting

 Cont’d
– Low weight-for-height, wasting

– Higher weight-for-height is a manifestation of over

weight and arise from gaining excess weight
relative to height or from gaining insufficient
height relative to weight

– In stunted children, weight may be appropriate for

length or height, whereas in wasting, weight is
very low for height
Modes of expression of anthropometric indices

– Percentiles
– Z-scores

• Compare with the reference population using

percentiles or Z-scores derived from the reference
data
 Percentiles

– Refers to the position of the measurement value

in relation to all the measurements for the
reference population, ranked in the order of
magnitude

– Adjustments are important for parental stature, to

distinguish between genetic and pathological
effects in children who are unusually short

– Adjustments are also important for low birth

weight and preterm infants
 Cont’d
– Percentiles for evaluating anthropometric indices
of individuals are not recommended for subjects
from low income countries given the references
are from industrialized countries
 Z-scores
– It measures the deviation of the
anthropometric measurement
from the reference mean or
median in terms of SD

– Is a measure of an individual’s
value with respect to the
distribution of the reference
population
 Cont’d
– In population based studies, it is possible to
calculate the mean and standard deviation of Z-
score

– Allows to describe the nutritional status of the

whole study population
 Cont’d

• Z-score = Actual weight - Expected weight

SD for expected weight

Example:
• 12-month old male, weight 8.13 kg
• NCHS median for 12-mo old male = 10.16 kg
• NCHS SD for 12-mo old male = 1.1 kg

Z-score = (8.13 - 10.16)/1.1 = -2.03/1.1 = -1.85

 Cont’d
≥ -2 z-score Normal

-3.0- (-2.0) z-score Moderately malnourished

< -3 Z-score Severely malnourished

Eg. Absence of acute protein energy malnutrition

is defined as weight for height Z-score of ≥-2
 Reference data
– Local growth reference data-references are
privileged groups

– Avoid ethnic difference and minimize genetic

influence
• Eg. US NCHS, (1977)

– Universal reference data

• WHO, (2005)
Growth charts
 Drawing growth curve
Steps
1. Find the child’s age on the chart
2. Find the child’s weight on the chart
3. Draw the growth curve
 Skin fold Thickness
– The skinfold thickness is an indicator of subcutaneous
fat stores and total body fat, and provides information
on fat patterning.

– Measurements can be compared to reference data- and

to previous measurements of the individual if available
for decision

– The anthropometrist lifts the skin fold with the thumb

and index finger, and places the calipers at the marked
point. After some seconds the handles of the calipers
are released and the measurement is taken
 Sub scapular Skin fold Abdomen skin fold

Triceps skin fold Superailiac skin fold Thigh skin fold

Mid Upper Arm Circumference /MUAC
– Is the circumference of the
upper arm, measured at the mid
point between the tip of the
shoulder and tip of elbow

– Recommended for use with

children between 1 and 5 years
of age, but is used to assess
adult under nutrition during
famine

– Is a quick and simple way to

determine status of nutrition
 Cont’d
Steps
– Determine the mid point between the elbow and the
shoulder

– Place the tape measure around the relaxed and hung

down left arm

– Make sure that the tape neither pinches the arm nor
is left loose

– Record the MUAC to the nearest 0.1cm or 1mm

 references
MUAC reading(CM) Interpretation

<11 Acute sever malnutrition

11-12.4 Acute moderate malnutrition

12.5-13.4 At risk of malnutrition

>13.5 Normal

Table: MUAC reading Cut-off for 6-59 months old children

 Use of MUAC for children
– MUAC is used for screening individual children
targeting interventions if weight, height
measurement is not available and the age of
children is not known

– MUAC was assumed to be independent of age

which is not true and results in over diagnosis of
wasting among younger children and under
diagnosis among older ones

– It is also sex dependant

 Cont’d
– WHO has developed and recommended the
adoption of MUAC-for-age reference data
– Is more applicable for adults
Head circumference
• The tap is placed just above the
supraorbital ridges covering the most
prominent part of the frontal bulge
and over the part of the occiput that
gives the maximum circumference

• HC-for-age can be used as an indicator

of chronic protein energy deficiency,
for <2yrs children

• Chronic malnutrition or intrauterin

growth retardation may hinder brain
development
 Cont’d
– Beyond 2 years, growth in head circumference is
slow and its measurement is no longer useful

– HC-for age is less sensitive to less extreme

malnutrition

– Can be affected by non-nutritional factors such as

disease, genetic variation, forceps-assisted
delivery at birth
 Cont’d
• Just for your information
• BMI is relatively unbiased by height and
appears to correlate well with laboratory-
based measures of adiposity
Partial correlation (r) of BMI with:
age Fat mass Lean mass Total mass
females
16-49 0.81 0.44 0.81
50-84 0.93 0.43 0.85
all 0.85 0.47 0.81
males
15-49 0.76 0.63 0.78
50-89 0.83 0.75 0.90
all 0.77 0.63 0.84
• BMI for age Z score is used for children.
• The cut point is not recommended.
 Waist circumference
– estimate of abdominal fat

– can be used to predict risk of cardiovascular

disease
Waist circumference
• Is measured at the umbilicus
level to the nearest 0.5cm

• The measurement should be taken

at the end of a normal expiration

• The subject stands erect with

relaxed abdominal muscles, arms
at the side, and feet together
 Cont’d
Levels Male Female

I >94 cm > 80 cm

II >102 cm > 88 cm

Level 1 is the maximum acceptable waist circumference

irrespective of the adult age and there should be no more
weight gain

Level 2 denotes obesity and requires weight management

Hip circumference
– Is measured at the point of
greatest circumference around hips
and buttocks to the nearest 0.5cm

– The subject should be standing

and the measurer squat beside

– Take measurement with a flexible,

non-stretchable tape in close
contact with the skin, but without
indenting the soft tissue
Interpretation of waist/Hip ratio
WHR> 0.80 for females and 0.95 for males are
indicators for the risk of central(upper body)
obesity and is considered high risk for
diabetes and CVD
 Conditions that determine interpretation of
anthropometric data

• Age, birth weight, birth length, gestational age, sex,

parental stature, and feeding mode during infancy

• Pre-pregnancy weight, maternal height, parity and

pregnancy

• Estimating age, birth certificate, local calendars of

special events, counting deciduous teeth, bone age
from left-hand-wrist radiograph
 Cons and Pros of Anthropometry
Cons Limitations
Highly specific/objective/ and sensitive Limited nutritional diagnosis

Measures many variables of nutritional Problems with references

significance (Ht, Wt, MUAC, HC, Skin fold standards
thickness, waist, and Waist–hip ratio and
BMI) Measurement errors
Readings are numerical and gradable on
standard growth chart

Readings are reproducible

Non expensive and need minimal training