ANTHROPOMETRY
Introduction
•Anthropos - "man" and Metron "measurement”
•It is used to evaluate both under & over
nutrition.
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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
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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 :
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 - 30gm/day
5-8 months - 20gm/day
9-12 months - 15gm/day
1-3 years - 2.25kg/yr
4-9 years - 2.75 kg/yr
10-18 years - 5.0-6.0kg/yr
B. Weight at 4-5 months 2 x birth weight
Weight at 1 year 3 x birth weight
Weight at 2 years 4 x birth weight
Weight at 7 years 7 x birth weight
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WEECH’S FORMULA
a) 3 – 12 months
Expected weight(kg) = age (months) + 9
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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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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.
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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 90⁰ , 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
Birth to 3 months
3 – 6 months
3.5cm/month
2.0cm/month
6 – 9 months 1.5cm/month
9 – 12 months 1.3cm/month
2 – 5 years 6 – 8cm/year
5 – 12 years 5cm/year
At birth 50cms
1 year 75cms
2 years 87.5cms
3 years 94 cm
4 years 100 cm
Gain during 4 – 12 years 5 to 7.5cms(6 cm average)
Adolescence (during pubertal spurt) 8cms/yr for girls during 12 to 16 years
10cms/yr for boys during 14 to 18
years
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B] Expected height upto 12 yrs
length or height (in cms) = age in years x 6 +77 ( Weech’s formula )
C] Prediction of adult height
• Mid-Parental height , Tanner’s formula and Weech’s formula are
used.
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HEAD CIRCUMFERENCE
• Brain growth takes place by 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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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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Expected head circumference
in children
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
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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 (Dine’s 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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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
Circumference:
• At birth: head circumference > chest
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
• Weight for height
• Body mass index
• Upper segment/ lower segment ratio
• Arm span
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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 hanging by the side.
• MUAC is measured with a non-stretchable 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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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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WEIGHT-FOR-HEIGHT
Weight-for-height = weight of the patient(kg)
weight of normal child of same height
:
But this need not be calculated as charts are
available for this.
If the weight for height is less than 2 standard
deviation it is called wasted.
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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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PROPORTIONAL TRUNK AND
LIMB GROWTH
•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
from total length. 27
• 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
[Link]
[Link]
[Link] Syndrome
[Link]’s Syndrome
[Link]
[Link] deformities (rickets, pott’s 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)Klinefelter’s 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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Classification
• If Weight for age is low – underweight or undernourished
• If height for age is low(<-2SD) -- stunted
• If weight for height is low(<-2 SD) -- wasted
• If head circumferance is less(<-3SD)- microcephaly
• If Head circumferance is more(> 2SD) – macrocephaly
• 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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Classification of Malnutrition by
Indian Academy of Pediatrics
Weight for age Grade of malnutrition
>80 % Normal
71-80% Grade 1
61-70% Grade 2
51-60% Grade 3
<50% Grade 4
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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 standard
growth charts
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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