ANTHROPOMETRIC ASSESSMENT

Gr. anthropos, man, human; metron, measures

INTRODUCTION
Measurements of the variations of the physical dimensions and the gross composition of the human body at the different age levels and degrees of nutrition. Two types:
1. Growth measurements 2. Body composition measurement - body Fat Free mass muscle mass and total body fat fat

ADVANTAGES OF ANTHROPOMETRICS
1. The procedures use simple, safe. Non-invasive techniques which can be used at the bedside and are applicable to large sample sizes 2. Equipment required is inexpensive, portable and durable and can be made or purchased locally 3. Relatively unskilled personnel can perform measurement procedures.

ADVANTAGES OF ANTHROPOMETRICS
4. The methods are precise and accurate, provided that standardized techniques are used. 5. Information is generated on past long-term nutritional history, which cannot be obtained with equal confidence using other techniques. 6. The procedure can assist in the identification of mild to moderate malnutrition as well as severe states of malnutrition

ADVANTAGES OF ANTHROPOMETRICS
7. The method may be used to evaluate changes in nutritional status over time and from one generation to the next, a phenomenon known as the secular- trend.

LIMITATIONS OF ANTHROPOMETRICS
1. Relativity insensitive method and it cannot detect disturbances in nutritional status over short periods or Time or- Identify specific nutrient deficiencies. 2. Unable to distinguish disturbances in growth or body composition Induced by nutrient deficiencies from those caused by imbalances in protein and energy intake.

ANTHROPOMETRIC ASSESSMENT
Measurements

GROWTH MEASUREMENTS
Measurement of head circumference
A narrow, flexible, and non-stretch tape made of fiberglass or steel about 0 6 cm wide should be used. The subject stands relaxed with the left side facing the measurer. Looking straight ahead so that the line of vision is perpendicular to the body and the Frankfurt plane of the head is in a horizontal position.

GROWTH MEASUREMENTS
Measurement of head circumference

GROWTH MEASUREMENTS
Measurement or the recumbent length
For infant and children less than 2 years or age, recumbent length is measured generally with a wooden measuring board two examiners are required to correct position the subject and ensure accurate and reliable measurements of lengths.

GROWTH MEASUREMENTS
Measurement of height
Children over 2 years of age and adults are generally measured in the standing position using a stadiometer or portable anthropometer.

GROWTH MEASUREMENTS
Measurement of height
Looking straight ahead the Frankfurt plane horizontal Shoulders relaxed Arms at sides Legs straight and knees together Feet flat and with heels almost together Shoulder blades, buttocks, and heels touching measurement board

GROWTH MEASUREMENTS
Measurement of the knee height Knee height is highly correlated with stature, and maybe used to estimate height. In person with severe spinal curvature and who are unable to stand. It is measured with a caliper consisting of an adjustable measuring stick with a blade attached to each end at a 90 degree angle. Knee height is measured on the left leg, which is bent at the knee at a 90 degree angle while the subject is in the supine position

GROWTH MEASUREMENTS
Measurement of the knee high

GROWTH MEASUREMENTS
Measurement of weight in infants and children In field surveys, a suspended scale and a weighing sling may be used for Infants and children less than two years of age. They should be weighed naked or with minimum clothing. After slipping the subject into the sling, the weight is recorded as soon as the indicator on the scale has been stabilized. A pediatric scale may also be used.

GROWTH MEASUREMENTS
Measurement of weight in older children and adults This should be done after the bladder has been emptied and before a meal. Beam balances tend to be heavy and therefore unsuitable for field use. In such cases, spring balance scales although less accurate and reliable are often used.

GROWTH MEASUREMENTS
Measurement of weight in older children and adults

GROWTH MEASUREMENTS
Measurement of elbow breath
This is measured as the distance between the epicondyles of the humerus. For the measurement, the right arm is raised to the horizontal, and the elbow flexed to 90 degrees with the back of the hand facing the measurer.

GROWTH MEASUREMENTS
Measurement of elbow breath

INDICES DERIVED FROM GROWTH MEASUREMENTS

Indices are constructed from two or more raw anthropometric measurements and are simple numerical ratios such as weight (height). or combinations such as weight for age, height for age, and weight for height These should not be written as weight/age height/age to avoid confusion with the numerical ratios. Indices are special part of the interpretation of anthropometric measurements (WHO, 1986)

INDICES DERIVED FROM GROWTH MEASUREMENTS

Head circumference for age
Can be used as an index of chronic protein energy nutritional status during the first two years of life. Chronic malnutrition during the first few months of life, or intrauterine growth retardation, may decrease the number of brain cells and result in an abnormally low head circumference. Beyond age Two years, growth in head circumference Is so slow that its measurement is no longer useful [Nutrition Canada, 1980) Head circumference for age Is not sensitive to less extreme malnutrition (Yarborough et al, 1974)

INDICES DERIVED FROM GROWTH MEASUREMENTS

Weight for age
Body weight represents the sum of protein fat, water and bone mineral mass, and does not provide any Information on relative changes in these four chemical components. Weight for age in children from six months to seven years of age is an Index of acute malnutrition, and is widely used to assess protein energy malnutrition and over nutrition, especially in Infancy when the measurement of length is difficult. A major limitation of weight for age as an index of PEM is that it ..

INDICES DERIVED FROM GROWTH MEASUREMENTS

Weight for age
does not take into account height differences and as a result, children with low weight for age are not necessarily wasted.

INDICES DERIVED FROM GROWTH MEASUREMENTS

Weight for height Is a sensitive Index of current nutritional status. It is relatively independent of age between one and ten years, enhancing its usefulness in areas where the ages of the children are uncertain. For age less Than one year, older Infants at a given height tend to be heavier, so that age grouping with a narrow range should be used. Weight for-height also appears to be relatively independent of ethnic group, particularly for children aged one to five years (Waterlow et. al, 1977).

INDICES DERIVED FROM GROWTH MEASUREMENTS

Height for age
It is an index of the nutritional status of a population group/s as it estimates past of chronic nutritional status.

INDICES DERIVED FROM GROWTH MEASUREMENTS

Weight height ratios
These are frequently used for adults. They measure body weight corrected for height with the underlying assumption that the ratios are highly correlated with obesity. Hence these ratios are frequently called obesity or body mass indices.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Body fat
The body fat content is the most variable component of the body, differing among individuals of the same 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 to 14 7% for men

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Measurements of the skinfold thickness
These provide estimate of the size of the sub-cutaneous fat depot, which in turn provides an estimate of the total body fat (Durnin and Rahaman 1967)

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Calipers used in measuring skinfold thickness: McGaw (digital version)

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Calipers used in measuring skinfold thickness: Lange

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Calipers used in measuring skinfold thickness: Harpenden

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Calipers used in measuring skinfold thickness: Holtain

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Triceps skinfoId
Measured at the midpoint of the back of the upper left arm (Weiner and Loune, 1969)

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Triceps skinfoId

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Biceps skinfold
Measured as the thickness of a vertical fold on the front of the upper left arm directly above the center of the cubital fossa, at The same level at the triceps skinfold.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Subscapular skinfold
Measured just below and laterally to the angle of the left shoulder blade, with the shoulder and left arm relaxed Placing the subject's arm behind the back may assist in the identification of the site. Skinfold is grasped at the mark site with the fingers on top, thumb below, and forefinger on the site at the lower tip of the scapular. The skinfold should angle 45 degrees from horizontal, in the same direction as the inner boarder of the scapula.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Subscapular skinfold

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Supraillac skinfold
Measured in the midaxillary line immediately superior to the midaxillary line and parallel to the cleavage lines of the skin.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Midaxillary skinfold
The skinfold is picked up horizontally on the midaxillary line at the level of the xiphoid process.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Midaxillary skinfold

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Skinfold thickness measurements are best made using precision skin thickness calipers they measure the compressed double fold of fat plus a skin. As a result of the compression, they always underestimate actual subcutaneous fat thickness.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Waist-hip circumference ratio
A simple method for describing the distribution of both subcutaneous and intra-abdominal adipose tissue.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Limb fat area
The calculated cross-sectional area of limb fat derived from skinfold thickness and limb circumference measurements may be used as anthropometric index. It provides a better estimate of total body fat than a single skinfold thickness at the same site, because it is more highly correlated with total body fatness (himes et.at.).

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Assessment of fat-free mass
A fat free mass is a mixture of water, protein, and mineral, with muscle serving as the major protein store. Assessment of muscle protein can therefore provide an index of the protein reserves of the body.

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Mid-upper arm circumference measurement
The arm contains subcutaneous fat and muscle; a decrease in mid-upper arm circumference may therefore reflect either a reduction in muscle mass or a reduction in subcutaneous tissue, or both. Changes in MUAC can also be used to monitor progress during nutritional therapy

ANTHROPOMETRIC ASSESSMENT OF BODY COMPOSITION

Mid-upper arm circumference measurement

ANTHROPOMETRIC ASSESSMENT
Measurement Errors

ANTHROPOMETRIC MEASUREMENT ERRORS

It must be borne in mind that the major concern of anyone measuring weight o height is to get quality and adequate measurement. The quality and adequacy c measurement is assessed in terms of how big the expected errors are made, i.e. the fewer and smaller the errors, the better the measurement.

ANTHROPOMETRIC MEASUREMENT ERRORS

Errors may arise from the following sources:

Observer Subjects Instrument System Data processing

ANTHROPOMETRIC MEASUREMENT ERRORS

The observer or the measurer is one source of error. The attitude of the observer can greatly influence the quality of measurement he or she is taking. It is important that he or she undergoes training on the proper techniques of getting the measurement and possesses high moral values to ensure intellectual honesty in collecting the data.

ANTHROPOMETRIC MEASUREMENT ERRORS

Errors may also be committed from the subjects being measured or examined Crying or struggling children are difficult to manage and unless they are pacified and calmed down before measuring, the reading is affected and erroneous data may be taken and recorded.

ANTHROPOMETRIC MEASUREMENT ERRORS

Another source of errors is the instrument used for taking the measurement. Whenever possible, it is advisable to use the recommended instruments for weighing and taking height. The instrument being used particularly the weighing scale, must be properly calibrated and checked from time to time.

ANTHROPOMETRIC MEASUREMENT ERRORS

Aside from the sources of errors mentioned above, the method or the system used in assessing or classifying the nutritional status of children is also another source of errors. Now that the Philippines is shifting from using the local standard over that of the IRS, it is important that each and every community health and nutrition worker be oriented and taught the new reference standards to be better equipped in their respective tasks.

ANTHROPOMETRIC MEASUREMENT ERRORS

Lastly, the way the data (data processing) is handled and processed is one source where error can be committed. It must be emphasized that they are subject to human errors and car influence the results of the data collected.

ANTHROPOMETRIC MEASUREMENT ERRORS

Measurement errors may be: Random - which are due to variations or differences in the measuring and recording technique. These errors may be committed when the same examiner repeats the measurements (within or intra-examiner error) or when different examiners repeat the same measurement (between- or inter-examiner error). This type of error affects precision of measurement.

ANTHROPOMETRIC MEASUREMENT ERRORS

Random measurement errors may result from inadequate training, defective or faulty instrument, and difficulties in doing or making the measurement. Although these errors can never be entirely eliminated (5), they can be minimized or avoided by proper training and doing a lot of practice in taking weight and height measurements using standardized techniques; and, by using precise and properly calibrated instruments.

ANTHROPOMETRIC MEASUREMENT ERRORS

Systematic - which reduces or affects the accuracy of the measurement by introducing bias which alters the mean or median values. Systematic measurement errors may be due to equipment bias, e.g., weighing scales which always overestimate or underestimate the measurement; the timing of measurement, for example, taking the weight after the child has eaten or has gone to the toilet in between weightings; and the misclassification of.

ANTHROPOMETRIC MEASUREMENT ERRORS

children due to the methods selected in comparing with reference data. Measurement bias can be reduced and avoided by taking care in eliminating them prior to measurement.

ANTHROPOMETRIC ASSESSMENT
Issues and Concern

NUTRITIONAL ANTHROPOMETRY ISSUES / CONCERN

Precision is the degree or extent to which repeated measurements of the same variable gives the same value; or the ability to repeat a measurement of the same subject. Oftentimes, it is referred to as reproducibility or reliability. It involves taking repeated but independent measurements on the same child or subject.

NUTRITIONAL ANTHROPOMETRY ISSUES / CONCERN

There are two ways to assess reliability of measurement:

Intra-observer reliability - extent to which a measure produces the same result at different time for the same subjects Inter-observer reliability - extent to which a measure produces the same result on the same child or subject for the different observers.

NUTRITIONAL ANTHROPOMETRY ISSUES / CONCERN

Validity is the degree or extent to which any measurement or index measures what it purports to measure. Accuracy is the degree or extent to which the measurement is close to the true value: the 'true' value can be considered either the average of the measurements made by all the observers/measurers or the measurement made by the trainer/supervisor;

NUTRITIONAL ANTHROPOMETRY ISSUES / CONCERN

the test for accuracy is more important than the test for precision, so the basis for observer selection and evaluation may be the accuracy test alone; it therefore follows that a measurement can be precise, but, at the same time, inaccurate - a situation which occurs when there is a systematic bias in the measurements; accurate measurements, however, necessitate high precision.