Professional Documents
Culture Documents
Anthropometry
3
Introduction
Anthropometrythe study and technique of human body measurement
is the most commonly used method for the assessment of two of the most
widespread nutrition problems in the world: (1) protein-energy malnutrition, especially in young children and pregnant women; and (2) obesity,
or overweight, in all age-groups (Jelliffe and Jelliffe, 1989). Measurements of weight, height (or length) and, less frequently, subcutaneous fat
and muscle, are the usual data collected. This chapter covers the basic
indiceslow birth weight, height-for-age, weight-for-height, weight-forage, mid-upper arm circumference, body mass indexderived from
anthropometric measurements related to body size and composition, as
well as standard cut-offs for indicators, and their application to decisionmaking at individual and population levels.
At the individual level, anthropometry is used to assess compromised
health or nutrition well being, need for special services, or response to an
intervention. A one-time assessment is used during emergency situations
to screen for individuals requiring immediate intervention. Under nonemergency conditions, single assessments are used to screen for entry
into health or nutrition intervention programs either as an individual or as
a marker for a household or community at risk.
Trend assessments for individuals, such as periodic monitoring of weight
gain in children three years and younger, are used to detect growth problems, to intervene early enough to prevent growth failure, or to assess an
individuals response to some type of intervention.
At the population level, anthropometric data from a single assessment
provide a snapshot of current nutrition status within a community, and
should help to identify groups at risk of poor functional outcomes in terms
of morbidity and mortality (Gorstein, et al., 1994). Under emergency conditions, these static measurements are used to identify priority areas for
assistance. In non-emergency situations, one-time anthropometric
assessments are used for geographic targeting and as the basis for
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Advantages
Anthropometric measurements are: (1) non-invasive and relatively economical to obtain; (2) objective; and (3) comprehensible to communities
at large. They produce data that can be graded numerically, used to
compile international reference standards, and compared across populations. They can also supply information on malnutrition to families and
health care workers prior to the onset of severe growth failure (or excessive weight gain).
Disadvantages
The disadvantages of anthropometry lie in: (1) the significant potential for
measurement inaccuracies; (2) the need for precise age data in young
children for construction of most indices; (3) limited diagnostic relevance;
and (4) debate over selection of appropriate reference data and cut-off
points to determine conditions of abnormality (adapted from Jelliffe and
Jelliffe, 1989).
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objectives of the exercise, some indicators are used frequently. For example, 2Z weight-for-age is the most common index of childhood malnutrition for children under 3 years. (See Annex A for a related discussion
of indicator sensitivity and specificity and for an explanation of Z scores.)
It is important to note that each index delivers unique informationin
children, weight-for-height does not substitute for height-for-age or
weight-for-age, as each reflects a particular combination of biological
processes. Guidance on the range of uses for each indicator and target
group is included in the text beginning on page 13. Refer to Annex A for
summary recommendations on survey design issues for various policymaking and program management purposes.
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Measurement issues
Weight (in grams or kilograms)
Various types of scales are available to measure the weight of a child,
including spring scales (Salter) or beam balance scales. Hanging scales
are commonly used in many countries because they can be transported
easily, can be used in almost any setting (particularly where a flat surface
is not available) and are relatively inexpensive. Direct recording scales
have been developed by Teaching Aids at Low Cost (TALC)1 where a
growth chart is inserted into the scale and a pointer indicates the spot on
the chart. A family member can mark the chart, which encourages participation in the growth promotion activity. Balance beam scales are commonly used in health centers, as they need to be positioned on a flat
surface for accurate measurement and are not easily transported.
Standing beam scales are used to measure weight of adults, particularly
in health centers. UNICEFs UNISCALE is a new nonbeam or digital scale
that allows for the calculation of both adult and infant weight. An adults
weight is measured, then the adult accepts an infant in her/his arms on
the scale and the additional weight is automatically calculated. Standing
scales (both beam and digital) must be placed on a flat horizontal surface. Weight is usually measured to the nearest 100 grams (see Table 2-1
for available measurement tools).2
1. TALC can be contacted at PO Box 49, St. Albans, Herts, UK, AL14AX. Telephone
(44 1) 727 853869, Fax (44 1) 727 846852. Information on low cost educational materials, books, slide sets, and newsletters is available at www.talcuk.org.
2. Weighing scales can be procured through UNICEFs supply services in
Copenhagen. Contact the Customer Service Officer at telephone: (45) 35.27.35.27,
Fax: (45) 35.26.94.21, email: supply@unicef.dk or customer@unicef.dk, or on the web at
www.supply.unicef.dk/. UNICEF-New York telephone: 212-366-7000; fax: 212-887-7465.
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Measures weight
of children and adults
Electronic Scale
(UNIscale)
Used to measure
weight of children
Single Beam
free hanging scales
Used to measure
weights of very
young children
and older children
Used to measure
weights of children
Single Beam
clinic scales
Use
Measuring Tool
Accurate and
standardized
CMS (UK)c
UNICEFa
UNICEFa, local
manufacturers
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CMSc Weighing
Equipment (UK),
UNICEFa
Advantages and
Disadvantages
Convenient, but
not of much use
in measuring arm
circumference in
children under the
age of one. Exact
age of child is required to interpret
results.
Accuracy/
Standardization
Source
$90
$3560
$1525
CMS:
$150300
UNICEF: $85.52
UNICEF: Pack
of 50 for $ 4.25.
TALC: $ 0.25
0.40 each
Cost
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Used to measure
recumbent length in
children under the age
of 2, and standing
height of older children
Used to distinguish
between stunting
and acute malnutrition.
Color-coded to identify
nutritional status
Measures height of
children and adults
Length/height
boards
Weight/height
Chart (Thinness
Measure)
Height Measuring
Instrument
Accurate, and
standardizable
UNICEFa
Needs to be mounted
on the wall, not portable, but easy to use.
Measures height up
to 2 m
Accuracy depends
on the accuracy
of height and weight
measures taken
from other sources
(Scale, board)
Can be locally
Should be accurate
manufactured (inand easy to
structions available
standardize
from CDCd and
TALC)b, and UNICEFa
TALCb
$NA
TALC: $27.50,
UNICEF: NA
$25
a. UNICEF Supply Division, UNICEF Plads, Freeport; DK-2100, Copenhagen, Denmark. Tel: (45) 35-27-35-27; fax (45) 35-26-94-21; e-mail: supply@unicef.org;
website: www.supply.unicef.dk; or contact UNICEF field office: www.unicef.org/uwwide/fo.htm.
b. Teaching Aids at Low Cost (TALC), PO Box 49, St Albans, Herts AL14AX, England; Tel: (44) 01727-853869; fax: (44) 01727-846852; website: www.talcuk.org. Payments
from overseas must be made by 1) International money order, National Giro or UK postal order; 2) Sterling cheque drawn on UK bank; 3) Eurocheque made out in Sterling;
4) US dollar check drawn on US bank using correct rate of exchange; or 5) UNESCO coupons.
c. CMS (UK) Weighing Equipment Ltd., 18 Camden High Street, London NWI OJH, U.K.; Tel: (44) 01 387-2060 or (44) 020 7383-7030.
d. Center for Health Promotion and Education of the Centers fo Disease Control and Prevention, 1600 Clifton Rd., NE, Atlanta, GA 30333; website: www.cdc.gov.
(Adapted from Griffiths, 1985)
Measures growth of
children by directly
recording weight on
a childs growth chart
TALC Direct
Recording Scale
to be replaced when
batteries are exhausted
(10 year life span)
10
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11
Straight arm
different ways) to confirm the birth date/age of the child will improve the
accuracy of the measurement. For example, after estimating the age of a
child with a local calendar compare dental eruption, height, and motor
development with a separately assessed child of similar age (Jelliffe and
Jelliffe, 1989).
International references
The current international reference, adopted by the World Health Organization, uses data from the US National Center for Health Statistics (NCHS)
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(FAO, 1993b)
12
12
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13
3. In 1995, the WHO Working Group on Infant Growth concluded that to adequately
reflect growth patterns consistent with WHO feeding recommendations (i.e., exclusive
breastfeeding through 6 months, with continued breastfeeding combined with adequate complementary foods through two years), new growth curves based on reference data from exclusively breastfed infants from a variety of countries/regions should
be developed. A consistent, distinct pattern of growth for infants breastfed for at least
12 months emerged from an analysis of multiple, geographically diverse growth studies
by the Working Group. Typically, breastfed infants grew as or more rapidly than the
NCHS-WHO reference for 2 to 3 months, but showed a relative deceleration, particularly in weight, from 3 to 12 months. Mean head circumference on the other hand, was
above the NCHS-WHO median throughout the first year. In the studies that went
through the second year, there was a reversal of the trend, with weight-for-age, lengthfor-age, and weight-for-length returning toward the current NCHS-WHO reference
means between 12 and 24 months of age. In the absence of a revision of the current
reference growth curves, health workers can easily misdiagnose thriving breastfed
babies as growth faltering, and wrongly counsel mothers to introduce solids and
breastmilk substitutes unnecessarily early on. In many environments, the risk of morbidity and mortality due to contaminated feeding utensils and foods is high (Dewey,
et al., 1995 and WHO Working Group on Infant Growth, 1995). The new growth curves
are anticipated in late 2004 or early 2005.
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14
than one month intervals, which is less than ideal for characterizing the
shape of the growth curve. However, various studies have shown that the
growth standards achieved by children under 5 years of age in the NCHS
reference population can be attained by children in developing countries
if they are given adequate food and a relatively clean environment.
Therefore, WHO has endorsed these as a universal reference. The development of country-specific references is time consuming and costly, and
use of a global reference has the advantage of permitting cross-country
comparisons.
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15
Individual Newborn
Estimate of
Population Risk
10th percentile
< 29 cm
a. The 1990 World Summit for Children set as an end-of-century goal the reduction in the incidence
of low birth weight to less than 10 percent. However in 2003, incidence was 14 percent (UNICEF).
b. Populations with LBW prevalence of >15% (approximately twice the level of high income settings)
are at risk of long-term adverse effects on childhood growth and performance.
c. Not yet established as an official indicator of fetal growth.
(WHO Expert Committee, 1995)
Weight-for-age (W/A)
Weight is influenced both by height and thinness. Low W/A (underweight)
is a combination indicator of height-for-age (H/A) and weight-for-height
(W/H). W/A is the most commonly reported anthropometric index and
used frequently for monitoring growth, identifying children at risk of
growth failure, and assessing the impact of intervention actions in growth
promotion programs. It is as sensitive an indicator as H/A in children
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Percent
Prevalence
LBW
AFRICA
Angola
Botswana
Burkina Faso
C.A.R.
Cameroon
Cape Verde
Comoros
Congo, Dem. Rep.
Cte dIvoire
Eritrea
Ethiopia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Madagascar
Malawi
Mali
Mauritania
Mauritius
Mozambique
Namibia
Niger
Nigeria
Rwanda
Senegal
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
12
10
19
14
11
13
25
12
17
21
15
11
12
22
11
14
14
16
23
42
13
14
16
17
12
9
18
31
9
13
15
7
12
10
11
Region/
Country
Percent
Prevalence
LBW
E.EUROPE and
CENTRAL ASIA
Albania
Armenia
Azerbaijan
Belgium
Bulgaria
Croatia
Czech Republic
Hungary
Kazakhastan
Kyrgyztan
Romania
Russian Federation
Turkey
Turkmenistan
3
7
11
8
10
6
7
9
8
7
9
6
16
6
LATIN AMERICA
and CARRIBEAN
Antigua and Barbuda
Argentina
Barbados
Belize
Bolivia
Brazil
Chile
Columbia
Costa Rica
Cuba
Dominica
Dominican Rep.
Ecuador
El Salvador
Guatemala
Guyana
Haiti
Honduras
Jamaica
Mexico
Nicaragua
Panama
Paraguay
Peru
Suriname
Trinidad/Tobago
Uruguay
Venezuela
8
7
10
6
9
10
5
9
7
6
10
14
16
13
13
12
21
14
9
9
13
10
9
11
13
23
8
7
Region/
Country
SOUTH ASIA
Bangladesh
India
Maldives
Pakistan
Sri Lanka
30
30
22
19
22
7
8
12
7
15
10
6
11
8
11
7
32
EAST ASIA
China
Fiji
Indonesia
Korea, Rep. of
Malaysia
Mongolia
Myanmar
Papua New Guinea
Philippines
Solomon Is.
Thailand
Vietnam
6
10
10
4
10
8
15
11
20
13
9
9
TOTALS
Sub-Saharan Africa
Middle East and
North Africa
South Asia
Latin America and
the Caribbean
East Asia and the
Pacific
World
Least Developed
(UNICEF, 2004)
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Percent
Prevalence
LBW
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14
15
30
10
8
16
18
17
under three years, and it has the advantage of requiring only one relatively simple physical measurement (i.e., weight). However, because it is
dependent upon accurate age data availability, rounding of age is the
frequent cause of substantial systematic bias (Gorstein, et al, 1994).
Different age groups also affect sensitivity of W/A. Among the three most
common indices (W/H, H/A, W/A)while none of them have high predictive capacitiesweight-for-age has the highest predictive ability for childhood mortality (Pelletier, 1991).
The assessment of early growth deficits in an individual childoften
detected during monthly growth monitoring sessionsis equally if not
more important than identifying the already malnourished child. W/A (or
gainsee Box 2-2), can be used to identify children at
better, weight gain
risk of becoming malnourished, and guide preventive measures such as
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nutrition counseling and entry into short-term food supplementation programs. (See Promoting the Growth of Children: What Works [Tool #4] for a
complete discussion of growth promotion.)
At the population level, W/A can be used to identify areas of highest
need for interventions and to assist in the allocation of resources among
communities or regions. Weight-for-age is also used to gauge response
to program interventions and to predict the health consequences of anthropometric deficits for populations (based on the predictive relationship
between W/A and childhood mortality). The younger the child, the better
the use of W/A as an indicator of nutritional status.
As described earlier, the international reference standard uses data from
the NCHS. To identify underweight, a childs actual weight is compared
with that of a reference child of the same sex at exactly the same age.
Annex B, Tables B-1ac contain the reference data for children 05 years.
See Annex A for a discussion of the presentation of W/A data as Z-scores.
Table 2-4 contains the proposed classification of malnutrition in a population using prevalence of low W/A. The classification of severity of malnutrition is useful for targeting purposes, but is not based on functional
outcomes. Even low levels of underweight may be a cause for concern
Prevalence of Underweight
(% of children < 60 months,
below 2 Z-scores)
< 10
1019
2029
30
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Height-for
-age (H/A) is a measure of cumulative linear growth and is
Height-for-age
often influenced by long-term food shortages, chronic and frequent
recurring illnesses, inadequate feeding practices, and poverty. This index
is used primarily with children under five years of age, with low H/A commonly not appearing before 3 months of age. Children who are short for
their age relative to a reference standard are classified as stunted. The
prevalence of stunting among children generally increases with age up to
2436 months and then remains relatively constant thereafter.
For individual children, H/A is not used to monitor growth because of
errors in measurement of relatively small changes in the short-term. In
regions where there is a known high prevalence of stunting such as
South Asia, H/A can be used to screen individual children under two
years of age for intervention. In areas with low prevalence of low H/A,
short children are more likely to be genetically short, making it inappropriate to assume a pathological basis for low H/A or to use the index as a
screening tool. (This can often be ascertained by looking at the height of
the childs parents.)
At the population level the prevalence of stunting is useful for long-term
planning and policy development, for targeting a range of interventions
to a community(s), and for monitoring malnutrition at the community,
regional, or national level. H/A is frequently used as a reflection of socioeconomic status and equity. For example, height measurements of similar age groups at intervals of years can demonstrate positive or negative
secular change within a community, region, or country. Poverty analyses
often use stunting as a nutritional indicator since it is cumulative and
cannot be compensated by fatness.
To identify whether a child is stunted, his/her actual height is compared
with that of a reference child of the same sex at exactly the same age.
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Annex B, Tables B-2ae contain the NCHS reference tables for H/A for
children ages 060 months. Stunting data are presented as Z-scores,
comparing a child or group of children with a reference population to
determine relative status. See Annex A for a full discussion of Z-scores.
To assess or estimate the prevalence of malnutrition in a population,
results are presented as the prevalence of children who fall below the
standard cut-off. Table 2-5 contains the proposed classification of malnutrition in a population using prevalence of stunting. The classification of
severity of malnutrition is useful for targeting purposes, but is not based
on functional outcomes. Interpret low and medium with cautiononly
2.3% of children in well-nourished populations would be expected to fall
below 2Z-scores, making even low levels of stunting cause for concern. All cut-offs are merely indicators of risk, not necessarily of actual
malnutrition.
Weight-for
-height (W/H) measures body weight relative to height. Beeight-for-height
cause weight can fluctuate rapidly in children due to illness or inadequate food intake, W/H reflects the current nutritional status of a child,
with low W/H (wasting) indicating current acute malnutrition with failure to
gain weight or actual weight loss. However, low W/H can also be a result
of a chronic condition in some communities. Weight in individual children
Prevalence of Stunting
(% of children < 60 months,
below 2 Z-scores)
< 20
2029
3039
40
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21
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Prevalence of Wasting
(% of children < 60 months,
below 2 Z-scores)
<5
59
1014
15
Mid-Upper Ar
m Cir
cumfer
ence (MUAC), the measure of the diameter of
Arm
Circumfer
cumference
fat, bone, and muscle tissue of the upper arm, is an alternative index to
consider in situations where it is difficult to collect weight and height
measurements. For example, in settings where health workers are illiterate or under emergency conditions, when screening is more important
than counseling, MUAC is useful. MUAC offers the operational advantages of a simple, easily portable measurement device (the arm band/
tape) and the use of a single cut-off for children under five years of age
(12.5 or 13.0 cm) as a proxy for low W/H or wasting. MUAC has also
been used as a screening device for pregnant women; because MUAC
is generally a stable measure throughout pregnancy, it is used as a proxy
of prepregnancy weight, and therefore an indicator of risk for low birth
weight babies. One type of color-coded measuring tape, the Shakir strip,
is made from locally available materials and is appropriate for illiterate/
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Cut-Off Value
> 13.5 cm
12.513.5 cm
< 12.5 cm
(FAO, 1993a)
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in school children is not the most appropriate indicator to target individual or population level nutrition intervention strategies, but rather to
advocate for increased resources to the education sector. It is useful for
targeting school-based interventions designed to increase enrollment,
promote attendance, and prevent dropouts (PAHO/WHO/UNICEF, 1997).
As with most anthropometric indicators, it is important to use the school
height census findings as part of a more complete set of data about the
physical, economic, and sociocultural context of a community or region.
Height-for-age data will not answer questions about the determinants of
earlier poor health and nutrition conditions. The primary objective of
height censuses is the construction of a classification scale and not exact prevalence estimates of height retardation in a specific population
(PAHO/WHO/UNICEF, 1997).
A school census provides relatively easy access to a population, and
may well furnish greater coverageparticularly at first gradethan surveying health center clients. It can be implemented in a few months and
is relatively cheap. The technology for obtaining the measurements is
simple and inexpensive, and teachers can readily be trained to carry out
the survey. The first grade of school is often the point at which the greatest numbers of individuals of similar age from different socioeconomic
backgrounds in the country are brought together, allowing for interregional comparisons to be made.
It is important that age data are collected rather than making the assumption that all first year students are the same age. And while
school-based data may capture high percentages of the school-age
population in middle-income countries, the most common source of
bias in height-for-age surveys is population coverage. Problems are
related either to the exclusion of a large number of schools from the
sampling frame because of accessibility issues, or a high percentage
of children missing from school enrollments because of gender bias,
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Diagnosis
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Classification
Low prevalence: warning sign,
monitoring required
Medium prevalence: poor situation
High prevalence: serious situation
Very high prevalence: critical
situation
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excess body weight. For example, it appears that abdominal fatness may
be less of a risk for cardiovascular disease and diabetes in black women
than in white, while Asians and Mexican-Americans appeared to have
higher risks of developing non-insulin-dependent diabetes mellitus than
Caucasians of similar BMI (WHO Expert Committee, 1995).
Table 2-10 contains the recommended cut-offs defining varying degrees
of overweight in an individual.
Classification
Overweight (pre-obese)
Class I obese
Class II obese
Class III obese (extreme obesity)
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gestation is used for referring women to facilities where small for gestational age (SGA) and preterm infants can receive specialized care. Population-specific cut-offs for pre-pregnancy weight should be established
within the range of 4053 kg.
Body Mass Index (BMI)
The WHO Expert Committee recommends the use of BMI with pregnant
women for prevention of preterm delivery or referral for neonatal care in
populations at risk of preterm delivery. Measured during the first trimester,
a population-specific cut-off between 17 and 21 has moderate sensitivity
and specificity for predictive purposes.
Low BMI (population-specific cut-offs) has also been used to determine
which women should receive counseling on diet and/or supplementary
feeding. It is important to note that there are several assumptions concerning causality of low BMI and the efficacy of the feeding intervention
implicit in this choice of targeting indicator:
1) Low maternal BMI is caused by chronically low energy intake and not
by morbidity;
2) Low intake is caused by inadequate access to food at the household
level, and not by detrimental intrahousehold allocation patterns; and
3) Supplementary food will be preferentially available to pregnant and/or
lactating women and will not substitute for the home diet (WHO Expert
Committee, 1995).
Height/Stature
Height in adults is a combination of genetic potential for growth and environmental effects that influence growth. Specifically for pregnancy, it is
an estimate of pelvis size and the only anthropometric measure that
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Mid-upper arm circumference (MUAC) may also be considered for screening (not monitoring) purposes as a predictor of low birth weight, particularly
in cases where program resources limit equipment options and/or women
have only one or very few contacts with the healthcare system during their
pregnancy. Because MUAC increases only minimally if at all during pregnancy, it is used as a proxy for maternal pre-pregnancy and early pregnancy weight. The disadvantages of MUAC are the possibility for
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And while it is a critical time for the development of many health and
nutrition risks (e.g., obesity, short stature in girls), it is a pointless exercise
unless specially-targeted intervention strategies (nutrition, life skills
education, family planning, and STDs/AIDS) prevention will be planned
and implemented.
It is important to disaggregate adolescent anthropometric data by sex
because of the differences in size and timing of the growth spurt between
the sexes. Due to the transient nature of adolescent growth patterns and
wide variability in timing of maturational changes, age intervals for collecting data should be shortened to six months (as opposed to one-year
intervals during middle childhood), for the period two years after the
growth spurt until adult height is attained.
Height-for-age (H/A), body mass index (BMI), and BMI-for-age are the
most commonly constructed indices for this population group. Weight-for
height (W/H) is no longer useful because the relationship between weight
and height changes with age and maturational stage during adolescence.
BMI-for-age is recommended as the best indicator during adolescence,
incorporating information on age, providing continuity with adult indicators,
and applicable to both underweight and overweight conditions.
Provisional references for adolescent anthropometry use NCHS data,
which include standard deviations and percentiles of height and weight
through the adolescent years. While BMI-for-age percentiles are acknowledged to be skewed toward higher values, they are currently recommended as the best option for uniform reporting purposes until other data
are compiled. H/A and BMI-for-age percentiles are presented in Annex B,
Tables B-7ab.
For individuals, stunting (H/A < 2 Z-scores) is used to identify adolescents who could benefit from improved nutrition or treatment of other
underlying health problems, with the greatest impact expected for
premenarcheal girls and pre- or early pubertal boys. Particularly for girls,
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girls and pre-pubescent boys are the at-risk groups that will derive the
greatest benefit from intervention.
To assess response to interventions directed at excess thinness among
adolescents, evaluate frequencies of BMI relative to either the NCHS
reference data or local reference standards. Secular change in thinness
prevalence can be a useful indicator of overall social or economic improvement (or decline). It is recommended that surveillance of adolescents (usually a component of surveillance covering other population
groups as well) occur every five years during periods of socioeconomic
change or while programs are in progress. During periods of social upheaval or rapid positive (or negative) change, more frequent assessment
is optimal. Ten-year intervals are sufficient otherwise (WHO Expert Committee, 1995). Again, report mean and SD of BMI and frequencies of BMIfor-age < 5th percentile.
In areas where overweight is an identified problem, prevalence can be
estimated by an anthropometric survey. Survey results will also assist with
the design or modification of intervention programs. Based on BMI reference data (Annex B Table B-6), report frequencies of adolescents with
BMI 85 percentile, mean, median, and SD of BMI and frequency of
BMI 30, disaggregated by age and sex.
To determine obesity (excessive body fat), the WHO Expert Committee
recommends combined use of three indices: BMI-for-age, triceps and
sub scapular skinfold thicknesses (TRSKF and SSKF). BMI alone is an
inexact measure of total body fat and obesity (implying knowledge of
body composition) is limited to those adolescents both at risk of overweight (high BMI) and characterized by high levels of subcutaneous fat
(high TRSKF- and SSKF-for-age). The suggested cut-off values in Table
2-11 are provisional, and are based on limited evidence of universal applicability. See Tables B-8a to B-8b and B-9a to B-9b in Annex B for reference percentiles of triceps and sub-scapular skinfold thicknesses for
adolescents.
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Indices
H/A
BMI for age
BMI for age
BMI for age
TRSKF for age
SSKF for age
Cut-Off Value
< 2 Z-score; 3rd percentile
< 5th percentile
85th percentile
85th percentile and
90 percentile and
90th percentile
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