GIZ 222 Dr.

Hadi Riyadi Kuliah 2

KONSEP PENGUKURAN
ANTROPOMETRI

Departemen Gizi Masyarakat

Fakultas Ekologi Manusia
Institut Pertanian Bogor
2018
 Direct Methods of Nutritional
Assessment
These are summarized as ABCD
 Anthropometric methods
 Biochemical, laboratory methods
 Clinical methods
 Dietary evaluation methods
 Indirect Methods of
Nutritional Assessment
These include three categories:
Ecological variables including crop
production
Economic factors e.g. per capita
income, population density & social
habits
Vital health statistics particularly
infant & under 5 mortality & fertility
index
 Anthropometry
Greek ‘anthropos’ = human, ‘metro’ =
measurement

Measurement of physical
characteristics e.g. height, weight,
body composition (fat!). Compare
with standards for age, sex …
 Anthropometry
Is the measurement of the human body,
Measurements of the variations of the physical
dimensions and the gross composition of the human
body at different age levels and degrees of nutrition
Jelliffe 1966

 Definition:
Anthropometry is the study and technique of
taking a person’s body measurements (height or
length, weight, arm circumference, etc),
especially for use on a comparison or
classification basis to establish his/her nutritional
status.
 Anthropometry
General uses
-To evaluate progress of growth: identify
people whose growth is outside normal values
suggesting under or over nutrition
-Screening tool to identify individuals at high
risk of malnutrition.
-To measure changes over time: monitor
effects of nutrition intervention for treatment of
disease, surgery or malnutrition. Also, can
track weight changes that may indicate disease
 LEVEL KOMPOSISI TUBUH
Models
Adipose
EC
Other solids Connective
Other
Tissue
Protein ECF
Hydrogen
ICF
Carbon Lipid Skeletal
Muscle
Cells
Oxygen Water
Bone
Whole
Tissue, body
Cellular
System
Molecular LEVEL V
Atomic LEVEL III LEVEL IV
LEVEL II
LEVEL I
 LEVEL ATOM

Tubuh manusia terbagi atas unsur-unsur

kimia : oksigen, hidrogen, karbon,
nitrogen, kalsium dan fosfor, dst

Pengukuran : neutron activation analysis

Keseimbangan nitrogen : indikator

turnover protein
Kalsium tubuh total : indikator mineral
tulang tubuh
 Levels of Body Components
Tissue-Organs Cellular Molecular Atomic
Adipocyte
Adipose tissue Lipid Hydrogen
Water
Skeletal Muscle Cells Carbon

Visceral Organs Oxygen

ECF Protein

Skeleton ECS Mineral N and Ca

 LEVEL MOLEKULAR
Tubuh manusia terbagi atas kompartemen
molekul utama : air, protein, glikogen, mineral
(tulang dan non-tulang), serta lemak.

Pengukuran : dapat diukur jumlah dalam tubuh

Protein tubuh total diduga dari nitrogen tubuh

total
Lemak tubuh total diduga dengan model dua
komponen tubuh {tubuh disederhanakan atas
dua komponen : Fat Mass (FM) dan Fat-Free
Mass (FFM)}
 Levels of Body Components
Tissue-Organs Cellular Molecular Atomic
Adipocyte
Adipose tissue Lipid Hydrogen
Water
Skeletal Muscle Cells Carbon

Visceral Organs Oxygen

ECF Protein

Skeleton ECS Mineral N, Ca,P,K,Na,Cl

 Body composition models

Composition can be measured at different levels

Atomic-molecular-cellular-tissue-whole body
FAT MASS (FM)
TERMINOLOGY
All extractable lipids from adipose and other tissues in the body

ADIPOSE TISSUE MASS (ATM)

Fat (~83%) plus its supporting structures (~2% protein, 15% water)

FAT FREE MASS (FFM)

All residual, lipid-free chemicals and tissues, including water, muscle, bone,
connective tissue and internal organs

LEAN BODY MASS

FFM plus essential lipids

ESSENTIAL LIPIDS
Compound lipids (phospholipids) needed for cell membrane formation
~ 10% of total-body lipid
Body composition; levels of
measurement
 Direct technique
Measurement?
– Cadaver studies
vs
 Indirect techniques
Prediction?
– Hydrostatic weighing
 Doubly indirect techniques Accuracy
– Skinfolds vs.
Validity
 Assessment techniques;
Hydrostatic weighing
The object’s loss of weight in water equals the
weight of the volume of water it displaces,
..... its specific gravity can be defined as the
ratio of its weight in air divided by its loss of
weight in water.
 Hydrostatic Weighing

Calculates whole body density

as
density=mass/volume
 Assessment techniques
 Body imaging
– Computed tomography
 uses x-rays
– Magnetic Resonance Imaging
 Bioelectrical impedence
 Chemical methods (e.g. labelled water;
potassium counting)
Figure 9.5 Bod Pod® Body Composition Tracking System.
 Anthropometric assessment of
body composition
o Duel Energy X-ray Absorptiometry (DEXA)
– measures bone mass, lean tissue (and fat by difference).
DEXA
BIA
 BIA BIPOLAR

Analyzer BIA
OMRON HBF 306
 BIA BIPOLAR
Analyzer BIA LAICA Scale
Teknik Air Tubuh Total (TBW)

 Asumsi :Kadar air FFM = 73%

 TBW/FFM = 0,73
 FFM = TBW/0,73
 FM = Body weight - FFM
 How do we measure body composition ?
Validity and reliability of different methods to measure or
estimate body composition should always be considered.
 DIRECT
 Dissection of cadavers.
 Chemical analyses of human carcasses
 Considerable variation exists in total body fat
 Compositions of the bone mass, lean mass and fat
tissues remain relatively stable
Criticisms
• Few human studies
– Cadaver subjects are often elderly and diseased
(Hawes, 1996).
– Changes in body composition after death
– Direct measurement is obviously not practical for
live subjects!
 Predicting body fat
percentages
Body fat %? Body density? Body
measurements?

 A variety of equations for body fat

– e.g. Siri equation
– % body fat= (495/body density)-450)
 A variety of equations for body density
 Skinfold measurement
 Assumes interrelationships between
– Subcutaneous fat
– Internal fat
– Whole body density

 Huge variety of sites

 Huge variety of equations
  Measures thickness of subcutaneous
SKINFOLDS adipose tissue
 Distribution of fat subcutaneously and
internally is similar within each sex
FOR
 Ease of administration
 Cost
 Reliability and validity
AGAINST
 Intratester reliability
 Intertester reliability
 Population specific regression equations
 Skinfold calipers
 Subject factors e.g. sex, age
 Double indirect estimates
 LEVEL SELULAR
Tubuh manusia terbagi atas sel, cairan
ekstraselular(ECF), cairan intraselular (ICF), dan
padatan ekstraselular (ECS).

Pengukuran : ECF dan ECS

Massa sel = massa sel lemak dan massa sel tanpa lemak
Massa sel tanpa lemak = massa sel tubuh (BCM)
Kalium tubuh total (TBK) dipakai utk menduga BCM
Kadar kalium dalam ICF konstan = 150 mmol/L
Rasio cairan dan padatan intraselular = 4:1
Cairan intraselular = BCM x 0,8
BCM = [TBK/150] x [1/0,8]
BCM = 0,0083 x TBK
Berat badan = lemak + BCM + ECF + ECS
 Levels of Body Components
Tissue-Organs Cellular Molecular Atomic
Adipose tissue Adiposity Lipid Hydrogen
Water
Skeletal Muscle Cells Carbon

Visceral Organs Oxygen

ECF Protein

Skeleton ECS Mineral N, Ca,P,K,Na,Cl

 LEVEL SISTEM JARINGAN
Tubuh manusia terbagi atas jaringan dan organ
utama.

Berat badan = jaringan adiposa + otot skeletal +

sisanya.

Magnetic resonance imaging (MRI) dan Computed

tomography (CT) = digunakan untuk mengukur
jumlah jaringan adiposa regional dan jaringan
adiposa tubuh total, serta otot skeletal

Jaringan adiposa dan otot skeletal = dapat diduga

dengan antropometri.

Persamaan antropometri tersedia utk menduga :

jaringan adiposa visceral, jaringan adiposa total,
otot skeletal, massa tulang pada level sistem
jaringan.
 Levels of Body Components

Tissue-Organs Cellular Molecular Atomic

Adipocyte
Adipose tissue Lipid Hydrogen
Water
Skeletal Muscle Cells Carbon

Visceral Organs Oxygen

ECF Protein

Skeleton ECS Mineral N, Ca,P,K,Na,Cl

 Adipocyte Size and Number
 Animal research suggests gestational feeding,
early nutritional feeding and physical activity
levels can affect adipocyte size and number.

 Although some people may have larger and

more abundant adipocytes, do they have to
be full?
LEVEL SELURUH TUBUH

Level seluruh tubuh adalah

dimensi antropometri utama.

Pengukuran : berat badan, tinggi

badan, lingkaran-lingkaran tubuh,
lebar atau luas bagian tubuh,
tebal lipatan kulit (Skinfold
thicknesses), densitas tubuh,
volume tubuh.
NUTRITIONAL ANTHROPOMETRY

 MEASUREMENTS
- Using Instruments

 REFERENCE VALUES / STANDARDS

- National, International

 INDICES
- Computed; Age dependent / Independent

 CLASSIFICATIONS
- For Grading of Nutritional Status
 Pengukuran, Indeks, dan Indikator
Antropometri

 Pengukuran (Measurement) :
pengukuran yg dilakukan terhadap
berat badan, tinggi badan, lingkaran
bagian-bagian tubuh, serta tebal lipatan
kulit (skinfold).

 Indeks : kombinasi dari pengukuran.

Cth. IMT : BB/TB2
ANTHROPOMETRIC MEASUREMENTS
- Weight (kgs)
- Height (cms)
- Mid Upper Arm Circumference (cms)

- Waist Circumference (cms)

- Hip Circumference (cms)
- Fat fold thickness (mms) :
at Triceps, Biceps, Supra-Iliac,
Sub-scapular regions
 We’ll be looking at five Anthropometric
indices:
– Height for age
– Weight for age
– Weight for height
– Mid-Upper Arm Circumference
– Body Mass Index

42
Indeks dapat dinyatakan dengan :

 Z-skor : deviasi nilai seseorang dari nilai

median populasi referensi dibagi dengan
simpangan baku populasi referensi.

 Persentil : tingkatan posisi seseorang pada

distribusi referensi (WHO/NCHS), yang
dijelaskan dengan nilai seseorang sama
atau lebih besar daripada nilai persentase
kelompok populasi.

 Persen terhadap median : rasio nilai

seseorang yang diukur (misal BB) dengan
nilai median data referensi menurut umur
atau tinggi badan yang sama, dan
dinyatakan dalam persentase.
 Z- Score or standard deviation score
The deviation of the value for an individual from the median value of the
reference population, divided by the standard Deviation for the reference
population

(Observed value) - (Median reference value)

Z- Score = --------------------------------------------------------
Standard deviation of reference population

•A fixed Z score interval implies a fixed height or weight difference for

children of a given age .
•Advantage:- Allows mean and SD calculation for a group of Z score in
population based applications
 Percentile :
 The rank position of an individual on a given
reference distribution, stated in terms of what
percentage of the group the individual equals or
exceeds .
Eg. A child of a given age whose weight falls in the
10th percentile weighs the same or more than 10% of
the reference population of children of same age.
 Summary statistics not possible
 If the distribution of reference values fallows a normal
distribution, percentiles and Z scores are related
through a mathematical transformation.
 Commonly used -3,-2 and -1 Z scores are
respectively the 0.13th , 2.28th and 15.8th percentiles
and the 1st ,3rd and 10th percentiles correspond to,
respectively, the -2.33,-1.88,and -1.29 Z scores.
 Percent of median:
Ratio of a measured value in the individual, for
instance weight , to the median value of the
reference data for the same age or height,
expressed as a percentage.

Main disadvantage-
• lack of exact correspondence with a fixed point of
distribution across age and weight status.

Eg. Depending on the child’s age, 80% of the median

weight for age might be above or below -2 Z score; in
terms of health, it reflects in different classification of risk.
•Cut off points for percent of median are different for the
different anthropometric indices.
 characteristic of three
measures of scale

Characteristic Z score Percentile Percent of median

Adherence to reference Yes Yes No

population
Summary statistics Possible Yes No Yes

Uniform Criteria across Yes Yes No

indices
Useful for detecting changes Yes No Yes
at extreme of distribution
 Comparison of the dimensions obtained
in a specific individual or patient with a
normal standard curve requires three
things:
1. standardized landmarks on the body from
which and to which measurements can be
taken;
2. standardized methods of taking
measurements;
3. standard equipment.
 Z - Scores

Measured Value – Median Value (reference)

Z Score = ----------------------------------------------------------
SD of Reference
Indikator : penggunaan atau aplikasi
indeks.

Indikator dibangun dari indeks, karena itu

indeks dan indikator bisa memiliki arti
yang sama.

Contoh : Angka kematian bayi adalah

indeks dan juga indikator keadaan
kesehatan masyarakat.

TB/U < -2 SD (stunting) : indikator

kemiskinan.
 REQUIREMENTS FOR NUTRITIONAL
ANTHROPOMETRY
Standard equipment:
- Accuracy / Consistency,
Appropriate techniques:
- Training & Standardization
Correct assessment of age:
- Wrong age vitiates the results
Reference values:
- For comparison and computation of indices
Classification:
- For grading nutritional status
STANDARD NORMAL DISTRIBUTION
“Measuring Changes in Nutritional Status”
(WHO, Geneva 1983).

Normal

34% 34%
14% 14%
2% 2%

-3.0 -2.0 -1.0 0.0 1.0 2.0 3.0

SD Score
( 2SD = 96 %)
STANDARD DEVIATION (SD) CLASSIFICATION

NUTRITIONAL GRADE
CUT-OFF LEVEL WEIGHT FOR HEIGHT FOR WEIGHT FOR
AGE AGE HEIGHT

 Median – 2 SD Normal Normal Normal

Median – 3 SD to Moderate Moderate Moderate

Median – 2 SD Underweight Stunting Wasting

Severe Severe Severe

< Median – 3 SD
Underweight Stunting Wasting
 Seleksi Indikator antropometri
Indikator antropometri dapat digolongkan
menurut tujuan penggunaannya :

1. Identifikasi individu atau populasi yang beresiko.

Perlu data : gangguan performan, kesehatan, dan kelangsungan
hidup.

Indikator ini harus :

 Merefleksikan resiko masa lampau atau sekarang
 Menduga resiko masa mandatang
Cth : indikator gizi kurang masa sekarang juga
dapat dijadikan prediktor peningkatan resiko
mortalitas dimasa mendatang.

Indikator jenis ini dapat digunakan untuk

mengidentifikasi masalah kesehatan dan potensi
intervensi.
2. Seleksi individu atau populasi untuk intervensi.
Indikator ini harus :
Dapat menduga manfaat yang akan diperoleh
dari intervensi
Cth : Stunting pada anak dan dewasa
merefleksikan adanya kondisi lingkungan yang
tidak kondusif bagi gizi dan kesehatan.
3. Evaluasi dampak dari pengaruh perubahan gizi,
kesehatan atau sosial ekonomi.

Indikator ini harus :

Merefleksikan respon terhadap intervensi masa
lampau atau sekarang.
Perubahan BB/TB adalah contoh indikator respon
pada anak wasted yang sedang diobati.
Perlu pertimbangan waktu dari awal intervensi
sampai munculnya respon.

4. Mengeluarkan individu dari perlakuan beresiko

tinggi, dari pekerjaan, atau dari manfaat tertentu.

Indikator ini harus dapat menduga

pengurangan/penurunan resiko :
Misal : indikator antropometri untuk menerima
seseorang dalam asuransi kesehatan.
5. Mencapai standar normatif.
Indikator ini harus : merefkleksikan
“normalitas”

Misal obesitas tingkat sedang pada lansia

tidak berhubungan dengan kesehatan yang
buruk atau peningkatan resiko mortalitas.

6. Tujuan penelitian yang tidak terkait

program pemerintah.
Misal: membuat model biologi, perilaku, dan
epidemiologi : tidak cukup dengan indikator
yang sederhana.
 Penggunaan antropometri pada
Individu
Antropometri pada individu digunakan untuk :
Mengidentifikasi seseorang yang memerlukan
pertimbangan khusus.
Menilai respon seseorang terhadap intervensi.

1. Screening dengan 1 kali pengukuran untuk

pentargetan intervensi
a) memilih titik batas yang terbaik.
direkomendasikan titik batas universal.
b) menyeimbangkan kebutuhan dengan sumberdaya
yang tersedia pada penduduk.
Perlu titik batas yang memaksimalkan individu
yang menjadi target.
 Penggunaan antropometri pada
Individu (lanjutan)
c) Membandingkan titik batas untuk
mengidentifikasi resiko dengan titik
batas untuk menduga manfaat.

Titik batasnya bisa berbeda

2. Menilai respon terhadap suatu intervensi

Pengukuran secara serial,minimal 2 kali
ukur.
 Penggunaan Antropometri pada
Populasi

1. Penggunaan yang berhubungan

dengan pengambilan keputusan
2. Pentargetan intervensi
3. Menilai respon terhadap intervensi
4. Menentukan determinan dan
konsekuensi kurang gizi
5. Surveillance gizi
 Karakteristik Data Referensi
Referensi : didefinisikan sebagai alat untuk
mengelompokkan dan menganalisis data dan sebagai
dasar untuk membandingkan antar populasi.
(Cth. WHO/NCHS, 1983; WHO 2007 untuk anak dan
remaja)
Standar : meliputi konsep tentang norma atau target yang
diinginkan, sehingga melibatkan pertimbangan nilai-
nilai. (Cth. WHO 2005)

Referensi kadang-kadang juga digunakan sebagai standar

(cth. : WHO/NCHS 1983; WHO 2007 untuk anak dan
remaja)

Data referensi berasal dari populasi sehat (healthy

population)
 Paling sedikit ada 4 definisi
populasi sehat :
1. Populasi yang tinggal dilingkungan yang sehat.
Ini jenis populasi pada data referensi WHO/NCHS

2. Populasi yang tinggal di lingkungan sehat, dan tidak

ada individu yang sakit atau sangat sedikit individu
yang secara klinis sakit.

3. Populasi yang tinggal di lingkungan sehat, dan hanya

berisi orang-orang yang benar-benar baik
kesehatannya (dilihat dari panjang umurnya) atau
melalui pengamatan kelangsungan hidup selama
beberapa tahun setelah pengukuran dilakukan.

4. Populasi ysng tinggal di lingkungan sehat, hanya

berisi orang-orang yang hidup secara sehat menurut
anjuran sekarang.
Cth : Bayi-bayi yang diberi ASI menurut anjuran WHO.
 Kriteria yang harus dipenuhi untuk membuat
Data Referensi Antropometri (WHO), agar
dapat digunakan secara internasional :

1. Jumlah sampel paling sedikit 200 orang pada

setiap kelompok umur dan jenis kelamin
2. Sampel harus cross-sectional, hal ini karena
perbandingan yang akan dibuat juga secara cross-
sectional
3. Prosedur pengambilan sampel (sampling) harus
didefinisikan dengan jelas dan dapat diulang
4. Pengukuran harus dilakukan secara hati-hati dan
diukur oleh orang yang terlatih dalam bidang
teknik antropometri, dengan menggunakan
peralatan yang rancangannya sudah teruji dan
dikalibrasi pada setiap interval tertentu
 Kriteria yang harus dipenuhi untuk membuat
Data Referensi Antropometri (WHO), agar
dapat digunakan secara internasional :

5. Pengukuran yang dilakukan pada sampel harus

mencakup semua variabel antropometri yang akan
digunakan dalam evaluasi status gizi

6. Data yang digunakan dalam membuat tabel dan

grafik referensi harus tersedia bagi setiap orang
yang ingin menggunakannya, dan prosedur yang
digunakan untuk memperhalus (smothing) kurva
dan mempersiapkan tabel harus dijelaskan dan
didokumentasikan dengan baik
 Pengukuran yang direkomendasi WHO
(1995)
Pengukuran Ibu hamil Bayi baru Bayi Anak Remaja Dewasa, Dewasa, Lansia
lahir overweight kurus
Umur X X X X X X X X
Jenis kelamin X X X X X X X X
Umur hamil X X
Tinggi fundus X
Tinggi badan X X X X X X
Tinggi duduk X X
Panjang badan X X X
Berat badan X X X X X X X X
Lingkar kepala X X
Lingkar lengan X X X X
Lingkar dada X
Lingkar perut X X
Lingkar pinggul X X
Lingkar betis X X
 Pengukuran rekomendasi (lanjutan)
Pengukuran Ibu Bayi Bayi Anak Remaja Dewasa, Dewasa Lansia
hamil baru overweight kurus
lahir
Tebal lipatan kulit
Triceps X X X
Subscapular X X X
Paha X
Indikator kematangan
Status menarche X
Payudara tahap 2 (B2) X
Genital tahap 3 (G3) X
Suara dewasa (AV) X
Indeks turunan
Kehilangan berat X X
IMT X X X X X
Indeks ponderal X
Rasio perut : pinggul X X

Lingkar otot lengan X

Luas otot lengan X
OK135S053
WHO Child Growth Standards
A growth
chart for
the 21 st

1 year 2 years 3 years 4 years 5 years century

WHO Child Growth Standards
 Attained growth
 Weight-for-age
 Length/height-for-age
 Weight-for-length/height
 Body mass index-for-age
 Mid-upper arm circumference-for-age
 Triceps skinfold-for-age
 Subscapular skinfold-for-age
 Head circumference-for-age
 Growth velocity
 Weight
 Length/height
 Head circumference
• Arm circumference
• Body mass index
Mean length from birth to 24 months for the six MGRS sites

Brazil
Ghana
India
Norway
Oman
80

USA
Mean of Length (cm)
70
60
50

0 200 400 600

Age (days)

WHO Multicentre Growth Reference Study Group. Assessment of linear growth differences
among populations in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl
Comparison of WHO with NCHS 1977 weight-for-age z-scores
for boys

-1
15

-2

-3
Weight (Kg)
10
5

WHO
NCHS

0 2 4 6 8 12 16 20 24 28 32 36 40 44 48 52 56 60
Age (months)

Source: WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-fo
weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organiz
WHO Child Growth Standards

The new
standards will
play a key role in
the prevention
and early
recognition of
childhood
obesity
 Breastfeeding
No
• provides perfect nutrition

• provides initial
gift immunization
• prevents diarrhoea
• maximizes a child’s

is physical
and intellectual potential
• supports food security

more • bonds mother and child

• helps birth spacing
• benefits maternal health

preciou • saves money

• is environment-friendly

s
WHO Multicentre Growth Reference Study
Motor Development Assessment
BMI-for-age and weight-for-height mean z-scores
associated
with pediatrician's clinical evaluation
Field testing, Italy (March 2005)

Clinical evaluation N BMI-for-age Weight-for-height

Mean z-score Mean z-score
Thin 8 -2.00 -2.08
Lean 284 -0.55 -0.50
Normal 883 0.18 0.24
Heavy, mostly muscle 354 0.96 0.99
Overweight 95 1.83 1.83
Obese 11 3.38 3.39
Total 1635 0.33 0.38
WHO Child Growth Standards

Child survival

Physical growth

Child
development
Any Questions or Comments?
 Daftar Pustaka
1. Gibson, R.S. 2005. Principles of Nutritional Assessment.
Second Edition. Oxford University Press, New York.
2. Lee RD & Nieman DC. 2012. Nutritional Assessment. Sixth
Edition. New York : McGraw-Hill.
3. Preedy VR (Editor). 2012. Handbook of Anthropometry :
Physical Measures of Human Form in Health and Disease. New
York : Springer.
4. WHO. 1995. Physical Status : the Use and Interpretation of
Anthropometry. Report of a WHO Expert Committee. WHO,
Geneva.
5. WHO Multicentre Growth Reference Study Group. 2006. WHO
Child Growth Standards: Length/height-for-age, weight-for-age,
weight-for-length, weight-for-height and body mass index-forage:
Methods and development. Geneva: World Health Organization