Anthropometric assessment

 Anthropometry is the measurement of the size, weight, and proportions of the

body. Common anthropometric measurements include weight, height, MUAC,
head circumference, and skinfold.
 Body mass index (BMI) and weight-for-height are anthropometric measurements
presented as indexes. Each of these indexes is recorded as a z-score.

Figure1. Bell curve

Bell curve shows that, from -2 to -3 is under nutrition and from 2 to 3 is
over nutrition.

 On the number line below, the arrow points in the direction in which the numbers
are getting bigger (to the right of the median) or smaller (to the left of the
median).
 The further a measurement is from the median (0) on either side, the greater the
risk of malnutrition. Whatever measures are used, the same measures should be
used every time a client’s nutritional status is assessed in order to compare results.

Weight
 Weight Weighing is usually the first step in anthropometric assessment and a
prerequisite for finding weight-for-height z-score (WHZ) for children and BMI
for adults.
  Weight is strongly correlated with health status. Unintentional weight loss can
mean poor health and reduced ability to fight infection. Weighing requires a
functional weighing scale that measures weight in kg to within the nearest 100 g.
 Accurate weight measurement is important because errors can lead to incorrect
classification of nutritional status and the wrong care and treatment.

LENGTH AND HEIGHT

 Measuring length or height requires a height board or measuring tape marked in

centimeters (cm). Measure length for children under 2 years of age or less than 87 cm
long. Measure height for children 2 years and older who are more than 87 cm tall and for
adults.

How to Measure Length for Children under 2 Years and for Adults too Weak to
Stand:
1. Place the length board (shown in the picture) on a table or the ground.
2. Remove the client’s footwear and any head covering.
3. Place the client on his or her back in the middle of the board with his or her arms at the
sides and feet at right angles to the board. The heels, knees, buttocks, and back of the
head and shoulders should touch the board.
4. Position the client’s head so his or her eyes point straight up. Gently bring the top of
the head to touch the fixed end of the board.
5. Hold the client’s ankles or knees. With the other hand, slide the moveable foot piece to
the client’s feet until both heels touch it.
6. Immediately remove the client’s feet from the foot piece to prevent the client from
kicking, holding the footboard securely with the other hand.
7. Read the measurement aloud to the nearest 0.1 cm.
 8. Ask another health care provider to repeat the measurement for verification and record
it.
9. If the child is 2 years of age or older or 87 cm or taller when standing up, subtract 0.7
cm from the measurement

Weight-for-height
 WHZ is an index that is used to assess the nutritional status of children from birth
to 59 months of age.
 It compares a child’s weight to the weight of a child of the same length/height and
sex in the WHO Child Growth Standards to classify the child’s nutritional status.
 WHZ can be used for infants under 6 months, but there are no globally agreed cut
off points for classification of nutritional status.

How to Calculate Weight-for-Height Z-Score (WHZ) in Children 0−59 Months of Age

A weight-for-length/height z-score (WHZ) compares a child’s weight to the weight of a child of

the same length/height and sex to classify nutritional status. To use the charts to classify
children’s nutritional status:

1. Find the correct table for the child´s age (0–23 months or 24–59 months) and sex (boy or
girl). Measure children 0–23 months of age or less than 87 cm long lying down (length).
Measure children 24–59 months of age or taller than 87 cm standing up (height).
2. Find the figure closest to the child’s length/height in the left column.
3. Move your finger to the right to find the range that contains the child’s weight.
4. The label at the top of the column with the range containing the child’s weight tells you
the child’s nutritional status.
MUAC

 MUAC is the circumference of the left upper arm measured at the mid-point between the
tip of the shoulder and the tip of the elbow, using a measuring or MUAC tape.
 MUAC measurements in millimeters (mm) are more accurate than measurements in cm.
 MUAC is a proxy measure of nutrient reserves in muscle and fat that are unaffected by
pregnancy and independent of height. Use MUAC to measure all pregnant women and
women up to 6 months postpartum.
 MUAC is also an appropriate alternative for measuring children (instead of WHZ),
adolescents (instead of BMI-for-age), and non-pregnant/postpartum adults whose weight
and height cannot be measured (e.g., if they cannot stand or no equipment is available).
 MUAC is not currently recommended for infants under 6 months and should not be used
to assess nutritional status in people with edema.
BMI

 BMI is an anthropometric indicator based on weight-to-height ratio. It is used to classify

malnutrition in non-pregnant/non-postpartum adults.
 BMI is not an accurate indicator of nutritional status in pregnant women or adults with
edema. Use MUAC for these groups.
 Calculate BMI by dividing a person’s weight in kg by the square of the person’s height in
meters. You will have to convert measurements in cm to m (100 cm = 1 m).

BMI-for-age z-score

 BMI can be used to measure the nutritional status of adults over 18 years of age because
they have completed their physical development.
 BMI-for-age is the preferred indicator of body thinness to classify malnutrition in
children and adolescents 5–18 years of age.

Below are the WHO BMI-for-age classifications of malnutrition in children and adolescents
5−18 years of age.