PRACTICAL – 01 DATE:

ASSESSMENT OF NUTRITIONAL STATUS BY ANTHROPOMETRY

METHODS
Anthropometric measurements are a series of quantitative measurements of the muscle, bone,
and adipose tissue used to assess the composition of the body. The core elements of
anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip,
and limbs), and skinfold thickness. These measurements are important because they represent
diagnostic criteria for obesity, which significantly increases the risk for conditions such as
cardiovascular disease, hypertension, diabetes mellitus, and many more. There is further utility
as a measure of nutritional status in children and pregnant women. Additionally,
anthropometric measurements can be used as a baseline for physical fitness and to measure the
progress of fitness.

Objectives

• To quantify malnutrition in a specific population at a given time ,using indicator of

malnutrition
• To identify higher risk groups .these may be a certain age groups, newly arrived
refugees, nomads as compared to sedentary people, etc.
• To estimate the numbers of children who may benefit from a nutrition programme.
Parameters Of Anthropometry

Age dependent factors Age independent factors

• Weight • Mid -arm circumference (1-5 yrs)
• Height • Weight for height
• Head circumference • Mid upper arm/ height ratio
• Chest circumference

Advantages

• Anthropometric measures are indicators of

▪ Past exposures (e.g. past malnutrition leads to low height)
▪ Future events (e.g. high waist circumference is a risk factors for cardiovascular
diseases)
• Fast
• Simple
• Non – invasive
• Relatively cheap
Limitations
 • Relatively insensitive towards disturbances in nutritional status over short period of
time.
• Impossible to detect specific nutrient deficiency.
Equipments

• Weight scale
• Calibration weights
• Box to sit on
• Stadiometer
• Knee calliper
• Skinfold callipers
• Tape measure

1. BODY MASS INDEX (BMI)-

Body mass index (BMI), is a measure of weight relative to height.BMI, formerly called the
quetelet index, is a measure for indicating nutritional status in adults.BMI is an estimate of
body fat and a good gauge of your risk for diseases that can occur with more body fat. It is
defined as a person’s weight in kilograms divided by the square of the person’s height in meters
(kg/m2).

BMI (kg/m2) = weight (kg)

[height (m)]2

BMI can be used as a screening tool but is not diagnostic of the body fatness or health of an
individual. The higher the BMI, the higher your risk for certain diseases such as heart disease,
high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers.

BMI Classification:

For adults over 20 years old, BMI falls into one of the following categories.

WHO Criteria BMI Asian Criteria BMI

Nutritional Status
Cut-Off Cut-Off
Underweight <18.5 <18.5
Normal weight 18.5–24.9 18.5–22.9
Overweight 25.0–29.9 23 – 24.9
Pre-obese - 25 – 29.9
Obese ≥30 ≥30
Obesity type I 30.0–34.9
Obesity type II 35.0–39.9
Obesity type III Above 40
These categories are the same for men and women of all body types. (2009. WHO:1998)

Factors To Consider When Interpreting BMI:

There are situations when the use of BMI alone is limited in its ability to appropriately classify
individuals into the proper weight category.

Scenarios where BMI may not be a suitable method of assessing and tracking weight-related
health risks include:

• Measuring individuals with a large amount of fat-free mass (e.g., power athletes, some
manual laborers).
• Assessing clients after a resistance training program who increased their muscle mass
(fat-free mass), masking a possible decrease in fat mass (resulting in no initial change
in body weight or BMI).

In these scenarios, BMI may classify these individuals with excess weight, caused by a large
amount of fat-free mass, as overweight or obese.

As children are still growing, BMI cut-offs are not considered appropriate for children.

It may underestimate body fat in older persons and others who have lost muscle.
For athletes or individuals who participate in heavy resistance training or manual labor,
assessment methods that estimate body composition (i.e., the proportion of fat and fat-free
mass in the body) may be more appropriate for determining if their high body weight is a result
of excess fat mass (health risk) or high fat-free mass (not a health risk)

Advantages:

• It is an inexpensive and method of screening for weight category.

• It is an easy-to-perform method.
• Determines an individual’s weight-related health risk.
• Body mass index works well for what it was intended to do; measure rates of obesity
in a population.

Disadvantages:

• For adults ages 20 years and older, BMI incorporates weight and height, but it does not
take age or sex into account.
• In pregnancy and breastfeeding, childhood and adolescence, BMI cannot accurately
indicate the state of a person's health
• BMI can be used as a screening tool for body fatness but is not diagnostic.
• BMI might underestimate the risk for people with normal weight but high body fat; it
can also overestimate the risk for muscular, healthy people.
• BMI also doesn't distinguish between the types of fat one carries- subcutaneous or
visceral fat.

2. WEIGHT-

This is one of the most important measurements in nutritional assessment. It is an important

variable used in equations predicting macronutrient and fluid requirements and a valuable
index in acute malnutrition.

Technique Of Weight Measurement:

• A digital weighing scale will give accurate measurements.
• Before measurements are taken zero calibration of the scale must be done.
• Weigh without shoes and only light clothing must be worn.
• The subject must stand still with the weight equally distributed on both feet.
• The child must not hold onto to anything for support.
• An average of 3 readings is taken and measurements are read to the nearest 0.1kg.

3. HEIGHT-

Standing height (also referred to as stature) is used for children older than 2 years who are able
to stand upright without assistance.
The measurement of height is important for calculating certain indices such as height-for-age,
weight-for-height, Body Mass Index (BMI), the creatinine height index and for estimating
basal energy expenditure.

Technique For Height Measurement:

A stadiometer is used to measure stature or use a right-angled headboard and a non - stretchable
tape measure with 1mm increments fixed to a vertical surface. Platform scales with moveable
measuring rods are not indicated because of inaccuracy.
• Subject is measured with minimal clothing and no shoes and socks must be worn.
• Feet must be together, arms to the side, legs straight and shoulders relaxed.
• The head must be in the Frankfort horizontal plane (looking straight ahead).
• Heels, buttocks, shoulder blades and back of the head must be against the vertical board
of the stadiometer.
• Measurement is taken at maximum inspiration.
• An average of 3 readings is taken and read to the nearest 0.1cm.
• To avoid errors of parallax, the measurer’s eyes should be level with the headboard.

4. MID-UPPER ARM CIRCUMFERENCE (MUAC)-

Mid-Upper Arm Circumference (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 (olecranon process and
the acromium).

MUAC is used for the assessment of nutritional status. It is a good predictor of mortality and
in many studies, MUAC predicted death in children better than any other anthropometric
indicator. This advantage of MUAC was greatest when the period of follow-up was short.

The MUAC measurement requires little equipment and is easy to perform even on the most
debilitated individuals. Although it is important to give workers training in how to take the
measurement, the correct technique can be readily taught to minimally trained health workers
and community-based volunteers. It is thus suited to screening admissions to feeding programs
during emergencies.

MUAC is recommended for use with children between six and fifty-nine months of age and
for assessing acute energy deficiency in adults during famine.

The major determinants of MUAC, arm muscle and sub-cutaneous fat, are both important
determinants of survival in starvation. MUAC is less affected than weight and height based
indices (e.g. WHZ, WHM, BMI) by the localized accumulation of fluid (i.e. bipedal or
nutritional oedema, periorbitaloedema, and ascites) common in famine and is a more sensitive
index of tissue atrophy than low body weight. It is also relatively independent of height and
body-shape.

5. WAIST-HIP RATIO-

Waist-to-hip ratio (whr) is one of several measurements doctor can use to see if one overweight,
and if that excess weight is putting ones health at risk. Unlike the body mass index (bmi), which
calculates the ratio of the weight to the height, whr measures the ratio of the waist
circumference to the hip circumference. It determines how much fat is stored on waist, hips,
and buttocks.

Not all excess weight is the same when it comes to health risks. People who carry more weight
around their midsection (an apple-shaped body) are at higher risk for heart disease, type 2
diabetes, and premature death than those who carry more of their weight in their hips and thighs
(a pear-shaped body). Even if the bmi is within a normal range, the risk for disease may be
increased.

WHO Waist-To-Hip Ratio Guidelines:

WHO Cut-Off Points And Risk Of Metabolic Complications

Indicators Cut-Off Points Risk Of Metabolic

Complications
Waist Circumference >94cm (M); >80cm (W) Increased
Waist Circumference >102 cm (M); >88cm (W) Substantially Increased
Waist-Hip Ratio ≥0.90cm (M); ≥0.85cm (W) Substantially Increased

According to the World Health Organization (WHO), a healthy WHR is:

• 0.9 or less in men
• 0.85 or less for women
In both men and women, a WHR of 1.0 or higher increases the risk for heart disease and other
conditions that are linked to being overweight.

Ways To Calculate Waist-To-Hip Ratio:

• Stand up straight and breathe out. Use a tape measure to check the distance around the
smallest part of your waist, just above your belly button. This is the waist
circumference.
• Then measure the distance around the largest part of your hips — the widest part of
your buttocks. This is the hip circumference.
• Calculate WHR by dividing waist circumference by hip circumference.

Advantages Of Using This Method:

• WHR is an easy, inexpensive, and accurate way to see how much body fat one has. It
can also help predict risk for heart disease and diabetes.
• A few studies suggest that WHR is even more accurate than BMI for predicting the
risks of cardiovascular disease and premature death. For example, a 2015 study of more
than 15,000 adults showed that a high WHR was linked to an increased risk of early
death — even in people with a normal BMI.
• This method could be particularly useful in certain groups of people. For example,
WHR may be a better gauge of obesity in older adults whose body composition has
changed.

Disadvantages Of Using This Method:

 • It’s easy to make mistakes while checking WHR, because one needs to take two
separate measurements. And, it can be hard to get an accurate measurement of hips.
• WHR can also be harder to interpret than waist circumference — another measurement
of abdominal obesity. One might have a high WHR because of weight gained in the
abdomen. Or, might simply put on extra muscle around hips from working out.
• Certain people won’t be able to get an accurate measure using WHR, including those
who are shorter than 5 feet tall and those who have a BMI of 35 or higher. WHR is also
not recommended for use in children.

6. WEIGHT-FOR-AGE AND HEIGHT FOR AGE-

In children the three most commonly used anthropometric indices to assess their growth status
are weight-for-height, height-for-age and weight-for-age.

Weight-for-age reflects body mass relative to chronological age. It is influenced by both the
height of the child (height-for-age) and his or her weight (weight-for-height), and its composite
nature makes interpretation complex. For example, weight-for-age fails to distinguish between
short children of adequate body weight and tall, thin children. Short-term change, especially
reduction in weight-for-age, reveals change in weight-for-height. The worldwide variation of
low weight-for-age and its age distribution are similar.

Height-for-age corresponds to the child's height when plotted at the 50th percentile on a
growth chart. The height of an individual is influenced by genetic and environmental factors.
The maximum growth potential of an individual is decided by hereditary factors. The most
important being nutrition and morbidity, determine the extent of exploitation of that genetic
potential. The height is affected only by long term nutritional deprivation; it is considered an
index of chronic or long duration malnutrition. In children below the age of two years (crown
heal length) should be measured with infantometer. The legs need to be held straight and firm
with the feet touching the sliding board. In order to children and adults heights are measured
with vertical measuring rod using anthropometer or stadiometer. The subject should stand erect
looking straight on a leveled surface with heels together and toes apart, without shoes. The
moving piece of anthropometer should be lowered to rest flat on the top of the lead and the
reading should be taken. Height should be 1/4 of the average of three measurements is taken
as final.

Child Height Growth Indicators And Their Interpretation:

In children the three most commonly used anthropometric indices to assess their growth status
are weight-for-height, height-for-age and weight-for-age. These anthropometric indices can be
interpreted as follows:
Low weight-for-height: Wasting or thinness indicates in most cases a recent and severe
process of weight loss, which is often associated with acute starvation and/or severe disease.
However, wasting may also be the result of a chronic unfavourable condition. Provided there
is no severe food shortage, the prevalence of wasting is usually below 5%, even in poor
countries. The Indian subcontinent, where higher prevalence’s are found, is an important
exception. A prevalence exceeding 5% is alarming given a parallel increase in mortality that
soon becomes apparent. On the severity index, prevalence’s between 10-14% are regarded as
serious, and above or equal 15% as critical. Typically, the prevalence of low weight-for-height
shows a peak in the second year of life. Lack of evidence of wasting in a population does not
imply the absence of current nutritional problems: stunting and other deficits may be present.
High weight-for-height: "Overweight" is the preferred term for describing high weight-for-
height. Even though there is a strong correlation between high weight-for-height and obesity
as measured by adiposity, greater lean body mass can also contribute to high weight-for-height.
On an individual basis, therefore, "fatness" or "obesity" should not be used to describe high
weight-for-height. However, on a population-wide basis, high weight-for-height can be
considered as an adequate indicator of obesity, because the majority of individuals with high
weight-for-height are obese. Strictly speaking, the term obesity should be used only in the
context of adiposity measurements, for example Skinfold thickness.
Low height-for-age: Stunted growth reflects a process of failure to reach linear growth
potential as a result of suboptimal health and/or nutritional conditions. On a population basis,
high levels of stunting are associated with poor socioeconomic conditions and increased risk
of frequent and early exposure to adverse conditions such as illness and/or inappropriate
feeding practices. Similarly, a decrease in the national stunting rate is usually indicative of
improvements in overall socioeconomic conditions of a country. The worldwide variation of
the prevalence of low height-for-age is considerable, ranging from 5% to 65% among the less
developed countries. In many such settings, prevalence starts to rise at the age of about three
months; the process of stunting slows down at around three years of age, after which mean
heights run parallel to the reference. Therefore, the age of the child modifies the interpretation
of the findings: for children in the age group below 2-3 years, low height-for-age probably
reflects a continuing process of "failing to grow" or "stunting"; for older children, it reflects a
state of "having failed to grow" or "being stunted". It is important to distinguish between the
two related terms, length and stature: length refers to the measurement in recumbent position,
the recommended way to measure children below 2 years of age or less than 85 cm tall; whereas
stature refers to standing height measurement. For simplification, the term height is used all
throughout the database to cover both measurements.
Low weight-for-age: Weight-for-age reflects body mass relative to chronological age. It is
influenced by both the height of the child (height-for-age) and his or her weight (weight-for-
height), and its composite nature makes interpretation complex. For example, weight-for-age
fails to distinguish between short children of adequate body weight and tall, thin children.
However, in the absence of significant wasting in a community, similar information is provided
by weight-for-age and height-for-age, in that both reflect the long-term health and nutritional
experience of the individual or population. Short-term change, especially reduction in weight-
for-age, reveals change in weight-for-height. In general terms, the worldwide variation of low
weight-for-age and its age distribution are similar to those of low height-for-age.

7. ANTHROPOMETER-

It is an instrument used for making anthropometric measurements and consisting of four hollow
graduated tubes that fit into one another to form a rigid rod.

It is designed to measure only the vertical dimensions of the human body .the instrument
consist of three aluminium square profiles and a double sided measuring system with a reading
scale from 50- 2133mm. The long axis of the instruments is mounted with a telescopic round
sleeve with a double sided groove that features a dimension reading index. The sleeve is
mounted with a sliding needle, whose tip is applied to the appropriate anthropometric points.
The needles also features a millimetre scale designed to read smaller dimensions. In order to
ensure the anthropometer is perpendicular, the instruments may include a spirit level.

Limitation:

• When taking height measurements such as vertex/ stature, height tragus, height
acromion etc. The subjects should be made to remove his/ her shoes before recording
the reading.
• In case of female subjects, while taking height vertex the hair at the back of the hair
should be let down.
• If the subjects stand against the wall his /her heels and buttocks should not touch the
wall and the head held in ear- eye plane.
Uses:

• The main purpose of the anthropometer is to take larger linear measurements on the
various parts of the body from the ground where the subjects stand to the required
landmarks as well as transverse breadths of the body e.g: arm span.
8. MEASURING OR WEIGHING SCALE (MACHINE)-

An equipment that one can stand on to find out weight or place an object on it to find its weight.
These machines measure how much a particular object weighs these skills give the
measurement of mass in kilograms, grams, pounds etc. Usually the weight machine gives the
weight in kilograms.

Advantages Of Using A Weight Scale:

• Helps in managing the progress: Weighing scale provides accurate data to manage the
process better. Checking your weight can give a sense of accountability that the method
we are following is working for weight loss weight gain.
• Motivates to continue: In additional to this weight scales act as a motivation and
evidence that hard work is paying off, being recognized for work is the biggest
motivation one needs to continue with the journey.
• Tracks productivity: Weight skills track the productivity, this provides with information
on the changes the body is going through at what rate one is losing weight. Before using
weighing scale understand the nature of numbers as this can help have a healthy
perspective when some extra grams appear overnight.
Disadvantages Of Using Weight Scale:

• Weight scale tracks overall body weight, not body fat alone. Therefore one may need
to consider how ones clothes fit or use other muscles to find out whether one has gained
fat or muscles.
• The chances of getting obsessed with the numbers that can have a damaging effect on
the relationship with food body and self esteem are more.
• The amount of water can have an impact on weight and also hormonal fluctuations.
 • Numbers have an inherent danger of linking self worth with weight loss, getting
approved by the pairs and by social influence may have both positive and negative
effect.

9. HANDGRIP DYNAMOMETER-

Handgrip strength is very important as it can be relative and predictive of health condition.
Handgrip dynamometer is an instrument used to measure Isometric strength of arm and forearm
muscles. It can be adjusted for the hand size and must be calibrated for consistent results.

Instructions To Use:

The patient holds the dynamometer in the hand being tested with arm at right angles with the
elbow by the side of the body. Adjust the handle of dynamometer as necessary, making sure
that the base rests on the first metacarpal (heel of the palm) while the handle rests on the middle
of 4 fingers. The patient then squeezes the dynamometer with maximum isometric effort for at
least 5 seconds. The patient is required to not move any other part of the body and is encouraged
to use maximum effort. Different positions can result in varied results: like an arm hanging by
side, extended arm swung above the head then out to the side during squeezing motion etc.

Advantages Of Hangrip Dynamometer:

• Easy to use with simple instructions.
• Easy to interpret as it has different values for different age groups.
• Portable.
• Reliable measurements can be taken.
• It is cost effective and time efficient.

Limitations Of Handgrip Dynamometer:

• Fatigue can induce failure in recording accurate results.
• Imbalance (homeostatic) like hunger for food or being in pain can record false results.
• Not being able to sit idle or constant meddling with equipment can result in false
results.
• Needs professional assistance to instruct and on look the test.
• Average scores/interpretations may not be suitable for all types of people.

(Helen C. Roberts et.al, 2011)

10. MUSCLE STRENGTH: OXFORD SCALE-

Assessment of muscle strength is typically a part of patient’s objective assessment. Muscle

strength can be assessed by a number of ways: manually, functionally or mechanically.

The Oxford scale is commonly used by the physiotherapists to assess muscle strength.
According to Oxford scale there are 0-5 grades for assessment of muscular strength, these are:

0 – No flicker of movement / resting phase

1 – Flicker of movement

2 – Through full range actively with gravity counter balanced

3 – Through full range actively against gravity

4 – Through full range actively against some resistance

5 – Through full range actively against strong resistance

Advantages Of Oxford Scale:

• Simple and easy to assess.

• Cost effective and time efficient.

Disdvantages Of Oxford Scale:

• Poor functional relevance.

• Non linearity, that is 3 & 4 grades are necessarily little different.
• Fatigue can alter grades.
• Only assesses when muscles contract concentrically.

11. SMALL HEIGHT ROD-

This is an instrument which consists of a stand-alone, height scale (20 – 106mm), along which
the head with a reading slot and a retractable tip move. Due to its scope of the scale, the
instrument is primary designated to determine selected vertical dimensions of the lower
extremity.

Applications Of Small Height Rod:

It helps in measuring the sphyrion height only.

12. SPREADING CALIPERS-

This instrument consists of two long arms, the upper half of which are covered outwards and
bounded at one end. The tips of the curved arms are provided with either small knob like
structure with a pointed end.

A scale is fixed at the middle of the left curved arms reaping the other end free. The scale
passes through the socket fixed on the other arm. A screw at the back side of the metal piece
controls the movement of the two arms and graduated scale of the instrument.

Spreading callipers are made in 2 sizes, one of 25cm for taking smaller measurements and
another of 60cm for taking measurements pelvis – pelvimeter. Spreading calliper, curved ends
which have knob like structure is known as spreading calliper with blunt ends while the one
with pointed ends is known as spreading calliper of Martin with pointed ends.

Instructions To Use:

While taking measurements the two arms of the instrument should be held in such a manner
that the curved arms remains between the middle finger below and the thumb above while, the
index finger touch the knob of the arms with the index finger touching the tips of the calliper
it is brought to touch the landmark from where the readings are to be recorded.

Precautions:

Under pressure should not be applied while taking the measurement.

Uses:

• The instrument with blunt ends is used for taking measurement on the lining while the
instrument having sharp or pointed ends is used on the non-lining.
• Measurements such as maximum head length, max head breadth, biauricular,
bizygomatic arch, etc are measured with the help of the spreading calliper with blunt
ends on the lining.
• Measurements such as maximum cranial length, max cranial breadth are taken on skull
with pointed ends.
• It is used in ensuring high accuracy in determining the measurements.
Advantages:

• Can be read directly and these instruments can be applicable for precise scientific work.
• Can be used by unskilled labour.
• Errors are + and – and neutralizes each other.
Disadvantages:

• Awkward to carry and wooden ones absorb moisture in humid condition.

13. PELVIMETER-
This instrument is a classic pelvimeter, ranges 0 to 500mm, fitted with sliding arms and
rounded ends. It is made up of stainless materials, this instrument whose arms are connected
with a steel joint to enhance the balance of the gauge, contains a removable magnifier for better
readability of the scale.

Application:

• Measuring the width and depth dimensions of adult population.

• Measure shoulder width.
• Sagittal diameter of chest.
• Width of pelvis.
Advantages:

• The MRI (magnetic resonance imaging) pelvimetry is free from ionizing radiation.
• Measurements with MRI are as reliable as those with x-ray pelvimetry.
• This tool plays an important role in selecting patients for possible vaginal delivery.
Disadvantages:

• X-ray pelvimetry involves foetal exposure to ionizing radiation.

14. SOFT METRIC TAPE-
In measuring girth dimensions, the tape measure needs to follow the girth accurately, i.e.
adhere to the body and at the same time not compress the soft tissue. Girth dimension are
determined with the help of a 1,500 mm measuring tape. It is recommended to add an extension
loop (e.g. made from a thin string) to the tape measure to facilitate the dimension reading. The
tape measure should undergo regular review for accuracy.
Measuring range: 1 – 1,500 mm, instrument width: 18 mm.

Applications Soft Metric Tape:

• Girth dimensions are measured using a soft metric tape.

• Chest circumference in the normal position – in the back the tape measure runs directly
below the lower angles of the shoulder blades, while in the front in men it goes directly
above the breast nipples (thelion) and in women over the middle of the sternum
(mesosternale). The chest shifts to the normal position to chest is neither in the
inspiratory or the expiratory position. To measure the minimum and maximum chest
circumference, the tape remains in the same position and is tightened or relaxed.
• Arm circumference relaxed – measured at the greatest protuberance of the biceps
brachii (muscles biceps brachii), perpendicular to the axis of the arm, with the arm
relaxed and hanging by the side, at the level of the mid-point between the acromiale
point and the elbow´s tip (olecranon).
• Arm circumference flexed – measured at the same level as the arm circumference
relaxed, with the maximum contraction of the flexors and extensors. The upper limb is
bent at right angle at the elbow joint.
• Waist circumference is measured-at the narrowest point above the iliac crests, half the
distance between the iliac crests and the lower edge of the ribs.
 • Abdominal circumference is measured- at the level of the navel (omphalion)
horizontally; abdominal muscles are relaxed.
• Gluteal circumference (hip girth, buttock girth) – measured horizontally in a standing
position with feet together, at the level of the greatest protuberance of the buttocks (over
underwear or thin sportswear)

15. SLIDING CALIPER-

A sliding caliper featuring a double sided measuring scale from 0 to 230 mm and two measuring
arms (with rounded and sharp ends). The slot of the sliding section (containing an arresting
bolt) features a highlighted index that provides the measured value. Made from stainless steel
with a matte finish, the instrument is designed to determine selected dimensions of the head
(e.g. morphological facial height, nasal height and width, the distance between the inner/outer
eye corners, lower jaw height, mouth width, physiognomic ear length, etc.), hand width, foot
width, etc. The rounded ends serve for measurements carried out on live bodies, while the sharp
ends are used for determining the dimensions of skeletal material. The instrument weighs 193
grams.

Anthropometric measurement of the head using a sliding caliper: width (left) and anterior–
posterior length (right). Performance is assessed with respect to an assumed optimal helmet
position on the head. It is widely regarded that helmet stability is more critical in protecting the
head than retention system strength alone

The aims of the current study were to:

• Identify factors that influence the size of the helmet worn;

• Identify factors that influence in use helmet position and adjustment; and
• Examine the effects of helmet size worn and adjustment on helmet stability.

Advantages:

A sliding caliper was used to measure head anterior–posterior length, the maximum distance
between the glabella and the occiput, and head width (or breadth), the maximum horizontal
distance between the temples above the ears. Head circumference was measured using a
flexible measuring tape placed above the brow.

Sl. Name Age Weight Height Waist Hip

No. (yrs) (kg) (cm) Circumference Circumference
(cm) (cm)
1
2
3
4
 5
6
7
8
9
10

BODY MASS INDEX (BMI)

Sl. Age Weight Height BMI BMI Category

No. (yrs) (kg) (cm) By WHO
1
2
3
4
5
6
7
8
9
10

WAIST HIP RATIO

Sl. Age Waist Hip Waist To Inference

No. (yrs) Circumference Circumference Hip Ratio
(cm) (cm)
1
2
3
4
5
6
7
8
9
10
Inference: