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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
Fat Free mass muscle mass and
total body 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 breadth
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
Elbow breadth is a measure of the width of
one's elbow. It is sometimes used to determine
a person's body frame size. There are three
main frame sizes: small, medium and large. A
person who falls into the small category is
generally expected to weigh less than an
individual with a large frame. Therefore,
figuring out the size of one's body frame is a
way of taking differences between individuals.
GROWTH MEASUREMENTS
Measurement of elbow breadth
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
Subscapular skinfold
Landmark
The lower angle of the scapula
(bottom point of shoulder blade)
If there is difficulty finding this
landmark, get the subject to
reach behind their back with
their right arm, while feeling for
the movement of the scapula
Pinch

The pinch is made following


the natural fold of the skin,
approximately on a line
running laterally (away from
the body) and downwards (at
about 45 degrees).
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.
Suprailiac or abdominal skinfold thickness
measured with a skinfold caliper as a predictor
of body density
Diagonal fold, directly above iliac crest.
The iliac crest is the curved ridge at the top of
the pelvic bone. It forms the prominent bone of
the hip.
ANTHROPOMETRIC ASSESSMENT
OF BODY COMPOSITION
Midaxillary skinfold
The skinfold is picked up horizontally on the
midaxillary line at the level of the xiphoid process.
Related Pages
ANTHROPOMETRIC ASSESSMENT
OF BODY COMPOSITION
Midaxillary skinfold
This measurement site is
not commonly used.
This site has also been

known as the Axilla and


Midaxillary
Midaxillary Site. skinfold
Some variations of this

site has the measurement


taken horizontally.
Body

Fat Caliper
All measurement should be madeProcedures
on the right side of the
body
Caliper should be placed 1 cm away from thumb and
finger, perpendicular to skinfold, and halfway between crest
and base of fold
Pinch should be maintained while reading the caliper
Wait 1 to 2 s (and not longer) before reading caliper
Take duplicate measures at each site and retest if duplicate
measurements are not within 1 to 2 mm
Rotate through measurement sites or allow time for skin to
regain normal texture and thickness
Body Fat Caliper Procedures

Source: American College of Sports


Medicine. ACSM's Guidelines For
Exercise Testing and Prescription. 6th
Edition. USA, Lippincott Williams &
Wilkins 2000.
ONLINE BODY FAT CALCULATOR

FOR MEN AND WOMEN


Body Fat and Skinfold Thickness
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
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
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

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;
NUTRITIONAL ANTHROPOMETRY
ISSUES / CONCERN
accurate measurements, however, necessitate
high precision.