amyanthropometry-130824161551-phpapp02

ANTHROPOMETRY

Anthropometry: Introduction

A branch of anthropology that involves the quantitative measurement of the human body.

*Anthropometry - Amarendra B. Singh 090201263*

Anthropometry - Amarendra B. Singh 090201263

Anthropometric MethodsAnthropometry is the measurement of body height, weight & proportions.It is an essential component of clinical examination of infants, children & pregnant women.It is used to evaluate both under & over nutrition.The measured values reflects the current nutritional status & dont differentiate between acute & chronic changes .

*

Classification of ageNeonates= birth to 28 daysInfant= till one year of ageToddler= 1-3 yearsPre-schoolar= 4-6 yearsSchoolar= 6-12 yearsAdolescents=13-19years



Anthropometric MeasurementsHeight, weightMid-arm circumference(1-5years)

Head circumference

chest circumference

Skin fold thickness

Hip/waist ratio

*

Anthropometry for children

*

Weight The measurement of weight is most reliable criteria of assessment of health and nutritional status of children.

The weight can be recorded using a :

Beam type weighing balance Electronic weighing scales for infants and children Bathroom type of mechanical scale (very unreliable) Salter spring machine (in field conditions) *Anthropometry - Amarendra B. Singh 090201263*

Anthropometry - Amarendra B. Singh 090201263Monitoring the weight is helpful in diagnosing malnutrition at early stage*

The periodic recording of weight on a growth chart is essential for monitoring the growth of under-five children.

Growth Velocity :

0-4 months 1.0kg/month(30g/day)

5-8 months 0.75kg/month(20gm/day) 9-12 months 0.50kg/month(15g/day) 1-3 years 2.25kg/yr 4-9 years 2.75 kg/yr 10-18 years 5.0-6.0kg/yr (0.5kg/month)

B. Weight at 4-5 months 2 x birth weight Weight at 1 year 3 x birth weight Weight at 2 years 4 x birth weight Weight at 7 years 7 x birth weight



*

Length or Height/Stature Measurement TechniqueUpto 2 years of age Recumbent Length is measured with the help of an Infantometer .

In older children Standing Height or Stature is recorded. It is convenient to use an Inbuilt Stadiometer affixed on the wall which provides a direct read out of height with an accuracy of +/- 0.1cm.

Nutritional deprivation over a period of time affects the stature or linear growth of the child.


Anthropometry - Amarendra B. Singh 090201263Tragion- an anthropometric point situated in the notch just above the tragus of the ear.*

Technique of length measurement The infant is placed supine on the infantometer.

Assistant or mother is asked to keep the vertex or top of the head snugly touching the fixed vertically plank.

The leg are fully extended by pressing over the knee, and feet are kept vertical at 90 , the movable pedal plank of infantometer is snuggly apposed against soles and length is read from scale.



Technique for height measurementIn older children who can stand , height can be measured by the rod attached to the lever type machine or by stadiometer.

Child should stand with bare feet on the flat floor against a wall with fit parallel and with heels buttocks, shoulders and occiput touching the wall. Head should be kept in Frankfurt plane.

With the help of a wooden spatula or plastic ruler. The topmost point of the vertex is identified on the wall.



Height Velocity

A


At birth 50cms Gain during 1st year 25cms Gain during 2nd year 12.5cmsGain during 3rd year 7.5 to 10cmsGain during 3 12 years 5 to 7.5cmsAdolescence 8cms/yr for girls during 12 to 16 years 10cms/yr for boys during 14 to 18 years

Birth to 3 months 3.5cm/month 3 6 months 2.0cm/month 6 9 months 1.5cm/month 9 12 months 1.3cm/month 2 5 years 6 8cm/year 5 12 years 5cm/year

AGE Approximate rate of increase in stature


Degree of malnutrition Expected weight ______________ x 100Actual weight(kg)*Anthropometry - Amarendra B. Singh 090201263*


WEECHS FORMULA3 12 months Expected weight(kg) = age (months) + 9 / 21- 6 years Expected weight(kg) = age (years) x 2 + 87 12 years Expected weight(kg) = age (years) x 7 - 5 / 2*Anthropometry - Amarendra B. Singh 090201263*

Anthropometry - Amarendra B. Singh 090201263Used to calculate expected weight between the ages of 3 months and 12 years*

Classification of Malnutrition by Indian Academy of Pediatrics*Anthropometry - Amarendra B. Singh 090201263*

Weight for age *Grade of malnutrition>80 %71-80%61-70%51-60%

B] Expected height upto 12 yrs

length or height (in cms) = age in years x 6 +77 ( wheechs formula )



WEIGHT-FOR-HEIGHT Weight-for-height = Weight of the patient (kg) X 100 Weight of normal child of same height

The nutritional status can be expressed as follows on the basis of weight-for-height:

*Reference standard NCHS data *Anthropometry - Amarendra B. Singh 090201263*

Weight-for-Height *Nutritional Status>90%85-90 %75-80 %

The term Macrocephaly refers to OFC of more than 2SD above the mean while Microcephaly refers to OFC more than 3SD below the mean for age , sex , height and weight.



Video



Chest circumferenceIt is usually measured at the level of nipples, preferably in mid inspiration.XiphisternumIn children

5 years - standing position*Anthropometry - Amarendra B. Singh 090201263*


Relationship between head size with Chest Circumference:

At birth: head circumference > chest circumference by upto 3 cms.

At around 9 months to 1 year of age: head circumference = chest circumference,

but thereafter chest grows more rapidly compared to the brain.



The head circumference is greater than chest circumference by more than 3 cms in :

a) preterms b) small-for-date , & c) hydrocephalic infants

In malnourished children, chest size may be significantly smaller than head circumference because growth of brain is less affected by undernutrition.

Therefore there will be considerable delay before chest circumference overtakes head circumference.*Anthropometry - Amarendra B. Singh 090201263*


AGE INDEPENDENT CRITERIA FOR ASSESSMENT OF NUTRITIONAL STATUSMid-upper arm circumferenceThickness of subcutaneous fatBody ratiosWeight for heightBody mass indexUpper segment/ lower segment ratioArm spanObesity



MID-UPPER ARM CIRCUMFERENCEDuring 1-5 Yrs of age it remains reasonably static between 15-17cms among healthy children .

It is conventionally measured over the left upper arm , at a point marked midway between acromion (shoulder) and olecranon (elbow) with arm bent at right angle.

The child is asked to stand or sit with the arm hanging loose at the side.

MUAC is measured with a fiber glass or steel tape.

If it is less than 12.5 cm it is suggestive of severe malnutrition.If it is between 12.5 -13.5 cm it is indicative of moderate malnutrition.



Bangle test quick assessment of arm circumference. A fiber glass ring of internal diameter of 4 cm is slipped up the arm, if it passes above the elbow, it suggests that upper arm is less than 12.5 cm and child is malnourished.

Shakir tape is a fiber-glass tape with

red less than 12.5 cmyellow 12.5- 13.5 cm green greater than 13.5 cmshading so that paramedical workers can assess nutritional status without having to remember the normal limits of mid arm circumference.*Anthropometry - Amarendra B. Singh 090201263*


QUAC stick Quaker Upper Arm Circumference Stick

It is developed on the principle that acute starvation severely affects mid-arm circumference while height is unaffected.It is a height measuring rod, calibrated in MAC.Values of 80% MAC for Ht. are marked on stick at corresponding ht. levelsThe malnourished child would be taller than the anticipated height derived from the mid-arm circumference


MAC (cm) Ht. (cm)16.5133.013.5103.512.570.0


Skinfold thicknessMeasured with Herpendens caliperTriceps or subscapular region

The skinfold with subcutaneous fat is picked up with thumb and index finger, and caliper is applied beyond the pinch.

Fat thickness

>10mm - healthy children 1-6 years

Body ratiosRao & Singhs weight-height index:

= [weight (kg) / (height)2 cms ] * 100 normal index is more than 0.15

Kanawati index: (during 3m to 4 years)

= Mid-arm circumference / Head circumference*Anthropometry - Amarendra B. Singh 090201263*

Normal 0.331Mild 0.310 0.280Modreate 0.279 0.250Severe < 0.250


Classification When malnutrition has been chronic, the child is stunted, weight-for-age is low/normal

height-for-age is lowweight-for-height is normal.

In Acute malnutrition, the child is wasted,

weight-for-age is lowheight-for age is normalweight-for-height is low*Anthropometry - Amarendra B. Singh 090201263*


BODY MASS INDEX (BMI)A BMI-for-age of > 85th percentile is suggestive of Overweight.

A BMI-for-age of > 95th percentile is or when it is associated with triceps or skinfold thickness-for-age of > 90th percentile, it is diagnostic of Obesity.



Measurements for adultsHeight:The subject stands erect & bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault & height is recorded to the nearest 0.5 cm.

*

WEIGHT MEASUREMENTUse a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable.Weigh in light clothes, no shoesRead to the nearest 100 gm (0.1kg)

*

Nutritional Indices in AdultsThe international standard for assessing body size in adults is the body mass index (BMI).BMI is computed using the following formula: BMI = Weight (kg)/ Height (m)Evidence shows that high BMI (obesity level) is associated with type 2 diabetes & high risk of cardiovascular morbidity & mortality

FSC (F)*

BMI (WHO - Classification)BMI < 18.5 = Under WeightBMI 18.5-24.5= Healthy weight rangeBMI 25-30 = Overweight (grade 1 obesity)BMI >30-40 = Obese (grade 2 obesity)BMI >40 =Very obese (morbid or grade 3 obesity)

*

Waist/Hip RatioWaist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.

The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together.The measurement should be taken at the end of a normal expiration.

*

Waist circumferenceWaist circumference predicts mortality better than any other anthropometric measurement.

It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified MALESFEMALELEVEL 1 > 94cm > 80cmLEVEL2 > 102cm> 88cm

*

Waist circumference/2Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain.

Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes & CVS complications.

*

Hip Circumference Is measured at the point of greatest circumference around hips & buttocks to the nearest 0.5 cm.The subject should be standing and the measurer should squat beside him.Both measurement should taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue.

*

Interpretation of WHRHigh risk WHR= >0.80 for females & >0.95 for males i.e. waist measurement >80% of hip measurement for women and >95% for men indicates central (upper body) obesity and is considered high risk for diabetes & CVS disorders.A WHR below these cut-off levels is considered low risk.

*

HEAD CIRCUMFERENCE

Brain growth takes place 70% during fetal life, 15% during infancy and remaining 10% during pre-school years.

Head circumference are routinely recorded until 5 years of age.

If scalp edema or cranial moulding is present , measurement of scalp edema may be inaccurate until fourth or fifth day of life .

The head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front.



Expected head circumference in children*Anthropometry - Amarendra B. Singh 090201263*

Age Head circumference (cm) At birth 34 35 2 months 38 3 months 40 4 months 41 6 months 42 - 43 1 year 45 - 46 2 years 47 - 48 5 years 50 - 51


Head Circumference Growth Velocity

During first year there is 12 cm increase in head circumference , while 1 5 year age , only 5 cm gain occur in head size.

Adult head size is achieved between 5 to 6 years .

the following formula (Dines formula) is used for estimating the head circumference in the first year of life : - ( length in cm + 9.5 ) 2.59 2*Anthropometry - Amarendra B. Singh 090201263*

Till 3 months 2 cm/month 3 months 1 year 2cm/3 month 1 3 year 1cm/ 6 month 3 5 year 1cm/ year


Ponderal index : - it is another parameter which is similar to BMI and is used for defining newborn babies with intrauterine growth retardation.

PI = (Body weight in grams) 100 length (cm) In malnourished small-for-date babies (asymmetric IUGR), ponderal index is

PROPORTIONAL TRUNK AND LIMB GROWTHThe mid-point of the body in newborn is at umbilicus whereas in an adult the mid-point shifts to the symphysis pubis due to greater growth of limbs than trunk.

The UPPER SEGMENT (vertex to upper edge of symphysis pubis) to LOWER SEGMENT (symphysis pubis to heels) ratio at birth is 1.7 to 1.0 .

This gradually becomes 1.0 to 1.1 in healthy adults.

In infants upper segment (crown to symphysis pubis) can be measured by using infantometer.

The lower segment is obtained by subtracting the upper segment from total length.



Clinical signs of nutritional deficiencyHAIR

Spare & thinProtein, zinc, biotindeficiencyEasy to pull outProtein deficiencyCorkscrewCoiled hairVit C & Vit Adeficiency

*

Clinical signs of nutritional deficiencyMOUTH

GlossitisRiboflavin, niacin, folic acid, B12 , pr.Bleeding & spongy gumsVit. C,A, K, folic acid & niacinAngular stomatitis, cheilosis & fissured tongueB 2,6,& niacinleukoplakiaVit.A,B12, B-complex, folic acid & niacinSore mouth & tongueVit B12,6,c, niacin ,folic acid & iron

*

Clinical signs of nutritional deficiencyEYES

Night blindness, exophthalmiaVitamin A deficiencyPhotophobia-blurring, conjunctival inflammationVit B2 & vit Adeficiencies

*

Clinical signs of nutritional deficiencyNAILS

SpooningIron deficiencyTransverse linesProtein deficiency

*

Clinical signs of nutritional deficiencySKIN

PallorFolic acid, iron, B12Follicular hyperkeratosisVitamin B & Vitamin CFlaking dermatitisPEM, Vit B2, Vitamin A, Zinc & NiacinPigmentation, desquamationNiacin & PEMBruising, purpuraVit K ,Vit C & folic acid

*

Clinical signs of nutritional deficiencyThyroid glandin mountainous areas and far from sea places Goiter is a reliable sign of iodine deficiency.

*

Clinical signs of nutritional deficiencyJoins & bonesHelp detect signs of vitamin D deficiency (Rickets) & vitamin C deficiency (Scurvy)

*

Infantile upper segment to lower segment ratio (trunk abnormally large or limbs abnormally small) is seen in :

AchondroplasiaCretinismShort limbed dwarfismSexual precocityBowed legs*Anthropometry - Amarendra B. Singh 090201263*


Advanced upper segment to lower segment ratio (trunk abnormally short or limb abnormally long) is seen in:

ArachnodactylyHypogonadismEunuchoidismTurner SyndromeKlinefelters SyndromeChondrodystrophySpinal deformities (rickets, potts spine)



ARM SPAN It is the distance between the tips of middle fingers of both arms outstretched at right angles to the body, measured across the back of the child.

In under-5 children , arm span is 1 to 2 cm smaller than body length.

During 10-12 years of age , arm span = height.

In adults arm span is more in adults by 2 cm.



Abnormally large arm span is seen in patients with Arachnodactyly (Marfan syndrome)EunuchoidismKlinefelters SyndromeCoarctation of aorta

Arm span is short compared to height in patients with :Short limbed dwarfismCretinismAchondroplasia



ADVANTAGES OF ANTHROPOMETRYLess expensive & need minimal training

Readings are reproducible.

Objective with high specificity & sensitivity

Measures many variables of nutritional significance (Ht, Wt, MAC, HC, skin fold thickness, waist & hip ratio & BMI).

Readings are numerical & gradable on standard growth charts

Limitations of AnthropometryInter-observers errors in measurement

Limited nutritional diagnosis

Problems with reference standards, i.e. local versus international standards.

Arbitrary statistical cut-off levels for what considered as abnormal values. *Anthropometry - Amarendra B. Singh 090201263*


Thank you*Anthropometry - Amarendra B. Singh 090201263*


*

*

*

Monitoring the weight is helpful in diagnosing malnutrition at early stage*

*Tragion- an anthropometric point situated in the notch just above the tragus of the ear.*Used to calculate expected weight between the ages of 3 months and 12 years**

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

Documents

amyanthropometry-130824161551-phpapp02