Anthropometric Assessment

8/3/2019 Anthropometric Assessment

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ANTHROPOMETRIC ASSESSMENT

Gr. anthropos, man, human; metron,

measures



INTRODUCTION

• Measurements of the variations of the physicaldimensions and the gross composition of the humanbody 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 anddurable 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 withequal 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 detectdisturbances in nutritional status over short periods orTime or- Identify specific nutrient deficiencies.

• 2. Unable to distinguish disturbances in growth or body

composition Induced by nutrient deficiencies from thosecaused by imbalances in protein and energy intake.




Measurements



GROWTH MEASUREMENTS

• Measurement of head circumference

A narrow, flexible, and non-stretch tape made of fiberglass orsteel about 0 6 cm wide should be used. The subject standsrelaxed with the left side facing the measurer. Looking straight

ahead so that the line of vision is perpendicular to the bodyand 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 orportable anthropometer.



GROWTH MEASUREMENTS

• Measurement of height

– Looking straight ahead the

Frankfurt plane horizontal

– Shoulders relaxed

– Arms at sides

– Legs straight and kneestogether

– Feet flat and with heelsalmost together

–Shoulder blades, buttocks,and heels touchingmeasurement 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 minimumclothing. 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 andtherefore 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 breath

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 theback of the hand facing the measurer.



GROWTH MEASUREMENTS

• Measurement of elbow breath



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)




MEASUREMENTS

• Head circumference for age

Can be used as an index of chronic protein energynutritional status during the first two years of life. Chronic

malnutrition during the first few months of life, orintrauterine growth retardation, may decrease thenumber of brain cells and result in an abnormally lowhead circumference. Beyond age Two years, growth inhead circumference Is so slow that its measurement is no

longer useful [Nutrition Canada, 1980) Headcircumference for age Is not sensitive to less extrememalnutrition (Yarborough et al, 1974)




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 ……..




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.




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 relativelyindependent of ethnic group, particularly for children

aged one to five years (Waterlow et. al, 1977).




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.




MEASUREMENTS

• Weight height ratios

These are frequently used for adults. They measure body

weight corrected for height with the underlyingassumption 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 Ishigher than that of men representing 26.9% of their total

body weight compared to 14 7% for men




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)




COMPOSITION

Calipers used in measuring

skinfold thickness:

• McGaw (digital version)




COMPOSITION


skinfold thickness:

• Lange




COMPOSITION


skinfold thickness:

• Harpenden




COMPOSITION


skinfold thickness:

• Holtain




COMPOSITION

• Triceps skinfoId

Measured at the midpoint of the back of the upper left

arm (Weiner and Loune, 1969)




COMPOSITION

• Triceps skinfoId




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.




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 inthe 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 thesame direction as the inner boarder of the scapula.




COMPOSITION

• Subscapular skinfold




COMPOSITION

• Supraillac skinfold

Measured in the midaxillary line immediately superior to

the midaxillary line and parallel to the cleavage lines of

the skin.




COMPOSITION

• Midaxillary skinfold

The skinfold is picked up horizontally on the midaxillary

line at the level of the xiphoid process.




COMPOSITION

• Midaxillary skinfold




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.




COMPOSITION

• Waist-hip circumference ratio

A simple method for describing the distribution of both

subcutaneous and intra-abdominal adipose tissue.




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 betterestimate 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.).




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.




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 subcutaneoustissue, or both. Changes in MUAC can also be used to monitor

progress during nutritional therapy




COMPOSITION

• Mid-upper arm circumference measurement




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.







ERRORS

The observer or the measurer is one source of error. Theattitude of the observer can greatly influence the qualityof measurement he or she is taking. It is important thathe or she undergoes training on the proper techniques of

getting the measurement and possesses high moralvalues to ensure intellectual honesty in collecting thedata.





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.





ERRORS

Another source of errors is the instrument used fortaking the measurement. Whenever possible, it isadvisable to use the recommended instruments forweighing and taking height. The instrument being used

particularly the weighing scale, must be properlycalibrated and checked from time to time.





ERRORS

Aside from the sources of errors mentioned above, themethod or the system used in assessing or classifying thenutritional 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 thateach and every community health and nutrition workerbe oriented and taught the new reference standards tobe better equipped in their respective tasks.





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.





ERRORS

Measurement errors may be:

Random - which are due to variations or differences inthe measuring and recording technique. These errors

may be committed when the same examiner repeats themeasurements (within or intra-examiner error) or whendifferent examiners repeat the same measurement(between- or inter-examiner error). This type of error

affects precision of measurement.





ERRORS

Random measurement errors may result frominadequate training, defective or faulty instrument, anddifficulties in doing or making the measurement.Although these errors can never be entirely eliminated

(5), they can be minimized or avoided by proper trainingand doing a lot of practice in taking weight and heightmeasurements using standardized techniques; and, byusing precise and properly calibrated instruments.





ERRORS

Systematic - which reduces or affects the accuracy of themeasurement by introducing bias which alters the meanor median values.

Systematic measurement errors may be due toequipment bias, e.g., weighing scales which alwaysoverestimate or underestimate the measurement; thetiming of measurement, for example, taking the weight

after the child has eaten or has gone to the toilet inbetween weightings; and the misclassification of …….





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.




Issues and Concern

NUTRITIONAL ANTHROPOMETRY




ISSUES / CONCERN

Precision is the degree or extent to which repeatedmeasurements of the same variable gives the samevalue; or the ability to repeat a measurement of thesame subject. Oftentimes, it is referred to as

reproducibility or reliability. It involves taking repeatedbut independent measurements on the same child orsubject.





ISSUES / CONCERN

There are two ways to assess reliability of measurement:

– Intra-observer reliability - extent to which ameasure produces the same result at differenttime for the same subjects

– Inter-observer reliability - extent to which ameasure produces the same result on the samechild or subject for the different observers.





ISSUES / CONCERN

Validity is the degree or extent to which anymeasurement or index measures what it purports tomeasure.

Accuracy is the degree or extent to which themeasurement is close to the “true” value”:

• the 'true' value can be considered either the average of

the measurements made by all the observers/measurersor the measurement made by the trainer/supervisor;





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;• accurate measurements, however, necessitate high

precision.

Documents

Anthropometric Assessment