Nutritional Assesment using Anthropometry
- 1. ANTHROPOMETRIC MEASUREMENTS By: Dr. Poonam Khanna, Dr. Rachana Srivastava, Dr. Savitesh Kushwaha School of Public Health, PGIMER, Chandigarh, India Methods Goals Introduction Objectives
- 2. Introduction Nutritional status refers to the state of the health of any individual, it is affected by the intake and utilization of nutrients. Nutritional assessment assesses the severity and magnitude of nutritional problems prevalent in communities due to faulty intake or utilisation of nutrients. •It is influenced by food intake, quantity & the quality & physical health. The spectrum of nutritional status spreads from obesity to severe malnutrition. Methods Objectives Introduction Goals
- 3. Introduction Methods Objectives Goals Goals 1 • To discover facts about the nutritional situation and guide action to improve nutrition and health. • To determine the specific nutritional component which is causing the adverse health effects in an individual and population. 2 • Factual evidence of the exact magnitude of nutritional problems is essential to sensitise administrators and politicians to obtain the allocation of material and human resources and plan appropriate intervention strategies. 3 • In formulating a public health strategy to combat malnutrition, an assessment of the nutritional status of the community is the first step.
- 4. Introduction Methods Objectives Goals • What Type? • Screening (the numbers affected) • Distribution (where?) • Identify the at-risk groups (Who?) • Determine the contributory factors (Why?) Objectives
- 5. Introduction Methods Objectives Goals Methods Methods of Nutritional Assessment Indirect Ecological Factors Health Stats Economic Factors Direct Clinical Dietary Physical Anthropometry Laboratory Body Composition
- 6. Introduction Methods Objectives Goals Methods Length Weight MUAC Head Circumference Chest Circumference Height Weight Bicep Skinfold thickness Hip Circumference Waist Circumference Triceps Skinfold Thickness Subscapular Skinfold Thickness Children Adults Both A N T H R O P O M E T R Y
- 7. Introduction Methods Objectives Goals Methods Frankfurt/Eye- ear/auriculo-orbital plane It was decided that a plane passing through the inferior margin of the left orbit (the point called the left orbitale) and the upper margin of each ear canal or external auditory meatus, a point called the porion, was most nearly parallel to the surface of the earth, and also close to the position the head is normally carried in the living subject. Frankfurt, Germany 1884 (World Congress of Anthropology)
- 8. Introduction Methods Objectives Goals Methods LENGHT Length assesses the maximum vertical size of an infant <2 years. Equipment: 1. Height Board. 2. Alcohol swabs to clean the board. Procedure: 1. Measuring board lying on a flat surface should be used for children. 2. Explain to the mother the reason for taking the length measurement. Explain that you will need their assistance in taking this measure and how they can help. 3. Wipe the height board with an antibacterial surface wipe before taking the measurements. 4. Place the child on the bed of the measuring board with his/her crown touching the headpiece and the mother standing at the head. 5. Straighten the infant’s legs by holding the legs by the ankles and applying gentle downward pressure over the legs with the other hand. 6. Move the infant’s head into the Frankfurt Plane position and ask the mother to hold it and ensure their head is in contact with the headpiece. 7. Releasing your hand from the baby’s ankles, move the footrest on which the measurement reader is mounted to touch the soles of the child’s feet; toes should be pointing directly upwards. 8. Height/length should be recorded in cms to the nearest mm.
- 11. Introduction Methods Objectives Goals Methods WEIGHT Equipment: 1. Child weighing machine or weighing balance. 2. Alcohol swabs to clean the weighing machine. Procedure: 1. If the child is less than two years old, use the lying scales. 2. Ask the mother to remove all clothing from the child (including their nappy). To avoid the child moving too much, ask the mother to help distract the child while you take the weight measurement. 3. The reading from the weight scale should be obtained when the reading becomes stable. We can use the Tare method if the child is scared of both scales. 1. Weigh the mother on the adult weighing scales. 2. Record the weight of the mother. 3. Then ask the mother to repeat the measurement by carrying the child. 4. Record this combined weight. 5. Now we can subtract the mother’s weight with combined weight to get the weight of the child.
- 13. Introduction Methods Objectives Goals Methods MUAC (Mid-upper arm circumference)
- 14. Introduction Methods Objectives Goals Methods MUAC (Mid-upper arm circumference) Mid-upper arm circumference is an anthropometric measure providing information on muscle mass and subcutaneous fat. Equipment: 1. UNICEF/WHO MUAC measuring tape. 2. White eyeliner pencil (to mark the measuring position on the infant’s arm) 3. Alcohol swabs to clean the tape. Procedure: 1. Explain the procedure to the mother. 2. The baby must have a bare arm and shoulder for this measurement. 3. Position the baby in a sitting position on the mother’s lap so you can easily access the left arm. The baby will need to have their elbow bent at a right angle. 4. The mother should hold the left hand to prevent the baby from pulling their arm away. 5. Identify the process of the Acromion (this is the end of the shoulder bone and the tip of the elbow (olecranon process). 6. Using the measuring tape, measure the distance between these points. Divide this measurement in half; this is the mid-point of the upper arm; mark this mid-point with the white eyeliner pen. 7. Pass the tape over the baby’s hand and slip it up the baby’s arm to the mid-point you have marked. 8. Read the measurement to the nearest 0.1cm. Loosen and then reposition the tape, and repeat the measurement two more times.
- 15. Introduction Methods Objectives Goals Methods MUAC (Mid-upper arm circumference)
- 16. Introduction Methods Objectives Goals Methods Head circumference
- 17. Introduction Methods Objectives Goals Methods Head circumference Head circumference measurement is a routine part of a child’s nutritional assessment because it provides important information about growth and development. Equipment: 1. Fibreglass tape/head circumference tape 2. Alcohol swabs to clean the tape. Procedure: 1. Explain the procedure to the mother. 2. Ask the mother to remove hair clips, bobbles, hair bands or hats from the child’s hair/head. 3. Place the measuring tape around the child’s head at its largest diameter midway between the eyebrows and the hairline at the front, above the ears and around the occipital prominence at the back of the head. 4. Aim always to measure the largest circumference possible. 5. Pull the tape snugly to compress the hair. Make sure that the tape passes the occipitofrontal plane (as described above) and does not slip when getting the reading. It may be helpful to ask the mother to hold the tape on the back of the head with a finger. 6. Read the measurement to the nearest 0.1 cm.
- 18. Introduction Methods Objectives Goals Methods Available for birth to 5 years
- 19. Introduction Methods Objectives Goals Methods Chest circumference Axilla Axial Skeleton Sternum
- 20. Introduction Methods Objectives Goals Methods Chest circumference Chest circumference measurement is part of a child’s nutritional assessment because it provides information on low birth weight whenever weighing newborns is not feasible. Equipment: 1. Fibreglass tape. 2. Alcohol swabs to clean the tape. Procedure: 1. Explain the procedure to the mother and remove the clothing. 2. Whilst the child is standing, feel for the xiphisternum where the ribs meet the sternum and mark with a short horizontal line. 3. The tape was wrapped around the head midway on the occipital bone, and for HC, the tape was wrapped under the axillary area around the back to meet at the mid-sternal area at the nipple level. 4. Make sure the tape is level and is not pulled too tight. 5. Take the reading at the end of expiration. 6. Read the measurement to the nearest 0.1 cm. 7. Record three measurements and calculate the mean. <30.5cm (low risk for LBW) <29.5cm (high risk for LBW) >=30.5 (Normal) For new born only
- 21. Introduction Methods Objectives Goals Methods Length Weight MUAC Head Circumference Chest Circumference Height Weight Bicep Skinfold thickness Hip Circumference Waist Circumference Triceps Skinfold Thickness Subscapular Skinfold Thickness Children Adults Both A N T H R O P O M E T R Y
- 22. Introduction Methods Objectives Goals Methods HEIGHT Standing height is an assessment of maximum vertical size. Equipment: 1. Height Board. Procedure: 1. Ask the person to remove hair ornaments, jewellery, buns, or braids from the top of the head. 2. Direct the person to the stadiometer platform. 3. Instruct the person to stand with the heels together and toes apart. The toes should point slightly outward at approximately a 60ºangle. 4. Check that the back of the head, shoulder blades, buttocks, and heels contact the board. 5. Align the head in the Frankfort horizontal plane. The head is in the Frankfort plane when the horizontal line from the ear canal to the lower border of the orbit of the eye is parallel to the floor and perpendicular to the vertical backboard. 6. Instruct the person to stand as tall as possible, take a deep breath, and hold this position. *The instructor should always be taller than the participant.
- 23. Introduction Methods Objectives Goals Methods WEIGHT Equipment: 1. Weighing machine Procedure: 1. Participant will be weighed in kilograms using a digital/analogue weight scale. 2. The participants will be asked to remove their shoes, ornaments, wallets etc. and to have minimal clothing. 3. The participant should be directed to step on and stand in the centre of the scale platform facing the recorder, hands at the sides, and looking straight ahead (Frankfurt plane). 4. The reading from the weight scale should be obtained when the reading becomes stable.
- 24. Introduction Methods Objectives Goals Methods Biceps Skinfold Thickness Do not take a skinfold measurement reading if you cannot construct a fold with two skin thicknesses and underlying fat. Repeatedly pressing of skinfold may dilate the fats and leads to inaccurate measurements.
- 25. Introduction Methods Objectives Goals Methods Biceps Skinfold Thickness The biceps skinfold provides information about the body, and the calculated muscle mass provides information on the protein reserves. Equipment: 1. Skinfold Caliper. 2. Alcohol swabs to clean the calliper. Procedure: 1. Ask the person to remove excess clothes from the upper body and have visible arms. 2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders relaxed, and the arms hanging loosely at the sides. 3. Flexing or tightening the arm muscles will yield an inaccurate measurement. 4. Using your thumb and index finger, grasp a fold of skin and subcutaneous adipose tissue approximately 2.0 cm above the mid-arm circumference mark and anterior surface of the arm. 5. Holding the skinfold 2.0 cm above the circumference mark, place the tips of the calliper jaws over the complete skinfold. 6. Ensure that the mark remains centred between the tips and that the jaws sit perpendicular to the length of the skinfold. 7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.
- 26. Introduction Methods Objectives Goals Methods Hip Circumference Data from most of the cross‐sectional studies suggested that waist circumference or waist-hip ratio are better indicators than BMI of the risk of diabetes. Equipment: 1. Fibreglass tape. 2. Alcohol swabs to clean the tape (if measurement is taken on the skin). Procedure: 1. Ask the person to remove excess clothes from the upper and lower body. 2. The participant should be made to stand straight; the head should be in the eye- ear plane and 60-degree angle between the toes. 3. Measure the hip circumference at a level parallel to the floor, at the largest circumference of the buttocks. 4. Ensure that the skin is not pressed too much or loose, and the tape should be in the horizontal plane. 5. Read the measurement to the nearest 0.1 cm from the sides. Cutoffs for Adults WHRs (ADA) Male: ≥0.88 Female: ≥0.81 https://doi.org/10.2337/diacare.26.5.1380
- 27. Introduction Methods Objectives Goals Methods Length Weight MUAC Head Circumference Chest Circumference Height Weight Bicep Skinfold thickness Hip Circumference Waist Circumference Triceps Skinfold Thickness Subscapular Skinfold Thickness Children Adults Both A N T H R O P O M E T R Y
- 28. Introduction Methods Objectives Goals Methods Waist Circumference WHO Guideline to measure the waist circumference.
- 29. Introduction Methods Objectives Goals Methods Waist Circumference Waist circumference can be used as a screening tool but is not diagnostic of an individual’s body fatness or health. Equipment: 1. Fibreglass tape. 2. Alcohol swabs to clean the tape (if measurement is taken on the skin). Procedure: (WHO) 1. Ask the person to remove excess clothes from the upper body. 2. The participant should be made to stand straight; the head should be in the eye- ear plane and 60-degree angle between the toes. 3. Locate the iliac crest and the lower rib of the participant. 4. Mark a mid-point between the iliac crest and the lower rib. 5. Measure the horizontal plane midway between the lowest rib and the iliac crest at normal expiration. 6. Ensure that the skin is not pressed too much or loose, and the tape should be in the horizontal plane. 7. Read the measurement to the nearest 0.1 cm from the sides.
- 30. Introduction Methods Objectives Goals Methods Waist Circumference Cutoffs for Adults (IDF) Cutoffs for Adults (ADA) Male: ≥85cm Female: ≥80cm
- 31. Introduction Methods Objectives Goals Methods Waist Circumference WC>90th Percentile will be considered central obesity (CNNS) (Sarna et al., 2020) Cutoffs for Children and Adolescents
- 32. Introduction Methods Objectives Goals Methods Triceps Skinfold Thickness (TSFT) The triceps skinfold provides information about the body, and the calculated muscle mass provides information on the protein reserves. Equipment: 1. Skinfold Caliper. 2. Alcohol swabs to clean the calliper. Procedure: 1. Ask the person to remove excess clothes from the upper body and have visible arms. 2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders relaxed, and the arms hanging loosely at the sides. 3. Flexing or tightening the arm muscles will yield an inaccurate measurement. 4. Using your thumb and index finger, grasp a fold of skin and subcutaneous adipose tissue approximately 2.0 cm above the mid-arm circumference mark. 5. Holding the skinfold 2.0 cm above the circumference mark, place the tips of the calliper jaws over the complete skinfold. 6. Ensure that the mark remains centred between the tips and that the jaws sit perpendicular to the length of the skinfold. 7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.
- 34. Introduction Methods Objectives Goals Methods Subscapular Skinfold Thickness (TSFT) The skinfold provides information about the body, and the calculated muscle mass provides information on the protein reserves. Equipment: 1. Skinfold Caliper. 2. Alcohol swabs to clean the calliper. Procedure: 1. Ask the person to remove excess clothes from the upper body and have visible scapula. 2. Have the participant stand upright with the weight evenly distributed on both feet, the shoulders relaxed, and the arms hanging loosely at the sides. 3. Open the back of the gown and palpate for the inferior angle, or triangle portion, of the right scapula. 4. Make the first line at 45 degrees to the spine and cross this with a line that bisects the inferior angle of the scapula. 5. Using your thumb and index finger, grasp a fold so that the index finger remains situated roughly 2.0 cm above and medial to the inferior angle of the scapula. 6. Position the tips of the caliper jaws over the complete skinfold perpendicular to the length of the fold and roughly 2.0 cm lateral to the fingers 7. Release the caliper handle to exert full tension on the skinfold. Wait 3 seconds for the needle on the caliper dial to settle on an accurate measurement. Read the thickness to the nearest 0.1 mm.
- 36. Introduction Methods Objectives Goals Methods Body Fat % Formulas
- 37. Introduction Methods Objectives Goals Methods https://dapa-toolkit.mrc.ac.uk/anthropometry/objective-methods/simple-measures-skinfolds Body Fat % Formulas
- 38. Introduction Methods Objectives Goals Methods BMI BMI=Kg/m2 WHO 2022 The Lancet 2004
- 39. Introduction Methods Objectives Goals Methods BMR (Basal Metabolic Rate) Basal Metabolic Rate (BMR) is the number of calories you burn as your body performs basic (basal) life-sustaining functions. Sex Age (years) Prediction equation proposed by FAO/WHO/UNU Consultation (2004) Males 18-30 15.1xB.W.(kg)+692.2 30-60 11.5xB.W.(kg)+873 >60 11.7xB.W.(kg)+587.7 Females 18-30 14.8xB.W.(kg)+486.6 30-60 8.1xB.W.(kg)+845.6 >60 9.1xB.W.(kg)+658.5 B.W.= Body Weight For a 60 kg adult (20 y) inactive male. BMR of Indians is 10% and 9% lower for males and females, respectively, than the international values (FAO/WHO/UNU, 2004). For a 60 kg adult (20 y) male, the BMR equation used is (15.1xB.W.(kg)+692.2), and the resultant value is multiplied by 0.90 to obtain the BMR of 1438 kcal/d.
- 40. Introduction Methods Objectives Goals Methods PAL (Physical Activity Level) The PAL, also achievement conversion, describes the amount of energy that is needed in addition to the metabolic rate in order to achieve physical performance. Physical activity level or energy requirement expressed as a multiple of 24-hour BMR. Level of activity ICMR 2020 FAO/WHO/UNU 2004 Sedentary Work 1.40 1.40-1.69 Moderate Work 1.80 1.70 – 1.99 Heavy Work 2.30 2.00 – 2.40* *PAL Value > 2.40 is difficult to maintain over a prolonged period. Physical Activity Level (PAL)/ Physical activity Factor (PAF) Men Women BMR x 1.4 inactive BMR x 1.4 inactive BMR x 1.7 moderately active BMR x 1.6 moderately active BMR x 1.9 very active BMR x 1.8 very active TEE=1438*1.4 TEE=2013.2 kcal/day Moderate BMR*PAL factor = TEE Sedentary BMR*PAL = kcal