BASIC ANTHROPOMETRY IN ADULTS AND CHILDREN

Based on Dept of Physiology Protocol by Prof Edith Fuetre Power-Point by Drs RM Abraham and Margie Matthews Clinical Skills NRMSM UKZN July 2011

Anthropometry: Introduction

A branch of anthropology that involves the quantitative measurement of the human body. It is the single most portable, universally applicable, inexpensive and non-invasive technique for assessing the size, proportions and composition of the human body. Appropriate use and interpretation from infancy to old age is a valuable tool for guiding the health and nutritional status of individuals and populations. Paediatricians have long used child growth as an important parameter to evaluate the health and well-being of children.

Anthropometric Parameters
Basic measurements Height (length) Weight (mass) Circumference eg OFC (infant up to age 2years only) Skin-fold thickness Derived measurements of body composition and interrelationships (e.g BMI, waist-hip ratio) Some measurements used for nutritional assessment include: Height Mass BMI Triceps skin-fold Waist, Hip and Midarm circumference (MAC) and derived measurements/ ratios

Height/Stature Measurement Technique

The subject must be barefoot, wearing as little clothing as possible The subject stands on a flat surface, at a right angle to the vertical board of the stadiometer His/her weight is distributed evenly over both feet, with the head positioned in the Frankfurt Horizontal Plane (in this position, the most inferior point on the left orbital margin is at the same horizontal level as the left tragion the line of vision is approximately horizontal ) The arms hang freely by the sides of the trunk, with palms facing the thighs

The subject places his/her heels together, with both heels touching the base of the vertical board The medial borders of the feet are at an angle of about 60 The scapulae and buttocks must also be in contact with the vertical board The subject must inhale deeply and maintain a fully erect position without altering the load on the heels The movable head board is brought onto the most superior point on the head with sufficient pressure to compress the hair The measurement is taken to the nearest 1 mm

Height/Stature Measurement

Mass/Weight Measurement Technique

Subject must be barefoot and wear as little clothing as possible. Subject stands on the platform of the scale with his/her weight distributed evenly over both feet. The arms hang by the sides of the trunk, with palms facing the thighs . The subject is instructed to maintain a stable position while the measurement is taken. The measurement is taken to the nearest 0.1 kg .

Body Mass Index

This ratio is expressed in Kg/m2 and provides a rough estimation of the body mass status of the individual in relation to his/her height.

BMI Ranges and Co-morbidity Risk

ANTHROPOMETRY QUANTIFYING OBESITY WITH BODY MASS INDEX (WEIGHT/HEIGHT) BMI (kg/m) 18.5 - 24.9 25.0 - 29.9 >30 30.0 - 34.9 35.0 - 39.9 > 40.0 CLASSIFICATION* Normal range Overweight Obese Class I Class II Class III Moderate Severe Very severe RISK OF OBESITY COMORBIDITY Negligible Mildly increased

* Classification of the World Health Organisation (WHO) and International Obesity Task Force

Waist-to-Hip Circumference Ratio

An indicator of the pattern of distribution of subcutaneous adipose tissue. Distribution of fat is an important indicator of CHD (coronary heart disease) More fat in the abdominal area increases risk of CHD.

Men generally have a higher ratio than women Women 0.85-1.7 (high risk)and <0.85 (Low risk) Men 0.95-1.9 (high risk) and <0.95 (Low risk)

Waist-to-Hip Circumference Ratio Measurement Technique

Waist circumference A good quality nonstretchable measuring tape should be used. View the patient from the front. Locate the narrowest point between ribs and iliac crests. Ensure that the tape measure is at the same height around the waist. Measure and state the measurement correctly to the nearest centimetre.

Waist-to-hip circumference ratio

Hip circumference View the patient from the front. Locate the greater trochanter. Hip measurement is taken at the widest lateral extension of the hips. Ensure that the tape measure is horizontal. Measure and state the measurement correctly to the nearest centimetre. Calculate Waist/Hip Ratio to 2 decimal places.

Measures of body composition

Weight loss, per se, does not provide the nutritionist with an indication of type of tissue lost (i.e. weight loss due to loss of adipose tissue or loss of muscle tissue). Measurements of skin-folds, mid-arm circumference and mid-arm muscle circumference therefore provide a more comprehensive picture of body composition/ changes.

Mid-arm circumference (MAC)

Locate the midpoint of the arm. Non-dominant arm elbow flexed at 90deg with palm facing upwards Measurer stands behind the subject & locates the lateral tip of the acromion and the most distal point on the olecranon process Place a tape measure so that it passes between these 2 landmarks and mark the midpoint Measure the midarm circumference The subject stands erect with arms hanging freely at the sides and the palms facing the thighs Place the tape measure perpendicular to the long axis of the arm at the marked midpoint & measure the circumference to the nearest mm. (e.g. 18.1 cm) Provide the actual MAC in cm.

Skin-fold measurements

Approximately half of the total amount of fat tissue in the human body is located below the surface of the skin. This makes it possible to predict total body fat from skin-fold thicknesses with a relative high degree of accuracy using a simple two-compartmental method. This accuracy is confirmed by CT scan as well as ultrasonic and radiographic

In general, when measuring skinfold thickness,

The assessor, using the forefinger and the thumb, grasps and lifts the subcut. tissue and skin from the underlying muscle.
Places the pincers of the skin-fold caliper, applying a constant pressure, 2cm below the fingers at a depth of 1cm. Holds this position for 3-4seconds.

Takes three measurements for accuracy.

Provides the actual skin-fold thickness in mm.

Triceps skin-fold (TSF)

A measure of subcutaneous fat stores taken at the midpoint of the posterior aspect of the humerus. Correlates closely with percentage of body fat and with total body fat. Triceps skin-fold thickness varies between 6 -12mm in lean individuals and between 40 - 50mm in obese individuals.

Triceps skin-fold measurement technique

Subject should be standing with arms hanging loosely at the sides. Assessor to be positioned behind the subject. To locate the triceps skin-fold site, locate the site previously marked for the midarm circumference measurement (MAC). The triceps skin-fold site is on the posterior surface of the arm, midway between the shoulder and the elbow. Using the forefinger and the thumb the assessor grasps and lifts the subcut. tissue and skin 2cm above TSF site. Place the pincers of the skin-fold caliper at the TSF point at a depth of 1cm. Hold this position for 3-4seconds. Take three measurements for accuracy. Provide the actual skin-fold thickness in mm.

Mid-arm muscle circumference (MAMC)

TSF is preferably used in conjunction with subscapular, biceps and supra-iliac skin-fold measurements to determine actual percentage body fat from set equations or in conjunction with MAC to determine mid-arm muscle circumference. MAMC provides an index of muscle mass. MAMC (cm)= MAC (cm) - [3.14 x TSF (cm)]

Standard adult values (helps interpret the above body compositional measurements) Triceps skin-fold (mm) Male 12.5 Female 16.5

Mid-arm circumference (cm) Male 29.3 Female 28.5

Mid-arm muscle circumf. (cm) Male 25.3 Female 23.2

Other skin-folds measured

Besides the most commonly used triceps skin-fold, other commonly measured skin-folds include the following: Biceps skin-fold Subscapular skin-fold Supra-iliac skin-fold

Biceps skin-fold measurement technique

Locate the biceps skin-fold site: The assessor positioned in front of the subject. Subject should be standing erect with arms hanging loosely at their sides. To locate the biceps skin-fold site, locate the level previously marked for the mid-arm circumference measurement. The biceps skin-fold site is on the anterior surface of the arm, midway between the shoulder and elbow. Measuring skin-fold thickness Using forefinger and thumb, grasp and lift the subcutaneous tissue and skin 2cm above the midpoint . Place the pincers of the skin-fold caliper at the midpoint at a depth of 1cm. Hold this position for 3 to 4 seconds. Take three measurements for accuracy (answer in mm). Provide the actual skin-fold thickness in mm.

Subscapular skin-fold measurement technique

The assessor is positioned behind the subject. The subscapular skin-fold site is located 1cm below the inferior angle of the scapula. The assessor grasps and lifts the subcut. tissue and skin at a downward angle of approximately 45 towards the lateral aspect of the body. Place the pincers of the skin-fold caliper at a depth of 1cm. Hold this position for 3 to 4 seconds. Take three measurements for accuracy (answer in mm). Provide the actual skin-fold thickness in mm.

Supra-iliac skin-fold measurement technique

The assessor to be positioned in front of the subject. The supra-iliac site is located 5cm above the anterior superior iliac spine. The assessor grasps and lifts the subcut. tissue and skin at a downward angle of 45 towards the medial aspect of the body. Place the pincers of the skinfold caliper at a depth of 1cm. Hold this position for 3 to 4 seconds. Take three measurements for accuracy (answer in mm). Provide the actual skin-fold thickness in mm.

Child Anthropometry
Basic measurements in children include: Weight

Clothing to be removed.

Baby weighed on clean calibrated scale.

The measurement is taken to at least 2 decimal places for accuracy in kg. An infantometer is used.

Height (Length)

The baby is placed supine with head against appropriate surface.

The baby is held in a fully extended position with the heels at a 90 position. The measurement is taken to the nearest 0.1cm. The OFC of the baby is measured to the nearest 0.1cm with a firm tape measure placed appropriately.

OFC (Occipitofrontal circumference)

Road-to-Health Chart
A simple, cheap, practical and convenient method of monitoring child health. Growth monitoring is the most useful tool available in child health as it assists with early identification of nutritional problems, disease, and developmental problems. The most sensitive indicator of a child's growth is weight.

Growth chart
Graph records child's growth progress. 1)Vertical axis is the weight axis (represented in kgs both on the right and left margin of each year starting from 0) 2)Horizontal axis is the age axis-one space per month goes up to 5 years

Standards and reference curves on the Road-to-Health Chart If the weights of 100 healthy children according to age groups are

plotted on a graph, the average weight is represented by the 50th centile reference curve (bold curve on the graph)

The weights will be scattered around this 50th centile with more weights near to it rather than far above or below it. To obtain a normal range of weights, an upper and lower reference curve is also plotted, referred to as the 97th and 3rd centile reference curves. This means that the weights of 3 healthy children will fall above the 97th centile and the weights of 3 healthy children will fall below the 3rd centile. In statistics, a centile (or percentile) is the value of a variable below which a certain percent of observations fall. For example, the 50th percentile is the value (or score) below which 50 percent of the observations fall. It is extremely important to plot the weight in a serial fashion in order to evaluate the growth trend. (term failure to thrive) Note 60% of standard weight or 50th centile

Nutritional assessment
Malnutrition may be acute/ chronic or a combination, with the acute form manifesting with weight loss/ failure to gain weight, and the chronic form resulting in stunting (child is shorter than normal). Normal Wasted Stunted
Weight/age % 100 70 70

Weight/height %

100

70

100

Height/age %

100

100

84

Nutritional assessment
Thus, the various anthropometric indices in children are used to measure the presence and severity of the various forms of malnutrition 1) Weight-for-height (decreased) indicates acute malnutrition (wasting) 2) Height-for-age (decreased) indicates chronic malnutrition (stunting) 3) Weight-for-age (decreased) in any proteinenergy malnutrition (underweight)

Types of Malnutrition
Malnutrition is a group of conditions in children and adults generally related to poor quality or insufficient quantity of nutrient intake, absorption, or utilization There are two major types of malnutrition: Protein-energy malnutrition - resulting from deficiencies in any or all nutrients Micronutrient deficiency diseases - resulting from a deficiency of specific micronutrients (eg iron, specific vitamins)

Types of Protein-Energy Malnutrition (PEM) in Infants

Condition 60-80% of standard weight < 60% of standard weight

No oedema
Oedema

Underweight
Kwashiorkor

Marasmus
Marasmic kwashiorkor

Standard refers to the 50th percentile or median

Kwashiorkor
-

60-80% of expected weight Sparse, depigmented hair Oedema Skin rash Distended abdomen and enlarged liver Diarrhoea

Marasmus
- Weight<60% mean for age - Wasted, wizened appearance

References
Basic anthropometric measurements in adults protocol (Dept of Physiology) WHO: Global database on body mass index (Davidson 2006) Illustrated Textbook of Paediatrics Lissauer and Clayden SA Family Practice Manual Bob Mash and Julia Blitz-Lindeque