nutritional assessment- anthropometry

NUTRITIONAL ASSESSMENT SURVEY(Anthropometric assessment)

Presented by-Dr Garima Gupta

MBBS, MD (Post Graduate Resident)University College of Medical Sciences and GTB Hospital

Delhi

NFHS-3, India, 2005-06

Why the need of Nutritional Assessment?

In the Triple-A Cycle model:

Indicators to assess and analyse nutrition

The ANALYSIS stage aims to analyse the causes of malnutrition

The ASSESSMENT stage aims to define the nutritional problem in terms of magnitude and distribution.

ASSESSMENTof the nutritional situation in target population

ACTIONbased on the analysis & available resources

ANALYSISof the causes of the problem

A Dream – Yet to be achieved !!

• Source- World Health Organisation

Nutritional assessment - ABCD

• Anthropometry: height, weight, BMI, MUAC

• Biochemical: analysis of blood, urine, and other body tissues

• Clinical: complete physical examination, and a medical and psychosocial history

• Dietary: foods and quantities consumed, eating habits, accessibility of food, and cultural and socioeconomic factors that affect selection of food.

Anthropometric measurement

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HEIGHT OR LENGTH• Height

Vertical distance measured from crown of head to bottom of feet (heels) for children 2 yr of age or older.

• Recumbent lengthDistance measured from crown of head to bottom of feet (heels) while child (< 2 yr of age) is in supine position.

StadiometerInfantometer

WEIGHTSubject 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

• Gives a picture of past nutritional status

• Deficit in height indicates chronic & prolonged under nutrition resulting often in permanently stunted physical status.

Indications of height/length

• Sensitive indicator of current nutritional status.

• Deficit in weight indicates short term under nutrition which can be easily reversed.

• PEM is best identified by weight deficiency in all groups.

Indications of weight

Mid-upper arm circumference (MUAC)MUAC is simple, cheap, more sensitive and less prone to mistakes. Appropriate cut-off points of MUAC for children between 6 to 59 months are given below:

Latest recommendations - UNICEF

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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.

•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.

CHEST CIRCUMFERENCE

• It is usually measured at the level of nipples, preferably in mid inspiration.

• In children ≤ 5years - lying down position > 5 years - standing position

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RELATIONSHIP BETWEEN HEAD SIZE WITH CHEST CIRCUMFERENCE

• At birth-head circumference > chest circumference by up to 3 cm.

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

• but thereafter chest grows more rapidly compared to the brain.

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INDICES• Relation between two measurements

• Weight For Age W/A general appreciation of nutritional status– combined measurement– NO individual diagnosis but trend assessment– For growth monitoring

• Height For Age H/A measure of linear growth deficit or STUNTING– not sensitive to change– slow progress– Community diagnosis

• Weight For Height/Length W/H measure of weight deficit according to length WASTING – Individual diagnosis– Community diagnosis– Sensitive to change

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STANDARD DEVIATION (SD) CLASSIFICATION

CUT-OFF LEVELNUTRITIONAL GRADE

WEIGHT FOR AGE

HEIGHT FOR AGE

WEIGHT FOR HEIGHT

Median – 2 SD Normal Normal Normal

Median – 3 SD to Median – 2 SD

Moderate Underweight

Moderate Stunting

Moderate Wasting

< Median – 3 SD Severe Underweight

Severe Stunting

Severe Wasting

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IAP CLASSIFICATION(Indian Academy of Paediatrics)

WEIGHT FOR AGE

(% of Harvard Standard)

NUTRITIONAL GRADE

80 Normal

70 – 89.9 Grade I (Mild Undernutrition)

60 – 69.9 Grade II (Moderate Undernutrition)

50 – 59.9 Grade III (Severe Undernutrition)

< 50 Grade IV (Severe Undernutrition)

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Classification BMI(kg/m2)

Principal cut-off points

Additional cut-off points

Underweight <18.50 <18.50

     Severe thinness <16.00 <16.00

     Moderate thinness 16.00 - 16.99 16.00 - 16.99

     Mild thinness 17.00 - 18.49 17.00 - 18.49

Normal range 18.50 - 24.9918.50 - 22.99

23.00 - 24.99

Overweight ≥25.00 ≥25.00

     Pre-obese 25.00 - 29.9925.00 - 27.49

27.50 - 29.99

     Obese ≥30.00 ≥30.00

          Obese class I 30.00 - 34-99

30.00 - 32.49

32.50 - 34.99

          Obese class II 35.00 - 39.99

35.00 - 37.49

37.50 - 39.99

          Obese class III ≥40.00 ≥40.00

Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004

Nutritional gradation based on BMI (adult)

Body Mass Index (BMI)

=

Weight in kg / height in meter sq.

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