anthropometric assessment
TRANSCRIPT
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ANTHROPOMETRIC ASSESSMENT
Gr. anthropos, man, human; metron,
measures
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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
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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.
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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
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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.
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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.
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ANTHROPOMETRIC ASSESSMENT
Measurements
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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.
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GROWTH MEASUREMENTS
• Measurement of head circumference
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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.
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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.
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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
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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
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GROWTH MEASUREMENTS
• Measurement of the knee high
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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.
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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.
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GROWTH MEASUREMENTS
• Measurement of weight in older children and adults
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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.
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GROWTH MEASUREMENTS
• Measurement of elbow breath
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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)
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INDICES DERIVED FROM GROWTH
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)
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INDICES DERIVED FROM GROWTH
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 ……..
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INDICES DERIVED FROM GROWTH
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.
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INDICES DERIVED FROM GROWTH
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).
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INDICES DERIVED FROM GROWTH
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.
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INDICES DERIVED FROM GROWTH
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.
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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
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ANTHROPOMETRIC ASSESSMENT OF BODY
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)
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
Calipers used in measuring
skinfold thickness:
• McGaw (digital version)
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
Calipers used in measuring
skinfold thickness:
• Lange
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
Calipers used in measuring
skinfold thickness:
• Harpenden
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
Calipers used in measuring
skinfold thickness:
• Holtain
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Triceps skinfoId
Measured at the midpoint of the back of the upper left
arm (Weiner and Loune, 1969)
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Triceps skinfoId
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ANTHROPOMETRIC ASSESSMENT OF BODY
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.
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ANTHROPOMETRIC ASSESSMENT OF BODY
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.
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Subscapular skinfold
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Supraillac skinfold
Measured in the midaxillary line immediately superior to
the midaxillary line and parallel to the cleavage lines of
the skin.
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Midaxillary skinfold
The skinfold is picked up horizontally on the midaxillary
line at the level of the xiphoid process.
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Midaxillary skinfold
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ANTHROPOMETRIC ASSESSMENT OF BODY
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.
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Waist-hip circumference ratio
A simple method for describing the distribution of both
subcutaneous and intra-abdominal adipose tissue.
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ANTHROPOMETRIC ASSESSMENT OF BODY
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.).
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ANTHROPOMETRIC ASSESSMENT OF BODY
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.
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ANTHROPOMETRIC ASSESSMENT OF 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
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ANTHROPOMETRIC ASSESSMENT OF BODY
COMPOSITION
• Mid-upper arm circumference measurement
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ANTHROPOMETRIC ASSESSMENT
Measurement Errors
ANTHROPOMETRIC MEASUREMENT
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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.
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ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC 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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC 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.
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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 …….
ANTHROPOMETRIC MEASUREMENT
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ANTHROPOMETRIC MEASUREMENT
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.
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ANTHROPOMETRIC ASSESSMENT
Issues and Concern
NUTRITIONAL ANTHROPOMETRY
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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.
NUTRITIONAL ANTHROPOMETRY
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NUTRITIONAL ANTHROPOMETRY
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.
NUTRITIONAL ANTHROPOMETRY
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NUTRITIONAL ANTHROPOMETRY
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;
NUTRITIONAL ANTHROPOMETRY
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NUTRITIONAL ANTHROPOMETRY
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.