ANTHROPOMETRY

Anthropometry: Introduction
Anthropos-"man"andMetron"measurement
Abranchofanthropologythatinvolvesthequantitativemeasurement
ofthehumanbody.
Goldstandardofnutritionalassessment.Itisthesinglemostportable,
universallyapplicable,inexpensiveandnon-invasivetechniquefor
assessingthesize,proportionsandcompositionofthehumanbody.
Itisusedtoevaluatebothunder&overnutrition.
Themeasuredvaluesreflectsthecurrentnutritionalstatus&dont
differentiatebetweenacute&chronicchanges

EQUIPMENTS REQUIRED
STANDARD GROWTH CHARTS AND TABLES: The growth chart
developed by the NCHS (National Centre for Health
Statistics) from US population is the currently accepted WHO
standard of growth pattern from birth to 20 years.
Weighing machines:
Electronic weighing scales are preferred.
Beam type weighing scale (Detecto scale) is also acceptable.
Infantometer for length measurement.
Anthropometer or stadiometer for height measurement.
Nonstretchable but flexible plastic tape.
Harpenden skin fold calliper.

Parameters of
anthropometry
Age dependent factors:a) Weight
b) Height
c) Head circumference
d) Chest circumference

Age independent factors:a)Mid-arm circumference (1-5 years)

b) Weight for height
c) Skinfold thickness
d) Mid upper arm/height ratio
4

Weight
Themeasurementofweightismostreliablecriteriaof
assessmentofhealthandnutritionalstatusofchildren.
Theweightcanberecordedusinga:

Beamtypeweighingbalance
Electronicweighingscalesforinfantsandchildren
Bathroomtypeofmechanicalscale(veryunreliable)
Salterspringmachine(infieldconditions)

METHOD OF RECORDING BODY WEIGHT

Set the weighing scale on a flat
horizontal surface and correct the zero
error before recording the weight.
Always remove the shoes, and clothing
should be the minimum, but hypothermia
should be avoided.
Child should not be in contact with any
other object.
Weight can be read directly or by
balancing the beam depending on the
type of weighing machine. Record the
reading when the beam is steady at its
balance point or the pointer becomes
stable.
,

In field conditions Salter spring machine is quite

satisfactory because it is convenient to carry. The
balance is hung from a hook or held by an attendant
and baby is placed on the sling attached to the
bottom hook.

Weight Increments
The average birth weight of a normal Indian newly
born baby after 40 weeks of gestation is 2.8 kg.
WHO accepted standard is 3.5 kg.
Increments in weight gain ideally should be compared
with growth chart or table.

Theperiodicrecordingofweightonagrowthchartisessentialfor
monitoringthegrowthofunder-fivechildren.
Growth Velocity :
A.1,2,3months1.0kg/month(30g/day)
4,5,6months0.75kg/month(20gm/day)
7,8,9months0.50kg/month(15g/day)
10,11,12months12g/day
1-3years2.25kg/yr
4-9years2.75kg/yr
10-18years5.0-6.0kg/yr
(0.5kg/month)
B.Weightat4-5months2xbirthweight
Weightat1year3xbirthweight
Weightat2years4xbirthweight
Weightat7years7xbirthweight

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WEECHS FORMULA
a) 3 12 months
Expected weight(kg) = age (months) + 9 /
2
b) 1- 6 years
Expected weight(kg) = age (years) x 2 + 8
c) 7 12 years
Expected weight(kg) = age (years) x 7 5/2
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Classification of Malnutrition by Indian

Academy of Pediatrics
Weight for age *

Grade of malnutrition

>80 %
71-80%
61-70%
51-60%
<50%

Normal
Grade 1
Grade 2
Grade 3
Grade 4

(Mild)
(Moderate)
(Severe)
(very severe)

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Length or Height/Stature
Measurement Technique

Upto2yearsofageRecumbentLengthismeasuredwiththehelpofan
Infantometer.

InolderchildrenStandingHeightorStatureisrecorded.Itisconvenientto
useanInbuiltStadiometeraffixedonthewallwhichprovidesadirectread
outofheightwithanaccuracyof+/-0.1cm.

Nutritionaldeprivationoveraperiodoftimeaffectsthestatureorlinear
growthofthechild.

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Technique of length
measurement

Theinfantisplacedsupineontheinfantometer.
Assistantormotherisaskedtokeepthevertexortop
oftheheadsnuglytouchingthefixedverticallyplank.
Thelegarefullyextendedbypressingovertheknee,
andfeetarekeptverticalat90,themovablepedal
plankofinfantometerissnugglyapposedagainst
solesandlengthisreadfromscale.
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15

Technique for height

measurement

Inolderchildrenwhocanstand,heightcanbe
measuredbytherodattachedtothelevertypemachine
orbystadiometer.
Childshouldstandwithbarefeetontheflatfloor
againstawallwithfitparallelandwithheelsbuttocks,
shouldersandocciputtouchingthewall.
HeadshouldbekeptinFrankfurtplane.
Withthehelpofawoodenspatulaorplasticruler.The
topmostpointofthevertexisidentifiedonthewall.
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17

Height Velocity
A

AGE
Birth to 3 months

Approximate rate of increase

in stature
3.5cm/month

3 6 months

2.0cm/month

6 9 months

1.5cm/month

9 12 months

1.3cm/month

2 5 years

6 8cm/year

5 12 years
At birth

5cm/year
50cms

Gain during 1st year

25cms

Gain during 2nd year

12.5cms

Gain during 3rd year

7.5 to 10cms

Gain during 3 12 years

5 to 7.5cms

Adolescence

8cms/yr for girls during 12 to

16 years
10cms/yr for boys during 14 to18
18 years

B]Expectedheightupto12yrs.
lengthorheight(incms)=ageinyearsx6+77(Weechsformula)

C]]Predictionofadultheight
Parentalheight,TannersformulaandWeechsformulaareused.

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HEAD CIRCUMFERENCE
Brain growth takes place 70% during fetal life, 15% during infancy and
remaining10%duringpre-schoolyears.
Headcircumferenceareroutinelyrecordeduntil5yearsofage.
Ifscalpedemaorcranialmouldingispresent,measurementofscalpedemamay
beinaccurateuntilfourthorfifthdayoflife.
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.
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 The marasmic children are seen to have

relatively large head for their body size
because brain growth is minimally affected
by malnutrition.
During states of undernutrition of varying
severity, weight, linear growth (height) &
brain growth are affected in that order.

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Expected head circumference

in children
Age
At birth

Head circumference
(cm)
34 35

2 months

38

3 months

40

4 months

41

6 months

42 - 43

1 year

45 - 46

2 years

47 - 48

5 years

50 - 51
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Head Circumference Growth Velocity

Till 3 months

2 cm/month

3 months 1 year

2cm/3 month

1 3 year

1cm/ 6 month

3 5 year

1cm/ year

Duringfirstyearthereis12cmincreaseinheadcircumference,
while15yearage,only5cmgainoccurinheadsize.
Adultheadsizeisachievedbetween5to6years.
thefollowingformula(Dinesformula)isusedforestimatingthe
headcircumferenceinthefirstyearoflife:-
(lengthincm+9.5)2.59
2
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ThetermMacrocephalyreferstoOFCofmorethan2SDabove
themeanwhileMicrocephalyreferstoOFCmorethan3SDbelow
themeanforage,sex,heightandweight.

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Chest circumference
Itisusuallymeasuredatthelevelofnipples,
preferablyinmidinspiration.
Some workers recommend measurement
of the chest circumference at the level of
xiphisternal junction because the
location of nipples may be variable.
Inchildren
<=5years-lyingdownposition
>5years-standingposition
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Relationship between head

size with Chest
At birth:headcircumference>chest
Circumference:
circumferencebyupto3cms.

Ataround9 months to 1 yearofage:head

circumference=chestcircumference,
butthereafterchestgrowsmorerapidly
comparedtothebrain.
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 Theheadcircumferenceisgreaterthanchest
circumferencebymorethan3cmsin:
a)preterms
b)small-for-date,&
c)hydrocephalicinfants

Inmalnourishedchildren,chestsizemaybe
significantlysmallerthanheadcircumferencebecause
growthofbrainislessaffectedbyundernutrition.
Thereforetherewillbeconsiderabledelaybeforechest
circumferenceovertakesheadcircumference.
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 In microcephaly chest exceeds the head in

circumference earlier than 9 months and in
hydrocephalus head continues to remain
larger than chest even after 1 year of age.
Growth of chest is adversely affected in
protein energy malnutrition, thoracic
cage abnormalities, spinal muscular
atrophy and congenital anomalies of
lungs.

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AGE INDEPENDENT CRITERIA FOR

ASSESSMENT OF NUTRITIONAL STATUS

Mid-upper arm circumference

Thickness of subcutaneous fat
Body ratios
Weight for height
Body mass index
Upper segment/ lower segment ratio
Arm span
Obesity
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MID-UPPER ARM
CIRCUMFERENCE

During1-5Yrsofageitremainsreasonablystaticbetween15-17cms
amonghealthychildren.
Itisconventionallymeasuredovertheleftupperarm,atapointmarked
midwaybetweenacromion(shoulder)andolecranon(elbow)witharm
bentatrightangle.
Thechildisaskedtostandorsitwiththearmhanginglooseattheside.
MUACismeasuredwithafiberglassorsteeltape.
Ifitislessthan12.5cmitissuggestiveofseveremalnutrition.
Ifitisbetween12.5-13.5cmitisindicativeofmoderatemalnutrition.
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Bangle test quickassessmentofarmcircumference.A

fiberglassringofinternaldiameterof4cmisslippedupthe
arm,ifitpassesabovetheelbow,itsuggeststhatupperarmis
lessthan12.5cmandchildismalnourished.

Shakir tape isafiber-glasstapewith

redlessthan12.5cm
yellow12.5-13.5cm
greengreaterthan13.5cm
shadingsothatparamedicalworkerscanassessnutritionalstatus
withouthavingtorememberthenormallimitsofmidarm
circumference.

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 QUAC stick Quaker Upper Arm Circumference Stick

Itisdevelopedontheprinciplethatacutestarvationseverelyaffects
mid-armcircumferencewhileheightisunaffected.

It is a height measuring rod, calibrated in MAC.

Values of 80% MAC for Ht. are marked on stick at
corresponding ht. levels
The malnourished child would be taller than the
anticipated height derived from the mid-arm
circumference
MAC (cm)

Ht. (cm)

16.5

133.0

13.5

103.5

12.5

70.0

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Skinfold thickness
Measured with Herpendens caliper
Triceps or subscapular region
The skinfold with subcutaneous fat is picked
up with thumb and index finger, and caliper
is applied beyond the pinch.
Fat thickness
>10mm - healthy children 1-6 years
<6mm - is indicative of moderate to
severe degree of malnutrition
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Body ratios
Rao & Singhs weight-height index:
= [weight (kg) / (height)2 cms ] * 100
normal index is more than 0.15
Kanawati index: (during 3m to 4 years)
= Mid-arm circumference / Head circumference
Normal

0.331

Mild

0.310 0.280

Modreate

0.279 0.250

Severe

< 0.250
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WEIGHT-FOR-HEIGHT
Weight-for-height=
Weightofthepatient(kg)X100

Weightofnormalchildofsameheight

WASTING
Weight-for-Height *
>90%
80-90 %
70-80 %
<70 %

Wasting
No wasting
Mild wasting
Moderate wasting
Severe wasting

*Reference standard NCHS data

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Classification

When malnutrition has been chronic, the child is stunted,

weight-for-age is low/normal
height-for-age is low
weight-for-height is normal.

In Acute malnutrition, the child is wasted,

weight-for-age is low
height-for age is normal
weight-for-height is low

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BODY MASS INDEX (BMI)

ABMI-for-ageof>85thpercentileissuggestiveofOverweight.
ABMI-for-ageof>95thpercentileisorwhenitisassociated
withtricepsorskinfoldthickness-for-ageof>90thpercentile,it
isdiagnosticofObesity.

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 Ponderal index : - itisanotherparameter

whichissimilartoBMIandisusedfordefining
newbornbabieswithintrauterinegrowthretardation.

PI=(Bodyweightingrams)100
length(cm)

Inmalnourishedsmall-for-datebabies(asymmetric

IUGR),ponderalindexis<2,whileitisusuallymore
than2.5intermappropriate-for-gestationbabiesand
hypoplasticsmall-for-datebabies.
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PROPORTIONAL TRUNK AND

GROWTH
LIMB
Themid-pointofthebodyinnewbornisatumbilicuswhereasinan
adultthemid-pointshiftstothesymphysispubisduetogreater
growthoflimbsthantrunk.
TheUPPERSEGMENT(vertextoupperedgeofsymphysispubis)
toLOWERSEGMENT(symphysispubistoheels)ratioatbirthis
1.7to1.0.
Thisgraduallybecomes1.0to1.1inhealthyadults.
Ininfantsuppersegment(crowntosymphysispubis)canbe
measuredbyusinginfantometer.
Thelowersegmentisobtainedbysubtractingtheuppersegment
41
fromtotallength.

 Infantileuppersegmenttolowersegmentratio
(trunkabnormallylargeorlimbsabnormally
small)isseenin:
1. Achondroplasia
2. Cretinism
3. Shortlimbeddwarfism
4. Sexualprecocity
5. Bowedlegs
42

Advanceduppersegmenttolowersegmentratio(trunkabnormally
shortorlimbabnormallylong)isseenin:
1.Arachnodactyly
2.Hypogonadism
3.Eunuchoidism
4.TurnerSyndrome
5.KlinefeltersSyndrome
6.Chondrodystrophy
7.Spinaldeformities(rickets,pottsspine)

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ARM SPAN
Itisthedistancebetweenthetipsofmiddlefingersofbotharmsoutstretchedat
rightanglestothebody,measuredacrossthebackofthechild.
Inunder-5children,armspanis1to2cmsmallerthanbodylength.
During10-12 yearsofage,armspan=height.
Inadultsarmspanismoreinadultsby2cm.

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Abnormallylargearmspanisseeninpatientswith
1)Arachnodactyly(Marfansyndrome)
2)Eunuchoidism
3)KlinefeltersSyndrome
4)Coarctationofaorta

Armspanisshortcomparedtoheightinpatientswith:
1)Shortlimbeddwarfism
2)Cretinism
3)Achondroplasia

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ADVANTAGES OF
ANTHROPOMETRY

Less expensive & need minimal training

Readings are reproducible.
Objective with high specificity &
sensitivity
Measures many variables of nutritional
significance (Ht, Wt, MAC, HC, skin fold
thickness, waist & hip ratio & BMI).
Readings are numerical & gradable on

Limitations of
Anthropometry

Inter-observers errors in measurement

Limited nutritional diagnosis
Problems with reference standards, i.e.
local versus international standards.
Arbitrary statistical cut-off levels for
what considered as abnormal values.

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Thank you
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