Basic Anthropometry lecture for medical students..

1. 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

2. 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.

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

4. Height/Stature Measurement
Technique
 The subject places his/her heels
 The subject must be barefoot, together, with both heels touching
wearing as little clothing as possible the base of the vertical board
 The subject stands on a flat surface,  The medial borders of the feet are at
at a right angle to the vertical board an angle of about 60°
of the stadiometer  The scapulae and buttocks must also
 His/her weight is distributed evenly be in contact with the vertical board
over both feet, with the head  The subject must inhale deeply and
positioned in the Frankfurt maintain a fully erect position
Horizontal Plane (in this position, the without altering the load on the heels
most inferior point on the left orbital  The movable head board is brought
margin is at the same horizontal level
onto the most superior point on the
as the left tragion – the line of vision
head with sufficient pressure to
is approximately horizontal )
compress the hair
 The arms hang freely by the sides of  The measurement is taken to the
the trunk, with palms facing the
nearest 1 mm
thighs

5. Height/Stature Measurement

6. 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 .

7. 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.

8. BMI Ranges and Co-morbidity Risk
ANTHROPOMETRY
QUANTIFYING OBESITY WITH BODY MASS INDEX (WEIGHT/HEIGHT²)
BMI (kg/m²) CLASSIFICATION* RISK OF OBESITY COMORBIDITY
18.5 - 24.9 Normal range Negligible
25.0 - 29.9 Overweight Mildly increased
>30 Obese
30.0 - 34.9 Class I Moderate
35.0 - 39.9 Class II Severe
> 40.0 Class III Very severe
* Classification of the World Health
Organisation (WHO) and International
Obesity Task Force

9. Waist-to-Hip Circumference Ratio
 An indicator of the  Men generally have a
pattern of distribution higher ratio than
of subcutaneous women
adipose tissue.  Women 0.85-1.7 (high
 Distribution of fat is an risk)and <0.85 (Low
important indicator of risk)
CHD (coronary heart  Men 0.95-1.9 (high
disease) risk) and <0.95 (Low
 More fat in the risk)
abdominal area -
increases risk of CHD.

10. Waist-to-Hip Circumference Ratio
Measurement Technique
Waist circumference
 A good quality non-
stretchable 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.

11. 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.

12. 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.

13. 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.

14. Skin-fold measurements
 Approximately half of the In general, when measuring skin-
fold thickness,
total amount of fat tissue in
the human body is located  The assessor, using the forefinger and
below the surface of the skin. the thumb, grasps and lifts the
subcut. tissue and skin from the
underlying muscle.
 This makes it possible to
 Places the pincers of the skin-fold
predict total body fat from caliper, applying a constant pressure,
skin-fold thicknesses with a 2cm below the fingers at a depth of
1cm.
relative high degree of
accuracy using a simple two-  Holds this position for 3-4seconds.
compartmental method.
 Takes three measurements for
accuracy.
 This accuracy is confirmed by
CT scan as well as ultrasonic  Provides the actual skin-fold
thickness in mm.
and radiographic techniques
used to measure subcut.fat.

15. 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.

16. 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.

17. Mid-arm muscle circumference
(MAMC)
 TSF is preferably used in conjunction Standard adult values
with subscapular, biceps and supra- (helps interpret the above body
iliac skin-fold measurements to compositional measurements)
determine actual percentage body fat
from set equations or in conjunction
with MAC to determine mid-arm  Triceps skin-fold (mm)
muscle circumference. Male 12.5
Female 16.5
 MAMC provides an index of muscle
mass.
 Mid-arm circumference (cm)
Male 29.3
 MAMC (cm)=
Female 28.5
MAC (cm) - [3.14 x TSF (cm)]
 Mid-arm muscle circumf.
(cm)
Male 25.3
Female 23.2

18. 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

19. 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.

20. 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.

21. 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 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.

22. 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.
Height (Length)
 An infantometer is used.
 The baby is placed supine with head against
appropriate surface.
 The baby is held in a fully extended position
with the heels at a 90º position.
 The measurement is taken to the nearest
0.1cm.
OFC (Occipitofrontal circumference)
 The OFC of the baby is measured to the
nearest 0.1cm with a firm tape measure
placed appropriately.

23. 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.

24. 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

25. 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 97 th centile
and the weights of 3 healthy children will fall below the 3 rd 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

26. 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

27. 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 protein-energy
malnutrition (underweight)

28. 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)

29. Types of Protein-Energy
Malnutrition (PEM) in Infants
Condition 60-80% of standard < 60% of standard
weight weight
No oedema Underweight Marasmus
Oedema Kwashiorkor Marasmic kwashiorkor
Standard refers to the 50th percentile or median

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

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

32. 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