NUTRITIONAL ANTHROPOMETRY Maria Raquel Pangan, RND.PhD OBJECTIVES Ate en ofthe session, te student shuld be able to ‘izuss the principle, uae, edvaniages, and limtaons of antropomatc acecement; 2. know saci artrrapemarie measuoments Used to 2 body size and growth body composition 23.te analyze and evaliste nina! satis of individuals using anthropometi indeingices basod on references, standards, and cute points ‘Advantages > procedures use simple, safe, noninvasive echriques > equipmontrequedi inexpensive, portable, curable ‘pd can be made or purchased locally > rlavely unsiled personnel canbe tained perform tho measurements > leformation rites to past long-term nutans istry ean asst inthe identification of mid, moderate, & ‘severe states of malnutition LIMITATIONS | > relatively inconstve and cannot dete dturbancos Ins over a shot timo (daysiteats) > cant itngush bawoon ssturbanece in growth ot body compostion neueed by nurien eetilonciae ‘fom those caused by Imbalances in enegy intake > nor-nstional factors can reduce spectcy & analy ef anlwopematie meesurements (seas, enetevriston, cual practios) Measurementerrors “Can be minimized by: ‘Ltraining peesonne! 2.using precise &callrated Instrumente, and Standardized, validated measurement teniquee 2. avoiding common avoidable errors due to: ‘instruments not calibrated before taking measurements b.miotakes in reading errors recording obecrvations «poor readings due to participants being restless uring measurements ‘Types of anthropometric measurements > 1. Assessment of body size & growth indices »» weight; recumbent length & height/stature; head circumference; growth indices; BMI > 2 Assessment of body composition » fat mass (body fat) » fat free mass1/31/2015 + Assestment of body fat * derivation of body fat from skinfolds biceps skinfold triceps skinfold; eubecapular ‘skinfold: & supraiac skinfold * waistto-hip ratio (WHR) & wait oreumference ‘Assessment of fates mace “1. mid-upper arm ciccurference (MUAC) 2. mid-uppersarm muscle circumference (MUAMC) ‘3. mic-upper.arm muscle area ‘Assecemant of body sao & growth indices 1. wigne ‘represents the sum of muscle, fat, water, & bone mineral mass-> measures body mass = most commonly used indicator of NS & fluld balance 128 sensitive indicator of curtent NS (acute malnutrition) in adults: weight is influenced by frame size WEIGHT Significance: “weightloss may represent the presence of, ‘2 disease or nutrional imssirment ‘weight gain may indicate development of ‘obesity or edema wh we uJ 4. WEIGHT (Geri measurements can be used to detect PEM in chidren as indicated by inadequate weight gain (aiture to thrive") fin children & adults: low wilor-ht > index of wasting high w-for-nt > index of obesity Calibrate Beam Balance ‘Spring Balance Espada (only in Calibrate - tare -1/31/2015 2. Height or length (recumbent length) + svesses linear dimension which s composed of the legs, peli, sine 8 the skal ‘ss meosuremant of skit growth * ue0d aan index of chronic NS of chien & ais ‘+ ingiatee stunting ofa chil ful gowthpotortat Heightorage: index of stuning Lang: measured for intants & chlden < 2 ys. ‘Height moasured wth subectn the standing pation ©2yra)1/31/2015 HEIGHT Proxy measures for height: 1. Knee height (in ut) ighly comtelated with stature: used to estimate height in persons wi severe curvature or are unable to stand 2 Arm spanhighly corelatad with stature; used when ‘2ctual height cannot be measured > useful for assessing retrospective stature at young ‘adulthood before any age-associated loos in the ciderly ton”1/31/2015 ‘3 HEAD CIRCUMFERENCE sa screening procedure to detect abnormalities cf head rain growth, pty nthe 1 year of fe used odes hronic PEW dunn the fret 29 wth ‘he bain apeynereoingin co: wih PEM, sma brain sizo Pinal voc malnuiton during i on ‘month aie or eur inrasrne grth ‘may impair am development lowhoad ‘steamer HEAD CIRCUMFERENCE, Limitations: 1 not useful beyond 2 yrs. old slow growth in HC beyond 2 yrs 2 not constive to less extreme malnutrition 3. nomnutrtional factors may influence HE Head Circumference ee cere Es ff HEAD CIRCUMFERENCE rea [sorsia | sen ee i 4 GROWTHINDICES « calculated from 2 or more raw measurements ‘© used to compare an individual ora group with reference population ‘Common growth indi “weightefor-age (WA) * weight-or-height (WH) *height-for-age (HA) * head crcumference for 2901/31/2015 ‘Weight-for-age (WIA «© most commonly used method of interpreting data > refers to the weight of a certain individual ata certain age ‘general index of undernutrition ‘widely used to assess PEM and overnutrition when measurement of height is dificult ‘¢ widely used to assess PEM among childron, mos. —7 years WEIGHT-FOR-AGE, LIMITATIONS: 1. requires accurate age information 2. does not distinguish between acute & chronic ‘austin 8. presence of edema can complicate interpretation WEIGHT FORAGE ... ‘Interpretation of WA data: + £280 value, th els within the normal mas + £2.5D valuos, the chile blow normal or "ow" for age + ®2.5D veluos the chidis above normal or “high for 990 HEIGHT/LENGTH FORAGE (H/A) ‘expressed as 2 function of the height of a reference Population of the same age ‘+n index of past or chronic nuritonal status ‘s measures stunting Limitations: 1. roles on age data 2. needs to be supplemented by another indicator lke WIAor WIH HEIGHT/LENGTH FORAGE... ‘interpretation of HFA data + £28 values, the chilis within the normal Hits +4260 value, the chidis “short” forage +2 28D valuoe,the cide “al” for age WEIGHT-FOR-HEIGHT (W/H) = sensitive indox ofeurrent NS. “it ie age-independent for the I" 10 yrs. of lif sa measure of wasting low weight-for-hoight is due to deficits in both, tissue & fat mass1/31/2015 WEIGHT-FOR-HEIGHT (W/H) + it diferentiates “wasted” & “stunted” indivievals: wasted” — children have normal height but low ‘weight indicating low fat & tissue mass “stunted” chitdren have deficits in height but ‘weight Is normal for height WEIGHT FOR HEIGHT/LENGTH... “Interpretation = 42.80 value, the ehldis within the normal its £28 valuoo the chile wasted or underweight for hither length or height +2280 valuos, the cid is overweight fr hisher length or height (GROWTHINDICES interpretation: ‘low WH or wasting > insuficient weigh lave to heght refre to recenoument weigh oes examines chorttom oft (soacoal changes infood supply, crtentiness) ‘slow HUA oF stunting > instant height relative to ge impli long-form (croc) malruiton & poor heath ‘How WIA or underweight > Insuficint weight relative to ape implies stunting Br wasting *teflece bth past chronic) ie recent (cui) underuttion BODY MASS INDEX (BMI) or Quetelet’ index wwoight in kg BMI= eight in meter)? > recommended for use among adolescents (9-19 yrs) & for adults BODY MASS INDEX (BM) OR QUETELET'S INDEX 4. BMI in Adis ‘mst commonly used Weight-to-Height ratio 2 useful measure of OW & obesity in aduts (Obesity index) Limitations: «a. does not distinguish between weight sssociated ‘with muscle or body fat » does not give an indication about the distribution of body fat1/31/2015 BM 2. BMHor-age as indicator of child OWiobesity WHO: internationally derived, age-speciic BMI values equivalent to adut's BMI definitions OW225 Obesity 2 30 BODY MASS INDEX “WHO classitcation for - Recommended Cutof bauite ints for Use in Asia and <165 the Pace Undenweight + <185~Undorwsight 4952499 1185-729 Normal Normal 2502909 +250-249- Overnight >= 90 Obese + 250-209-Obe00| 1 80.0—Obeve ery high prevalence (rea MEASUREMENT OF BODY COMPOSITION > Assessment of Body Fat 1. Skinfold thickness — estimates percentage of body {at using available generalized or population- ‘specific equations; derives bedy fat from skinfolts Sites of measurement: triceps biceps « subseapular suprailiae Body fat “Body fat content: most variable component ofthe body - cifers among individuals ofthe same sex, height, wight on average: fat content of women is higher than that of men ‘SKINFOLD 7 2. Triceps skinfold «© most frequently used to obtain single indirect measure of body fat ‘* measurement taken at the marked midpoint ofthe back of the upper arm1/31/2015 MEASUREMENT OF BODY COMPOSITION: sini 1. Bloeps skinfold © monsures subcutancous adipose tissue & skin thickness on the anterior aspect of the arm ‘together with triceps, can caleulate the “muscle plus bone” cross-sectional area «© useful in obese where many other skinfolds. ‘cannot be measured ‘SKINFOLD 2. Subseapular skinfold ‘¢ measures subcutaneous adipose tissue & skin thickness on the posterior aspect of the torso ‘together with other skinfolds, may predict total body fat, blood pressure, & blood lipids ‘Subscapular skinfold measurement ASSESSMENT OF BODY FAT 2. Woaletto-Hip Ratio (WHR) & Waist Circumference WHR ~ used to assesses body fat distribution & ‘ops identity 2 types of body fat distrbution: 2. upper body (android or male typo) ', loner body (gyncid or female type) \waist or abdominal circumference (em) WHR= hip circumference (em) + secerivesaubeuteneous& nk abominal apace tose WHR ‘an index of abdominal fat cstbution «simple indicator of andkoid obesity : accumulation cof body fat around the abdomen, associated with increased risk of cardiovascular disease Recommended WHR (James, 1998) Male: <1 (£09) Fomale: <85 (= 083)1/31/2015 WHR CCutofis for increased risk of disease: WHR> 1.0 for males: WHR .85 for forales Limitation of WHER: itis possible fora person to have 2 ratio below the cut-off but has large waist circumference WAIST CIRCUMFERENCE (WC) + 2 measure of obesity + itreflects intra-abdominal fat mass Recommended WC (James, 1996) 102 em for Males < 88 em for Females Clinical threshold indicating obesity: > 102 om for males ( = 40 inches) > 88 em for females (= 36 inches) ASSESSMENT OF FAT-FREE MASS ‘a midture of water, minerals, & protein, with most of the protein stored in the muscle + assessment of muscle mass gives an index of body protein reserves. FAT-FREE MASS [Mid.upper-arm circumference (MUAC) > correlates with measures of total muscle mass > Used to presiot changes in protein NS used for rapid diagnosis of PEM in children 1-4 yrs. old Principe: the arm contains subcutaneous fat & muscle “a decrease in MUAC may reflect eer 2 reduction In muscle mass, reduction in subcutaneous fat, or reduction in both subcutaneous fat & muscle mass ‘ASSESSMENT OF FAT FREE MASS muac “in developing countries: changes in MUAC tend to reflect changes in muscle mass * useful as @ predictor of childhood mortality in veloping counties * MUAC combined with skinfold thickness can bo sed to caleuiate area of arm muscle & adipose tissue é 101/31/2015 Shakir Strip a MUAC INTERPRETATION unc | INTERPRETATION | <125 em | Udernation 12510 135em | Risk of undemuion > 135 t0 16cm | Adequate nutrition THANK YOU FOR YOUR ATTENTION.... a