Anthropometric and Growth monitoring

Deddy S Putra

Anthropometric
Anthropometri : measurement of numerous physical dimention of human body in various age Measurement: to obtain values/raw datas

Anthropometric
Indexes: combination of measurement results eg: BW/age, BH/age
Indicators: cut off point of indexes e.g : c.o.p for severe MEP BW/ H: < 70%

Measurement : - Data base for obtain indexes & indicator - Reliable - Reproducible - Could be the result of observation

Usage of Anthropometry
Medical services

Public health purposes

Research

Body weight
- simplest parameter - easy to measure & reproducible

- index for present nutritional status

Measurement:
no/less cloths no shoes

spring/beam balance

Accuracy:

- children : 0.5 kg - infants : 0.1 kg

Body weight/age
Reflect recent nutritional status
Widely use in determining PEM

Disadvantage: does not take into account height

Children with low weight/age do not always wasting

Chronic malnutrition BW/age and H/age : low Proportional Genetically short

Severe malnutrition prevalence might be over estimate

Kartu Menuju Sehat (KMS)

Below Red Line (Bawah Garis Merah/BGM) Percentile 70 of Median

Need further clinical and anthropometry examination to determine malnutrition

Body height - simple parameter - easy to measure & reproducible - with BW give significant information - indicated chronic nutrients deficiency

How to measure?
Infant & children less than 2 years 1.Recumbent length 2.Using wooden measuring board 3.Face upward 4.Head towards the fix end 5.The body parallel to the long axis of the board 6.Shoulders blades should rest against the surface of the board

How to measure? Children 2 years - adult : 1.Standing position using stadiometer 2.Looking straight ahead with Frankfurt plane horizontal 3.Shoulders relaxed 4.Arms at sides

5.Leg straight and knees together

6.Feet flat and with heels almost together

Weight/height
Gives a reasonably accurate estimate of body wasting: 1.BW sensitive to rapid change in food supply, while height remains constant, changing only slowly 2.Children < 5 years, the relationship of BW to H is nearly constant, regardless of sex & ras

3.BW/H is relatively independent of childs age, which is often difficult to ascertain reliably 4.There are good internationally accepted and globally applicable reference values of BW for height of this group

5.Ministry of Health has agreed to use index BW/H as measurement of nutritional status in primary health care

BW/BH Girls only up to 138 cm height Boys only up to 145 cm height Advantage: need no age data

BW/BH value corespondens to 50 th centiles assumed as normal/adequate nutritional status

The wider the value from 50 th centiles occurred the more severe malnutrition (over/deficiency) happen

Common error in measurement

Measurement General Body weight Error Inadequate instrument, Restless child, Reading, recording Room cold, no privacy, Scale not calibrated to zero, Subject wearing heavy clothing, Subject moving anxious Incorrect method for age, footwear & headwear not removed, Head not in correct plane, Child not straight along board, feet not parallel with moveable board, board not firmly against head Incorrect method for age, footwear & headwear not removed, Head not in correct plane

Length

Height

Head circumference
Interfere by nutritional status up to the age 0f 36 months Routine measurement ==> detect/screen neurologic disorders using non elastic band just above supra-orbita ridges, over part of occiput

Interpretation
HC < 5th centiles or < - 2 SD

probably chronic malnutrition in intrauterine or infant or child period

Mid-upper arm circumference

Useful if : 1.No data of BW & Height 2.BW & Height can not be measured precisely
Examples patients with - organomegaly - edema - hydrocephalus

Mid upper arms circumference

Children 1-5 years MUAC per se can showed nutritional status Left arm Middle between acromion-olecranon Using non elastic band (WHO/CARE) Divided in to 3 colors: green, yellow and red

Skin fold thickness

Almost 1/2 body fat is in subcutaneus tissue Total body fat can be estimated Measurement using Caliper Results plotting in curve/standard

Point out/Reflect: - Present nutritional status & body - Amount of reserve energy - Together with BWB/BH index --> chronic malnutrition

Body mass index

Quatelet index = BW (Kg)/H2 (m) Age & sex dependent in interpretation High correlation with fat body mass Important for medical complication risk identification Recommended by WHO (1997), NIH (1998), as gold standard for measurement of obesity in children and adolescent

Anthropometry for specific condition

Cerebral palsy

Spina bifida
Contractures

Alternative anthropometric measurement

Sitting hight Segment length

- upper arm
- lower arm

- lower leg
Skin fold

Upper arm length

Shoulder to elbow The arm is bent to a 900 angle Measurement: superior lateral surface of to the inferior surface of the elbow

Arm span

Lower arm (Ulna length)

Gauld et al 2004 Reproducible & precise predict height

in school age children

Superior than arm span when

neuromuscular weakness, joint or spinal

deformity

Lower leg length (Knee height)

Knee heel measurement

Growth Monitoring
To plot the result of anthropometric measurements Need Reference growth chart

Local
International

Percentile
Standard Deviation Score (Z score)

Local : Jumadias

6-18 years of age In correlation with age and sex

Based on study in school age children in Jakarta 1966 3rd & 97th percentiles not available

Local :Yayah Husaini

Aged 6 14 years Based on studies done in several provinces 3rd & 97th percentile not available

International
NCHS
1. Used in USA in 1977

2. Based on study in white population

3. Mainly breast fed children

4. 5th & 95th percentile

WHO-NCHS 1.NCHS adopted by WHO for international use 1983 2.based on data from several sources 3.Includes 3rd & 97th percentiles 4.Best used for children < 10 years because of differences in age of peak height velocity for some population (eg. Asians)

CDC 2000 Growth chart

Revised growth chart, consist of 16 chart (8 for boys & 8 for girls) Aged 2-20 years Both breast fed and formula fed infants Includes BMI for age

Normal children Male boy, 1 year of age 75 cm length Ideal body weight 10.2 kg

Growth monitoring for genetic abnormalities/syndromes

Achondroplasia Brachman-de Lange syndrome Down Syndrome Marfan syndrome Noonans syndrome Prader-Willi syndrome Silver-Russell syndrome Turners syndrome Williams syndrome

Achondroplasia

Down Syndrome

Down Syndrome

Male boy, 1 year of age, 75 cm length Ideal Body Weight 8.4 kg

Marfan Syndrome

Premature infants
VLBW ( < 1500 g) LBW ( 2500 g) Classic anthropometric measurement Weight Height Head Circumference Duel Energy X Ray Absorptiometry

Premature infants growth charts

Lubchenco Babson & Benda

IHDP ( Infant Health & Development Program)

NICHD ( The National Institute of Child Health & Human Development Program)) Fenton (Updated Babson & Benda)

Lubchenco
Weekly age interval Used percentile Weight, length, head circumference

Babson & Benda

Biweekly age interval Up to 40 weeks gestation Used standard deviation

18 mos old female baby 1st visite 2nd visite 3rd visite 4th visite : Bw 11 kg, L 80 cm : Bw 11 kg, L 82 cm : Bw 11 kg, L 84 cm : Bw 11 kg, L 84 cm

A: FTT with normal stature

Need intervention

Estimation of body weight increment

Age Gram/day
30 0-3 months

3-6 months
9-12 months 1-3 years > 4 years

20
15 8 6

Estimation height increment

Estimation length (Mean birth length 50 cm)
1 year of age : 1.5 X birth length

4 years of age
6 years of age 13 years of age Adult

: 2 X birth length
: 1.5 X length in age of 1 year : 3 X birth length :31.5 X birth length (2 x length on the age of 1 year)