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Anthropometr

Dr.Nishan Silva
(MBBS)
Anthropometry
• Nutritional care
• Body mass index
• Basal metabolic rate
• Recommended Daily allowances
• Physical Measurements
• Energy expenditure
The Nutrition Care Process
• Identifying and meeting a person’s nutrient and nutrition
education needs. Five steps:
1. Assess Assessment of nutritional status
2. Analyze Analyze assessment data to determine nutrient
requirements
3. Develop Develop a nutrition care plan to meet patient’s
nutrient and education needs.
4. Implement: Implement care plan
5. Evaluate: Evaluate effectiveness of care plan: ongoing
follow-up, reassessment, and modification of care plan.
Assessing Nutritional Status

• Historical Information
• Physical Examination
• Anthropometric Data
• Laboratory Analyses
CLINICAL ASSESSMENT
Good nutritional history should be
obtained
General clinical examination, with
special attention to organs like hair,
angles of the mouth, gums, nails, skin,
eyes, tongue, muscles, bones, & thyroid
gland.
Detection of relevant signs helps in
establishing the nutritional diagnosis
Anthropometric Data –
physical measurement of the body

anthropos = human metric = measure

• Indirect assessment of body composition and


development
• Used in Nutrition Assessment:
– Measures using height and weight
– Measures of body composition (fat vs. lean tissue)
– Functional Measures
Indices
• W/A: combined measurement:
– NO individual diagnosis but trend assessment
– For growth monitoring and FU
• W/H indicates degree of wasting
– Individual diagnosis
– Community diagnosis
– Sensitive to change
• H/A indicates linear growth retardation
– not sensitive to change
– slow progress
– Community diagnosis
Body Mass Index
Nutritional Indices in Adults
• The international standard for assessing body
size in adults is the body mass index (BMI).
• BMI is computed using the following formula:
BMI = Weight (kg)/ Height (m²)
• Evidence shows that high BMI (obesity level) is
associated with type 2 diabetes & high risk of
cardiovascular morbidity & mortality
Measures Using Height and Weight

BMI Body Mass Index


wt (kg)
ht (m)2

or
wt (lb) X 705
ht (inches) 2
International classification of BMI
Measurements
Example
• Height –
1.96 m (6 ft 5 in)

• Weight –
125 kg (276 lb; 9 st 10 lb)

• BMI – 32.55 kg/m2


•Still … BMI – 32.55 kg/m2
Run 100m

in 10.8 s!!!!
Measures Using Height and Weight
Cons: BMI can misclassify up to one
out of four people.
– Does not account for fat distribution
– Doesn’t account for LBM - may
misclassify frail/sedentary or very
muscular people
Other anthropometric Measurements

• Mid-arm circumference
• Skin fold thickness
• Head circumference

• Hip/waist ratio

• Head/chest ratio
Measuring weight - Video
Measuring weight
Measuring weight
Measuring Height - video
Infantometer

Stadiometer
Measuring Length - video
Circumferences - video
Skin fold thickness - video
Skin fold thickness - video
Growth percentile charts
Growth charts

What is normal
growth?

When can you


call it abnormal?

When does it
tends to change?

Drawbacks?
ADVANTAGES OF ANTHROPOMETRY
• 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
standard growth charts
• Readings are reproducible.
• Non-expensive & need minimal training
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.
Energy Expenditure

Humans oxidise (metabolise)


carbohydrate, protein, fat (and
alcohol) to produce
Energy.
Energy is used to….
• To maintain body functions - to breathe, to
keep the heart beating, to keep the body
warm and all the other functions that keep
the body alive.
• For physical activity - for active movement
- muscle contraction.
• For growth and repair, which require new
tissues to be made
Measurement…
• Energy can be measured in either joules
or calories
• 1 kcal = 4.184 kj
• The average daily energy intake in the UK
is 10250kJ (2450 kcal) for men and
7030kJ (1680 kcal) for women.
• The energy in the diet is provided by
carbohydrate,protein, fat and alcohol.
A gram of…..
• carbohydrate (starch or sugar)
provides 16kJ (3.75 kcal)
• protein provides 17kJ (4 kcal)
• fat provides 37kJ (9 kcal)
• alcohol provides 29kJ (7 kcal)
Energy Expenditure…
The energy expenditure
(EE) of a man or woman
over a whole day is
often divided into
different components,
which can be
individually determined.

These are:
Basal metabolic rate
(BMR),
Diet induced
Thermogenesis (DIT),
Physical
activity (PA)
Calculating

total energy

expenditure
Basal Metabolic Rate
(BMR)
• is the amount of daily energy
expended by humans (and other
animals) at rest.

• Rest is defined as existing in a


neutrally temperate environment
while in the post-absorptive state.
BMR
• Basal metabolism is usually by far the largest
component of total caloric expenditure.
• Basal metabolic rate is usually expressed in
terms of daily rates of energy expenditure.
(kcal/day)
• The primary organ responsible for regulating
metabolism is the hypothalamus.
• The basal metabolic rate varies between
individuals.
Energy Expenditure at Rest
• Basal Metabolic Rate
– BMR is rate of energy expenditure fasted,
rested and supine conditions in thermoneutral
environment
– Resting metabolic rate (RMR) is rate of energy
expenditure when at rest but not basal
– BMR proportional to BSA, after age 20 reduces
2% & 3% per decade in women and men,
respectively
Factors effecting BMR
• Regular exercise – Keeps BMR elevated
at rest
• Muscle mass – More muscles – more
BMR
• Diet – Severe calorie restriction reduces
BMR
• Food type – Proteins increase BMR
Factors effecting BMR
• Hormones – Thyroxine
• Stress – Increases BMR
• Age – Reduces BMR
• Gender – Males higher
• Body temperature – Elevates BMR

• ? What happens to BMR in an infection /


inflammation?
Dietary reference intakes (DRI)
• Recommended Dietary Allowance
(RDA)
• Adequate Intake (AI)
• Tolerable Upper Intake Level (UL)
• Estimated Average Requirement (EAR)
Recommended Daily
Allowances
Recommended Dietary Allowance
(RDA)
• It is the average daily level of
intake sufficient to meet the
nutrient requirements of nearly all
(97%-98%) healthy people.