UNIT 15 ASSESSMENT OF

NUTRITIONAL STATUS
In the previous units you have learnt about the body's needs through various stages
of the life cycle. Now you may question, how one can judge whether a person of a
particular age group has normal health or is under or overnourishad. Let us try to
find out the answer to this question in this unit.

Structure
Objectives
Introduction
Does Nutrition Make a Difference?
Nutritional Status
Measurement of Body Size
Growth Monitoring of Children
Adults and their Body Size
Dietary Assessment
Let Us Sum Up
Glossary
Answers to Check Your Progress

15.0 OBJECTIVES

After completing this unit, you will be able to :

.explain the effect of good nutrition on the body and its performance,
describe the methods used to determine nutritional status,
describe the methods used to meqsure body size (weight and height), and
a help monitor growth of children.

16.1 INTRODUCTION
So far you have learnt about the body's needs through the various stages of the life
cycle. You have also understood how to meet these needs by proper selection and
inuke of foods. One of the questions you may be asked by people i s 'Does nutrition
really make a difference in your life? The answer is definitely YES. The next
question is: 'How do you know if you are well nourished?.let us try to answer these
questions. '

lq.2 DOES NUTRITION MAKE A DIFFERENCE?

learnt in Unit 5, a person's growth rate and size is decided by two main
her inborn capacity to grow and the environmental conditions. Of the
is one important condition, which you can modify. Obviously, these
on each other, because you know heredity decides the final size
actually reach that size is largely dependent on your nutrition.
is in your heredity, but the bricks and mortar are in

Bod Size: You may have noticed that there is a progressive increase in the body size
dh\~alh,Tho hdp
~t~iumtnU you to ncord the c h a n p in body s i z 9

h.vi:g~tand b&ht. body w softtissues such as muscle .and

Onefat.
way lt of
is
brides the skeletal frame, Y
diRlruL muscles, but you can measure the Iat
doing it is to measure the skidoldour
thickness. Affects your capacitY 'O
,-&,mme: Besides body size, Y
~~dUamlwla*Fod~~a whrk asd-to live a long happy life. As you have learnt in Unit 5, your brain is the
H lcwl Mhnwi- fastest growing part of the body. By the time you are two years old, 90 per cent of
your brain si= is reached. The most rapid growth of the brain takes place from the
wcond half of pregnancy upto the tenth month of infancy. You will appreciate how
important it is to ensure that the mother and infant are fed well in this period.
Another aspect of learning is the ability to concentrate. You know that children, who
are hungry, are unable to concentrate on their school work.
Many facton affect your capacity to work and nutrition is an important factor. It
was found that increasing the food intake of underfed farm and road building
labourers by 30 per cent increased their work output by 50 per cent. As you may
have observed, the capacity for physical work is related to your body size.
Underweight persons are not able to carry heavy loads for long. When you are
malnourished, you are unable to resist infections and may have to remain absent
from work frequently. Thus your work output is inconsistent and bw.
Thus you will appreciate that a well-fed, productive m n is an asset to the work
force. For example, when anaemia was corrected by iron therapy in Indonesia, the
work output increased measurably. 1
Longevity: An Indian child born in 1901 was predicted to live to about 25 years of ,
age; by 1980 life expectancy of an Indian male had inCrcased to about 57 years. The '
gain in life expectancy has been made possible by controlling certain diseases such as
small pox, tuberculosis and some childhood ailments. It is difficult to assess the
-
i I
exact role of nutrition in life expectancy. But if you look at improvement in life
expectancy in countties where people are well-f@ you can see that it does make a
difference. For example, the life expectancy of people in countries such as the USA
and UK was 75 years in 1985. If the productive years in a 55 year life-span is 35
years these will increase to 50 years when the lire-span increases to 70 years. With
the knowledge you have gained in this course, you can help to achieve this goal. I
I
You will certainly agree that this is enough evidence for us to take care of our health
and well-being, thtough good nutrition I

UCheek Your Propea

1 Explain how learning is affected by nutrition.

2 What is the effect of nutrition on work performance?

3 Fill in the blanks.

a) . Two simple measurements help you to record body size ....................................
and ...................................
b) By the time you are two years old .................... per cent of your ...................is
reachd.

15.3 NUTRITIONAL STATUS

You may have r e a l i i that nutritional status is the level of nourishment of your
body. Each of us would like to maintain a good nutritional status. So far you have
learnt that nutrition affects your body size, your brain develo~ment.VOIIT
p n o m n n c e , your capacity to work and life-span. Nutritional status
- - ' reflects
L J--- the kind
of nourishment your bady gets from the foods you at.If foods provide your body's
needs optimally, you look and feel healthy and you enjoy a good nutritional status.
'The child that is botn on a &b&h
Is bOn%acd happy and good and my. *
\
 This nursery rhyme reflects our desire for good health and happiness and describes a h m m d d N~lMtlonrlW
child, who enjoys good nutritional status and health. When you think of signs of
good nutrition, you think of a healthy complexion, bright eyes, a good figure, a
positive, happy temperament, willingness to work, etc., in short, a person, who is an
asset to the family and community.
These are some of the indicators of good nutritidnal status. You can measure and
record some. while others are qualitative ones and cannot be easily measured. Body
size is a gross indicator of nutritional status. Let us get acquainted with the methods
used to measure body size.
Check Your Progress
4 Describe the signs of good nutritional status.

5 Fill in the blanks.

a) Nutritional status reflects the .............................our body gets from the
........................
b) Body size is a ............................... of nutritional status.

15.4 MEASUREMENT OF BODY SIZE

In Units 5 and 7, you have learnt that body weight and height indicate your body
size. In addition, the head, chest and midarm circumferences give an idea of growth
and development, especially of small children (0-5 years). So you record these body
iheasurements at various stages of development to study the growth pattern. Let us
i get acquainted with the correct methods of recording these measurements.
Weigbt: Weight is a commonly used indicator of body size, as it reflects the level of
food intake. You know that in the hospital a baby 1s weighed soon after birth. Even
babies born at home are weighed by the visiting mid-wife or nurse on a portable
weighing scale. The normal weight of a healthy baby varies between 2.5 to 3.5 kg. If
the baby weighs less than that, you need to take special care to see that the baby
attains good health as soon as possible after birth. After birth it is advisable to
maintain a record of the baby's weight at monthly intervals. You can advise you
family members and neighbours to maintain a periodic record of their infant's
weight. t
You will realise that the scales used for weighing babies need to be more sensitive
. than those used for weighing adults. Baby scales, which have 100 gm divisions, are
ideal for weighing infants (Figures 15.1 and 15.2). Another weighing scale used by
field staff of variorls agencies is a portable one, which can be hung from a roof or a
tree, and as shown in the figure, has a sling to hold the baby. When a baby scale is
not available, you can use an adult weighing balance, and record the weight of child
with mother and then the mother alone. The difference of the two weights is the
weight of the child.
You can record the wieght of children regularly to check if there is a normal gain in
weight. The weight can be platted against age to see if the pattern of growth is
normal, by comparing it with the normal curve presented in Figure 5.3 in Unit 5. If
a child fails to gain weight, and does not follow a normal pattern of growth, you
must find the reason gnd take remedial action.
You can compare the weights of adults with the weight for height (Tables 7.2 and
--7.3) given in Unit 7. As you noted in Unit 7, weight record helps to check energy
balance in adults.
Linear Measurements: As you noted above, a number of linear measurements are
included in this group, such as height, circumferences of head, chest and mid-arm,
and skinfold thickness. Let us get t o know to record each of these.
Height: Height is another measure of growth of a child. As you have learnt in Unit
5, there is a 50 per cent increasein height in the first year and a child reaches half of
--
 Fbure 15.1 W e w a g Preschool child with Standud UNICEF Berm Imlmce sede

N s ie the hrndng eaie which & rtronJy recommended. As lllurtratcd the child may be placed Introusersor a
number of dher rtccptstlcs, depending on the local culture.

hislher adult height by the second birthday. Thus, recording height helps you to
know if the child is growing normally. In addition you can compare weight for
height of the child to the norm (Tables IS. 1 and 15,2) for that height for age and sex
to evaluate a child's growth. In adults, weight for height for age and sex, tells you
how well the body's food intake meets the energy needs.
You can use a vertical measuring tape scale fixed on the wall to record the height of
older children and adults [Figure 1 5.3 (a)]. The scale used for measuring height
should be two metres in length and capable of measuring to an accuracy of 0.2. cm.
You need a different device t o measure.the length of infhts. It can be made by
attaching a scale tb a Jhaped wooden board [Figure 15. (b)]. You can place the
I T.)k 15.1 Wdgbt Ik Hd* for 1-18 Yam, Boys

Height Mean &V van)

cms Weight
kg. I 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
65 7.0 7.0
70 7.6 7.5 7.6
75 8.7 8.5 8.7 8.8
80 9.9 9.8 9.9 9.9 10.0
85 10.8 10.7 10.8 11.01 1.0
90 12.0 11.912.012.1 12.1
95 13.1 13.0 13.1 13.213.2
100 14.3 14.2 14.3 14.3 14.4 14.6
105 15.5
11U 1 I."
-

115 18.5 18.418.518.5 18.7 18.5 18.9

120 20.2 20.420.I20.I 20.2 20.5 20.6 21.0
125 22.5 22.222.3 22.3 22.5 22.7 22.5 22.7
130 24.6 24.3 24.3 24.4 24.6 24.7 25.1 24.8
135 27.1 26.6 26.6 27.0 27.1 27.2 27.5 27.7
140 29.5 28.8 29.3 29.5 29.8 29.9 30.2 29.9
145 33.2 32.0 32.3 32.6 33.2 33.3 33.3 34.9
I50 36.3 35.5 36.1 36.2 36.3 38.0 39.2 41.4
155 40.8 38.7 39.2 39.8 40.8 41.3 42.1 43.3
160 44.7 43.7 43.2 43.5 44.7 45.3 46.7
165 47.3 46.2 47.1 47.3 48.4 49.0
170 51.0 49.8 50.9 51.6 51.8

Tabk 15.2 Wd@t for Hdght for A p 1-18 Yam, CLrb

Heat Mean &(yam)

cmr Weight
kg. 1 2 3 4 5 6 7 8 9 10 11 I2 13 14 I5 16 17 18
60 5.3 5.3
65 6.56.3 6.7
70 7.4 7.3 7.4
75 8.4 8.2 8.5 8.7
80 9.7 9.4 9.5 9.8 10.1
85 10.8 10.410.8 10.8 11.0
90 11.8 11.61 1.711.81 1.912.0
95 12.8 12.7 12812.9 13.0 13.0
100 14.4 14.014.014.214.514.8
105 15.4 15.3 15.315.415.415.4 15.5
110 17.0 16.8 16.816.916.9 16.9 17.2
115 18.6 18.418.418.518.5 18.6 18.5 18.8
I20 20.6 20.220.320.420.4 20.5 20.7 21.0
125 22.6 22.222.2 22.3 22.6 22.6 22.9 23.0
130 24.7 24.2 24.4 24.5 24.8 24.9 25.3
135 2fL5 27.1 27.4 27.8 28.0 28.5 29.0 31.0
140 33.1 29.3 29.8 30.5 31.8 33.1 34.9 360 36.7 37.4
145 36.3 32.6 33.0 33.4 34.9 36.3 37.8 38.8 39.2 39.8
I50 40.1 37.3 38.3 39.3 40.1 41.4 422 425
155 42.9 40.5 42.1 42.9 44.0 44.7 44.5
160 46.1 45.3 46.2 46.1

COURTESY
Growth and Physical Development of IndLn Infanta md Children, ICMR Tedurkal Repart Series NO:
18, a p k d t- TW 14, pp. 7477,1972 .ad ~ a b k14 pp 7477.1972

The M k t b percentile is +en.

Nutdllond 98atu8, Food HablIa Figure 15.3 (a) Height measurement of School Child
and F w d M h e o ~ e p t l o w

In case of infants height is known as length and a different type of balance is used
(b) irngth measurement of infant.
int*inton it with head touching the head board. The knees are extended by gentle -dNml%atm
pressure. A light wooden block is moved to touch the heels and the length is read t o
the nearest 0.1 cm.
If you record the weight and height at regular intervals, the weight for height can be
checked.
Head, Chest, Mid-arm Circumferences: In addition to height, three other length
measurements help you to note the gross status of your body. These are head, chest
and mid-arm circumferences. You will find that these are very useful to check growth
in small children. You can measure these very easily with a measuring tape and
record these.
Head Circumference: You have noticed that babies have a large head a t birth
compared to the rest of their body. The head circumference continues to increase
rapidly upto six months after birth, and then it increases slowly.
You use a narrow (less than 1 cm wide), flexible, non-stretch tape to measure the
head circumference. Please avoid using a cloth tape, a s it tends to stretch with use.
You measure the greatest head circumference by placing the tape firmly around the
head and passing it at the centre of the forehead. Please be sure that it is at the level
on each side of the head and it passes over the maximum Protrusion (which is called
the occipital prominence) at the back of the head [Figure 15.4 (a)]. Measure the head
circumference to the nearest 0.1 cm.
Chest Circumference: It is useful as a measure of growth only upto three years. If
your child grows normally in the first year, the head and chest circumferences are
almost equal at about six months of age. After that, the head grows slowly and the
chest more rapidly (Table 15.3). The chestlhead circumference ratio is useful t o
detect undernutrition in early childhood.

Table 15.3 Head and Chest Ci~umferenceMeasurements In Flrsi Flve Years

COURTESY
Growth and Development of Children,4thed. by E.H. Wagon and G.H. Lowrey Yearbook Medical Publishers
Inc. 1962.

You can use the same tape, which you used to measure head circumference, to
record the chest circumference. Be sure to measure the chest circumference at the
nipple line, preferably in mid-inspiration (that is half way between full breathing in
land full breathing out) [Figure 15.4 (b)]. Please d o not take the reading when the
child is crying or breathing irregularly. Measure the chest circumference to the
nearest 0.1 cm.
If you find that the chest circumference to head circumference ratio 1s less than one
etween six months of age and five years, you know that the child is undernorxished
needs special attention. If you don't have a tape measure, you can compare the
cir~umferenceswith a piece of string and note if the chest circumference is more
C)r less than the head circumference after six months of age.
 Natrleonrl sahu, F o ~ dH~MIO Arm Circumferedce: The mid-arm circumference gives you an idea of the size of the
and Food Mbcompliom arm muscle and the fat laver below the skin. T o measure arm circuderence, you let
the arm hang loosely by the side of the body and measure the arm circumference at
the midpoint of the upper arm, between the tip of the shoulder and the elbow
[Figure 15.4 (c)]. Use a measuring tape with divisions of 0.1 cm (the same tape used
for measuring chest and head circumferences).
Mid-arm Circumference to Head Circumference Ratio (MC/HC Ratio): You will be
interested to know that the MC/HC ratio can be used to check if the child is normal
or malnourished. It can also help to detect the degree of malnutrition in children
between one and five years of age. As these are length measures, you need only a
tape to record these. After you record these two measurements, you can consult
Table 15.4 to check the state of nutrition of the child. In table 15.4 head
circumference (in relation to mid arm circumference) is classified into mild, moderate
and severe degree of malnutrition. Here there is no need to calculate MC/HCratio;
you can just find out mid arm circumference and head circumferepce and consult
B
k
Table'15.4. For example, if the mid arm circumference of a child is 10.5 cm and the
i head circumference is between 34.0 and 37.5 cm, the child is mildly malnourished.
Remember that you q n use this ratio only when the child does not have edema.
Edema is an accumulation of fluid under the skin due to disturbance in the fluid
retention of the cells.

/
'Skinfold Measurement: About 50 per cent of the fat in your bddy is in a layer .benmnt b nu hi^ sum
directly beneath the skin. Insufficient intake of calories over a period of time leads to
reduction in the thickness of the fat layer under the skin. You can measure the
double layer of skin and subcutaneous fat, which is known as skinfold thickness and
tell the state of fat reserves of your body. This measurement helps you to know the
extent of the body's fat reserves. If the reading is lower than the norm, you are
undernourished; if it is higher than the norm, it indicates too much fat deposition,
which has an adverse effect on your health.
Skin-fold measurement can be used along with other measurements such as weight
for height to evaluate nutritional status. However, skin-fold measurement requires
more training and expertise than measuring weight and height.
Generally, in order to evaluate nutritional status, weight and height are the easiest to
determine. In small children, the three circumferences are also very useful.

Table 15.4 : Mid-arm Circumference to Head Circumference

Midarm Head Circumference (cm)

Circum-
ference Degms of malnutrition

(cm) Normal Mild Moderate Severe

8.0 Upto 25.8 25.9 to 28.6 28.7 to 32.0 32.1 and above
8.5 Upto 27.4 27.5 to 30.3 30.4 to 34.0 34.1 and above
9.0 Upto 29.0 29.1 to 32.1 32.2 to 36.0 36.1 and above
9.5 Upto 30.6 30.7 to 33.9 34.0 to 38.0 38.1 and above
10.0 . Upto 32.2 32.3 to 35.7 35.8 to 40.0 40.1 and above
10.5 Upto 33.9 34.0 to 37.5 37.6 to 42.0 42.1 and above
11.0 Upto 35.5 35.6 to 39.3 39.4 to 44.0 '44.1 and above
11.5 Upto 37.0 37.1 to 41.0 4 1.1 to 46.0 46.1 and above
12.0 Upto 38.7 38.8 to 42.8 42.9 to 48.0 48.1 and above
12.5 Upto 40.3 40.4 to 44.6 44.7 to 50.0 50.1 and above
13.0 Upto 41.9 42.0 to 46.4 46.5 to 52.0 52.1 and above
13.5 Upto 43.5 43.6 to 48.2 48.3 to 54.0 54.1 and above
14.0 Upto 45.1 45.2 to 50.0 50.1 to 56.0 56.1 and above
14.5 Upto 46.7 46.8 to 5 1.7 5 1.8 to 58.0 58.1 and above
15.0 Upto 48.4 48.5 to 53.5 53.6 to 60.0 61.1 and above
15.5 Upro 50.0 50.1 to 55.3 55.4 to 62.0 62.1 and above

COURTESY
1 Mudambi, Sumati R., Age-Independent Anthropometry. Jour. Fly. Welfare. XXlX (2) : 57, 1982.
2 Classification based on ratios suggested by Kanavati and McCaren (1970), developed by Dr. S.R.
Mudambi (1981).

Check Your Progress

6 Why is weight measurement important in early childhood?

7 List the 1inear.measurements used to record growth in children.

...............................................................................................................................
...............................................................................................................................
...............................................................................................................................
Nrmak.ll8(.(r.
~ n dFond MLu-
~ o o d~ . b l b .-
8
-
What is the significance of head and chest circumference..in the first year?
................................................................................................................................

9 Match the following:

1) There is 50 per cent increase a) is a n indirect measure of fat
reserves.
2) Head circumference is greater b) height in the first year.
, than
3) Mid-arm circumference c) chest circumference at birth.

15.5 GROWTH MONITORING OF CHILDREN

Growth monitoring is very important in children. As children between 0 to 5 years

are at a vulnerable stage of growth, detecting any faltering in growth is very useful.
Because at this stage, it is possible to bring the child back to normal, by judicious
improvement in food intake. Thus you can prevent further adverse changes, which
take longer to reverse and hence cost more.
You have learnt how to record the physical growth by taking weight, height and
head, chest and mid-arm circumferences of children. You should carry out these
measurements at regular intervals and record these. You must be wondering how
often these should be measured. The infant grows very fast, so you should record
these every month in the first year, every other month in the second and about onct
in three months from 3 to 5 years of age.
Monitoring Growth-Weight and Height
First check if there is an increase in weight each time you weigh the child. If you
find successive increase in the weight of a child, it shows that the child is growing.
Secondly, check if the weight increase is normal by comparing with the growth curve
(Figure 5.3). When you compare this weight increase with the growth curve you can
see if the weight increase is normal. Thirdly, compare the weight for height with the
help of the growth chart. The comparison of the weight for height with a growth
chart tells us if there is proportional growth of the body.
Monitoring Growth-Other Measurements
As you have learnt the head circumference is greater than the chest circumference,
until the infant is about six months old. After that the chest circumference exceeds
the head circumference. If you find that the chest circumference is less that the head
circumference between six months of age and five years, you know that the child is
undernourished and needs special attention. Thus these measures are useful only in
early childhood.
The mid-arm circumference is a gross measure of body fat reserve and muscle
development. When a child is chronically undernourished, there is poor muscle
development. The muscle tissue and fat are used up to meet the body's need for
energy. This results in reduction in mid-arm circumference. Therefore you can
measure it to detect under nutrition in young children. Note that it is useful only
when no edema is present.

15.6 ADULTS AND THEIR BODY SIZE

In India, a large number of adults suffer from malnutrition. The methods you learnt
to measure body size are useful to monitor the body size of adults also.
 AS you may remember, adults must normally maintain the body weight attained at
25 years of age (if that was desirable weight) throughout their life. A change of + 5
per cent away from this weight must be a cause for concern. Periodic record of
weight and arm circumference can help to detect a change in the early stages when
simple modification in food intake may be needed to return to normal.
At the other end of the scale you may find those who have started gaining weight,
especially after 35 years of age.
As you learnt in Unit 7, regular monthly body measurements such as weight and arm
circumference could help them to note the change in weight early enough to avoid
becoming obese. Other measurements that are useful in adulthood are chest and
waist circumference. Normally the chest is about 15-25 centimetres more than waist
in healthy adults. If this difference decreases, it is time to take appropriate remedial
steps to come back to normal.

15.7 DIETARY ASSESSMENT

You have learnt that your nutritional status is affected by the amounts and kinds of
foods you normally eat. In the first part of this unit you have got acquainted with
some of the physical measurements which can help you to assess the nutritional
, status (condition). If the condition is not satisfactory, you will want to modify your
diet. How will you do it? You must know the present food intake pattern to be able
to modify it suitably. Hence the dietary assessment needs to be carried out.
When and How to Record Food Intake
I You need to know your normal or habitual pattern of food intake. So you select
three normal working days to record the food intake. On Sundays, holidays and
festivals, you generally have special menus, and the schedule of eating changes. So
please avoid such days while recording your normal food pattern.
You write down the foods you eat each day at each meal. Please record the snacks,
, fruits and beverages you take between the meals, or with the meals. Record the
amount of each preparation eaten and also the time when you ate it. The amount
can be recorded in volume or weight. Later you can convert all the amounts into
weights. In Unit 3, you learnt about normal servings of individual foods; you will
find that (knowledge) helpful in recording food intake. Please pool the data as .
shown in Table 3.1.
Evaluation of Food Intake Data
You can evaluate the food intake to check how the food selection compares with the
daily food guide. This is qualitative check and will help you to identify if any of the
, food groups are missing from the day's intake. Secondly, you can compare the
amounts of foods taken with the suggested minimum number of servings to see if the
j amounts of foods included are insufficient.
This evaluation will help you to decide what changes need to be made in the diet to
improve the nutritional status.
I
1
*check
--10 Your Progress
'what is growth monitoring?
j

...............................................................................................................................
11 How 'would you monit'or growth of children?
12 Why is dietary assessment important?

...............................................................................................................................
13 Explain how .you would evaluate food intake data of a pre-school child.

15.8 1,ET US SUM UP

In this unit you have learnt that good nutrition is essential not only for optimal
growth and development of your body, but also to ensure your capacity to work and
longevity. Therefore you would like to maintain a good nutritional status. You can
use several methods to measure nutritional status of individuals. You can record
physical measurements such as weight, height and skin-fold thickness for all
individuals. In addition, you can record head, chest and midarm circumferences of
small children (below 5 years), to assess the nutritional status, if needed. You can
record the normal dietary intake so that it can be modified suitably to improve the
nutritional status, if there is a need to do so.

15.9. GLOSSARY

Aness: : Evaluate, estimate

Edeau/odema Swollen star.: of body due to retention of fluid.
Heredity : The phensmena of transmitting qualities from parents to off-
springs
Uts Expectancy : A statistical prediction at birth about the number of years a
person can be expected to live, when heishe is born in a
particular country. It is based on the general health conditions
and vital statistics of that country.
I--~evitY : Long length of life.
Monitor : To keep control through regular vigilance.
Vulnerable : Liable to be easily affect&. '

15.10 ANSWERS TO CHECK YOUR PROGRESS

1 The most rapid growth of the brain takes place from the second half of
pregnancy to the 10th month of infancy and this mental growth is directly
affected by the nutrition received during this period. If nutrition of the pregnant
mother or infant is inadequate the development of the brain will be affected.
 The ability to concentrate among school children also depends upon the food
they eat. Hungry children are not able to concentrate and therefore their
learning ability is poor.
2 Food gives energy to do physical work. Therefore if labourers involved in
physical work are underfed, they will have less energy to work and their work
output will be decreased.
3 Fill in the blanks
a) Weight, height.
b) 9096, brain size.
4 The signs of good nutritional status are a healthy complexion, bright eyes, good
figure, a positive, happy temperament, willingness to work, etc.
5 Fill in the blanks
a) Kind of nourishment, food you eat.
b) Gross indicator.
6 Weight gain during childhood indicates the pattern of growth of the child. In
case gain in weight is not normal, it requires remedial action.
7 Height
head, chest and mid-arm circumferences, skin-fold thickness.
8 Head circumference continues to increase rapidly upto six months after birth
and then it increases slowly and is therefore useful as a measure of growth in the
first year.
If growth is normal, head and chest circumference are almost equal at 6 months.
The chest/ head circumference ratio is a useful indicator of growth in early
childhood.
9 Match the following
There is 50% increase in1height in the first year
Head circumference is greater than chest circumference at birth
Mid-arm circumference is an indirect measure of fat reserves
10 Growth monitoring is the regular measurement of growth in children to check if
growth is normal. Any faltering in growth can be detected by growth monitoring
and corrected by improvement in food intake.
11 Growth in children can be monitored by taking their weight, height and head,
chest and mid-arm circumference.
12 In case the nutritional status is not satisfactory, the diet has to be modified. This
would require an assessment of the present diet before any modifications could
be made. Dietary assessment would indicate where the diet is lacking.
13 Food intake data of a pre-school child would be evaluated by comparing it with
the daily food guide of that age group. This would indicate if any food groups
are missing. Secondly, the amounts of foods taken can be compared to see if
intake is sufficient.
Practical Exercises
Assessment of Nutritional Status
A) Record Weight of 10 Children (3-10 year old)
Please ensure accuracy in weighing by taking the following precautions:
1) Place the scale on a firm, flat level surface. (If it is the hanging type of scale,
be sure to hang it from a firm bar or hook.)
2) Bring the needle to zero, by zero adjustment, before recording the weight.
3) Take the weight after the needle comes to a stop after moving.
4) Do not hold the child while weighing. If the scale is the hang type, the feet of the
child should not touch the ground. the scale should be hung at a reasonable
height.
5) Record the weight in a notebook immediately to avoid error in entering it. If
you have a growth chart for the child, enter it in the chart.
B) Record Height of 10 children (3-10 year old)
Please observe the following precautions to ensure accuracy:
1) Take the height without shoes or chappals.
Nutdtlo~lStatus, Food HnMC
and Food Mbconeeptlom
2) Fix the scale on the wall, near a flat floor.
3) Request the child to stand on the floor near the scale with feet parallel and
heels, hips, shoulders and back of the head erect and touching the rod with
arms hanging at the sides.
4) Place a light wooden block on the head, press it firmly and read the height
at the point where its lower end touches the rod.

Record of Weight and Height

No. Name of the child Age Weight in kg. Height in cm.

C) Record head, chest and midarm circumferences

Please follow the guidelines given in the text and record the three circumferences in
the following tables.
a) Record the head and chest circumferences ef 5 infants and 5 pre-school
children. Check if chest circumference exceeds head circumference after six
months of age.
Use the ~ollowingformat to record head and chest circumferences.

No. Name of the infant/child Age Head ce cm Chest ce cm

Note. ce = abbreviation for circumference.

No, of intants. whose chest .ce exceeds head, ce =
No, of children where chest .ce exceeds head. ce =
 b) Record the head and mid-arm circumferences of 10 children (14 year old) in
the following format :

No. Name of the child Age Head .ce Midann .a

Consult Tabk 15.4 in the text and check the state of nutrition of the child, and word.
No. of children in normal range =
No. of children mildy malnourished =
No. of children moderately malnourished =
No. of children smrely malnourished =