Nutritional

Anthropometry
Unit 3 (Part 2 of 4)
2nd sem. S.Y. 2021 - 2022
Classification of Anthropometric
Measurements
Measures of Body Measures of Body
Size Composition
Weight Direct
Length / height Indirect (simple
Body and laboratory
circumferences methods)
Measures of Body Composition
• Direct Method • Indirect - Laboratory
Cadaver analysis (Gold Methods
Standard) Isotope dilution:
• Indirect - Simple deuterium
Methods Bioelectrical impedance
Mid- upper arm analysis (BEA)
circumference (MUAC) Water/ air displacement
Waist circumference methods
Hip circumference Neutron analysis
Skinfold thickness Imaging techniques
(DEXA, MRI, CT scan)
Indirect - Simple Methods
Mid – Upper Arm Circumference (MUAC)
• Indicates fat and muscle
development as well as
wasting (reduction of either
muscle mass, subcutaneous
fat or both)
• Proxy indicator for weight
• Useful in diagnosis of
malnutrition or in monitoring
progress during nutritional
therapy
• Can be used for screening for
PEM emergencies (ex. famine
and refugees crises)
• Serves as a proxy measure of the nutrient
reserves in muscle and fat

Advantages:
Useful when weight and stature are impossible to
get
Can be used even when precise age of the child
is unknown
Used as an alternative to weight – for – height
in children, but not recommended when edema is
present
Inexpensive tool
MUAC Cut – Offs to Classify Nutritional
Status of Children
Source: WHO, 2010

AGE Severe Acute Moderate Acute

Malnutrition Malnutrition (MAM)
(SAM)
6 – 59 months < 115 mm >115 to < 125 mm
 Acute Malnutrition (0 – 59 months)
Severe Acute
Malnutrition
• Very low weight for height
(below -3Z scores of the
WHO growth standards), or
• MUAC <115 mm, or
• Presence of edema
GLOBAL ACUTE MALNUTRITION (GAM)
- Refers to the sum of the prevalence of SAM plus MAM at a population level
Moderate Acute
Malnutrition
• Weight – for – height
between -3 and -2 Z – scores
below the WHO child growth
standards, or
• MUAC >115 mm to <125 mm
 WHO/UNICEF Standard for Classifying
Children with Severe Acute Malnutrition
(SAM)

INDICATOR MEASURE CUT - OFF

Severe wasting(2) Weight – for – < - 3SD
height(1)
Severe wasting(2) MUAC <115 mm
Bilateral edema(3) Clinical sign

(2,3) Independent indicators of SAM that require urgent action

(1) Based on WHO standard
Source: WHO child growth standards and the identification of SAM in infants and children
MUAC for Adults
• NO international evidence–based cut–offs are
established yet for MUAC among adults. However
some countries have established their own cut–off.
• In addition, a 2017 meta – analysis found that MUAC
cut- offs in the range of <23.0 to <25.5 cm could
potentially serve as appropriate indicators for low
BMI (<18.5) among adults screened at the
community level.
• This suggest that <24.0 cm may be an appropriate
cutoff to trigger referral to a health facility for further
assessment.
MUAC for Pregnant Women
• May be used to classify nutritional status in
pregnant and non- lactating women.
• There is yet NO consensus of a common cut-off
for malnutrition using MUAC. However based on
literature, MUAC less than 22 cm predicts low
birth weight but a cut-off using 23 cm can
include more women for nutrition intervention.
Mid-Upper Arm Muscle Circumference (MUAMC)

• Calculated circumference of
the inner circle of muscles
surrounding a small central
core bone
• Computed from the
measurements of MUAC and
triceps skinfold thickness
• Used to assess PEM, as the
muscle mass is an index of
protein reserves
• Insensitive to small changes of
muscle mass
Mid Upper Arm Muscle Area (MUAMA)/
Arm Muscle Area (AMA)
• Index of lean tissue or muscle in the body.

AMA = [(MUAC) – (π x TSK) 2]/4π

Where:
AMA = Arm Muscle Area (cm)
TSK = Triceps skinfold (cm)
MUAC = Mid Upper Arm Circumference

cAMA = [(MUAC – (π x TSK))2/ 4 π] – 6.5

corrected for “bone free” AMA by subtracting bone, nervous

tissue, vascular tissue with 6.5 for females and 10 for males
Head Circumference
• An important measure to screen abnormalities
of the head and brain growth particularly during
the first year of life.
• Measured using a non-stretch tape which is
positioned just above the eyebrows, above the
ears and around the circumference of the head
to get the largest circumference.
• Head/Chest circumference ratio is of value in
detecting PEM in early childhood.
HC–for-Age
• Can be used as an index of chronic protein-
energy deficiency for children < 2 y.o.
• Chronic malnutrition during the first few
months of life or intrauterine growth retardation
may hinder brain development and result in
abnormally low HC for Age
• Beyond 2 y.o., growth in HC is slow and is no
longer useful
• Not sensitive to extreme malnutrition
 Tools Needed in Measuring the
Head Circumference
Infant head tape measure/
Measuring tape for head
circumference/head circumference
measuring band/Lasso-o head
circumference tape measure
Flexible but non- stretchable tape
Procedure
 Anthropometric Measures & Indices
for Adults
NOTE: Details of the procedures, data processing, and interpretation will be
discussed further in the laboratory.
• Weight • BMI
• Height • Ideal Body Weight
• Waist Circumference • Relative weight
(WC) • Usual body weight
• Calf Circumference • Percent usual body
• Arm span/ demi span weight
• Knee height • Percent Weight Change
• Waist – Hip Ratio
 Alternative Measurements
(Proxy anthropometric measures)
• These are alternative
measures used to estimate
stature in older adults
who have contractures of
the spine or unable to
stand or those with
deformities.
Compression Fractures of the Vertebrae
Lead to Loss of Height and Forward
Bending of the Upper Spine
Knee Height
• Subject in supine position
• Blade on anterior surface
of thigh, proximal to the
patella
• Blade under heel of left
foot
• For people who cannot
stand or have severely
curved spines
Knemometer
Knemometer
Formula to calculate for height using
Knee Height (For Filipinos)
• Men ( ht in cm) = 96.50 + (1.38 x knee ht) –
(0.08 x age)

• Women (ht in cm) = 89.68 + (1.53 x knee

ht) – (0.17 x age)
Armspan
• distance between outstretched fingers of
right and left hands, with arms extended
laterally and maximally to the level of the
shoulders
• measured using a steel tape
Formula to Calculate for Height using
Arm Span (Tanchoco et al)
Men (ht in cm)= 118.24 + (0.28 x arm
span) – ( 0.07 x age)

Women (ht in cm) = 63.18 + (0.63 x arm

span) – (0.17 x age)
• Halfspan – distance between middle
finger of stretched hand and arm to the
mid u bone at the base of the neck
Demi - span
• Useful in the clinical setting for patients
with lower limb dysfunction
• Using the left arm if possible
• Measure the distance from the web of the
middle finger to the middle of the sternal
notch
Formula to calculate for height from
Half Span
• Females (ht in cm) = (1.35 x Half – span in
cm) + 60.1
• Males (ht in cm) = (1.40 x Half – span in cm)
+ 57.8
Weight – for – Height Ratios
• Measure body weight corrected for height
• Highly correlated with obesity
• Frequently called obesity or body mass
indices ( BMI)
Body Mass Index (BMI)
• Also known as Quetelet’s Index
• Considered to be the best body mass index for
adult population group
• Least biased by height and easily calculated
• Used to classify overweight and obesity
• Used to estimate prevalence of obesity and
risks associated with it
• Does not account for the variation in the nature
of obesity and differences in body build and
proportion
From Deficiency to Excess: The BMI Spectrum in Adults
International Classification of Body
Mass Index (BMI) for Adults

Principal cut – Category Health risk

off points
<18.5 Underweight For BMI<16, suggests possible
eating disorder
18.5 – 24.9 Normal Healthy, low health risk
25.0 – 29.9 Overweight Associated with increased risk
of disease
> 30.0 Obese Associated with further
increase risk of disease

Adapted from WHO, 1995, 2000, 2004

Asians have lower BMI but higher Body Fat
MALES FEMALES

Caucasians Asians Caucasians Asians

mean SD mean SD mean SD mean SD

BMI 25.1 3.0 23.4 3.0 23.9 3.4 22.5 3.3

BF % 19.3 6.4 21.4 6.3 30.1 8.7 31.6 6.5

SOURCE: Wang et al.,1994

BMI Cut – Off for Public Health Action

< 18.5 Underweight

18.5 - <23.0 Low to Recom-
mended
moderate risk for
ASIANS
23.0 - <27.5 Moderate to
high risk
= > 27.5 High to very
high risk
• 20 – 25 – Caucasians
• 22.5 – 27.5 – Western Pacific
• 18.5 - <25 – For all Countries(WHO)
Classification of BMI for the Asia – Pacific
Population (NICE Guidelines, 1991)

PRINCIPAL CUT – OFF CATEGORY

POINTS

<18.5 Underweight
18.5 – 22.9 Normal
23.0 – 27.5 Overweight
> 27.5 Obese
Cut – off points to determine magnitude and severity
of underweight (BMI <18.5) for adults 19.0 years and
over as public health problem (WHO, 1995)

Magnitude and Prevalence Group

Severity for Underweight
Low 5–9%
Medium 10 – 19 %
High 20 – 39 %
Very High > 40 %
Waist Circumference
• Waist circumference will be taken over one
layer of light clothing using a fiber glass tape
measure
• Measurement will be taken with the tape in a
horizontal position pulled firmly but not causing
indention
• Measurement will be taken at the end of the
normal expiration and will be recorded to the
nearest 0.1 cm
Location Recommended by WHO, 2011
• Measured at the smallest
circumference of the waist or
midway between the lowest rib and
the iliac crest (WHO, 2011)
• Site recommended by NCBI in US and
Canada – around the iliac crest (based on
studies that showed higher fat
composition in this area.
Not Recommended
Waist Circumference Cut - offs
AGENCY INCREASED RISK OF DISEASE
WHO Men > 94 cm Women > 80 cm
Substantially increased risk if:
Men > 102 cm Women > 88 cm
International Diabetes Men (Asian) – refers to South Asian,
Federation Chinese, and Japanese: > 90cm
Men (European): >94cm
Women (European and Asian): >80 cm
U. S National Men: > 102 cm
Cholesterol Education Women: > 88 cm
Program
Range of cut – offs Men: > 80 cm to > 96 cm
established by countries Women: >75 cm to >99 cm
Hip Circumference

• Is measured by positioning the

measuring tape around the hips at the
level of the great trochanters

• Recorded to the nearest 0.1 cm

Waist/ Hip ratio
• Provides index of both subcutaneous and intra
– abdominal adipose tissue and therefore a
valuable indicator of fat distribution
• Can classify obesity as gynoid or android
• WHR = waist circumference (cm)/ hip
circumference (cm)
• WHR > 0.90 men or > 0.85 women
indicates increased risk of cardiovascular
complications stroke and diabetes mellitus
Waist – Height Ratio (WHtR)
• Calculated from WC (cm) divided by
the height (cm), with a cut – off of
greater 0.5 to indicate increased
risk to CVD and co - morbidities
 Body Fat
• Skinfold thickness measurements ( triceps,
biceps, subscapular, etc.)
• Provide an estimate of the size of the sub –
cutaneous fat depot which in turn estimate
the total body fat
• Waist – hip circumference ratio and limb
fat area may also be used as
anthropometric indices of body fat.
Errors in Anthropometry (skinfold)
Measurement and Common Error Proposed Solution
TRICEPS FATFOLD

Wrong arm Use left arm

Mid –arm point or posterior plane Measure midpoint
incorrectly measured or marked carefully
Finger thumb pinch or caliper Correct techniques with
placement too deep (muscle) or too training, supervision and
superficial (skin) regular refresher courses
Caliper jaws not at marked site; reading and workshops
done too early, pinch not maintained;
caliper handle not released
Examiner not comfortable or level with Ensure examiner is
subject correctly positioned

Source: Gibson, R.S. (2005). Principles of Nutritional Assessment. 2nd ed. Oxford University Press
Calf Circumference
• Indicates changes in muscle mass due to
age and inactivity, thus it is used to
estimate muscle mass in elderly
populations.
Formula to Approximate Weight from CC:
Weight ( women) = (1.27 x CC) + (0.87+ KH) + (0.98 x
MUAC) + (.4 x SSF) – 62.35

Weight (men) = (0.98 x CC) + (1.16+ KH) + (1.73 x

MUAC) + (0.37 x SSF) – 81.69

Where:
CC – calf circumference
MUAC – mid upper arm circumference
SSF – subscapular skinfold
KH – knee height
 Rapid Nutrition Assessment

 Assessment of nutritional status based

on simple anthropometric data:
 Weight
 Height
 Mid-upper arm circumference or
MUAC

Source: National Policy on Nutrition Management in Emergencies and

Disasters
Why use MUAC?

 MUAC is:
 simple
 quick
 accurate
 inexpensive
How to interpret MUAC
cm SAM MAM NORMAL
11.5 12.5

For Children 6-59 months

RED SAM MUAC < 115 mm (<11.5
cm)
YELLOW MAM MUAC ≥ 115 mm (>11.5
cm) and < 125 mm (<12.5
cm)

GREEN Normal MUAC ≥ 125 mm (>12.5

cm)
TRAINING PACKAGES
Measuring edema
FOR HEALTH EMERGENCIES 08\
END