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Learning objectives
NUTN 401/613: Calculate and interpret the different modes of
Assessment of expression of anthropometric indices
1. Z-scores
nutritional status I 2. Percentile
3. Percentage of median
ANTHROPOMETRY
LECTURE 10: EVALUATION OF ANTHROPOMETRIC INDICES

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Modes of expression of anthropometric

indices The shape of a normal distribution
▪ Z-scores
▪ Percentile
▪ Percentage of median

A bell-shaped and symmetrical distribution, with the mean, the median, and the mode all
coinciding at its peak and with frequencies gradually decreasing at both ends of the curve

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Marks distribution for quiz 1 Normal distribution facts

N:
Mean:
69 (80)
5.32
N: 134 (148)
Mean: 4.19
▪ Area under the curve = 100%
Median:
Mode:
5.00
5.00
Median: 4.00
Mode: 2.00
▪ Fifty percent of all scores fall on each side of the mean
SD: 1.78 SD: 1.92
▪ 68 percent of scores fall within one standard deviation of the mean
▪ 27 percent fall between one and two standard deviations of the
mean
▪ 4.7 percent fall between two and three standard deviations of the
mean
▪ 68-95-99.5 rule

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Areas Under the Normal

Curve by Measuring Standard Deviation (SD) Classification
Standard Deviations
NUTRITIONAL GRADE
Percentages under the Normal CUT-OFF WEIGHT
Curve LEVEL WEIGHT FOR HEIGHT
FOR
AGE FOR AGE
HEIGHT

 Median – 2 SD Normal Normal Normal

Median – 3 SD Moderate
Moderate Moderate
to Median – 2
Underweight Stunting Wasting
SD

Severe Severe Severe

< Median – 3 SD
Underweight Stunting Wasting

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Standard scores Standard deviation

▪ Z-scores are standard scores ▪ The standard deviation is a single number that indicates
▪ How many standard deviations a score falls from the mean the spread of a distribution.
1. Calculate the mean
▪ A z-score of -2 would indicate that a person scored 2 2. Subtract mean from each score
standard deviations below the mean 3. Square each of these scores
▪ A z-score of +2 would fall two standard deviations above 4. Add up all squares of these scores
the mean 5. Divide by total number of scores (variance)
▪ Distribution: mean = 0; standard deviation = 1 6. Take the square root of the variance to find the standard
deviation

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Calculating the z-score Example 1:

z = Measured value – mean value (reference) Billy is a three year old child weighing 4.7kg. If the mean of the
population and standard deviation are 7.8 and 1.2 respectively
Standard deviation of reference
Calculate and interpret the z-score.
X −X
▪ Sample z-score z=
s
X −
▪ Population z-score z=


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Percentiles Example 2:
▪ Percentiles are distributions ▪ Say you got a score of 8 on the last test we had for NUTN
▪ Percentiles divide data into 100 groups 401 and for a score of 8 this corresponds to the 65th
▪ A percentile is the value of a variable below which a certain percent of percentile
observations fall
▪ What does that mean?
▪ Percentile is not the same as percentages
▪ E.g. if a student gets 72 correct out of 100 on a test, they earn 72%.
▪ If a score of 72 correct answers corresponds to the 64th percentile, then
they did better than 64% of the students in the class, but still receives a
score of 72%

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Percentile formula Example 3:

▪ The percentile for a given value of X is computed with the ▪ Below are the scores of 10 students on a 20-point
following formula: test. Find and interpret the percentile rank of a
score of 12.
Percentile =
(number of values below X ) + 0.5 x100% 8, 6, 12, 11, 13, 20, 18, 10, 15, 16
total number of values

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Example 4: Example 5:
▪ In a visit to a community for nutritional assessment, the Suppose you have 25 test scores, and in order from lowest to
following weight measurement were obtained on 10 highest they look like this:
children less than 5 years. 43, 54, 56, 61, 62, 66, 68, 69, 69, 70, 71, 72, 77, 78, 79,
◦ 8.4, 8.0, 6.4, 6.5, 8.5, 6.1, 9.1, 8.0, 6.1, 7.0 85, 87, 88, 89, 93, 95, 96, 98, 99, 99.
1. Find the 90th percentile for these (ordered) scores
a. Calculate percentile for a child weighing 8.0kg 2. Find the 30th percentile
b. What does this mean?

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Percentile rank z score Percentile rank z score Percentile rank z score Percentile rank z score
99 2.33 74 0.64 49 -0.03 24 -0.71
98 2.05 73 0.61 48 -0.05 23 -0.74
97 1.88 72 0.58 47 -0.07 22 -0.77
Percent of median 96
95
1.75
1.64
71
70
0.55
0.52
46
45
-0.1
-0.12
21
20
-0.8
-0.94
94 1.55 69 0.49 44 -0.15 19 -0.88
▪ When the distribution around the median is not know, growth 93 1.48 68 0.47 43 4.18 18 -0.91
92 1.41 67 0.44 42 -0.2 17 -0.95
indices are expressed as percent of median 91 1.34 66 0.41 41 -0.23 16 -99
90 1.28 65 0.39 40 -0.25 15 -5
▪ It is the ratio of a measured anthropometric value e.g., weight to 89
88
1.22
1.18
64
63
0.36
0.33
39
38
-0.28
-0.31
14
13
-1.08
-1.13
the median value of the reference data for the same age or height, 87 1.13 62 0.31 37 -0.33 12 -19
86 1.08 61 0.28 36 -0.36 11 -1.22
expressed as a percentage 85 1.04 60 0.25 35 -0.39 10 -1.28
84 0.99 59 0.23 34 -0.41 9 -1.34
▪ E.g., if the head circumference of a newborn is 29.7 cm and the 83 0.95 58 0.2 33 -0.44 8 -1.41
82 0.91 57 0.18 32 -0.47 7 -1.48
median HC for newborns is 33.0, then the percent of the median 81 0.88 56 0.15 31 -0.49 6 -1.55
for HC 80
79
0.84
0.8
55
54
0.12
0.1
30
29
-0.52
-0.55
5
4
-1.64
-1.75
78 0.77 53 0.07 28 -0.58 3 -1.88
▪ = (29.7/33.0) x 100 = 90% 77 0.74 52 0.05 27 -0.61 2 -2.05
76 0.71 51 0.03 26 -64 1 -2.33
75 0.67 50 0 25 -0.67

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Example 7: Finding the percentile rank Example 8:

1. Suppose your weight was 85kg. The mean class
weight is 70 kg and a standard deviation of 10kg.
Calculate the percentile.
▪ Consider a 12 month old girl who weighs 8.9kg. On the
basis of the reference standard weight-for-age, it can be
established that the median weight for healthy girls of this
age is 10.3kg and that the standard deviation in the
reference population is 0.8. Calculate:
a. WAZ
b. Percent of the median for age
c. Find the percentile rank

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Equivalents of percentile and Z-scores in

a normal distribution
Percentile z-score Solution:
10 -1.28 1. WAZ = (8.9– 10.3)/0.8 = -1.75
9 -1.34
8 -1.41 2. Percent of median = 8.9/10.3 x 100
7 -1.48 = 86.4%
6 -1.55
5 -1.64 3. On the basis of aggregate tables, we
4 -1.75 can establish that -1.75 falls on the
3 -1.88 4th percentile
2 -2.05
4. Interpret your results
1 -2.33

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