Understanding and

Interpreting Anthropometric
Data
Dorothy Scheffel
Nancy Mock, Dr.P.H.
May 31, 2004
 Key Components
• Anthropometric indicators
• Cut-off points for describing nutritional
status
• Description of each indicator
• Decision tree example
 Summary of Nutritional Status Indicators
 
Indicator Measures Type of Program Problems to
Malnutrition Uses be aware of

Weight / Height - Current Status - Wasting - Emergency programs -Errors in

- Acute Malnutrition measurement

Height / Age - Long term status - Stunting - Development -Errors in

- Past Malnutrition - Chronic Malnutrition programs measurement
- Poverty indicator -Errors in Birthdates
- Program impact - catch up problem

Weight / Age - composite measure - Underweight - child survival - Errors in birthdates

projects - interpretation
- growth monitoring
with EPI programs

MUAC - Current status - Wasting - Emergency programs - high rate of error,

should follow up with
a WFH survey

BMI - Current status - Wasting - Emergency programs  

for high risk adults

Adapted from Maxwell, Nutritional Data

 
 Cut-Off Points for Describing Nutritional Status
 

Status Z-Score % of Median Percentile MUAC BMI

Cut-off Cut-off Cut-off Cut-off Cut-off

Moderately - 2.00 to – 3.00 70% to 80% 3rd to 5th 11 - < 12.5 cm 16 to 18

Malnourished

Severely < - 3.00 < 70% < 3rd < 11.0 cm < 16
Malnourished

Notes
Global malnutrition = Moderate + Severe malnutrition
Z-scores, % of median and percentiles can all be used with wt/ht, ht/age or wt/age
BMI cut-offs refer to kilograms/meter2

Adapted from Maxwell, Nutritional Data

 Global Acute Malnutrition
• Comparison values are the NCHS
US values, adapted by WHO as a reference set
Pros and cons—
• Now results reported mostly in Z scores (standard deviations below the
mean)
Normal Mild-moderate Severe

WFH  -2 Z score <-2 to –3 Z <- 3Z score

score +oedema
no oedema
MUAC >12.5 cm 11.0-12.5 cm <11.0 cm

Global Malnutrition Rate

 Weight for Height (WFH)
• Measure of current status
• Low weight for height is called wasting
• Sometimes called acute malnutrition
• WFH is very sensitive to the loss of weight which can
be influenced by illness, low food consumption or
poor care
• Advantage – does not depend on knowing the child’s
birth date (but should know approximate age to
determine appropriate measurement technique)
• Can be errors in height measurements
• Very good indicator of short term problems i.e.
famine, epidemics, etc.
• Not a good long term indicator for monitoring and
evaluation
Adapted from Maxwell, Nutritional Data
 Weight for Age (WFA)
• A composite measure
• Low WFA is referred to as underweight,
meaning less than expected weight for a given
age and sex
• Low WFA can reflect either stunting or wasting
• Most useful as a monitoring indicator
• Can be errors made in determining age

Adapted from Maxwell, Nutritional Data

 Mid-Upper Arm Circumference (MUAC)

• Can be measured at all ages

• Can give a quick estimate of wasting in a
population
• Theoretically, MUAC correlates to WFH, but is
a cruder measure and not as accurate
• WHO recommends using WFH instead, even
in extreme emergency situations

Adapted from Maxwell, Nutritional Data

 Body Mass Index (BMI)
• Measure of current status
• Sensitive to short term gains and losses in
weight
• No standardization required, so independent
of age
• Weight / height 2
• Example in Indonesia
• Low BMI among adults called Chronic Energy
Deficiency (CED)

Adapted from Maxwell, Nutritional Data

 Measuring Children
Under Two’s are Measured Lying Down (recumbent)

< 2yrs, lie child down

 Bilateral oedema
a sign of
kwashiorkor
or
severe acute malnutrition

an important sign in
emergencies
 Comparison of Wasting, Stunting, and Underweight
in African and Asian Countries

Key Anthropometric Indicators for Children Under

5 in Selected Countries Underweight
Wasting
60 Stunting
50
% under five

40

30
20

10

0
Mozambique

Cambodia
Sri Lanka

Bangladesh

Nepal
Zambia
Lesotho

Zimbabwe

India

Afghanistan
Malawi
Swaziland

Vietnan
Angola

Lao
Southern Af rica South Eastern Asia

Source UNICEF 1995-2002 At a Glace: Compiled from DHS, MICS, WHO, UNICEF
Underweight, wasting and stunting as severe and moderate (<-2sd)
Severity of Growth Deficits by Prevalence
Ranges (%) Children under 5 Years

Indicator Low Medium High Very high

Stunting < 20 20-29 30-39 ≥ 40

Wasting <5 5-9 10-14 ≥ 15

Underweight < 10 10-19 20-29 ≥ 30

Source: WHO, 1995

 Comparison of Several Anthropometric
Indicators in Same Sample

Prevalence of Malnutrition According to Different Indices and Methods of

Comparison with Reference Population
(Niger 1986)
Weight-for-Age Percent Malnourished
Z score (< -2SD) 35.3
Jelliffe (< 80% median) 41.2
Gomez (< 75% median) 26.1

Length (Height)-for-Age
Z score (< -2SD) 39.6
% of Median (< 90% median) 25.1

Weight-for-Length (Height)
Z score (< -2 SD) 12.0
% of Median (< 80% median) 8.5
Comparison of Various Food Security
Indicators

Klasen, 2002
Data for Management

How will YOU use the

information that you collect?
Acting on the Global Malnutrition Rates
FINDING INTERPRE- ACTION
TATION REQUIRED
GMR > or = to 15% Serious General Ration
OR situation Blanket SF for at
10-14% w/aggravating risk
factors TF for severely
malnourished
GMR 10 – 14% ALERT Target SF for
OR /Risky mod.
Situation Malnourished
5-9% w/ aggravating
factors TF for severely
malnourished
GMR < 10% w/ no ACCEPTABL General ration
aggravating factors E adequate
Attend to
malnourished
through existing
channels
 Aggravating Factors
 Epidemics (measles, whooping cough…)
 High prevalence of respiratory or
diarrhoeal diseases
 CMR>1/10,000
 Inadequate general rations
 Severe cold
 Inadequate shelter
 References
• Maxwell, Daniel. “Understanding Nutritional
Data and Nutritional Indicators.” CARE: East
Africa Regional Management Unit.
• MSF. Refugee Health, An Approach to
Emergency Situations. TALC. 1997.
 Other Issues
• Anthropometry and Age
• Why International Reference Populations
are used
• How to Compute Anthropometric
Indicators
• Caution Using International Reference
Data