Chapter 2

Antropometric Assessment
By: Bayachew A.
(BSc, MPHN)

In 2020
 Objective
At the end of this class, students will be able to
List down types of anthropometric measurements
List down types of instruments used to conduct
anthropometric measurements
Shown us the steps of conducting anthropometric
measurements
 Exercise ??
1. What is anthropometry?
2. What is anthropometric assessment
3. What anthropometric measurements did you know: including
the instruments used
4. What advantages and limitations of anthropometric
measurements did you know
5. What anthropometrical indices did you know?
6. Did you ever conducted anthropometric assessment ? When ?
Where?
Chapter 2
Anthropometric assessment
Presentation outline
 Introduction
 Anthropometric assessment of body size
 Measurements of body size
 Anthropometric indices
 Introduction

o Nutritional anthropometry is defined as:-

• Measurements of the variations of the physical dimensions &

the gross composition of the human body at different age

levels & degrees of nutrition.

o Anthropometric measurements assess

• Growth: head circumference, length, weight

• Body fat: skinfolds, hip & waist circumference

• Fat-free mass: mid-upper arm circumference

 2.1 Anthropometric assessment of body size.

o Stature (height/length) & body weight: the most common

• Can be made quickly & easily, & accurately with care &

training

2.1.1 Measurements of body size

A. Head circumference

o Closely related to brain size

o To detect pathological conditions associated with unusually large

(macro cephalic) or small (micro cephalic) head

• Need a flexible, non stretch tape
- Subject stand with left side facing; arms relaxed; legs apart
•Ensure tape at same level on each side of head; pull tightly to
compress hair
•Measure to nearest mm
- HC-for age: index of chronic PEM for children < 2 y
 B. Recumbent length

 In infants & children <2yrs having <=85cm

 Wooden measuring board used

 2 examiners required to correctly position the subject &

ensure accurate & reliable measurement

 Subject placed face upward, head towards fixed end of the

board & body parallel to the board’s axis

 Shoulder rest against the surface of the board

 Recmb. Length cont …

o One examiner holds the child’s head in a Frankfurt position

o The other examiner holds the subject’s feet

 Without shoes

 Toes pointing upward

 Keep knees straight

 Brings moveable footboard to rest against the heals

Recumbent length board
Measurement of recumbent length
 C. Height
 For children >85cm & adults

 Measured in the standing position using a free-standing

stadiometer

 There should be minimal clothing to see posture clearly

 Shoes & socks should not be worn

o Height cont…
• To measure
• Head in Frankfurt plane
• Feet together, knees straight
• Heels, buttocks, & shoulder blades in contact with the
stadiometer
• Arms hanging loosely at the sides with palms facing the
thighs
• For younger subjects hold the heel to ensure they do not
leave the ground
• Headboard lowered until it touches
 HEIGHT BOARD

14 5/26/2020
Positioning subjects for height
measurement
 D. Weight in infants & children

 Suspended scale & weighing sling for infants &

children <2yrs
 Slip the subject on it & record weight when indicator

stabilized

 Pediatric scale-used alternatively

 There should be equal distribution of weight on each

sides of the center of the pan

 Record weight when the infant lay quietly
 Weight cont…

 Beam balance or electronic scale - if no alternative

 Weigh subjects together with the mother (A)

 Weigh the mother alone (B)

 Subjects weight = A-B

 Subjects should be weighed naked or with minimal

clothing
Measurement of weight in infants & children
Suspended scale for those < 2 y
Weigh naked
 E. Weight in older children & adults

• Preferably done after the bladder is empty & before meal

• Place balance on hard & flat surface, adjust for zero

balance

• Subject stand: at center, look straight ahead, stand

unassisted, relaxed, minimal clothing

• Balance should be calibrated with a set of weights

Measurement of weight in infants, children, adults
(a) Pediatric balance for infants
(b)Beam balance for older children & adults
 F. MUAC Tape
 This arm circumference insertion tape measures mid-
upper arm circumference of children, up to 25 cm.
 Colour-coded in (red, yellow, green), non-tear,
stretch-resistant plasticized paper.
 Supplied in pack of tapes together with written and
pictorial instructions for use
MUAC..
 2.1.2 Anthropometric indices:

• Measurements of the physical dimensions and

gross composition of the body at different levels
and degrees of nutrition.
• Particularly useful when chronic imbalances of
protein and energy are likely.
• Provides information about past nutritional
history.
Purposes of anthropometric measurements:
In children: to assess physical growth
In adults: to assess changes in body composition
or weight
Anthropometric indices……
A. growth
• Derived from two or more raw measurements
1. Weight-for-length or height: low wt-for-ht = thinness and
reflects wasting
• Failure to gain sufficient weight relative to height or
losing weight
• Overweight: excess weight relative to height or
insufficient height relative to weight
• Stunted children: weight may be appropriate for length
Weight-for-length or height cont…

• Poor linear growth should not be considered normal

based on WFH alone

• If prevalence of stunting is much higher than wasting

use a combination of WFH & HFA

• Useful where age is uncertain

• Independent of ethnicity: age 1-5yrs

2. Length or height-for-age: low ht-for-age = shortness
and reflects stunting
• An index of past nutritional status
• From an extended period of inadequate food intake,
poor dietary quality, increased morbidity or a combined
effect
3. Weight-for-age: low wt-for-age = lightness and reflects
underweight
• Fails to distinguish tall, thin children from those that
are short with adequate weight
Meanings of the indices derived from growth
measurements:
Weight for Age = Weight of the child x 100
Weight the normal child of
the same age

Weigh for height = Weight of the child x 100

Weight of the normal child of
the same height

Height for age = Height of the child . X 100

Height of the normal child of
the same age
 4. Head circumference-for-age:
• Reflects chronic PEM in children < 2 yr
• Abnormally low: intrauterine growth retardation or
chronic malnutrition
• Non nutritional factors: disease, genetic variation, cultural
practices(binding head), difficult or forceps assisted
delivery may affect
 5. Body mass index ( weight/height 2 )
• Indicate body weight in relation to height
• Measure of overweight & obesity
• Chronic energy deficiency
• Easy, quick, non invasive & more precise than skinfold
thickness
• Does not distinguish weight associated with muscle & fat:
elevated BMI: adiposity, muscularity, or edema
• No indication on distribution of fat: use it with skinfold
thickness & waist circumference
• Affected by ethnicity
Age groups for use in presentation of
anthropometric data for populations (WHO,1983)
• Infants
0 - < 6 mo
6 - <12 mo
• Preschool children
12 - < 24 mo
24 - < 48 mo
48 - <72 mo
• Primary school children
72 - < 96 mo
96 - <120 mo
2.2 Assessment of Body composition
Five levels of body composition assessment
 Atomic level(C, H, N, P, Ca, O)
 Molecular level(fat, Water, protein)
 Cellular level(body cell mass, intra/extra cellular water,
intracellular solids)
 Tissue level(adipose tissue, muscle, bone)
 Whole body level(Weight, height, skin folds)
ASSESSMENT BODY COMPOSITION
Using Anthropometry

Whole body level assessment is used:

 In assessing body composition we consider the body to be made
up of two compartments:
 The fat mass and the fat free mass.
 Total body mass= Fat mass + fat free Mass.
 Therefore different measurements are used to assess these two
compartments:
A. Measurements used to assess fat mass :
Skin fold thickness
Waist to Hip circumference ratio
Waist circumference
Body mass index
 1. Skinfolds Thickness
 Be able to change skinfold thickness measurements
to Indices and Indicators

 Measure body fat percent (body composition)using

skinfold thickness
 Skinfold Thickness
 Measures double thickness of
skin and subcutaneous fat
 Advantages:
 inexpensive
 fast
 portable
 large database
 Skinfold …
Layers of subcutaneous
fat are measured at
different sites of body
to estimate total body fat
levels

Cross sectional view

Measuring Skinfold Fat Thickness
at the Triceps Skinfold Site

© Human Kinetics
Skinfold Thickness
Assumptions:
 Sites selected represent average
thickness of all subcutaneous fat
 predicts non-subcutaneous fat as well
 >50% of fat is subcutaneous
 compressibility of fat similar between
subjects
 thickness of skin negligible
 Skinfold Thickness
Limitations
 Technician error
 Skinfold thickness affected by factors
other than amount of fat
 exercise increases skin thickness
 dehydration reduces skin thickness
 edema increases skin thickness
 dermatitis increases skin thickness
 Poorly predicts visceral fat
SKIN FOLD THICKNESSES # 3
Skin fold should be read to the
nearest 0.5 mm after 2-3 seconds of
caliper application
Measurements are made in triplicate
until readings agree within ± 1.0 mm
All the measurements should be
made on the left side
Precision skin fold calibers
Some of precision skin fold calipers
are:
Lange (USA) measures to the nearest
0.5mm
Holitain, Harpenden (UK) measures
to the nearest 0.2 mm
Low cost plastic Mcgaw calipers are
also available
SKIN FOLD THICKNESSES # 2
 The measurement should be performed using precision
SFT calipers, which have a constant and defined
pressure of 10g/sq.mm through out the range of
measured skin folds.

 Other ordinary SFT calipers result in underestimation of

the subcutaneous fat as a result of compression.
 7 Site Skinfold Measurements

•Triceps.

•Chest/Pectoral.

•Midaxillary.

•Subscapular.

•Suprailiac.

•Abdominal.

•Thigh.
Single skin folds site
 Used to estimate total body fat or percentage body fat
 No agreement on best site as index of total body fat
 Triceps most frequent site used
Multiple skin folds
 For total body fat: one limb skinfold (e.g., triceps) plus one body
skinfold (Subscapular) recommended
 Because the distribution of body fat: depends on ethnicity, age,
& sex
 Sites of skin fold thickness measurements are :
 biceps, triceps, Sabscapular and Suprailiac and midmaxillary
skinfolds
Measurement of triceps skinfold
thickness
 Subjects stands erect, arms hanging freely at sides
 Vertical fold grasped 2 cm above midpoint in line with elbow
 Skinfold pulled away gently from muscle & caliper applied at
marked midpoint
 Skinfold held while measurement taken to nearest 0.1 or 0.5 mm
Difference between trainee-trainer 0-0.9 mm
 Generally all skin fold measurements
• Estimate size of subcutaneous fat depot
• Measure compressed double fold of fat plus skin otherwise leads
to underestimation of actual subcutaneous fat
• Must 1st locate mid-point of back of upper left arm when arm
bent at 900
• Use skin fold calipers of different types
Measurement of triceps skinfold thickness…..
Measurement of triceps skinfold thickness…..
 What indicators can we drive from
skinfold thickness measures?
Calculating Body fat % from Skin
fold Thickness
The calculation of body fat % involves:
 Measuring skinfold sites, triceps, biceps, subscapular
and suprailiac…..

 substitute the log of their sum into one of the following

equations, Where
D = predicted density of the body (g/ml),

L = log of the total of the skinfolds (mm).

The density value can then converted to percent
bodyfat (%BF) using the Siri Equation.

 We can also use body fat calculators

 http://www.health-calc.com/body-composition/skinfold-d-and-w
Body density calculations
equations for
age (years) equations for males
females
< 17 D = 1.1533 - (0.0643 X L) D = 1.1369 - (0.0598 X L)

17-19 D = 1.1620 - (0.0630 X L) D = 1.1549 - (0.0678 X L)

20-29 D = 1.1631 - (0.0632 X L) D = 1.1599 - (0.0717 X L)

30-39 D = 1.1422 - (0.0544 X L) D = 1.1423 - (0.0632 X L)

40 -49 D = 1.1620 - (0.0700 X L) D = 1.1333 - (0.0612 X L)

> 50 D = 1.1715 - (0.0779 X L) D = 1.1339 - (0.0645 X L)

L= log (sum of the skin fold thicknesses)

SIRI EQUATION
Assumed Densities:
FAT MASS(Density) = 0.9 gm/ml
FAT FREE MASS(Density)= 1.1 gm/ml
Equation:
% Body Fat = (4.95/Density) - 4.5) x 100
BROZEK EQUATION
Assumptions:
FAT MASS(Density)= 0.9 gm/ml
LEAN BODY MASS(Density)=1.095 gm/ml
(some essential lipids in Lean Body Mass)
Equation:
% Fat = (4.57/Density)-4.142) x 100
Cut-off for percentage of body
fat

Description Women Men

Essential fat 10–13% 2–5%

Athletes 14–20% 6–13%

Fitness 21–24% 14–17%
"Average" 25–31% 18–24%
32%+
Obese 25%+
>35%(WHO)
Source: American Council on Exercise
2. WAIST TO HIP CIRCUMFERENCE RATIO
It is the circumference of the waist
measured mid-way between the
lowest rib cage at the mid-clavicular
line and anterior superior iliac spine
divided by the circumference of the
hip measured at the level of the
greater trochanter off the fumer
(widest Area) (both are measured to
the nearest 0.1cm)
Cut-off point
The optimal cutoffs points for WHR were
 >1 in men and
 > 0.85 for in women
3. Waist circumference: proxy for central fat
No universally accepted method of measurement
WHO: taken around natural waist at its widest point
(Fig.A)
Midway defines WC level OR At least 2.5cm above
belt (Fig.B)
 cut‐off points of 90 cm in men and
 80 cm in women for the optimum
 Recommended cutoffs for increased health risk are a waist
circumference
 of more than 102 cm (>40 inches) for men and more than 88
cm (>35 inches) for women. 4.Waist circumference is
strongly associated with risk of death, independent of BMI.
 4. Body mass Index(BMI)
 The best method for assessing adult nutritional status
as the index is not affected by the height of the person.
 Best used for individuals between the ages of 20 and
65 years
 Therefore, it is most frequently used for assessing adult
nutritional status
Cut-off points for BMI
 ≥ 35 kg/m2 = Very obese
 30-34.9 kg/m2 = Obese
 25-29.9 kg/m2 = Overweight
 18.5-24.9kg/m2 = Normal
 17-18.4 kg/m2 = mild chronic energy deficiency
 16-16.9kg/m2 = Moderate chronic energy deficiency
 < 16 kg/m2 = severe chronic energy deficiency
This classification is based on the mortalities
and morbidities associated with either
extremities

Mortality Chronic diseases

Malnutrition
And (hypertension,
related The
Morbidity diabetes, cancer,
infections and Safe zone
In % coronary heart
deficiency
disease
diseases
18.5
16

25

30

40
Body mass index KG/M2
 BMI...
 Advantage:
 Used in large-scale surveys:
 Easy, quick, non-invasive
 More precise than skin folds
 Disadvantage:
 Does not distinguish between weight associated with muscle
vs body fat.
 High BMI may be due to:
 Excessive adiposity
 Muscularity
 Edema
 No indication of distribution of body fat.
Arm span and Demi-span and Knee height
 When it is not possible to measure height as in the case
of :
 Elderly people
 Kyphosis / Scoliosis
 People unable to assume erect position
 Height can be estimated from arm span or demi-span.
Arm span and Demi-span and Knee height
 Arm span:
 The distance between the two tallest fingers when a person
stretches his/her arm on straight line with 180 degree .
 Demi-span:
 The distance between the roots of the two tallest fingers
when a person stretches his/her arm on straight line
 Knee height:
 The distance measured from the heel to the top of the knee.
3.2.2 Assessment of fat free mass

A. Mid-upper arm circumference

Subject erect and sideways to measurer
Head in Frankfurt plane
Measurement taken at marked mid-point
upper left arm
Arm must be hanging loosely at side with
palm facing inward
Do not squeeze arm
 Mid-upper arm circumference cont …
 MUAC for age can be used to differentiate those with
PEM from normal: used for screening
 Measurement taken at mid-point of upper arm
 Flexible non-stretch tape should be used
 Fibre-glass insertion tape preferred
 Subject should stand erect with head in Frankfurt
plane
 Measurement taken at mid-point of upper arm
between acromiom process and tip of olecranon
 Precision of measurement must be high as MUAC
varies little at any given age
 Difference between trainee and trainer should be 0 –
5 mm
Mid upper arm circumference (MUAC)
 Is used for screening purposes especially in emergency
situations where there is shortage of human resource,
time and other resources as it is less sensitive as
compared to the other indices.
 It is measured half way between the olecranon process
and acromion process using non stretchable tap.
 In children the cut-off points are:
 Normal > 12.5 cm
 Mild to moderate malnutrition 11.5-12.5 cm
 Severe malnutrition < 11.5 cm
 MUAC…
 It is a sensitive indicator of risk of mortality.
 Useful for screening of children (6-59 months)
for community based nutrition interventions.
 Useful for the assessment of nutritional status
of pregnant women.
 MUAC < 110(115) mm indicates severe wasting
or SAM.
 MUAC 110(115) to 125 mm indicates moderate
wasting or MAM.
Evaluation of measurement error in
anthropometric measurements
 2.3 Anthropometric reference data

International growth reference data

 New WHO 2005 growth curves: for children < 5 y

 NCHS/WHO 1977 Reference data for children 2 to 18 y

 Still recommended for children >5 y – 19y

 Adults: NCHS/WHO 1977 for height at 18 y

 Adults age-specific BMI percentile cutoffs

 NCHS/WHO (1983)*
 still recommended for:
• children > 5 yrs
• adults: height at 18 yrs recommended
• Based on data from several sources
 NB: * Best used for children < 10y only because
of differences in age of peak height velocity for
some populations (e.g.: Asians)

 US National Center for Health Statistics/Center

for Disease Control & Prevention (NCHS/CDC)
2000 growth data
CDC 2000 Growth Chart. Stature-for age: Girls 2 to 20 y
CDC Growth Charts – BMI for age, Boys 2 to 20 y
2.4 Evaluation of Nutritional Assessment Indices
 Nutritional assessment indices can be evaluated by
comparison with a distribution of reference values,
or with reference limits drawn from the reference
distribution which is obtained from a healthy reference
sample group.
 2.4 Evaluation of anthropometric indices
A. How to compare growth indices with
reference data?
 Taking age and sex into consideration,
differences in measurements can be expressed
in a number of ways:
 Z-score
 Percent of the median
 Percentiles
 1. The Z-score or standard deviation (SD)
 Is the difference b/n the value for an
individual & the median value of the reference
population for the same age or height,
divided by the SD of the reference population.
 For low income countries exact z-score value
calculated using reference SD values

(observed value) – (median reference value)

 Z-score =
SD of reference population
International Reference Standard
Distribution
 Class activity
 If a 6 years old child has:-
• Weight 13.3 , height 107.5 and
 median values are:-
• H/A = 118.5
• W/A = 21.6
• W/H = 17.6 and standard deviation are 4.9, 3.2, 1.6 respectively.
 Calculate
a. HFA Z score
b. WFH Z score
c. WFA Z score
 2. Percentage of the Median
 The median is the value at exactly the midpoint
b/n the largest & smallest
 If a child’s measurement is exactly the same as
the median of the reference population we say
that they are “100% of the median”
Cut off points for acute malnutrition
(weight for height)
 Acute malnutrition based on weight-for-Height in z-scores
and percentage of the median
Cut off points for chronic malnutrition
(height for age)
 Chronic malnutrition based on Height-for-Age in z-scores
and percentage of the median
 Cut off points for Underweight
 Underweight based on Weight-for-Age in z-scores and percentage
of the median
 3. Percentiles

 The percentile is the rank position of an individual on a given

reference distribution arranged in order of magnitude.

 Percentiles are stated in terms of what percentage of the

group the individual equals or exceeds

 E.g., the child's height-for-age being at the 80th percentile

means that 80% of children of his age in the reference

population have a height lower than him

 If a boy’s height is 141.8 cm and he is at the 10th percentile,

it means 10 percent of boys have a height below 141.8 cm

 Percentiles
 The percentile reference limits commonly used for designating
individuals “at risk” to malnutrition are either below 3rd or 5th
percentile or above 97th or 95th percentile
 Used for affluent countries
 Not recommended for low income countries because some persons
may have indices below extreme percentiles
Exercise
 Plot the height & weigh percentiles of a 12 mo old boy weighing
12 kg and being 75 cm.
 What is his weight & length percentile?
 How do you interpret it?
Reference limits for defining risk of malnutrition based on SD
scores or percentiles
WHO criteria for assessing severity of
under- nutrition in children < 60 months
Growth Monitoring and Promotion {GMP}
o GMP is a periodic measurement of the weight of under
five children.
o It is important to detect nutritional problems earlier.
o GMP is a simple and powerful tool to:
• Monitor the growth of children
• Detect growth faltering early before it becomes too
late
• Assess and make the growth pattern of a child visible
to the parents
Using a child growth card to assess nutritional status
(Weight for Age)

 Determine age of child in months

 Weigh child (lightly dressed)
 Plot weight of child against age in months
 Determine if point is the normal or indicating under
nutrition
 Direction of growth is important, so more than one
point in time is desirable
 Using multiple growth indices for screening, &/or assessing
response to interventions
 Three growth indices often used
• wt-for-ht; ht-for-age, wt-for-age
• each can be classified as: low; normal, high based on reference
limits i.e. percentiles or Z-scores
 Combination yields following possible interpretations:
 Normally fed with past history of malnutrition
 Normal
 Tall, normally nourished
 Currently underfed
 Obese
 Currently overfed with past history of malnutrition
 Overfed but not necessarily obese
Using a combination of growth indices
Classifying Nutritional status of Adults
using BMI
Adult BMI level Nutritional Status
<16 kg/m2 Severely Malnourished
16-16.99 kg/m2 Moderately malnourished
17-18.49 kg/m2 Mildly malnourished
18.5-24.99 kg/m2 Normal weight
25-29.99 kg/m2 Overweight
>30 kg/m2 Obese
NB. BMI is not used for pregnant and lactating mothers rather MUAC is
used?
Classifying Nutritional status of 5-17
years using BMI

Age 5-17 Nutritional Status

<-3 SD Severely Malnourished
-2 to -3 SD Moderately malnourished
-1 to -2 SD Mildly malnourished
>-1 Normal weight
Classifying Nutritional status of 6 months
to 5years old children using MUAC

MUAC cut-off points Nutritional Status

< 11 cm Severe Acute Malnutrition

11-12 cm Moderate Acute

Malnutrition

>12 cm Not malnourished

Classifying Nutritional status of 5-14
years using MUAC
Age MUAC level Nutritional Status
In years
5-9 <135 mm Severe malnutrition
10-14 <160 mm
5- 9 < 145 mm Moderate malnutrition
10-14 < 180 mm
5- 9 >145 mm Normal
10-14 > 180 mm
MUAC cutoff for pregnant and lactating
women

Nutritional Severe acute Moderate Normal

Status malnutrition acute
malnutrition

MUAC level <18.0cm 18-21 cm > 21 cm

Classification of Nutritional Status Based
Anthropometric Indices
 1.

Advantage: Differentiates between "wasting" and "stunting"

Limitations: The need for height, weight and age and the relative complexity
of the classification could be a disadvantage in some situations
2. The Gomez Classification
Indicator: Weight-for-age

% Expected Category of Nutritional Status

Weight for Age
90-109% Normal
75 - 89% 1st degree malnutrition (mild)
60 - 74% 2nd degree malnutrition (moderate)
< 60% 3rd degree malnutrition (severe)
Limitations: ** Now used only in few countries
 Disadvantages of Gomez classification
 The cut off point 90% may be too high as many well-
nourished children are below this value,
 edema is ignored and yet it contributes to weight
 Does not take account of height differences.
 Age of the child must be known.
 Difficult to know in developing countries (agrarian society).
 It does not indicate the duration of malnutrition.
 It does not also differentiate between kwashiorkor and
marasmus.
 3. The Welcome Classification
Indicator: Weight-for-age and edema

% expected OEDEMA
Weight for Age Present Absent
80 - 60 Kwashiorkor Underweight
< 60 Marasmic- Marasmus
Kwashiorkor

Advantage: Useful for classifying more severe forms of

malnutrition
 Disadvantages
 Does not differentiate:
 Acute malnutrition (for emergency planning) and
 Chronic malnutrition( for food security planning).
 Depends on knowledge of the child’s age.
 Does not take height differences in to account.

OEDEMA
 Evaluation of data for studies of anthropometry among
populations
 Compare the distribution of anthropometric indices with the

reference population using:

 percentiles : for affluent countries

 standard deviation scores (Z-scores): for low-income

countries

 Calculate number & % of persons with anthropometric indices

at low levels compared to reference

 Calculate mean Z-scores for growth indices across countries

 provides no information on distribution of indices

 Uses of anthropometric data: at population
level
 For international comparisons of growth
 To identify trends in growth over time
 For nutritional surveillance
 continuous monitoring of population in
emergencies
 For targeting interventions
 For assessing response to an intervention
 Identifying determinants and consequences of
malnutrition
 Assessing response to an intervention
 At least two measurements are needed, taken
before and after the intervention
 Difference in population mean Z-score of chosen
indicator is then calculated; OR
 Difference in proportion of population below
chosen reference limit of indicator is calculated
 Choice of indicators is critical
 depends on type and length of intervention;
baseline anthropometry; study design; time delay
before indicator can be expected to show evidence
of change
 Screening adults & children at
individual and population levels for
risk of chronic energy deficits &
obesity
Screening individuals at risk to
underweight, & obesity based on
anthropometry
Adults
 BMI: for under- weight, over-weight and
obesity
 Waist: Hip circumference:
 Waist: proxy for central fat
 Hip: proxy for peripheral fat
 Waist circumference: Proxy for central fat
 Screening individuals at risk to
underweight, & obesity based on
anthropometry
Children
 Weight-for-height Z scores: under-weight and
over-weight
 BMI percentiles: overweight and obesity
WHO classification scheme for adults
based on low BMI
WHO classification to assess public
health significance of low BMI’s
WHO classification scheme to screen for
overweight for adults based on BMI
 Rational for use of BMI as index of body
fatness in adults
 BMI correlates well with percent body fat
 BMI unbiased by height
 Height and weight are quick; non invasive;
more precise than skinfolds
 BUT:
 high BMI could = lean or fat
 Provides no information on distribution of body fat
Relationship between BMI and
relative risk of mortality
 BMI and measures of body fat and
disease risk
 BMI said to be an independent index of
body fat
 subjects with same BMI said to have
same relative fatness irrespective of
age, sex, ethnicity
 BUT: relationship b/n BMI & body fat
depends on:
 Age: older women more percent fat than younger
women with same BMI
 Sex: women more fat than men for same BMI
 Ethnicity: Chinese, Asian Indians, Indonesian more
percent fat than Caucasians for same BMI
 Pacific islanders: less percent fat for same BMI
Health risks also associated with regional
body fat distribution as well as total body fat
 Health risks associated with central body
fat
Central fat consists of:
 visceral (intra-abdominal) fat
 subcutaneous fat
 increased health risk due mostly to visceral fat
Central fat:
 tends to be greater in men; related to
testosterone and other factors
 tends to increase with age
 women put on more central fat after menopause
 protected by oestrogen in pre-menopausal women
 Waist-hip circumference
 Distinguishes fatness in lower trunk (hip &
buttocks) (mainly subcutaneous) and in upper
trunk (waist & abdomen)
 WHR correlates with total body fat
 Elevated WHR strongly associated with
increased risk of CHD, stroke, type 2 diabetes
in childhood, adolescents, adults
Limitations of waist: hip circumference ratio
 Cutoffs for waist-hip circumference ratio
 WHO: adult cutoffs: M, > 1.0 ; F, > 0.85
 Cutoffs may vary with: age, sex, race,
geographic region, degree of overweight
 Ability of serial measurements of WHR to
assess changes in intra-abdominal fat over time
uncertain
 Negative correlation of WHR with serum HDL
across age, sex, ethnicity in children from
NHANES III: may be useful to assess
atherosclerosis risk in childhood
 More research to establish need for ethnic-
specific cutoffs
 Rational for using waist circumference
(WC)
 Studies shows that:-
• WC more strongly associated with total body fat than WHR

• Higher correlations between WC and abdominal visceral fat

than with WHR

• WC better index of central adiposity than WHR

• WC more closely related to atherogenic metabolic disturbances

associated with abdominal obesity than WHR

 Adult cutoffs for waist circumference for
risk of abdominal obesity
 WHO cutoffs for Caucasians :
 M>102cm;F>88cm
 WHO cutoffs for urban Asians: lower
 M > 90 cm; F > 80 cm
 high rates of obesity-related disorders
 more prone to central adiposity
 Use of universal cutoffs for WC to delineate
health risks may not be appropriate
 Additional population-specific cutoffs needed
 Methods for screening for overweight in
children and adolescents
 Weight-for-height
 Greater than + 2 Z scores
 Omits adolescence
BMI percentiles
 U.S classification
 85th P: risk of overweight; > 95th P: overweight
 WHO classification
 cutoff based on Cole approach
 Basis for use of BMI as indicator of
overweight & obesity in children
 Strong +ve correlations b/n BMI and fatness
 Association b/n BMI or changes in BMI & risk
factors for CHD
 increased blood pressure; adverse lipoprotein
profiles; late onset diabetes; early atherosclerotic
lesions
 BMI in childhood tracks more closely with BMI
in adulthood than skinfolds
 Boys with BMI > 75th P have increased risk of
mortality from all causes, CHD, cerebrovascular
disease
 WHO classification for overweight and
obesity in children: Cole approach
 Cutoffs for overweight by sex from 2-18 y,
defined to pass through BMI = 25 at 18 y
 Cut offs for obesity by sex from 2-18 y,
defined to pass through BMI = 30 at 18 y
 NB: Not known whether these age-specific
BMI cutoffs in childhood are associated with
health risks similar to those for adults.
 Anthropometry Advantages:
 Simple, safe, non-invasive
 Equipment is inexpensive, portable, & durable
 Needs less skill
 Precise and accurate
 Info is obtained on past nutritional history which cannot be
obtained with equal confidence using other techniques
 Can be used to evaluate changes in nutritional status overtime
(secular trend)
 Can serve as a screening test
Anthropometry Limitations:

 Relatively insensitive and can’t detect changes in nutritional status

over short periods of time
 Can’t identify specific nutrient deficiencies (e.g. stunting from Zn
deficiency Vs PEM)
 Thank you for attention
…..
…..
THE END OF CHAPTER 2