Anthropometric Measurements Height

Height, or stature, is measured in adults and children over the age of 2 years using a stadiometer, a portable anthropometer, or a moveable headboard on a vertical measuring rod. The measuring device should be checked for accuracy using a standard 2-m steel tape. Subjects should be measured to the nearest 0.1cm. Subjects, in minimal clothing with bare heads and feet, should stand straight, arms hanging loosely to the side, feet together and with heels, buttocks and shoulder blades in contact with the vertical surface of the stadiometer. Errors occur if subjects do not stand straight, do not keep heels on the ground, or overstretch. Diurnal variation results in people being 0.5-1 cm shorter in the evening than in the morning.

Height cannot be measured accurately in adults with severe kyphosis of the spine and in those who are bed- or chair-ridden. Since knee height is highly correlated with stature, height in such adults can be estimated from the measurement of knee height, using a sliding calliper. The regression equations, derived from a nonrandom sample of American people over the age of 60 years, are:

Height (cm) for men = (2.02 x knee height, cm) — (0.04 x age, years) + 64.19

Variations in the proportion of limb length to trunk length can lead to a standard error in the estimate (SEE) of height from knee height of ±8 cm. Demispan, which is the distance between the sternal notch of the right collar bone and the left finger root of the middle and ring finger when the subject's arm is horizontal and in line with the shoulders, can also be used to estimate height.

Length, rather than height, is measured in infants and children under the age of 3 years. Length is measured by laying a child face upwards on a measuring board with the head against the fixed headboard, and moving another board up to and resting against the child's heels with the legs straight (Figure 1). Small changes in length (±0.5 cm) may not be significant as it is a difficult measurement to make. Children wriggle and will not stretch out their legs. Length measurements are 1-2 cm longer than height.

Height (stature) or length indicates attained size or growth of adults and children. Long periods of inadequate food intake or increased morbidity result in a slowing of skeletal growth and individuals being short for their age, or stunted. Consecutive measurements of height every 3-6 months can be used to assess growth velocity in children and to indicate the timing of the adolescent growth spurt.

Figure 1 Measurement of recumbent length in children younger than 3 years of age. The head should be in contact with the fixed headboard, with child facing straight up. With legs fully extended, the mobile footboard should be placed firmly against the infant's heels. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Figure 1 Measurement of recumbent length in children younger than 3 years of age. The head should be in contact with the fixed headboard, with child facing straight up. With legs fully extended, the mobile footboard should be placed firmly against the infant's heels. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Weight

Weight is measured with digital weighing scales, using a pan, basket, sling, standing platform or chair, depending on the age and mobility of the people being measured. Weighing scales must be set on a hard, level, and even surface. Scales should be accurate, sensitive, and robust. They must be carefully maintained, calibrated, regularly checked for accuracy using known weights, and always set at zero before use. Weight is usually measured to the nearest 0.1 kg for adults and 0.01 kg for infants.

Weight measures total body mass but does not provide information on the proportions of fat, water, protein, and minerals. Weight and fat are only synonymous in very heavy people. Adults can be heavy for height if very muscular, overfat, and/or big framed. With accurate scales, small changes in weight are detectable but may not necessarily reflect change in body fat or lean body mass. In healthy persons, day-to-day variation in body weight is usually small (±0.5 kg). Consecutive measurements of weight can be used to monitor the effects of treatment such as weight loss on reduction diets or weight gain with nutritional interventions and supplementation. Weight changes are assumed to reflect changes in the amount of body fat. However, changes in body weight may also result from differences in hydration, oedema, tumour growth, and trauma, as well as from factors such as the amount of food in the gastrointestinal tract and the fullness of the bladder. Weight may remain constant if the loss of muscle mass is masked by increased fat as seen in sarcopenia, the age-related loss of muscle, or by increased fluid retention.

Weight-for-height (or length) can be used to indicate body composition in adults and is an age-independent measure of body composition in children. Growth can be measured in children by consecutive measurements of weight over time (growth velocity) or by weight-for-age if the children's ages are known.

Head Circumference

Head circumference is measured in infants and young children, to the nearest 0.1 cm, with a narrow flexible nonstretch tape laid over the supraorbital ridges and the part of the occiput which gives the maximum circumference. The head circumference of infants increases rapidly in the first 2 years of life. Increase in head circumference in the first 2 years of life is affected by nutritional status and nonnutri-tional problems, including some diseases, genetic variation, and cultural practices.

Mid-Upper Arm Circumference

Mid-upper arm circumference (MUAC) is measured in adults and children, to the nearest 0.1 cm, using a flexible nonstretch tape laid at the midpoint between the acromion and olecranon processes on the shoulder blade and the ulna, respectively, of the arm (Figure 2). MUAC is a measure of the sum of the muscle and subcutaneous fat in the upper arm. In severe malnutrition both fat and muscle are reduced in the upper arm. Oedema may increase a limb's circumference but it is not usually a problem of the upper arm. MUAC can be used as a indicator of body composition in adults and children. Since MUAC increases little between the age of 6 months and 5 years, it can be used in preschool children as

Figure 2 Measurement of upper arm circumference at the mid-point of the upper arm. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Figure 2 Measurement of upper arm circumference at the mid-point of the upper arm. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

an age-independent screening tool for severe malnutrition. A MUAC less than 12.5 cm suggests malnutrition. A MUAC greater than 13.5 cm is normal.

Skinfold Thickness

Precision skinfold thickness callipers are used to measure the double fold of skin and subcutaneous fat to the nearest millimeter. The usual sites of measurement are at the triceps (TSFT), the midpoint of the back of the upper arm (Figure 3); the biceps (BSFT) at the same level as the TSFT but to the front of the upper left arm; the subscapular (SSFT) just below and laterally to the left shoulder blade (Figure 4); and the suprailiac (SISFT) obliquely just above the left iliac crest. Skinfold thicknesses can also be measured at the mid-thigh, mid-calf, and abdomen.

Skinfold thicknesses are difficult measurements to make with precision and accuracy: It is difficult to pick up a consistent fold of skin and subcutaneous fat; in the very obese, the skinfold may be bigger than the callipers can measure; the fold of skin and fat compresses with repeated measurements; and the careless use of the callipers causes pain, bruising, and skin damage to subjects. There is, therefore, likely to be considerable inter- and intraobserver error in the measurements.

Skinfold thicknesses measure subcutaneous body fat and, therefore, indicate body composition. TSFT

Figure 3 Measurement of triceps skinfold using a Lange caliper. With the subject's arm in a relaxed position, the skinfold is picked with thumb and index fingers at the mid-point of the arm. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Figure 3 Measurement of triceps skinfold using a Lange caliper. With the subject's arm in a relaxed position, the skinfold is picked with thumb and index fingers at the mid-point of the arm. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Figure 4 Measurement of subscapular skinfold using a Lange caliper. With subject's arm and shoulder relaxed, a horizontal skinfold is picked approximately 1 cm below the tip of the scapula with thumb and index fingers. The caliper is applied 1 cm from fingers. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

Figure 4 Measurement of subscapular skinfold using a Lange caliper. With subject's arm and shoulder relaxed, a horizontal skinfold is picked approximately 1 cm below the tip of the scapula with thumb and index fingers. The caliper is applied 1 cm from fingers. (Reproduced with permission from Frisancho AR (1990) Anthropometric Standards for the Assessment of Growth and Nutritional Status. Ann Arbor: University of Michigan Press.)

and SSFT indicate subcutaneous fat on the limbs and body trunk, respectively. Skinfold thickness measurements mistakenly assume that subcutaneous fat, measured at one or more selected sites, measures total body fat stores. However, subcutaneous fat at one site may not reflect fat stores at another site, and may not be positively correlated with the amount of visceral fat deposited around the internal organs of the body. Subcutaneous fat, and therefore skinfold thicknesses at the different sites, changes at varying rates with age, weight change, with diseases such as diabetes, and in women during pregnancy, postpartum, and at the menopause. Skinfold thicknesses are not useful for monitoring short-term change in fat stores. If only one skinfold thickness measurement is made, TSFT is most commonly selected. TSFT correlates with estimates of total body fat in women and children. SSFT is better than TSFT as an indicator of total body fat in men. SSFT has been shown to be a predictor of blood pressure in adults independently of age and racial group.

Waist and Hip Circumferences

Waist and hip circumferences are measured to the nearest 0.1cm using a flexible narrow nonstretch tape in adults wearing minimal clothing, standing straight but not pulling in their stomachs. Waist circumference is measured halfway between the lower ribs and the iliac crest, while hip circumference is measured at the largest circumference around the buttocks. Measurement error occurs if the tape is pulled too tight or loose, or if subjects wear clothes with belts and/or full pockets.

With increase in waist circumference there is an increase in insulin sensitivity, while a waist circumference greater than 94 cm in men and 80 cm in women has been associated with increased risk factors for cardiovascular disease.

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