DIFFERENT TYPES OF ANTHROPOMETERY MEASURMENT.pptx

DIFFERENT TYPES OF ANTHROPOMETRIC MEASUREMENT

1. Presented by- Dr. Ankita Mishra PhD Scholar Department of Kaumarbhritya National Institute of Ayurveda , Deemed to be University, Jaipur, Rajasthan DIFFERENT TYPES OF ANTHROPOMETRIC MEASUREMENT

2. INTRODUCTION Anthropos means “man” and metron means “measurement” A branch of anthropology that involves the quantitative measurement of human body. It is use for assessing the size proportions and composition of human body. It is single most portable, universally applicable, inexpensive and non-invasive technique . It is used to evaluate both under and over nutrition

3. ANTHROPOMETERIC PARAMETERS AGE DEPENDENT FACTORS- Height Weight Head circumference Chest circumference AGE INDEPENDENT FACTORS- Mid arm circumference (1-5 years) Thickness of subcutaneous fat Weight for height Upper segment/lower segment ratio Arm span Obesity

4. Assessment of Normal Growth and Development Growth : Increase in the size of the organ with mass of tissues due to multiplication of body cell and increase in intracellular substance is called as growth. Growth can be measured by various anthropometric measures. It is objective and quantitative. Development : Development is assessed in terms of psychological, social, spiritual, moral, emotional, and behavioural parameters. Development is subjective and more qualitative.

5. Assessment of Growth Nutritional anthropometry Weight Height Head circumference Chest circumference Assessment of tissue growth Measurement of muscle mass Skin thickness Bone age Dental age Biochemical and histological measures

6. Growth Chart Also called “road to health’’ chart. Graphical display of a child’s physical growth and development. WHO chart is recognized internationally. Chart is different for girls and boys.

7. Uses of growth chart Growth monitoring Diagnostic tool Planning and policy making Educational tool Tool for action Evaluation Tool for teaching Tool for information

8. Weight The measurement of weight is a simple and most reliable criteria for assessment of health and nutritional status of children. Weight is a measure of total body mass and sensitive to changes in fluids, fat, muscle mass skeleton and body organ. The weight can be recorded using a:- Beam type weighing balance Electronic weighing scales for infants and children Salter spring machine

9. ELECTRONIC WEIGHING MACHINE

10. cont…. The periodic recording of weight on a growth chart is essential for monitoring the growth of under-five year children. Growth velocity:- 0-4 month 1.0kg/month (30g/day) 5-8 month 0.75kg/month (20g/day) 9-12 month 0.50kg/month (15g/day) 1-3 years 3.0kg/ yr 4-12 year 2.0kg/ yr

11. conti … Adolescence Girls 12-16 years 3.0-4.0 kg/ yr Boys 14-18 years 6.0-7.0 kg/ yr Weight at 4-5 month 2 x birth weight Weight at 1 years 3 x birth weight Weight at 2 years 4 x birth weight Weight at 7 years 7 x birth weight

12. cont… ADOLESCENCE Girls 12-16 years 3.0-4.0 kg/ yr Boys 14-18 years 6.0-7.0 kg/ yr Weight at 4-5 month 2 x birth weight Weight at 1 years 3 x birth weight Weight at 2 years 4 x birth weight Weight at 7 years 7 x birth weight

13. WEECH’S FORMULA 3-12 months Expected wt. in kg = age (months) + 9/2 1-6 years Expected wt. in kg = age (years) x 2 + 8 7-12 years expected wt. in kg = age (years) x 7-5/2

14. Classification of malnutrition by Indian Academy of Pediatrics Weight for age Grade of malnutrition >80% Normal 71-80% Grade 1 (mild) 61-70% Grade 2 (moderate) 51-60% Grade 3 (severe) <50% Grade 4 (very severe)

15. Length or height CHL-It is the distance from the crown of the head to the heel in embryos fetuses and infants. CHL - 47-50 cm. Up to 2 years of age recumbent length is measured with the help of an infantometer . In older children standing height is or stature is recorded. It is convenient to use an inbuilt Stadiometer affixed on the wall which provides a direct read out of height with accuracy of +/- 0.1 cm. Nutritional deprivation over a period of time affects the stature or linear growth.

16. TECHNIQUE OF LENGTH MEASUREMENT The infant is placed supine on the infantometer . Assistant or mother is asked to keep the vertex or top of the head snuggly touching the fixed vertically plank. The leg are fully extended by pressing over the knee, and feet are kept vertical at 90 degree the movable pedal plank of infantometer is snuggly apposed against the soles and the length is read from the scale.

17. INFANTOMETER

18. TECHNIQUE OF HEIGHT MEASURMENT In older children who can stand, height can be measured by the rod attached to the lever type machine or by stadiometer. Child should stand with bare feet on the flat floor against a wall with fit parallel and with heels ,buttocks, shoulders and occiput touching the wall. Head should be kept in frankfurt plane . Head should be held erect with eyes aligned horizontally and ears vertically without any tilt.

19. conti … With the help of wooden spatula or plastic ruler the topmost point of vertex is identified on the wall. The linear growth cease after fusion of epiphyses when puberty or sexual maturation is achieved. Nutritional deprivation over a period of time generally over 6 month affects the stature or linear growth of the child .

20. Technique of Height Measurement

21. Length or height velocity At birth 20 inches (50 cm) Gain during 1 st year 10 inches(25 cm) Gain during 2 nd year 5 inches (12.5 cm) Gain during 3 rd year 3-4 inches (7.5-10 cm) Gain during 3-12 year 2-3 inches/year (5-7.5 cm) Adolescence Girls 12-16 years 8 cm/year Boys 14-18 years 10 cm/year

22. Calculation of Expected Height Up to 12 Year Length or height (inches) = Age in years x 2.5 + 30 Length or height (cm) = Age in years x 6 +77 Prediction of adult height Boy’s = Mother's height in cm + Father's height in cm/ 2 + 6.5 cm Girls = Mother's height in cm + Father's height in cm / 2 – 6.5 cm Tanner,s formula Adult height = height at 2 yr x 2

23. Head Circumference During fetal life almost 60 to 70 % of brain growth takes place. During infancy 15% of brain growth occurs while remaining 10% of brain growth takes place during pre school year. Head circumference is are routinely recorded until 5 year of age. If scalp edema or cranial moulding is present measurement of scalp edema may be inaccurate until fourth or fifth day of life. Head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front.

24. Technique of Head Measurement

25. Head Circumference in under Five Children AGE HEAD CIRCUMFERENCE Birth (40 weeks) 32 - 35.5 cm 1 month 34 - 37.5 cm 2 month 36 – 39.5 cm 3 month 38 -41.5 cm 6 month 40 – 43.5 cm 9 month 42 – 45 cm 1 year 43.5 – 46.5 cm 1.5 year 44.5- 48.0 cm 2 year 45.5 – 49 cm 2.5 year 46.5-50 cm 3 year 46.8- 50 cm 3.5 year 47.1- 50.6 cm 4 year 47.5 – 50.9 cm 5 year 48.1 – 51.5 cm

26. Head Circumference Growth Velocity First 3 months 2 cm/ month 3 months -1 year 2 cm/ 3 months 1 - 3 years 1 cm/ 6 months 3 – 5 years 1 cm/ year During first year there is 12 cm increases in head circumference while 1- 5 year age only 5 cm gain in head size. Clinical Significance: The marasmic children are seen to have relatively large head for their body size because brain growth is minimally affected by malnutrition.

27. Conti….. The term macrocephaly refers to OFC of more than 2SD above the mean while microcephaly refers to OFC more than 3 SD below the mean for age, sex, height, and weight

28. Chest Circumference It is usually measured at the level of nipples, preferably in mid inspiration Xiphisternum In children < = 5 years – lying down position > 5 years – standing position

29. Relationship Between Head & Chest Circumference At birth : head circumference > chest circumference by upto 3cms At around 9 months to 1 year of age : head circumference = chest circumference . But there after chest grows more rapidly compared to the brain .

30. Conti…. The head circumference is greater than chest circumference by more than 3 cm in : Preterm Small for date Hydrocephalic infants Clinical Significances : In malnourished children chest size may be significantly smaller than head circumference because growth of brain is less affected by undernutrition Therefore there will be considerably delay before chest circumference overtakes head circumference.

31. Age Independent Criteria for Assessment of Nutritional Status Mid upper arm circumference Thickness of subcutaneous fat Body ratio Body mass index Upper segment/lower segment Arm span Obesity

32. Mid Upper Arm Circumference At birth - 9-11cm. 1 – 5 yrs - 15 - 17 cm among healthy children. It is conventionally measured over the left upper arm at a point marked midway between acromion ( shoulder ) and olecranon (elbow) with arm bent at right angle. The child is asked to stand or sit with the arm hanging loose at the side MUAC is measured with a fiber glass or steel tape. MUAC< 12.5 cm - severe malnutrition. MUAC 12.5 – 13.5 –cm. - moderate malnutrition.

33. BANGLE TEST: - Quick assessment of arm circumference. A fiber glass ring of internal diameter of 4 cm is slipped up the arm if it passes above the elbow it suggests that upper arms is less than 12.5 cm and child is malnourished. SHAKIR TAPE:- It is a fiber glass tape with red – less than 12.5 cm yellow- 12.5-13.5 cm green > 13.5 cm

34. Quac stick It is developed on the principle that acute starvation severely affects mid upper arms circumference while height is unaffected. Quac stick is meter rod with two sets of marking . It is a height measuring rod calibrated in MAC The malnourished child would be taller than the anticipated height derived from the mid-arm circumference.

35. Arm Circumference for different Height Mid upper arm circumference (cm) Height (cm) 16.50 133 16 129 15.50 125 15 121 14.50 116 14 110 13 90

36. Thickness of Subcutaneous Fat Measured with herpenden’s or lange caliper over the triceps, subscapular or suprailiac region. The skin folds with subcutaneous fat is picked with left thumb and index finger, and caliper is applied beyond the pinch. fat thickness > 10 mm or more - healthy children between 1 and 6 year of age. < 6mm is indicative of moderate to severe malnutriton .

37. Technique of measurement of skin fold thickness

38. Body Ratio Rao and singh’s weight - height index weight in kg/( height in cm) 2 x100 Normal index is more than 0.15 Kanawati and McLaren index (during 3month to 4 year) Mid – upper arm circumference / head circumference Clinical Significance : The normal ratio is more than 0.31 while a ratio of less than 0.25 suggests severe malnutrition.

39. NORMAL 0.331 MILD 0.310-0.280 MODERATE 0.279-0.250 SEVERE <0.250 Grading of kanawati scale

40. Weight for Height weight of the patient (kg) x 100 weight of normal child of same height weight for height nutritional status > 90% normal 85-90% borderline malnutrition 75-80% moderate malnutrition <75% sever malnutrition

41. Weight for Height and Height for Age Classification When malnutrition has been chronic the child is “stunted” weight for age is low height for age are low. weight for height is usually normal. In acute malnutrition child is “wasted” weight for age is low height for age is normal weight for height is low

42. Body Mass Index [BMI] Body mass index is considered as a better criterion for the diagnosis of overweight and obesity because it expresses body weight in relation to height. BMI = Weight in kg x100 height in meter 2 A BMI for age of > 85 th percentile is suggestive of overweight A BMI for age >95 th percentile is or when it is associated with triceps or skinfolds thickness for age of > 90 th percentile it diagnostic of obesity.

43. PONDERAL INDEX It is another parameter which is similar to BMI and is used for defining newborn babies with intrauterine growth retardation Body weight in grams PI = x 100 length in (cm) 3 In malnourished small for date babies (asymmetric IUGR) PI is <2 while it is usually more than 2.5 in term appropriate for gestation babies and hypo plastic small for date babies

44. Proportional Trunk and Limb Growth The mid point of the body in newborn is at umbilicus where as in an adult the mid point shift to the symphysis pubis due to greater growth of limb than trunk The upper segment (vertex to the upper edge of symphysis pubis) to lower segment ( symphysis pubis to heel) ratio at birth is 1.8 to 1.0 The ratio is around 1:0 to 1:0 at 10 – 12 year of age This gradually becomes 1.0 to 1.1 in healthy adult In infant upper segment (crown to symphysis pubis) can be measured by using infantometer . The lowe r segment is obtained by subtracting the upper segment from total length

45. Arm Span It is the distance between the tip of middle fingers of both arms outstretched at right angle to the body with palms facing forward. In under- 5 children span is 1 to 2 cm smaller than body length During 10-12 year of age span is equal to the height In adult span is more than height by 2 cm

46. Technique of measurement of Arm Span

47. Arm Span It is the distance between the tips of middle fingers of both arms outstretched at right angles to the body measured acrossed the back of the child . <5 year children , arm span is 1-2 cm. smaller than body length. 10-12 year ,arm span= height

48. conti … Abnormally larger span is seen in patient with – Arachnodactyly ( Marfan syndrom ) Eunuchnodactyly Klinefelter syndrome Coarctation of aorta Arm span is short as compared to height in patient with - Short limbed dwarfism Cretinism Achondroplasia

49. Anthropometery in ayurveda Different Pramanas are explained in Ayurveda. Anguli Praman and Anjali Pramana are the two important elements. According to Charak total length of Purush in terms of his own Anguli is 84 angulas . According to Sushruta total length of the body is 120 angula According to Vagbhat total length of body is 3 1/2 hasta

50. अंगुल प्रमाण शरीर अंगुल प्रमाण- ८४ अंगुल (च वि. ८) पाद- ४ अंगुल जंघा- १८ अंगुल जानु- ४ अंगुल उरु- १८ अंगुल उदर- १२ अंगुल उर- १२ अंगुल ग्रीवा- ४ अंगुल मुख- १२ अंगुल

51. सु.सू ३५ मद्घ्यामा- ४ अंगुल प्रदेशनी, अनामिका- ४/२, ३/२ अंगुल हस्त तल- ६ x ४ अंगुल प्रपानी- १६ अंगुल प्रबाहू- १६ अंगुल हृदय से ग्रीवा मूल-१२ अंगुल नाभि से हृदय-१२ अंगुल उरु- १८ x ३२ अंगुल जनु- ४ x १४ अंगुल जंघा- १८ x १४ अंगुल

52. Conti… पाद- १४ अंगुल प्रपाद- ४ x ५ अंगुल पर्शनी- ५ x ४ वृषण,चिबुक,दशन,नासापुट,कर्णमूल,नयनअंतर- २ अंगुल मेहन,वदनअंतर,नासा,कर्ण,ललाट,ग्रीवा,दृष्टीअंतर-४ अंगुल भगविस्तार,शिश्न नाभिविस्तार.स्तानांतर-१२ अंगुल इंद्रबस्ती परिनाह,अंसपीठ कर्पुरअंतर- १६ अंगुल दोनों भुजा- ३२ अंगुल मणिबंध कर्पुरअंतर- १६ अंगुल

53. दीर्घायु लक्षण शिर- प्रकृत्या,अतिसम्पनम,इस्तप्रमाण.अतिवृतमनुरुपमातपन्नोपम ललाट- व्यूढ,दृढ़,सम,उर्ध्वव्यंजन,अर्धचन्द्रकार त्वचा- स्थिर,बहल उर- व्यूढम,उपचितम बाहू,स्थिक्त- वृत्त,परिपुन्र्नायतो कटी- समा,समुपचितमांसा स्फिच- वृत्त,स्थिर,उपचितमांस,नाअतिउन्नत,नाअतिअवनत उरु- अनुपूर्व,वृता,उपचययुक्त जंघा- प्रगूदसिरा,अस्थिसंधि गुल्फ- नाअतिउपचित,नाअतिअपचित