Nutritional assessment- anthropometry

nutritional assessment - a community based survey/study performed in children.
Anthropometry holds an important position in the assessment of nutrition.
it comprises easy and simple tools that can be analysed by ASHAs and ANMs at community level too apart from physicians.

1. NUTRITIONAL ASSESSMENT SURVEY (Anthropometric assessment) Presented by- Dr Garima Gupta MBBS, MD (Post Graduate Resident) University College of Medical S ciences and GTB Hospital Delhi

2. NFHS-3, India, 2005-06 Why the need of Nutritional Assessment?

3. In the Triple-A Cycle model: Indicators to assess and analyse nutrition The ANALYSIS stage aims to analyse the causes of malnutrition The ASSESSMENT stage aims to define the nutritional problem in terms of magnitude and distribution. ASSESSMENT of the nutritional situation in target population ACTION based on the analysis & available resources ANALYSIS of the causes of the problem

4. A Dream – Yet to be achieved !! Source- World Health Organisation

5. Nutritional assessment - ABCD A nthropometry: height, weight, BMI, MUAC B iochemical: analysis of blood, urine, and other body tissues C linical: complete physical examination, and a medical and psychosocial history D ietary: foods and quantities consumed , eating habits, accessibility of food, and cultural and socioeconomic factors that affect selection of food.

6. Anthropometric measurement

7. HEIGHT OR LENGTH Height Vertical distance measured from crown of head to bottom of feet (heels) for children 2 yr of age or older. Recumbent length Distance measured from crown of head to bottom of feet (heels) while child (< 2 yr of age) is in supine position. Stadiometer Infantometer 7

8. WEIGHT Subject must be barefoot and wear as little clothing as possible. Subject stands on the platform of the scale with his/her weight distributed evenly over both feet. The arms hang by the sides of the trunk, with palms facing the thighs. The subject is instructed to maintain a stable position while the measurement is taken

9. Mid-upper arm circumference (MUAC) MUAC is simple, cheap, more sensitive and less prone to mistakes.  Appropriate cut-off points of MUAC for children between 6 to 59 months are given below:

10. Latest recommendations - UNICEF

11. HEAD CIRCUMFERENCE Brain growth takes place 70% during fetal life , 15% during infancy and remaining 10% during pre-school years. Head circumference are routinely recorded until 5 years of age . The 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 . 12

12. CHEST CIRCUMFERENCE It is usually measured at the level of nipples, preferably in mid inspiration. In children ≤ 5years - lying down position > 5 years - standing position 13

13. RELATIONSHIP BETWEEN HEAD SIZE WITH CHEST CIRCUMFERENCE At birth - head circumference > chest circumference by up to 3 cm. At around 9 months to 1 year of age- head circumference = chest circumference, but thereafter chest grows more rapidly compared to the brain. 14

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15. INDICES 16 Relation between two measurements Weight For Age W/A general appreciation of nutritional status combined measurement NO individual diagnosis but trend assessment For growth monitoring Height For Age H/A measure of linear growth deficit or STUNTING not sensitive to change slow progress Community diagnosis Weight For Height/Length W/H measure of weight deficit according to length WASTING Individual diagnosis Community diagnosis Sensitive to change

16. STANDARD DEVIATION (SD) CLASSIFICATION CUT-OFF LEVEL NUTRITIONAL GRADE WEIGHT FOR AGE HEIGHT FOR AGE WEIGHT FOR HEIGHT  Median – 2 SD Normal Normal Normal Median – 3 SD to Median – 2 SD Moderate Underweight Moderate Stunting Moderate Wasting < Median – 3 SD Severe Underweight Severe Stunting Severe Wasting 17

17. IAP CLASSIFICATION (Indian Academy of Paediatrics ) WEIGHT FOR AGE (% of Harvard Standard) NUTRITIONAL GRADE  80 Normal 70 – 89.9 Grade I (Mild Undernutrition ) 60 – 69.9 Grade II (Moderate Undernutrition) 50 – 59.9 Grade III (Severe Undernutrition) < 50 Grade IV (Severe Undernutrition ) 18

18. Classification BMI(kg/m 2 ) Principal cut-off points Additional cut-off points Underweight <18.50 <18.50      Severe thinness <16.00 <16.00      Moderate thinness 16.00 - 16.99 16.00 - 16.99      Mild thinness 17.00 - 18.49 17.00 - 18.49 Normal range 18.50 - 24.99 18.50 - 22.99 23.00 - 24.99 Overweight ≥25.00 ≥25.00      Pre-obese 25.00 - 29.99 25.00 - 27.49 27.50 - 29.99       Obese ≥30.00 ≥30.00           Obese class I 30.00 - 34-99 30.00 - 32.49 32.50 - 34.99           Obese class II 35.00 - 39.99 35.00 - 37.49 37.50 - 39.99           Obese class III ≥40.00 ≥40.00 Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004 19 Nutritional gradation based on BMI (adult) Body Mass Index (BMI) = Weight in kg / height in meter sq .

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