ANTHROPOMETRY

By Shiva Prasad tiwari Mpt 1st year

DEFINITION:-Greek

anthropos = human, metro = measurementIs the measurement of the human body, Measurements of the variations of the physical dimensions and the gross composition of the human body at different age levels and degrees of nutrition jelliffe 1966 966 Measurement of physical characteristics e.g. height, weight, body composition (fat!). Compare with standards for age, sex Anthropometric measurement is a series of standardized measuring techniques that express quantitavely dimensions of human body It helps in measurements for determining the size proportion,& shape of an individuals body

Uses or need
To evaluate progress of growth;identify people whose growth is outside normal values suggesting under or over nutrition so its a Screening tool to identify individual at high risk of malnutrition or any other disease To measure change over time: monitor effects of nutrition intervention for treatment of disease, surgery or malnutrition. Also, can track weight changes that may indicate disease Helps in comparison of morphological status in b/w individuals. Ex: growth status of school children Used as an outcome variable in evaluating interventions such as effects of exs & wt reduction on body wt &sc fatness

The measurements include Height weight height and weight BMI Girth measurements Skin fold thickness Waist to hip ratio Specific segmental length Head circumference Other method

height
Procedure Person in standing erect position, without shoes ask person to take deep breath and hold it. Weight equally distributed on both feet tighter arms hanging side head in Frankfort horizontal plane. Taken from standing surface to the top(vertex) of the skull, Body wt is measured of body mass .remove the shoes and as much other clothing. Compare the subjects height and weight Planning and policy making

Demispan
A measurement of skeletal size Used as an alternative to height measurement when difficult to obtain an upright posture Demispan is the distance between the sternal notch and the roots of the middle and third fingers with the arm stretched out at shoulder height to the side of the body

Height

Height for age

Height should be taken in standing position. Length for baby at birth is about 50cm it increase by about 25 cm during first year and 12 cm during 2nd year Indian girls reach 98%of final height at 16.5 years and and boys at 17.75 years Low height for age :also known as nutritional stunting or dwarfing .which reflect malnutrition Use of 2SD VALUE bellow the median reference as cut off point.

Weight for age

Measurement of weight as reference monthly from birth to 1 year every 2 month during 2nd year ,3 month thereafter up to 5 .to monitor the physical growth Average Indian weight at birth is 2.7 to2.9 kg Baby should gain atleast 500gm wt in 1st 3 month there after 7 kg at end of 1st year 2.5 kg thereafter

Weight for height

Height and weight are interrelated and consider important then single parameter alone(height , weight) Low weight for height: also known as nutritional wasting or emaciation (acute mal nutrition)a child who is less then 70% of expected weight for height is classed a severe wasted

Growth chart used in India

Consist 4 line 1st topmost represent 80% of median lower line 70%,60%,50% of standard It shows 3 degree of malnutrition Mild or first degree between 70to 80% Moderate or 2nd degree between 60 and 70% Severe or 3rd degree between 50 to 60% Use of growth chart 1)For growth monitoring 2) Evaluation or diagnostic tool 3)Planning and policy making 4)Educational tool

BMI
BMI is also called quetelets index Used to access weight relative to height BMI gives a single number for comparison ,as opposed to the weight to height range or table. BMI=weight(kg)/height(m2) BMI provides a slightly more accurate assessment of body composition than simple height/weight charts but the same bias is present PROBLEM: 1)it doesn't differentiate fat weight from fat free weight 2)It doesn't represent an improvement over the relationship between only weight and body mass

Waist to hip ratio

an effective way to examine regional fat distribution Pattern of body wt distribution is important predictor of health risk of obesity Individual with more weight or circumference on trunk are at increased risk of hypertension ,type2dibetes, hyperlipidemia and CAD compared with individual who are equal wt but have their more wt distribution on extremities Waist :- its the smallest waist circumference .usually 1 inch above the level of umlicus Hip :- maximum circumference of the buttocks above the gluetal fold Normal values of waist: hip ratio Healthy young men -0.94-1.00 young women 0.80 -0.90 Fat deposit in lower body is pear shaped and abdominal is apple shaped Subcutaneous and visceral fat deposition

Waist hip circumference

Circumference or girth
Uses: 1)for estimation of body composition 2)quantify change in the muscle bulk with training (eg.resistance weight training) Advantage: Easily learned Quick to administer Inexpensive in equipments need

Anatomical sites for circumference management

1)right upper arm: 2)right forearm: 3)abdomen(waist) 4)hip; 5)right thigh: 6)right calf: 7)head circumference To estimate %of body fat uses three sites (acsm) Young man(18 to 26yrs):arm, forearm, abdomen Yong women(18 to 26)forearm,thigh,abdomen Older man(27 and above )forearm, buttock(waist) abdomen Older woman abdomen, thigh ,calf % fat = - 47.372 + (.579 x abdomen) + (.252 x hip) + (.214 x iliac) + (.356 x BW)

Arm circumferennce:midpoint between shoulder and elbow with arm straight ,midway between acromian and olecranon

Forearm:
Maximum girth around the forearm with rt arm straight ,extended in front of body and palm up.

Proximal thigh:
Subject standing leg slightly apart(10cm) maximum circumference at hip just bellow the gluetal fold

Right calf: subject standing erect(feet apart 20cm )horizontal measure is taken at the level of maximum circumference between knee and ankle usually midpoint.

Head circumference
Also known occipitofrontal circumference Widest anteroposterior diameter Normal 32 to 38 Vary with age and sex .

Skinfold measurement
Procedure for measuring fat fold thickness is to grasp a fold of skin and subcutaneous fat firmly with the thumb and forefingers. Pulling it away from the underlying muscle tissue following the natural contour of the fat fold. The calliper is applied worth it jaws exerting constant tension of 10gm/mm2 at the point of contact with the skin. The thickness of the double layer of skin and subcutaneous tissue is then read directly from the calliper dial and recorded in millimetres within several seconds after applying the calliper principle :the amount of subcutaneous fat is proportional to total amount of body fat . the proportion of subcutaneous fat to body fat may vary with gender, age so regression equation considering to predict body density or %of body fat

Skin fold technique

Layers of subcutaneous fat are measured at different sites of body to estimate total body fat levels

Benefits
Easy to perform Inexpensive Widely used method Gives reasonable accuracy

Measurement errors Poor technique Inexperienced examine Improper calibrated caliper

Triceps
Vertical fold on the Midline of the posterior aspect of the arm over the triceps muscle. Halfway between the acromian and olecranon process

bicep
Vertical fold on anterior aspect of arm 1 cm above level used to mark the tricep

sub scapular
Diagonal fold (at45degree) at 1 to 2 cm bellow the inferior angle of scapula.

Suprailliac
Diagonal fold in line with the natural angle of iliac crest taken in anterior axillaries line immediately above iliac crest.

abdomen
Vertical fold 2cm right to the umbilicus

thigh
Vertical fold on anterior midline of the thigh ,midway between proximal boarder of patella and inguinal crease

Chest /pectoral
Diagonal fold one half the distance between anterior axillary line and nipple in man In women one third of distance between anterior axillary line and nipple.

Medial calf
Vertical fold at the maximum circumference of calf on midline of its medial boarder

midaxillary
Vertical fold on mid axillary line at level of xiphoid process of sternum .alternatively horizontal fold at level of xiphoid sternal boarder in mid axillary line

Skin fold prediction equation

Jackson pollock 7 site formula Men and women sites:(chest,midaxillary,tricep ,sub scapular ,abdomen,suprailliac ,thigh) For man BD=1.112-0.00043499(sum of seven fold)+0.00000055(square of sum of seven fold )0.00028826(age) For women BD=1.097-0.00046971(SUM OF seven skin fold +0.00000056(square of sum of seven skin fold)-0.00012828(age)

 Jackson pollock 3 sites skin fold formula For man(chest, thigh ,abdomen) Body density (BD)=1.10938-0.0008267(sum of three skin fold)+0.00000016(square of sum of three skin fold)-0.0002574(age) For women site are tricep,suprailliac,thigh BD=1.099421-0.0009929(sum of three skin fold)+0.0000023(square of sum of three sites)0.00001392(age)

How to identify %of body weight

Siri equation %of body fat=(495/BD)-450 Brozek equation %of body fat=(457/BD)-414.2

Body fat % rating

Body fat% using Jackson Pollock equation
Male
<13 18-13 22-19 26-23

Female
<18 23-18 29-24 34-30

Rating
excellent Good Average Fair

>26

>34

Poor

Limb length measurement

1)true limb length 2)apparent limb length Procedure Patient position: supine lying the distance between 2 medial malleoli should be 15 to 20 cm Squaring of pelvis : bilateral measurement from lower boarder of umbilicus to iliac crest if their is significant difference in measurement that suggest either the leg is in abduction or adduction Then correct it by doing adduction or abduction to opposite side leg respectively.

 Whole upper limb length:

Measurement is taken from most superior lateral point of acromion process (acrmorial landmark) to the lower and lateral border of styloid process of radius (radial landmark). The arm is positioned in the anatomical position, relaxed at the side of the subject Segmental measurement: - Upper arm length: With arm flexed at 90, so that ulnar surface of forearm and hand are horizontal and palms facing medially with fingers extended, measurement is taken from acromial landmark to the posterior surface of olecranon process of ulna. - Forearm length: It is the distance from the head of radius (upper radial landmark) to the most distal point of the styloid process of radius (or styloin). - Hand length: With hand extended and the palm rested in the direction of the longitudinal axis of forearm, measurement is taken from styloid process at base of thumb to the tip of middle finger.

Whole lower limb length:. To determine true leg length, first place the patient's legs in precisely comparable positions and measure the distance from the anterior superior iliac spines (ASIS) to the medial malleoli of the ankles (from one fixed bony point to another). Begin measurement at the slight concavity just below the anterior superior iliac spine, as the tape measure may slide if pressed directly onto the spine. If there is tilting of pelvis. Measurement will be taken from the umbilicus to the medial or lateral malleolus. If there is shifted umbilicus, measurement is then taken from xyphoid process to the medial or lateral malleolus. Apparent shortening (due to pelvic tilt) should be differentiated from true shortening (bony). Unequal distances between these fixed points verify that one lower extremity is shorter than the other.

 To determine in short order where the discrepancy lies (whether in the tibia or in the femur), ask the patient to lie supine, with his knees flexed to 90 and his feet flat on the table. If one knee appears higher than the other, the tibia of that extremity is longer; while if one knee projects furthers anteriorly than the other, the femur of that extremity is longer(telescopic view or gallent sign). A true shortening may be due to poliomyelitis or a fracture that crossed the epiphyseal plate during childhood

Segmental
For neck of femur: From asis to greater trochanter For femoral shaft : from greater trochanter to lateral epicondyle of femur For tibia length:from medial tibia tubercle to medial malleolus Foot length: It is the distance between the most posterior part (center) of the heel to the most anterior part of the longest toe (2nd toe).

Apparent leg length discrepancy: Before testing for apparent leg length discrepancy, no true leg length discrepancy should be confirmed (no true bony inequality). Apparent shortening may arise from pelvic obliquity, hip adduction or flexion deformity. During inspection, pelvic obliquity manifests itself as uneven ASIS or PSIS while the patient is standing. While the patient is in supine with his legs in the neutral position, measurement is taken from the umbilicus (or xiphi-sternal juncture ) if obese 2 cm bellow the umbilicus to the medial malleolus (from a non-fixed point to a fixed bony point). Unequal distances signify an apparent leg length discrepancy, if the true leg length measurements are equal

Other method to measure body composition

Direct method Two approaches have been used for direct assessing body composition In one the body is literally dissolved in the chemical solution and the fat and non fat component mixture is determined The other techniques involves the physical dissection of variety of body component such as fat, fat free adipose tissue, muscle &bone Disadvantage Time consuming & tedious Specialized lab equipments needed Ethical &legal problems in obtaining cadavers for research

Indirect method
Anthropometry Hydrostatic weighing Air plethysmography Bioelectric impedance analysis dexa

Hydrostatic weighting
Its an technique where the density of a persons body is measured .Use to be a gold standard Based on Archimedes principle which states A body immerses in a fluid experience a loss in weight equals to the weight of displaced fluid

Procedure
The subject to be submerged in water & body volume is determined by displacement of water. Calculating body density &volume of water displaced .Density=Weight/Volume Compute relative fat, fat mass &fat free mass Relative fat estimated using siri equation %fat=495/BD-450 Lean weight= body weight-fat weight Fat weight = (%fat /100)*body weight Source of error Residual lung volume Body density varies with age& activity level

Air Pletsmography
Bod pod Dual chambered plethysmography In contrast to hydrostatic weighing,Bodpod uses air displacement rather than water displacement to determine body density

 The volume of empty measurement chamber is determined first The test is then perfomed with the subject inside, and that volume is measured In the second measurement the chamber volume has been reduced by an amount equal to the subjects volume So by subtraction ,the volume of the subject can be calculated To obtain an accurate volume, thoracic gas volume(residual gas)to be taken into account Normal value:0.003-.007g/cc

Bioelectrical impendence
Based on resistance to current flow Lean tissue has more water So less resistance. Fat tissue has less water So more resistance A small portable instrument is used to pass an electric current of

50 x 10 -6 A at 50 KHz

Sources of error Temperature Hydration status

DEXA Dual energy x-ray absorptiometry

High technology procedure Mostly used for bone density assessment for osteoporosis diagnostic purposes

 Used to estimate regional bone mineral content and bone mineral density primarily spine, pelvis, femur Advantage; Precise Reliable

 estimates bone density and mineral content Normal bone mineral density Males:3.88g/cm3 Females:2.90g/cm3

Rest is yours