Assessment of Nutritional Status

Assessment of
Nutritional
Status
Assessment
•One of the First step in formulating any public health strategy to combat malnutrition
•Aim: 1)To determine the type, magnitude and distribution of malnutrition
2)To identify “at risk” groups
3)To determine contributory factors
•In addition it gives evidence of exact magnitude of malnutrition to administrators & politicians to
obtain allocation of material, human resources to plan appropriately.
Anthropometric assessment
Anthropo-man, Metron- measurement
Branch of Anthropology that involves the quantitative measurement of human body
Human body- reflect changes morphological variation due to inappropriate food intake or
malnutrition
A variety of anthropometric measurements can be made either covering whole body or parts of the
body.
There is no permanent standards as there is no uniformity of growth in subsequent generations
Local standards need to be developed for various ethnic groups periodically

Body weight
Most widely used, simple, sensitive
Indicates body mass
It composes of water, mineral, fat, protein and bone
It reflects more recent nutrition than does height
Serial measurements are more sensitive indicators than a single measurement
Rapid loss of body weight- indicator for potential malnutrition

Weight can be measured using
Beam type weighing scale
Spring balance
Electronic weighing scales for children & adults
Bathroom type of mechanical scale ( very unreliable)(error upto 1.5kg)
Salter spring balance (in field work)

Height
•Influenced by both genetic and environmental factors
•Genetic factors: decide the maximum growth potential
•Environmental factors (Nutrition & morbidity)- determine extent of exploitation of genetic potential
•Height is affected only by long term nutritional depreciation, therefore considered as index of chronic
or long duration malnutrition.
•For children less than 2yrs- recumbent length is considered

Recumbent length
•Distance measured from crown of head to bottom of feet
•Measured by infantometer
Stadiometer
• No shoes
• Height should be read to the nearest 0.5cm
• An Average of 3 measurements is taken as the
final measurement.
BMI
• Used as an indicator of health risk

• Cannot be used for children
• BMI has good correlation with fatmass
Weight for Height
Weight of the child / Wt, corresponding fort the height of the child *100
<90% PEM
>90-120% Normal
>120% Obesity
Most often accurate assessment af age may not be possible. Weight for height is age independent
Height for Age
If one knows age of the child accurately, one can use McLaren’s classification
Status Percentage of height for age

dwarf <80
Short 80-93
Normal 93-105
Weight for Age
Gomez classification for public health
Grades Weight for age
Normal >90%
Grade-I 75-90%
Grade-II 60-75%
Grade-III <60%
IAP & ICMR Classification
Grades Weight for age
Normal >80%
Grade-I 70-80%
Grade-II 60-70%
Grade-III 50-60%
Grade-IV >50%
Waterlow malnutrition
classification
Types/degrees of malnutrition %wt/age %wt/ht
Normal >90 >80
Short duration malnutrition >90 <80 wasted
Long duration malnutrition <90 <80 stunted

(Nutritional dwarf)
Current & long duration <90 <80 stunted and wasted
malnutrition
Cut off level as % of NCHS median indicator

Classification identifies type and duration of malnutrition
Children with oedema are classified
according to Welcome clinical classification
Types %wt. for age Oedema
Normal >80% -
Undernutrition 60-80% -
Kwashiorkor 60-80% +
Marasmus <60% -
Marasmic Kwashiorkor <60% +

MUAC
•Indicates the status of muscle development
•Useful not only in identifying malnutrition but also in determining the mortality risk in children
•It corelates well with weight, weight for height and clinical signs
•On the left hand, the mid-point between the tip of acromion of scapula and tip of olecranon of the fore
arm bone, Ulna is located with the arm flexed at the elbow and marked with a marker pen
•Fibre glass type is used and reading is taken to the nearest millimeter
•MUAC can be measured using shakir tape or bangle test

Head & Chest circumference
•Head size relates mainly to the size of the brain which increases quite rapidly during infancy
•Head circumference at birth is 35cm
•It increases 1cm/month for 6 months
•Then it increases 4cm totally for next 6months
•By the end of 1 year it should be 45cm
•By 2 years 47cm, by 3years- 48cm, by-5years-50cm, by 18 years-55cm
•Ratio of head & chest circumference is 1 at the age of 1 year
•If head circumference is more than chest circumference it indicates malnutrition

Head & Chest circumference
•Chest is normally nourished child grows faster than head during the 2nd and 3rd year of life
•AS a result, chest circumference overtakes head circumference by about one year age
•In PEM due to poor chest growth, the head circumference may remain to be higher than the chest even
at the age of 21/2 or 3 years
•Flexible fibre glass tape is used
•Chest circumference is taken at the nipple level preferably in mid inspiration
•Head circumference is measured passing the tape round the head over the supra-orbital ridges of the
frontal bone in front and the most protruding point in the occiput on the back of the head
Measuring Head & Chest Circumference
Skin fold thickness meausrement
•Body fat is located both internally and subcutaneously
•A total body fat can be estimated by measureing the amt. subcutaneous fat layer at different sites of the
body using a skin fold caliper
•Most often measured skinfolds for the assessment of total body fat are skinfolds on
Upper arm biceps and triceps
Under the scapula (sub scapular)
Above the iliac crest (suprailiac)

▪ Triceps: located halfway between shoulder and elbow joints.
▪ Fold is taken in a vertical direction directly on the center of back of the upper arm.
▪ If you are right handed, pull out the fold of skin with its underlying layer of fat with
your left hand. Don't worry about getting muscle as muscle is very firm & taut it
won't come out with skin & fat.
▪ Fold it over as shown in Figure.
▪ Then holding the caliper in your right hand place the jaws of the caliper about
1/4" from fingers of your left hand which continues to hold the fold of skin.
▪ Completely release the trigger of the caliper so the entire force of the jaws is
on the skin fold.
▪ Do not release the fold of skin held in your left hand while taking the
reading.
▪ Best to take all 4 reading & add together & with the aid of charts.
▪ % body fat is calculated.
Triceps BICEP
S
Sub-scapular SUPRA-
ILIAC

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Assessment of

•Aim: 1)To determine the type, magnitude and distribution of malnutrition

2)To identify “at risk” groups

3)To determine contributory factors

Branch of Anthropology that involves the quantitative measurement of human body

Local standards need to be developed for various ethnic groups periodically

Indicates body mass

It composes of water, mineral, fat, protein and bone

It reflects more recent nutrition than does height

Serial measurements are more sensitive indicators than a single measurement

Rapid loss of body weight- indicator for potential malnutrition

Electronic weighing scales for children & adults

Bathroom type of mechanical scale ( very unreliable)(error upto 1.5kg)

Salter spring balance (in field work)

•Genetic factors: decide the maximum growth potential

•For children less than 2yrs- recumbent length is considered

• Height should be read to the nearest 0.5cm

• An Average of 3 measurements is taken as the

• Used as an indicator of health risk

Status Percentage of height for age

Grades Weight for age

Normal >90 >80

Short duration malnutrition >90 <80 wasted

Long duration malnutrition <90 <80 stunted

Cut off level as % of NCHS median indicator

Marasmic Kwashiorkor <60% +

•MUAC can be measured using shakir tape or bangle test

•Head circumference at birth is 35cm

•It increases 1cm/month for 6 months

•Then it increases 4cm totally for next 6months

•By the end of 1 year it should be 45cm

•By 2 years 47cm, by 3years- 48cm, by-5years-50cm, by 18 years-55cm

•Ratio of head & chest circumference is 1 at the age of 1 year

•If head circumference is more than chest circumference it indicates malnutrition

•Flexible fibre glass tape is used

•Chest circumference is taken at the nipple level preferably in mid inspiration

Upper arm biceps and triceps

Under the scapula (sub scapular)

Above the iliac crest (suprailiac)

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