ANTHROPOMETRIC MEASUREMENTS

INTRODUCTION-

 Anthropometric measurements are a series of quantitative measurements of the muscle,

bone, and adipose tissue used to assess the composition of the body.
 The core elements of anthropometry are height, weight, body mass index (BMI), body
circumferences (waist, hip, and limbs), and skinfold thickness.

IMPORTANCE AND INDICATIONS-

1. They represent diagnostic criteria for obesity, which significantly increases the risk
for conditions such as cardiovascular disease, hypertension, diabetes mellitus, etc.
BMI is useful to identify obesity and the severity of obesity.
2. Utility as a measure of nutritional status in children and pregnant women. In children,
indications include stunting, wasting, and being underweight.
Stunting is when children have a low height-for-age, wasting is a low weight-for-
height, and underweight is a low weight-for-age.
Mid-upper arm circumference (MUAC) is a viable measurement in children or
pregnant women as a marker of nutritional status.
BMI is another commonly employed index of nutritional status and used as a gauge
of malnutrition in children and adults.
3. Anthropometric measurements can be used as a baseline for physical fitness and to
measure the progress of fitness. It is used as part of the evaluation of fitness in
athletes.

ANTHROMETRIC MEASURES-

1. HEIGHT
2. WEIGHT
3. BMI
4. HEAD CIRCUMFERENCE
5. MID UPPER ARM CIRCUMFERENCE
6. CHEST CIRCUMFERENCE
7. WAIST CIRCUMFERENCE
8. WAIST HIP RATIO
9. LIMB LENGTH MEASUREMENT
10. SKINFOLD MEASUREMENT

1. Height – Standing height

- Sitting height

 Standing height is measured in millimeters with a wall-mounted Harpenden stadiometer.

  Sitting height is a measure of the upper segment of the body including the trunk, neck,
and head heights. The difference between sitting height and standing height offers an
accurate estimate of leg length, or subischeal height.
 Measuring sitting height includes its usefulness in the interpretation of pulmonary
function tests. Sitting height may provide a more accurate estimate of thorax size.
Apparatus Used – Stadiometer, Infatometer (For length of infants in lying position)

Procedure –

Standing Height -
1) The participant should be relaxed, barefoot or wearing thin socks or stockings.
2) Ask the participant to remove any hairpiece or rearrange any hair styling that might
interfere with firm contact between the headboard and the scalp.
3) The stadiometer should be mounted on a straight wall that is at a true 90° angle to the
floor. The heel plate should be mounted on the floor in the same vertical plane as the
back board of the stadiometer.
4) The floor should be level and free of carpeting. If bare floor is unavailable, firm, non-
compressible carpeting (e.g., indoor-outdoor) is acceptable.
5) There should be about a foot or more of unoccupied wall space on either side of the
stadiometer.
6) Have the participant stand with their back against the wall-mounted stadiometer, heels
together. The back (scapulae), buttocks and both heels should be touching the wall-plate.
7) Check that the arms are relaxed and hanging loosely at the sides and that the shoulders
are relaxed by running your hands over them and feeling the relaxed trapezius muscle.
8) The head should be in the "Frankfort Horizontal Plane" in which the lowest point on the
inferior orbital margin (orbitale) and the upper margin of the external auditory meatus
(tragion) form a horizontal line.
9) Bring the horizontal bar down firmly onto the top of the head and make contact with the
top of the scalp.
10) Have the participant breathe in deeply. Record the reading on the stadiometer just before
the participant exhales.

Sitting Height –
1) Have the participant sit on the seat with the legs hanging unsupported over the edge and
with the hands resting on the thighs in a cross-handed position.
2) The participant’s thighs are in horizontal position. Body weight should be on the buttocks
and not (partly) on the feet.
3) The knees should be directed straight ahead, and the back of the knees should be near the
edge of the seat but not in contact with it.
4) The participant should face straight ahead with their head in the Frankfort position.
5) Place the horizontal bar firmly on the top of the head.
6) Have the participant breathe in deeply. Record the reading on the stadiometer just before
the participant exhales.
 2. Weight

 Weight can be measured on a weighing scale.

 It determines the nutritional status in children
 Also used as a baseline to determine the effectiveness of the weight loss programmes.
 Measured in kilograms.

3. Body Mass Index (BMI)

 Body mass index (BMI) is a value derived from the mass (weight) and height of a
person. The BMI is defined as the body mass divided by the square of the body height,
and is universally expressed in units of kg/m2, resulting from mass in kilograms and
height in metres.
 The BMI is universally expressed in kg/m2, resulting from mass in kilograms and height
in metres.

 The BMI ranges are based on the relationship between body weight and disease and
death.[26] Overweight and obese individuals are at an increased risk for the following
diseases:[27]

 Coronary artery disease

 Dyslipidemia
 Type 2 diabetes
 Gallbladder disease
 Hypertension
 Osteoarthritis
 Sleep apnea
 Stroke
 Infertility
 At least 10 cancers, including endometrial, breast, and colon cancer[28]
 Epidural lipomatosis[29]
Among people who have never smoked, overweight/obesity is associated with 51%
increase in mortality compared with people who have always been a normal weight.
  BMI is particularly inaccurate for people who are very fit or athletic, as their high muscle
mass can classify them in the overweight category by BMI, even though their body fat
percentages frequently fall in the 10–15% category, which is below that of a more
sedentary person of average build who has a normal BMI number.

4. Head Circumference

 Measuring head circumference (HC) is a quick, noninvasive method of determining if

infant head size is too large (megacephaly) or too small (microcephaly).1 When
compared with normative growth curves, serial HC measurements are extremely
important in monitoring infant health.
 Measuring occipital-frontal HC is quick and easy, involving a nonelastic tape measure
and 1 to 2 minutes of a clinician’s time to measure (at least twice) and plot the
measurement on the appropriate growth chart.
 HC is a measure of the largest area of a child’s head or the distance around the back of
the head with the tape measure held above the eyebrows and ears.
 It has numerous correlates in the typical and clinical population such as cognitive ability
[3] and both risk and outcome for a number of neurological and genetic conditions [4].
Abnormal HC growth trajectories have also been reported in children and adults in a
number of mental health and high risk populations, including –
1) Autism
2) Schizophrenia
3) Dementia
4) Premature Birth
5) Malnourishment

5. Mid Upper Arm Circumference

 The MUAC is a much simpler anthropometric measure than the BMI, as its use eliminates
the need for expensive equipment, such as height charts and scales, and the need for
calculations. It is also much easier to perform on a patient who is acutely unwell, bed bound
or sedentary.
 The circumference of the left upper arm measured at the mid-point between the tip of the
shoulder and the tip of the elbow (acromion process and the olecranon) is referred to as
MUAC.
 MUAC can provide high accuracy for the assessment of obesity in children and adolescents.
 A number of studies from low-income, middle-income and high-income countries have
shown that high MUAC has high diagnostic accuracy (sensitivity, specificity and predictive
values) for the identification of overweight and obesity and for the identification of over
fatness.
 Interpretation of Mid-Upper Arm Circumference MUAC indicators

 MUAC less than 110mm (11.0cm), RED COLOUR, indicates Severe Acute Malnutrition
(SAM). The child should be immediately referred for treatment.
 MUAC of between 110mm (11.0cm) and 125mm (12.5cm), RED COLOUR (3-colour Tape)
or ORANGE COLOUR (4-colour Tape), indicates Moderate Acute Malnutrition (MAM).
The child should be immediately referred for supplementation.

 MUAC of between 125mm (12.5cm) and 135mm (13.5cm), YELLOW COLOUR, indicates
that the child is at risk for acute malnutrition and should be counselled and followed-up for
Growth Promotion and Monitoring (GPM).

 MUAC over 135mm (13.5cm), GREEN COLOUR, indicates that the child is well nourished.

6. Chest Circumference for Thoracic Expansion

 The subject will be in standing with arms along the body. The thoracic part should be
exposed.
 The measure tape will be placed at the particular level. It will be held with an index finger
between the participant’s body and the tape. Any deformation or cutaneous folds will be
avoided.
 The subject will be asked to inhale slowly through the nose, pushing against the tape and
expand the thorax as much as possible. The measurement will be noted.
 Then the participant will be asked to exhale completely through the mouth and measurement
will be noted. To determine the expansion, difference between the inspiratory diameter and
expiratory diameter will be taken.
 The method will be done at 3 levels-
1. Axillary level - Second intercostal space
 2. Xiphoid level
3. Abdominal level – Midpoint between xiphoid process and umbilicus.

7. Waist Circumference/ Abdominal Circumference

 Excessive abdominal fat may be serious because it places you at greater risk for developing
obesity-related conditions, such as Type 2 Diabetes, high blood pressure, and coronary artery
disease.
 To correctly measure waist circumference:

 Stand and place a tape measure around your middle, just above your hipbones
 Make sure tape is horizontal around the waist
 Keep the tape snug around the waist, but not compressing the skin
 Measure your waist just after you breathe out

 Have a higher risk of developing obesity-related conditions for:

 A man whose waist circumference is more than 40 inches

 A non-pregnant woman whose waist circumference is more than 35 inches

8. Waist Hip Ratio

 The waist-hip ratio or waist-to-hip ratio (WHR) is the dimensionless ratio of the
circumference of the waist to that of the hips. This is calculated as waist measurement
divided by hip measurement (W ÷ H).

 Waist circumference should be measured at the midpoint between the lower margin of the
last palpable ribs and the top of the iliac crest, using a stretch‐resistant tape
 Hip circumference should be measured around the widest portion of the buttocks, with the
tape parallel to the floor.

 For both measurements, the individual should stand with feet close together, arms at the side
and body weight evenly distributed, and should wear little clothing. The subject should be
relaxed, and the measurements should be taken at the end of a normal respiration. Each
measurement should be repeated twice; if the measurements are within 1 cm of one another,
the average should be calculated. If the difference between the two measurements exceeds
1 cm, the two measurements should be repeated
 9. Limb Length Measurement – True
- Apparent

True Limb Length

 True length is the measurement taken from the anterior superior iliac spine to the
tip of medial malleolus while both lower limbs are in identical positions and the
pelvis is square.
 Please note that identical position of the lower limb is and pelvis squaring is very
important because the upper reference point ASIS [anterior superior iliac spine] is
outside the limb and any change in the position can affect the length.
 Actual true limb length should be measured from mid of head of the femur to medial
malleolus but lack of reference point makes us select anterosuperior iliac spine, an
easy to locate reference point.

Apparent Limb Length

 Apparent length is measured in a similar way with the following differences

 The pelvis is not squared

 The limbs are not brought into the identical position
 The upper reference point is common [xiphisternum, umbilicus]

 In nutshell, the deformity is left as such and limb length is measured from a common
point such as xiphisternum or umbilicus.
 For finding the apparent and true shortening, both the limbs are measured separately
and the difference of the measurements is calculated. Apparent shortening means the
difference between apparent leg lengths of two limbs.
 Leg length discrepancy (LLD) or anisomelia, is defined as a condition in which the paired
lower extremity limbs have a noticeably unequal length.

 There are two types of limb length discrepancy (LDD)

 Anatomical

Structural limb length inequality. It’s a physical (osseous) shortening of one lower limb
between the trochanter femoral major and the ankle mortise. Congenital conditions include
mild developmental abnormalities found at birth or childhood, whereas acquired conditions
include trauma, fractures, orthopedic degenerative diseases and surgical disorders such as
joint replacement. A systemic review evaluating the prevalence of LLD by radiographic
measurements revealed that 90% of the normal population had some type of variance in bony
leg length, with 20% exhibiting a difference of >9 mm

 Functional

Non-structural shortening. It is a unilateral asymmetry of the lower extremity without any

shortening of the osseous components of the lower limb. FLLD may be caused by an
alteration of lower limb mechanics, such as joint contracture, static or dynamic mechanical
axis malalignment, muscle weakness or shortening. It is impossible to detect these faulty
mechanics using a non-functional evaluation, such as radiography. FLLD can develop due to
an abnormal motion of the hip, knee, ankle or foot in any of the three planes of motion.

10. Skinfold Measurements

 The rationale for using skinfolds to estimate body fat comes from the interrelationships
among three factors:
(1) adipose tissue directly beneath the skin (subcutaneous fat),
(2) internal fat, and
(3) whole-body density

 A pincer-type caliper accurately measured subcutaneous fat at selected anatomic sites.

 Measuring skinfold thickness requires firmly grasping a fold of skin and subcutaneous fat
with the thumb and forefingers, pulling it away from the underlying muscle tissue following
the natural contour of the skinfold.

 When calibrated, the pincer jaws exert a relatively constant tension of 10 g mmH 2O at the
point of contact with the double layer of skin plus subcutaneous adipose tissue.

 The caliper dial indicates skinfold thickness in mm recorded within 2 seconds after applying
the full force of the caliper.
 Measurement sites –

 The investigator should take a minimum of two or three measurements in rotational

order at each site on the right side of the body with the subject standing.
 The anatomic location of five of the more frequently measured sites:

1) Triceps: Vertical fold at the posterior midline of the right upper arm, halfway between
the tip of the shoulder and tip of the elbow; elbow remains in an extended, relaxed
position
2) Subscapular: Oblique fold, just below the bottom tip of the right scapula
3) Iliac (iliac crest): Slightly oblique fold, just above the right hipbone (crest of ileum); the
fold follows the natural diagonal line
4) Abdominal: Vertical fold 1 inch to the right of the umbilicus
5) Thigh: Vertical fold at the midline of the right thigh, two thirds the distance from the
middle of the patella (kneecap) to the hip

Other sites include:

1) Chest: Diagonal fold with long axis directed toward the right nipple; on the anterior
axillary fold as high as possible
2) Biceps: Vertical fold at the posterior midline of the right upper arm.

 Skinfold measurements provide meaningful information about body fat and its distribution.

 Young women, ages 17 to 26 years , % Body fat = 0.55A + 0.31B + 6.13

Young men, ages 17 to 26 years, % Body fat = 0.43A + 0.58B + 1.47

IMPLICATIONS OF ANTHROPOMETRIC MEASUREMENTS IN

PHYSIOTHERAPY

1) Anthropometric measurements have utility in assessing data of physical fitness

for a wide variety of the population from children to elite athletes to the elderly.
These measurements, including height, weight, circumferences, and skin
folds, can be used either as a baseline or as a marker of progress.
2) One study of Australian volleyball players revealed that anthropometric data
improves with increases in playing level.
3) Another study used anthropometric measurements as a marker of physical fitness
progress in women age 60-100. They found that pilates combined with
hydrogymnastics decreased BMI, weight, and hip and waist measurements.
4) Since obesity is a major modifiable risk factor of cardiovascular disease,
stroke, diabetes mellitus, dyslipidemia, and hypertension, one of the best clinical
utilities of anthropometric data is to define obesity. The best measurement to
define obesity is not uniformly agreed upon, as is illustrated by one study which
compared BMI, waist circumference, waist-to-hip ratio, and waist-to-height ratio.
This study found that there is not adequate evidence to support one method of
measurement over any other, but states BMI is the most logical choice given
its historical use. The authors also demonstrated that elevations in anthropometric
measurements led to a higher odds ratio of dyslipidemia, hypertension, and
hyperglycemia.
5) Head circumference is another anthropometric measurement routinely used in
children. This measurement is important to diagnose microcephaly, which has
well-documented complications.
6) Anthropometric evaluation is an essential feature of geriatric nutritional
evaluation for determining malnutrition, being overweight, obesity, muscular
mass loss, fat mass gain and adipose tissue redistribution. Anthropometric
indicators are used to evaluate the prognosis of chronic and acute diseases, and
to guide medical intervention in the elderly.
7) A study in Chicago stated that both overweight and low weight values were
associated with a lower quality of life, worse physical performance and less
physical wellbeing.

8) A study to investigate the physiological and anthropometric characteristics of

amateur rugby league players concluded that the physiological and
anthropometric characteristics of amateur rugby league players are poorly
developed. These findings suggest that position specific training does not occur in
amateur rugby league. The poor fitness of non-elite players may be due to a low
playing intensity, infrequent matches of short duration, and/or an inappropriate
training stimulus.
9) A study to investigate the relationship between anthropometric variables and lung
functions (LF) of children concluded that gender did not have any influence on
the anthropometric and LF of the children in this study. However, the height,
weight WC, HC and CC were all strong determinants of LF. It was also
concluded that the lower BMI groups had lower FEV 1 and FVC compared
to the over-weight BMI group in both male and female children. Conversely,
BMI group did not have any effect on PEF of the children.