2. • It is a valuable index for assessment of nutritional
status of children
• Anthropometric parameters can be classified in to
two group
I. Age dependent criteria
II. Age independent criteria when child`s age is not
known .
3. I. Age dependent criteria
(a) Weight for age: –
serial weight for age chart is most useful, most sensitive
and commonly applied method for supervising growth
and identifying those with nutrition and health
problems.
4. Classification of PEM (I.A.P)
Grade of malnutrition Weight for age standard
(mean)%
Severity
Normal >80%
Grade 1 71-80% Mild
Grade 2 61-70% Moderate
Grade 3 51-60% Severe
Grade 4 <51% Very severe
5. b) Height for age :-
compare child height with expected height/length
for a healthy reference child of the same age.
It is not useful for early diagnosis as changes in
height occurs slowly.
6. II. Age independent criteria :-
1) Mid upper arm circumference(MUAC):-
Widely used and requires minimum equipments.
Useful in screening large number of child during
medical emergency.
Less useful in long term growth monitoring
programs.
7. • It is measured conventionally over the left upper arm
(midway b/w acromian and olecranon in children
b/w 1-5yr old)
• As MUAC increases rapidly in first yr of life (11-16cm)
• Remain stable in 1-5yr (16-17cm)
8. Methods:-
(a)Shakir`s tape :– fiber glass tape of accuracy 0.1cm
Red <12.5cm wasted Severe PEM
yellow 12.5-13.5cm borderline Mild-moderate
green >13.5cm normal normal
9. b) Bangle`s test :-
In this test bangle of 4cm diameter is used
If it passes above the elbow then upper arm circumference
is <12.5 cm, child is malnourished
c)QUAC stick test :- QU- quacker, A-arm,
C-circumference
It is a rod with two sets of marking ,
one indicates the height and
other indicates MUAC for corresponding height.
If height is more than expected height for measured arm
circ.
Then child is considered as malnourished.
10. c)Kanawati and Mc laren index:-
It is a ratio b/w MUAC and Head circ.(HC)
Measured in children b/w 3 month to 5yr old.
PEM RANGE
normal >0.31
mild 0.31-0.28
moderate 0.279-0.25
severe <0.25
11. d) MUAC and Height ratio:-
In normal child 0.32-0.33
In PEM <0.29
2) Ratio of chest circumference (CC)
and head circumference(HC):-
Jeliffe`s ratio:-
NORMAL P.E.M
HC=CC at 1 yr <1
CC>HC after 2 yr CC<HC
12. • 2) Skin fold thickness:-
• It is an indicator of available calorie store
in body in form of subcutaneous fat.
• Sites : triceps , sub scapular region
• Measured by: Herpenden`s caliper with an accuracy of
0.1mm
• Value based on Tanner`s chart
PEM Skin fold thickness
Mild 6-10 mm
Moderate to severe <6 mm
Normal >10 mm in children age 1-6 yr
13. 3) Weight for Height index:-
(a) Rao`s and singh:-
weight in kg divided by square of height in cm multiplied
by 100
Normal :- 0.14- 0.16
PEM :- 0.12 - 0.14
(b) Dugdale`s index:-
Normal 0.88-0.97 ; PEM <0.79
(c) Body mass index :-
weight in kg divided by square of height in m.
Normal 18.5-24.99
PEM <16
