1. NUTRITIONAL ASSESSMENT
BY
USING ANTHROPOMETRY AND BMI
Md. Moksed Ali Pramanik
Principal Research Associate
INFS University of Dhaka
Nutritional Assessment: Nutritional Assessment is the evaluation of individual nutritional status.
Types or Methods of Assessment
Direct Indirect
Clinical Biochemical Biophysical Anthropometry
Food Consumption / Dietary Survey Nutritional Epidemiology
1

2. Anthropometric Assessment:
For Anthropometric Assessment, information is needed on each individual’s sex, age, weight,
height, Mid Upper Arm Circumference etc.
Anthropometric Data Analysis:
The anthropometric data were calculated and analyzed as standard deviation scores (Z-scores) of
NCHS (The US National Center for Health Statistics) reference height-for-age, weight-for-age and
weight-for-height and as percentage of reference median of these indicators. The Anthro software
package and Epi Info were used in this regard.
Z-score (Standard Score): Z-score is simple a position score in terms of standard vdeviation with
reference to the mean.
Individual’s value ─ Mean value x = ∑ x I ÷ n
Z score = ------------------------------------------------------------------ SD = ∑ √ ( xi ―x)2
÷ (n ― 1)
Standard deviation = √ 1 [ ∑ xi
2
―(∑xi)2
]
There are three categories of z-score for Anthropometric Data Analysis. They are as follows
• HAZ (Height for age z-score) – Measures Stunting
Low HA is considered an indicator of stunting (i.e. shortness) which is frequently associated
with poor overall economic condition and/or repeated exposure to adverse condition. (past
chronic under nutrition)
• WAZ (Weight for age z-score) – Measures Underweight
WA is primarily a composite of WH and HA, and fails to distinguish tall, thin. Children from
short, well proportioned children (stunting wasting / current acute and chronic under
nutrition).
• WHZ (Weight for height z-score) – Measures Wasting
Low WH is considered an indicator of wasting (i.e. thinness) and is associated with failure
to gain weight or a loss of weight.
2

3. (Individual’s height) ─ (Mean or median height of reference
for given age and sex)
HAZ = ---------------------------------------------------------------------------------------
Standard deviation of reference
Cut-off point of HAZ –
HAZ < − 3 SD : Severely stunted
HAZ < − 2 SD to − 3 SD : Moderately stunted
HAZ ≥ − 2 SD : Not stunted
(Individual’s weight) ─ (Mean or median weight of reference
for given age and sex)
WAZ = ---------------------------------------------------------------------------------------
Standard deviation of reference
Cut-off point of WAZ
WAZ < − 3 SD :Severely underweight
WAZ < − 2 SD to − 3 SD : Moderately underweight
WAZ ≥ − 2 SD : Not underweight
(Individual’s weight) ─ (Mean or median weight of reference
for given sex and height)
WHZ = ---------------------------------------------------------------------------------------
Standard deviation of reference
Cut-off point of WHZ
WHZ < − 3 SD : Severely wasted
WHZ < − 2 SD to − 3 SD : Moderately wasted
WHZ − 2 SD & WHZ < + 2 SD : Normal
WHZ + 2 SD to + 3 SD : Over-weight
WHZ > + 3 SD : Obese
Epi info software G 18 eQi eqm ch©š— †Q‡j ‡g‡q‡`i HAZ Ges WAZ
calculate Kiv hvq| WHZ Gi †¶‡Î †Q‡j‡`i eqm 11.5 eQi Ges D”PZv
145 †m.wg Gi Kg Ges †g‡q‡`i Rb¨ 10 eQi Ges D”PZv 137 †m.wg.
Gi Kg| D”PZv 49 †m.wg. Gi Kg n‡j WHZ calculate Kiv hvq bv|
(HAZ and WAZ of children aged up to 18 years can be calculated by using Epi Info software.
WHZ of boys aged 11.5 years and height less than 145 cm. and for girls aged 10 years and
height less than 137 cm can be calculated. When height less than 49 cm. WHZ can not be
calculated.
3

4. Weight for-age percent of median (WAM) (PEM or Gomez Classification):
Percent Expected
weight for age
Classification Category of
Nutritional status
Weight for-age percent of
median (WAM) > 90 %
Normal Normal
Weight for-age percent of
median (WAM) 76-90 %
Mild malnutrition 1st
degree
malnutrition
Weight for-age percent of
median (WAM) 61-75 %
Moderate
malnutrition
2nd
degree
malnutrition
Weight for-age percent of
median (WAM) ≤ 60 %
Severe
malnutrition
3rd
degree
malnutrition
Wellcome Classification
Percent Expected
weight for age
Edema present Edema absent
WAM 60-80 % Kwashiorkor Underweight
WAM < 60 % Marasmic-Kwashiorkor Marasmus
In Waterlow classification children are categorized into four groups on the basis of percentage
deviation from the reference median height-for-age and weight-for-height. The following cut-off
points were used to categories normal, stunted, wasted and stunted & wasted:
Normal : Height-for-age ≥ 90 % of reference median
Weight-for-height ≥ 80 % of reference median
Stunted : Height-for-age < 90 % of reference median
Weight-for-height ≥ 80 % of reference median
Wasted : Height-for-age ≥ 90 % of reference median
Weight-for-height < 80 % of reference median
Stunted : Height-for-age < 90 % of reference median
and wasted Weight-for-height < 80 % of reference median
4

5. Degree of Stunting
Height for age percent of median (HAM) Category of nutritional status
HAM > 95% Grade ‘0’ or normal
HAM 90 – 95% Grade 1 stunting
HAM 85 – 89.99% Grade 2 stunting
HAM < 85% Grade 3 stunting
WAM = (hs ÷ hp) × 100
Where hs = height of the sample
hp = height of the reference population.
Equivalents of percentile and Z-score in normal distribution
Below Mean Above Mean
percentile Z-score percentile Z-score
0.0 to 4.9 - 3.090 to – 1.650 50.0 to 54.9 0.000 to 0.120
5.0 to 9.9 - 1.645 to – 1.290 55.0 to 59.9 0.126 to 0.250
10.0 to 14.9 - 1.282 to – 1.040 60.0 to 64.9 0.253 to 0.380
15.0 to 19.9 - 1.036 to – 0.850 65.0 to 69.9 0.3855 to 0.520
20.0 to 24.9 - 0.842 to – 0.680 70.0 to 74.9 0.524 to 0.670
25.0 to 29.9 - 0.675 to – 0.530 75.0 to 79.9 0.675 to 0.840
30.0 to 34.9 - 0.524 to – 0.390 80.0 to 84.9 0.842 to 1.030
35.0 to 39.9 - 0.385 to – 0.260 85.0 to 89.9 1.036 to 1.280
40.0 to 44.9 - 0.253 to – 0.130 90.0 to 94.9 1.282 to 1.640
45.0 to 50.0 - 0.126 to – 0.000 95.0 to 99.9 1.645 to 3.090
Anthropometric classification for the evaluation of growth
and nutritional status
Category Percentile Z –score Growth
status
Weight
status
Muscle status
Category I 0.0 to 5.0 Z<-1.650 Short Low
Weight
Low Muscle
Wasted
Category II 5.1 to 15.0 -1.645<Z
<-1.040
Below
Average
Below
Average
Below Average
Category III 15.1 to 85.0 -1.036<Z
<+1.030
Average Average Average
Category IV 85.1 to 95.0 +1.036<Z
<+1.640
Above
Average
Above
Average
Above Average
Category V 95.1 to 100.0 Z>+1.645 Tall Heavy
Weight
High muscle:
Good Nutrition
5

6. Table AP9.1: Weight-for-age for young children (birth to 60 months;sexes combined) in kg.
(in standard deviations above and below reference (NCHS/WHO data)
Age (months) As standard deviations
+ 4SD + 2SD Reference ─ 2SD ─ 4SD
0 5.0 4.1 3.2 2.3 1.4
1 6.7 5.4 4.1 2.9 1.7
2 7.9 6.4 4.9 3.4 1.9
3 8.9 7.3 5.7 4.0 2.3
4 9.8 8.1 6.4 4.6 2.8
5 10.6 8.8 7.0 5.2 3.4
6 11.3 9.4 7.5 5.7 3.9
7 12.0 10.0 8.0 6.2 4.4
8 12.5 10.5 8.5 6.6 4.7
9 12.9 10.9 8.9 6.9 5.0
10 13.4 11.3 9.2 7.1 5.3
11 13.8 11.7 9.6 7.5 5.6
12 14.2 12.0 9.8 7.8 5.8
13 14.5 12.3 10.1 8.0 5.9
14 14.9 12.6 10.3 8.2 6.1
15 15.1 12.8 10.6 8.4 6.2
16 15.4 13.1 10.8 8.5 6.3
17 15.6 13.3 11.0 8.7 6.4
18 15.8 13.5 11.2 8.8 6.5
19 16.0 13.7 11.4 8.9 6.6
20 16.3 13.9 11.5 9.1 6.7
21 16.7 14.2 11.7 9.2 6.8
22 17.0 14.4 11.8 9.4 7.0
23 17.3 14.6 12.0 9.5 7.1
24 17.8 15.0 12.1 9.7 7.2
25 18.3 15.4 12.3 9.9 7.3
26 18.8 15.7 12.5 10.0 7.4
27 19.2 15.9 12.7 10.2 7.5
28 19.5 16.2 12.9 10.3 7.6
29 19.8 16.5 13.1 10.4 7.7
30 20.1 16.7 13.3 10.5 7.8
Table AP9.1 continued
6

7. Age
(months)
As standard deviations
+ 4SD + 2SD Reference ─ 2SD ─ 4SD
31 20.1 17.0 13.5 10.7 7.9
32 20.8 12.2 13.6 10.8 8.0
33 21.1 17.4 13.8 10.9 8.1
34 21.4 17.7 14.4 11.0 8.1
35 21.6 17.9 14.2 11.2 8.2
36 21.9 18.1 14.4 11.3 8.2
37 22.2 18.4 14.5 11.4 8.3
38 22.5 18.6 14.7 11.5 8.4
39 22.7 18.8 14.9 11.7 8.4
40 23.0 19.0 15.0 11.8 8.5
41 23.3 19.2 15.2 11.9 8.6
42 23.6 19.5 15.4 12.0 8.6
43 23.9 19.7 15.5 12.1 8.7
44 24.1 19.9 15.7 12.3 8.8
45 24.3 20.1 15.9 12.4 8.8
46 24.6 20.3 16.0 12.5 8.9
47 24.8 20.5 16.2 12.6 9.0
48 25.1 20.7 16.3 12.7 9.0
49 25.4 21.0 16.5 12.8 9.1
50 25.7 21.2 16.6 13.0 9.2
51 26.0 21.4 16.8 13.1 9.3
52 26.3 21.6 16.9 13.2 9.4
53 26.5 21.8 17.1 13.3 9.5
54 26.8 22.0 17.2 13.4 9.6
55 27.1 22.2 17.4 13.5 9.7
56 27.4 22.5 17.6 13.7 9.8
57 27.7 22.7 17.7 13.8 9.9
58 28.0 22.9 17.8 13.9 10.0
59 28.3 23.1 18.0 14.0 10.0
60 28.6 23.4 18.2 14.1 10.1
Table AP9.5: Weight-for-age (kg) for children aged 5-9.5 years (sexes combined) as
standard deviations from reference population (NCHS/WHO data)
7

8. Age (years) As standard deviations
+ 2SD Reference ─ 2SD
5.0 23.4 18.2 14.1
5.5 24.8 19.1 14.8
6.0 26.4 20.1 15.5
6.5 28.2 21.2 16.2
7.0 30.2 22.3 17.0
7.5 32.5 23.6 17.7
8.0 35.1 25.1 18.5
8.5 37.9 26.6 19.3
9.0 41.0 28.3 20.1
9.5 44.2 30.1 21.0
Table AP9.6: Height-for-age (cm) for children aged 5-9.5 years (sexes combined) as
standard deviations from reference population (NCHS/WHO data)
Age (years) As standard deviations
+ 2SD Reference ─ 2SD
5.0 118.2 109.2 100.1
5.5 121.7 112.3 102.9
6.0 125.1 115.4 105.6
6.5 128.5 118.3 108.1
7.0 131.7 121.1 110.6
7.5 134.9 123.9 112.9
8.0 138.1 126.7 115.3
8.5 141.2 129.4 117.6
9.0 144.4 132.2 120.0
9.5 147.6 133.0 122.5
Table AP9.8: Weight-for-age (kg) of children aged 10-18 years (sexes seperate) as standard
deviations from reference (NCHS/WHO data)
8

9. Age (years) Weight (kg) of Boys Weight (kg) of Girls
+ 2SD Mean ─ 2SD + 2SD Mean ─ 2SD
10.0 46.0 31.4 22.1 49.2 32.5 21.9
10.5 49.3 33.3 23.1 52.8 34.7 23.1
11.0 52.7 35.3 24.1 56.4 37.0 24.5
11.5 56.3 37.5 25.4 60.0 39.2 25.9
12.0 59.9 39.8 26.8 63.3 41.5 27.4
12.5 63.5 42.3 28.4 66.5 43.8 29.1
13.0 67.2 45.0 30.4 69.4 46.1 30.8
13.5 70.9 47.8 32.5 72.1 48.3 32.5
14.0 74.6 50.8 34.9 74.5 50.3 34.2
14.5 78.2 53.8 37.4 76.5 52.1 35.9
15.0 81.6 56.7 39.9 78.3 53.7 37.4
15.5 84.9 59.5 42.4 79.6 55.0 38.7
16.0 87.9 62.1 44.7 80.6 55.9 39.8
16.5 90.7 64.4 46.8 81.2 56.4 40.7
17.0 93.2 66.3 48.6 81.5 56.7 41.3
17.5 95.3 67.8 49.9 81.5 56.7 41.8
18.0 97.0 68.9 50.9 81.3 56.6 42.1
Table AP9.8: Height-for-age (cm) of children aged 10-18 years (sexes separate) as standard
deviations from reference (NCHS/WHO data)
Age (years) Height (cm) of Boys Height (cm) of Girls
+ 2SD Reference ─ 2SD + 2SD Reference ─ 2SD
10.0 149.7 137.5 125.3 152.0 138.3 124.6
10.5 153.1 140.3 127.6 155.3 141.5 127.6
11.0 156.7 143.3 129.9 158.7 144.8 130.9
11.5 160.5 146.4 132.2 162.0 148.2 134.4
12.0 164.7 149.7 134.6 165.2 151.5 137.9
12.5 168.9 153.0 137.2 168.0 154.6 141.1
13.0 173.0 156.5 139.9 170.5 157.1 143.8
13.5 176.9 159.9 142.8 172.4 159.0 145.7
14.0 180.2 163.1 146.0 173.7 160.4 147.0
14.5 183.0 166.2 149.4 174.7 161.2 147.8
15.0 185.1 169.0 152.9 175.3 161.8 148.3
15.5 186.7 171.5 156.2 175.6 162.1 148.7
16.0 187.9 173.5 159.2 175.7 162.4 149.1
16.5 188.8 175.2 161.5 175.8 162.7 149.7
17.0 189.4 176.2 163.1 175.7 163.1 150.4
17.5 189.8 176.7 163.7 175.7 163.4 151.1
18.0 190.0 176.8 163.6 175.6 163.7 151.8
Table AP9.12: Weight-for-height (in kg and cm) for children (49-120 cm; sexes combined) in as
standard deviations above and below reference (NCHS/WHO data)
9

10. Weight (kg)
Height (cm) + 2SD + 1SD Reference ─ 1SD ─ 2SD ─ 3SD
49 4.1 3.7 3.2 2.9 2.5 2.2
50 4.3 3.9 3.4 3.0 2.6 2.3
51 4.5 4.0 3.5 3.1 2.7 2.3
52 4.7 4.2 3.7 3.3 2.8 2.4
53 5.0 4.5 3.9 3.4 2.9 2.4
54 5.2 4.7 4.1 3.6 3.1 2.6
55 5.5 4.9 4.3 3.8 3.3 2.8
56 5.8 5.2 4.6 4.1 3.5 3.0
57 6.1 5.5 4.8 4.3 3.7 3.2
58 6.4 5.8 5.1 4.5 3.9 3.3
59 6.7 6.0 5.3 4.7 4.1 3.5
60 7.0 6.3 5.6 5.0 4.3 3.7
61 7.3 6.6 5.9 5.3 4.6 3.9
62 7.6 6.9 6.2 5.5 4.8 4.1
63 7.9 7.2 6.5 5.8 5.1 4.4
64 8.2 7.5 6.7 6.1 5.4 4.7
65 8.5 7.8 7.0 6.3 5.6 4.9
66 8.9 8.1 7.3 6.6 5.9 5.2
67 9.2 8.4 7.6 6.9 6.1 5.4
68 9.5 8.7 7.9 7.2 6.4 5.7
69 9.8 9.0 8.2 7.5 6.7 6.0
70 10.1 9.3 8.5 7.7 6.9 6.2
71 10.4 9.6 8.7 8.0 7.2 6.4
72 10.6 9.8 9.0 8.2 7.4 6.6
73 10.9 10.1 9.2 8.4 7.6 6.8
74 11.2 10.4 9.5 8.7 7.8 7.0
75 11.4 10.6 9.7 8.9 8.1 7.2
76 11.7 10.8 9.9 9.1 8.3 7.4
77 11.9 11.0 10.1 9.3 8.5 7.6
78 12.1 11.3 10.4 9.5 8.6 7.7
79 12.4 11.5 10.6 9.7 8.8 7.9
80 12.6 11.7 10.8 9.9 9.0 8.1
81 12.8 11.9 11.0 10.1 9.2 8.3
82 13.0 12.1 11.2 10.3 9.4 8.5
83 13.3 12.4 11.4 10.5 9.6 8.7
84 13.5 12.5 11.5 10.6 9.7 8.8
85 13.7 12.7 11.7 10.8 9.9 9.0
86 13.9 12.9 11.9 11.0 10.1 9.2
87 14.1 15.1 12.1 11.2 10.3 9.4
88 14.4 13.4 12.4 11.5 10.5 9.6
Table AP9.12 continued
10

11. Weight (kg)
Height (cm) + 2SD + 1SD Reference ─ 1SD ─ 2SD ─ 3SD
89 14.6 13.6 12.6 11.7 10.7 9.8
90 14.8 13.8 12.8 11.8 10.8 9.9
91 15.1 14.1 13.0 12.1 11.1 10.2
92 15.3 14.3 13.2 12.3 11.3 10.4
93 15.6 14.6 13.5 12.5 11.5 10.5
94 15.8 14.8 13.7 12.7 11.7 10.7
95 16.1 15.1 14.0 13.0 11.9 10.9
96 16.4 15.3 14.2 13.2 12.2 11.2
97 16.6 15.6 14.5 13.5 12.4 11.4
98 16.9 15.9 14.8 13.7 12.6 11.6
99 17.2 16.1 15.0 14.0 12.9 11.9
100 17.6 16.5 15.3 14.3 13.2 12.2
101 19.0 17.4 15.8 14.4 13.0 11.6
102 19.3 17.7 16.1 14.7 13.3 11.9
103 19.7 18.1 16.4 15.0 13.5 12.1
104 20.0 18.4 16.7 15.2 13.7 12.2
105 20.3 18.6 16.9 15.5 14.0 12.6
106 20.7 19.0 17.2 15.7 14.2 12.7
107 21.1 19.3 17.5 16.0 14.5 13.0
108 21.4 19.6 17.8 16.3 14.7 13.2
109 21.8 20.0 18.1 16.6 15.0 13.5
110 22.2 20.3 18.4 16.8 15.2 13.6
111 22.6 20.7 18.8 17.2 15.5 13.9
112 23.0 21.1 19.1 17.5 15.8 14.2
113 23.4 21.4 19.4 17.8 16.1 14.5
114 23.9 21.9 19.8 18.1 16.4 14.7
115 24.4 22.3 20.1 18.4 16.7 15.0
116 24.8 22.7 20.5 18.8 17.0 15.3
117 25.4 23.1 20.8 19.1 17.3 15.6
118 25.9 23.6 21.2 19.4 17.6 15.8
119 26.4 24.0 21.6 19.8 18.0 16.2
120 27.0 24.5 22.0 20.2 18.3 16.5
Source : Community nutrition Assessment; Jelliffe
Anthropometric reference data.
Example: Age of a male person =40 yrs, weight = 50 kg. Evaluate the nutritional status by using WAZ
classification.
Solution: Age 40 yrs, average weight = 81 kg and SD 13.5 (from the reference value).
Calculated WAZ = (50 ― 81.4) ÷ 13.5 = ― 2.325
Comment : Calculated WAZ value is ― 2.325 which is lies between ― 2SD and ― 3SD.
This implies that the sample moderately underweight.
Body Mass Index (BMI):
11

12. Weight in kg.
BMI = -----------------------------
(Height in metre)2
The following cut-off points were used to categories the nutrition status by BMI:
Grade 3 Chronic energy deficiency (CED) ( Severely thinness) :BMI < 16
Grade 2 Chronic energy deficiency (CED) (Moderate thinness) :BMI 16-16.99
Grade 1 Chronic energy deficiency (CED) :17- 18.49 (Mild thinness)
BMI 18.5-24.99 : Normal
Grade 1 Over weight :BMI 25-29.99
Grade 2 Overweight :BMI 30.00-39.99
Grade 3 Over weight :BMI ≥40
(Source: WHO 1995)
Three category of BMI
Body Mass Index were usually classified into three categories. The following cut-off points were
used to categories chronic energy deficiency (CED), normal and obese:
CED = BMI < 18.5
Normal = BMI 18.5-24.99
Obese = BMI equal or greater than 25
Classification of malnutrition in children aged 1-5 years by
Mid Upper Arm Circumference (MUAC)
Circumference (cm) Level of nutrition
MUAC > 14 Normal
MUAC 12.5 – 14.0 Mild / moderate malnutrition
MUAC < 12.5 Severe malnutrition
For Bangladeshi children 11 cm. is the cut-off point.
Classification of adult malnutrition by MUAC
Sex Circumference (cm) Level of nutrition
Male MUAC ≥ 23
MUAC < 23
Normal
Malnourished
Female MUAC ≥ 22
MUAC < 22
Normal
Malnourished
12