Anthropometry muscle wastage in undernutrition. Skinfold thickness is related

Anthropometry Essay Anthropometry (the use of body measurements to assess nutritional status) is a practical and immediately applicable technique for assessing individual and population health status.  Discuss. This essay will explain how different factor can influence the use of anthropometry in fetal growth and child. Growth charts are an essential component of the pediatric toolkit. Their value resides in helping to determine the grade to which physiological needs for growth and development are met during the important childhood period.

   Nutrition assessment is the systematic process of collecting and interpreting information in order to make the decision about the nature and cause of nutrition related to the health issue that effects on individual (British Dietetic association (BDA), 2012). According to nutritional assessment, anthropometry is an essential tool to evaluate underweight and obesity conditions, which is very important to evaluate risk factor in human health, (Jensen & Rogers, 1998; Visser et al.1998).  Anthropometric measurements are used to assess the size, proportions, and composition of the human body those measurements obtained, can be used as indicator of health, development and growth/compositions into fetal, Infants, children, adult, old people as a single individual or a whole population.  Body composition can be organized according to a comprehensive model that consist of five levels: atomic, molecular, cellular, tissues system, and whole body.                                               Figure one the five body composition levels.

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    What nutrition look at is the whole body and it is divided into body fat and fat-free mass.The most common anthropometry methods are Weight (or mass), Height, Circumferences (head, waist, hip, mid-upper arm, mid-thigh, calf, chest, and neck), Limb lengths (knee height, arm-span, demi-span, half-span), Abdominal diameter, Skinfold thicknesses. Body measurement used as an index of physiological development and nutrition status; a non-invasive way of assessing body compositions. Weight for age provides information about the overall nutrition status of children; weight for height is used to detect acute malnutrition; height for age is used to detect chronic malnutrition.

Mid-upper arm circumference provides an index of muscle wastage in undernutrition. Skinfold thickness is related to the amount of subcutaneous fat as an index of over-or undernutrition.Anthropometry measurements can be combine with each other or even some extra information as age and gender to have a clear index and guidelines.  Advantages  This technique is Easy-to-administer, does not require expensive equipment it is non-invasive, anthropometry is applicable to the general population and it is available a low cost.One of the most anthropometry system use is the calculation of BMI (Body mass index) and it is a calculation, which is weight in kilogram divided by height in meters squared (kg/m2), one of the most system that has been adopt by the world health organizations (WHO).  Disadvantages however this technique does not give us enough information of our body compositions, there is a lot of facts that influence it if we use BMI to see if bodybuilder is overweight it definitely shows the person is obese, that is because most of his body weight come from muscle and not actually fat. If we do a skinfold thickness into two patients to see who is more obese, it will be enough to rank the subject correctly. Two weeks later after having lost some weight, and wanted know which of them had lost more fat, a repeat of the skinfold measurements would not be adequate, because the error of an estimation of fat from skinfolds is large compared with the amount of fat that people lose in two weeks.

 WHO adjusted all of this data from BMI in order to make it more clear and accessible divided by ethnics gender age health etc..; For example south Asian have more body fat, while Polynesians tend to have more muscle.   The application of the anthropometry can be used in different contexts such as Children,  The primary index of growth is the size of the newborn of an overall nutritional status of the infant and its well-being. The size at birth is an important indicator of health in fetal and neonatal as individual or population; it is the product of duration of gestation and rate of fetus growth. During fetal life, serial measurement is able only with ultrasound and have not proved to be sufficiently valid or precise. All of the recent articles published early-gestation shows that there is a  reference curve that could be used to developing for single or population fetus growth up to 24-26wk. Because the fetus-growth in different sex and race do not appear diverse until the third trimester.

(de Onis and Habich JP1993) Starting at about the third-trimester female fetuses are, on averages smaller than male fetuses, and other many factor start to influence the growth of the fetus such as: race, age, nutrition, environment, maternal health and other many factor .Growth is define as an increase in size over time, and to measure it is required two or more serial measurement; body size is obviously proportional to age, not only in the fetus but throughout childhood until the time of skeletal fusion. Some problem can arise if the infant will born at different gestation age it will make inference about normal growth. This is one of the reason why anthropometry have to be adapted to a single individual and cannot follow the standard curves that has been made from whole populations.

   Using anthropometry in individual new-born, is often use weight for gestational age at birth. it is able to categorize an individual infants as having experienced as normal, or subnormal growth in utero; the classification often use is: small for gestational age (SGA) weight below 10th percentile, appropriate for gestational age (AGA)weight between 10th and 90th percentiles, large for gestational age (LGA) weight above 90th percentile.The normal birth weight range is considered to be between 2500 to 4200 grams.  Low birth weight have been defined by WHO as weight at birth of < 2500 grams, is a major cause of infant mortality and has been linked with l   

23 Extreme immaturity of newborn, gestational age 24 completed weeks.    Various criteria have been used as the dividing lines between these three categories.Those most commonly used are based on percentiles of a distributions of birth weight for gestational age derived from an accepted reference populations.

Because the effect on fetal growth of different sex , race , and exposure to growth promotions and growth inhibition environment influences do not appear to diverge until the last second or early third trimester, any of the paper can be used for developing a single fetal growth, up to at least  24-26 weeks. For the later gestations must use different curves because the sex, race, mother height and weight can influence the fetal growth.  For boys and girls from birth to 5 years there is a recent WHO child growth standard (WHO, 2016). Infants are weighted more frequently, so a broader horizontal scale is needed; infants’ stature is measured lying down and length is 1.

0-2.0cm longer than height. The reference subjects were healthy and included all ethnic groups, excluding those who had very low birth weights. In UK, the current weight for age reference (Freeman et al., 1995) is based on measurement of 25,000 white children between 1978 and 1990. These references replace early standards because more infants are now breast-fed and children have fewer infections and growth taller.  Moreover, in 1993 the World Health Organization (WHO) undertook a comprehensive review of the uses and interpretation of anthropometric references. The review concluded that the NCHS/WHO growth reference, which had been recommended for international use since the late 1970s, did not adequately represent early childhood growth and that new growth curves were necessary.

  The World Health Assembly endorsed this recommendation in 1994. In response WHO undertook the Multicenter Growth Reference Study (MGRS) between 1997 and 2003 to generate new curves for assessing the growth. The MGRS combined a longitudinal follow-up from birth to 24 months and a cross-sectional survey of children aged 18 to 71 months. Primary growth data and related information were gathered from 8440 healthy breastfed infants and young children from widely diverse ethnic backgrounds and cultural settings (Brazil, Ghana, India, Norway, Oman and USA). The MGRS is exclusive in that it was purposely designed to produce a standard by selecting healthy children living under conditions likely to favor the achievement of their full genetic growth potential. Furthermore, the mothers of the children selected for the construction of the standards engaged in fundamental health-promoting practices, namely breastfeeding and not smoking.

 The method used was Length/height-for-age, length-for-age, from 0 to 24 months and height-for-age, from 2 to 5 years. The creation of the weight-for-length (45 to 110 cm) and weight-for height (65 to 120 cm) standards followed a procedure similar to that applied to construct the length/height-for-age standards. The lower limit of the weight-for-length standards (45 cm) was chosen to cover up to approximately -2 SD girls’ length at birth. The upper limit for the weight-for height standards was influenced by the need to accommodate the tallest children at age 60 months that is 120 cm is approximately +2 SD boys’ height-for-age at 60 months.  To construct the BMI-for-age standard based on length (0 to 2 years), the longitudinal sample’s length data and the cross-sectional sample’s height data (18 to 30 months) were combined after adding 0.7 cm to the height values.

Analogously, to construct the standard from 2 to 5 years, the cross-sectional sample’s height plus the longitudinal sample’s length data (18 to 24 months) were combined after subtracting 0.7 cm from the length values. Thus, a common set of data from 18 to 30 months was used to generate the BMI standards for the younger and the older children. The resulting disjunction between the two standards thus in essence reflects the 0.7 cm difference between length and height. This does not mean, however, that a child at a specific age will have the same length- and height-based BMI-for-age z-score as this is mathematically impossible given the nature of the BMI ratio.    In conclusion growth in fetal is similar in early third trimester between 24-26 weeks for that reason anthropometry can used any of the curves that represent it to determinate the health status of the fetus.

 Afterward if there is no evidence health problem should be use guideline refer to ethnicity, for example one of the reason is that black infants are larger than white. For the later gestations must use different curves and tools because there is many other factor that can influence the growth of the child that can be; mother height and weight, mother health, if the child is born premature etc.WHO is in continues development, analyzing the entire factor that can influence the growth of child, creating new curves and SD for anthropometry value that are compared across individuals or populations in relation of reference values.