Growth charts and Anthropometry

Types of growth charts

• Charts based on growth standards
  • the describe how children grow in optimal conditions
  • prescriptive
• Charts based on growth references
  • they describe how children actually grew in specific place and time
  • descriptive

Organizations issuing growth charts

• WHO
  • based on growth standards
  • for children up to 5 years
  • prescriptive in nature
• IAP
  • based on growth references
  • Indian data
  • from birth to 18 years
• CDC
  • based on growth references

IAP recommendations

• use WHO growth charts till 5 years
• followed by IAP growth charts from 5 to 18 years
• combined IAP and WHO charts has been published to address this issue

Interpreting growth charts

Weight for height charts

• less than -3 ⟶ SAM
• -2 to -3 ⟶ MAM
• +2 to +3 ⟶ overweight
• more than +3 ⟶ obese

height for age charts

• short stature ⟶ less than -2 SD or below 3rd percentile

BMI for age

• +1 to +2 ⟶ overweight
• +2 to +3 ⟶ obesity
• more than +3 SD ⟶ severe obesity

weight for age charts

• underweight ⟶ -3 to -2 SD
• severely underweight ⟶ less than -3 SD

Age independent Anthropometric measurements

MUAC

• mid upper arm circumference
• most common and practically used age independent tool
• cut-offs
  • <115 mm - SAM
  • 115 to 125 mm - MAM

  • 125 mm - normal

• color coded Shakir's tape is used in community to calculate MUAC

Weight for height

• strong indicator for wasting
• $-2to-3$ SD ⟶ MAM
• $\le -3$ SD ⟶ SAM

Kanavati index

• $\frac{MUAC}{Height}$
• $<$ 0.31 malnourished
• $\ge$ 0.31 normal

Rao's Index or BMI

• age independent in certain age groups

MUAC / HC ratio

• $\frac{MUAC}{HC}$
• • $<$ 0.31 malnourished
• $\ge$ 0.31 normal

Skinfold thickness

• triceps and subscapular skin fold thickness are used to estimate subcutaneous fat and total body fat
• in low fat population they are used as measurements of calorie reserve
• they can be used as age independent metric, but in practice they are used as age-specific data for clinical precision