The assessment of nutritional status of a person or groups of people is an exercise carried out to find the level of nourishment. A person can either be nourished, malnourished, or over-nourished. The nutritional status of a person is influenced by many factors such as measure and quality of food intake and physical health. Nutritional assessment helps to design health programs that will suit a population according to its nutritional needs. Also, this assessment evaluates the efficiency of nutritional and health programs and intervention needed. Methods of nutritional assessment are categorized as direct and indirect. Indirect methods make use of community health statistics that portray nutritional influence. Direct methods of nutritional are referred to as the ABCD methods: anthropometric methods, biochemical/biophysical methods, clinical methods, and dietary methods. This paper aims to explore the different anthropometric methods available for assessing hospitalized patients who are unable to stand safely.
The term ‘anthropometry’ is derived from two words: Anthropo meaning ‘human’ and metry meaning “measurement.” These methods are used to measure growth and body change or body composition of people mostly children and patients. They measure body weight, height and proportions. They determine nutritional status of infants, children, patients, and expectant women. However, these methods only show the current nutritional status but do not distinguish between chronic and acute changes. Other anthropometric methods include mid-arm circumference, head/chest ratio, skin-fold thickness, head circumference, and hip/waist ratio (Charney P., 2008).
It is measured if the patient is a child below the age of two years. A wooden measuring board also known as a sliding board is used to measure the length of the child to the nearest millimetre. It is done while the child is lying flat on the fixed part of the board and usually gives readings that are beyond the real height of the child by one to two centimetres. The measurer needs an assistant to carry out these measurements and it is done when they are on their knees. The assistant holds the head of the child with his or her both hands and make sure that the head is in touch with the bottom part of the board. The arms of the assistant should be firm and comfortably straight. Also, they should ensure that line of vision of the child is perpendicular to the bottom part of the board facing straight upwards. While the child is lying flat on the board, the measurer places his or her hands on the knees or shins of the child. The feet of the child should be flat and straight against the foot piece. The measurement is read from the tape or scale attached to the board. Then, this measurement is recorded on a questionnaire (Preedy V., 2011).
The head circumference (HC) is the dimension of the head along the location of the supra orbital ridge (anteriorly), also known as the forehead and occipital prominence (the major section on the back region of the head) posterior. HC is measured on children or patients of below two years of age and measurement is read to the nearest millimetre using a supple, non-stretchable measuring tape around 0.6cm in width. HC is important for appraising chronic nutritional conditions in children under the age of two years as the brain develops and grows at a faster rate during the first two years after birth. However, after the first two years the brain grows at a slower rate and HC is thus not important. In some countries like Ethiopia, HC is determined at birth for all new-born kids (Joshi Y., 2008).
The “salter scale” also known as the weighing sling (spring balance), is used for determining the weight of children or patients under the age of two years, to the nearest 0.1 kg. A more modern scale called the digital electronic scale can also be used if it is readily available. It is very important to re-adjust the scale to zero before any weighing is done. The scale to be used should be confirmed if it is in a good working condition and if it is measuring correctly by weighing an item of whose weight is relatively known. The measurer needs an assistant to carry out these measurements. It would be better if the assistant is someone familiar to the child for the purposes of calming the child nerves and soothing the child to cooperate. After adjusting the pointer scale to zero, the child is undressed all heavy outfits and shoes. The measurer should hold the legs of the child through the holes of the weighing pant and then hold the feet to support and secure the child. Then, the child is put on the salter scale. The measurement on the scale is read straight at eye position to the nearest 0.1 kg (Duggan C., 2008).
In extreme cases improvisation is needed such as where the medical centre is in a marginalized region and/or is not well equipped. It is cumbersome to use the weighing pant appended to the scale to measure the weight of very young children who have not yet learnt to sit by their own. On top of that, some children go into panic mode during the measurement and pass urine, making the pant unclean. For that reason, mothers or caregivers may not be for the idea of letting their children’s weight be measured in such a way. The weighing pant affixed to the scale can be improvised by a plastic washing-basin which is appended to the salter scale and re-adjusting the pointer to zero. The measurer has to make sure that the basin is close enough to the ground as possible to lower the chances of injury in case the child topples out. Also, it is important in making the child feel safe and secure during weighing process. A disinfectant such as clinical methylated spirit, Dettol or clean water and soap can be used to clean the basin if it is dirty. It is much more reassuring and comfortable method of weighing the child, which can be employed when weighing ill children (Charney P., 2008).
Anthropometric Measurements Used to Assess Body Composition
Measuring Fat-free Mass (Muscle Mass)
The Mid Upper Arm Circumference (MUAC) is an exact and precise methodto measure fat-free mass. The MUAC refers to the upper left arm and the middle of the shoulder’s tip and the elbow’s tip circumference. The middle point of the arm is determined by measuring the length from the tip of the shoulder to the elbow and dividing the measurement by two. Loss of muscle mass is indicated by a low reading. A special tape is used for determining the MUAC of children. The tape consists of three colours: green, yellow and red. Green indicates normal nutritional status; yellow indicates moderate acute malnutrition; and red indicates severe acute malnutrition. The measurement is read and recorded to the nearest 0.1cm (Gershwin M., 2000).
MUAC is an effective screening tool in assessing the stake of mortality among children, hospitalized patients and persons living with HIV/AIDS. It is the only anthropometric measure for determining nutritional level among expectant women. Also, MUAC is very easy for use in screening large masses of people during crisis conditions. MUAC is used for examining target children and expectant women for moderate acute malnutrition (MAM) and severe acute malnutrition (SAM).
Measurements of Fat-mass (Fatness)
Body Mass Index (BMI) is the unit measure of a person’s weight in kilograms divided by his or her height in meters squared. However, hospitalized patients of more than two years of age who are unable to stand safely cannot be weighed on the beam balance. Therefore, their weight cannot be determined and so is their BMI (Bernstein M., 2010).
Above all it is important to uphold accuracy when taking all of these anthropometric measurements for proper response to be initiated. Weight and height measurements are used to check and assess the physical growth of children. Weight measurements are important in monitoring the health and nutritional status of hospitalized patients. Anthropometric methods measure many variables of nutritional significance with high sensitivity and specificity, and require minimal training. They are non-expensive and the readings are reproducible, numerical, and can be graded on standard nutritional charts. However, they present limited nutritional diagnosis and they are subject to errors during measurements. There may be differences between local and international reference standards. In addition, gender, culture, religious beliefs, dignity, and privacy should be considered and respected before any measurements are done (Maqbool S., 2008).