Professional Documents
Culture Documents
BLOCK 3.6
Skills Laboratory
Faculty of Medicine
Universitas Gadjah Mada
Yogyakarta
2015
ANTHROPOMETRY FOR HEALTH RISK SCREENING
CONTRIBUTORS
Santosa Budihardjo Neni Tri Lusiana Rahmawati
Staff of Department of Anatomy and Staff of Department of Bio- &
Embryology Paleoanthropology
Faculty of Medicine UGM Faculty of Medicine UGM
Istiti Kandarina
Staff of Department of Public Health
Faculty of Medicine UGM
PREFACE
Students of medical school need to learn and practice some clinical skills as
preparing to enter clinical rotation before they become real doctor. Medical school is
nowadays convinced that students should master the skills before they make contact with
real patients. Therefore, an early skills training is needed. Skills laboratory allows
students to learn and practice their clinical skills.
The topic in this manual book is one of the topics under the main topic: General
Physical Examination which will be studied continuously within blocks during
undergraduate studies. The skill included in this book is based on Competency-Based-
Curriculum 2007. The topics included under General Physical Examination in Year 3 are
listed as follows:
3 ESP 1 3.5
(Neuro-sensory Complaint)
4 ESP 2 3.6
(Life-style related Complaint)
5 Anthropometry for health status screening 3.6
(Life-style related Complaint
It is important for students to be aware that all topics included are related to each
other. Therefore, students are hoped to be able to group those topics under their main
topic so that the continuity of the topics is obtained. We hope this skills training manual
book will be useful for the students to improve their skills especially in physical
examination and for instructors who involved in the skills training.
LEARNING OBJECTIVE:
1. Collecting data for health screening using anthropometry methods nutritional
status assessment.; body composition, and risk factors,
2. Skillful in measurement of anthropometry professionally including good
interpersonal relationship, subject satisfaction, and clinical reasoning.
3. Analyze data and presentation
LESSON PLAN:
Session one (2 hours at Skills Lab)
1. Tasks description Review material with instructor (20 minutes)
2. Collecting data (measurement) (80 minutes)
Independent Learning
1. Analyzing and interpreting the data
2. Reporting the conclusion and negotiating future plan
Panel Discussion
1. Report presentation
2. Reflection
ANTHROPOMETRY FOR HEALTH STATUS SCREENING
ANTHROPOMETRY SCOPE
Anthropometry is the measurement of man and is often referred to as the study
of body dimensions. Anthropometry is the technique of expressing quantitatively the
form of the body (Cameron, 1978). Hrdlicka (1947), cit. Cameron (1978), defines it as a
system of techniques, the systematized art of measuring and taking observation of man,
his skeleton, his brain, and other organs, by the most reliable means and methods for
scientific purposes. Thus, anthropometry consists of systemized measuring techniques
that express in a quantitative manner the dimensions of the human body (Roche &
Malina, 1983).
The science of anthropometry developed mostly in an anthropological context,
frequently anthropometry is viewed as the traditional and perhaps the most basic tool in
physical anthropology, but it also has a long tradition of use in physical education.
Anthropometry developed as a study for the classification and identification of racial
differences and the effects of diet and living conditions on growth (auxological
anthropometry). Lately, anthropometry has become important in the rapidly expanding
field of ergonomics, the science and ad of adapting machines and working space to the
people who use them (Olivier, 1968). Roche and Molina (1983) noted that
anthropometry has many diverse applications. It is an essential element of growth
studies, morphological comparisons among population nutritional status assessment,
constitutional medicine, human engineering and studies of human performance.
Anthropometry appears deceptively simple. However, the development of an
anthropometrists touch is seldom achieved without extensive practice. Most individuals
seem to establish reasonable competence after triple measurement and spot checking
for systematic error on 100 or more subjects. By definition, a criterion anthropometrist is
one who purportedly does not make systematic errors from a prescribed technique. As a
service to the international scientific community, the International Working Group in
Kinanthropometry (IWGK) holds certification courses and workshops that are designed
primarily for established investigators to learn I~ protocols.
Anthropometry involves the use of carefully defined body landmarks for
measurements, specific subject positioning for these measurements, and the use of
appropriate instruments. The number of measurements that can be taken on an
individual is almost limitless. They are generally divided into measurements on mass
(weight), lengths and heights, breadths or widths, depths, circumferences or girths,
curvatures or arcs, and soft tissue measurements (skin folds). In addition, numerous
special measurements for specific body parts can be defined, as in cephalometry for the
head and face. In other words, the measurements either treat the body as a whole (e.g.,
stature), or divide the body into specific parts (e.g., limb lengths).
Implicit in studies utilizing anthropometric methods is the assumption that every
effort is made to ensure accuracy of measurement and standardization of technique.
Further, it is assumed that measurements are made by trained observers. In
anthropometry we consider observer error, to err is human. Differences between
observers (inter-observer error) and imperfect replications by a single observer (intra-
observer error) contribute significantly to measurement error in anthropometric studies.
Therefore, quality control and careful monitoring of the measurement process is
essential.
Accurate instrumentation has overcome many of the inherent errors in
anthropometry, but the greatest source of error comes from the measurer himself.
Hirdlicka (1947), in his treatise on practical anthropometry, described the qualities
needed by an anthropometrist: good eyesight for distance and color, freedom from
halitosis and other unpleasant odors, sympathy, perseverance, orderliness, honesty and
carefulness. He should be careful of the sensibilities of his subjects, careful in technique,
careful in reading the scale of his subject, careful in recording and capable of
concentration on his work. The lack of these qualities has produced more errors than all
other causes together. It is interesting to note that he thought men to be superior to
women as anthropometrists, although women excelled in carefulness and devotion to
work, they lacked the stamina for field work and marriage would seriously hamper their
careers. Though this is only a reflection of the times in which he practiced medicine, and
holds little credence today.
Body measurements have multiple uses in many disciplines, including pediatrics,
orthopedics, dentistry, orthodontics, physical education, general education, human
engineering, sports medicine, public health, and nutrition. Before any measurement is
made, certain questions should be asked. What is the purpose of this measurement?
What information will this measurement provide? Thus, a necessary preliminary to the
application of anthropometry is through logical analysis beginning with a clear concept of
the knowledge sought and leading to a selection of the measurements needed to obtain
an acceptable answer.
Anthropometric data are relevant to the design of workspace, clothing, furniture,
and toys. Subject comfort, safety, and function are of basic importance, yet a broad
range of normal variability must be accommodated. For example, seating for elementary
school children must be wide enough and long enough to accommodate larger children
in the age group but not uncomfortable for a small child. To solve such problems,
designers and manufactures need data on anthropometric dimensions.
We can take the data from subjects both static, i.e., measurements made while
the subjects in a fixed, standardized position, and functional or dynamic, i.e.,
measurements made while the subjects is in the position required for a specific task or
while the body is in motion (e.g., functional arm or leg lengths).
Measurements of body composition are more complex than the measurement of
body size and dimensions. Although studies of stature and weight provide information
that is valuable in understanding growth processes, these external dimensions represent
many tissues. Stature is the sum of a large number of bone lengths, plus the intervening
cartilages less an amount due to the fact that the long axes of the bones that contribute
to stature are not in the same straight line. Similarly, body weight is the sum of weight of
muscle, fat, the skeleton and numerous organs.
Indirect estimates of body composition are usually based upon a two
compartment model, i.e., body weight is partitioned into a fat component and a lean
component. The weight of one component is measured indirectly, while the weight of the
other is derived by subtraction from total body weight.
However, definition of the lean component varies. It is referred to as either lean
body mass (LBM), lean body weight (LBW), fat free mass (FFM) or fat free weight
(FFW). Some treat these terms as synonymous, but there are basic differences between
them. LBM and LBW are in vivo concepts, while FFM and FFW are based on in vitro
concepts. The two differ in that essential lipids, variously estimated from 2 to 10% of
FFW, are included with LBM and LBW but not with FFM or FFW.
PROTOCOL
The measurement protocol outlined is summarized notes, based on
Anthropological view: Comas (1960) and Olivier (1968), Auxological anthropometry:
Cameron (1978), Ergonomics Perspectives: Pheasant (1978), Pulat (1986),
Bhattacharya & McGlothlin (1994), Sports and Kinanthropometry view: Ross & Marfell-
Jones (1991), and Norton (2004)
INSTRUMENTS
The anthropometry instruments consist of various types, such as field or portable
instruments, and others with digital display counters or not. The instruments are
anthropometer (portable), calibrated weighing beam or scale, flexible steel tape, and
skinfold calipers. The instruments are manufactured by many licensed and well-known
factories such as Siber-Hegner GPM of the Martin, Creative Health Product, TNM
Product, Cambridge Scientific Industries, and Cambridge Maryland. It is important to use
instruments that are produced by licensed firms, so that high reliability and
reproducibility can be ensured.
The anthropometer is used to measure heights, length, and span. The weighing
beam measures weight. Flexible steel tape is used to measure circumferences. The
skinfold calipers measure skinfold thickness.
Anthropometric
Anthropometry instruments
2. Body Weight
Body mass, or ideally body weight, should be obtained on an accurately
calibrated beam-type balance and recorded to the nearest tenth of a kilogram. The
subject should be weighed nude or in clothing of a known weight so that a correction to
nude weight can be made. The most stable values for monitoring weight change are
those obtained routinely in the morning (12 hours).
3. Circumferences (girths)
Hip circumference
Hip circumference is taken at the symphysion (the upper point at the symphysis pubis)
and the maximal posterior of the buttock.
Infrascapular skinfold
The subject stands as for triceps skinfold with the shoulders and arms relaxed. It
is quite easy on an average subject to determine the inferior angle of the scapula below
which the skinfold should be taken, but it is not so simple on the obese subject. To
locate this point, palpate the medial border of the scapula and run the fingers of the left
hand downwards along its full length until the inferior angle is located. The skinfold is
picked up immediately below the inferior angle of the scapula with the fold either in the
vertical line or slightly inclined, downwards and laterally, in natural cleavage of the skin.
Supraspinale skinfold
With the subject standing sideways with his arm folded, the skinfold is picked up
vertically about 1 cm above and 2 cm medial to the anterior suprailiaca spine. The
caliper is applied just below the fingers. This site varies, depending on the position of the
superior anterior iliac spine and may be in the mid-axillary line or anterior to it.
Measuring supraspinale skinfold
Source: Norton, K.; Olds, T., 2004. Anthropometrica. Australia, UNSW Press.
Measure this body dimensions with the proper instrument and procedures! Use and fill
the anthropometric form Furthermore during you measure, check your work by check
list.
1. Nutritional status: body weight, body height
Estimating Body Fat and Fat-Free Mass According to the Method of Durnin and
Wormesley
Method. (1) Determine the patients age and weight (in kgs). (2) Measure the following
skinfolds (in mms): biceps, triceps, subscapular and suprailiac / supraspinale. (3)
Compute the sum by adding the four skinfolds. (4) Compute the logarithm of the sum. (5)
Apply one of the equations from Table [equations for estimating Body Density from the
sum of 4 skinfolds measurement] to compute body density (D, g/mL). (6) Fat mass is
calculated as follows:
Where D is obtained from the formulas shown in Table. (7) Fat-free body mass (FFM) is
calculated as follows:
FFM (kg) = body weight (kg) fat mass (kg)
Sum your four skinfold thickness i.e. Triceps, biceps, infrascapular and suprailiaca (mm)
Please consult your result to this table.
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ANTHROPOMETRIC SKILLS CHECK LIST FOR TRAINING SESSION
NUTRITIONAL STATE
Case: Measure the patient on stature and body weight. Determine the body patient mass index of
the patient.
No Point of Adjustment Feedback
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient and informed consent
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure body-weight properly
8. Measure body-height / stature properly
9. In measuring; Observer, instruments and subject in proper Position
10. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
11. Three times measurement each parameter (repeat the procedure) and
count the average
Communicating the conclusion of examination result
12. Record the mark, and filled in the correct form and tell the result (average)
to the patient or observer
13. Conclusion
Negotiating treatment plan for patient with patient and patients family
14. Future plan
Case : Measure the patient on stature and body weight. Determine the body patient mass index of the
patient
I. Identity
No Variable
1 Name of subject
2 Age
3 Sex
4 Race / Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time
Classification BMI
(Asian people-adult)
Morbidity Obese over 40
Obese 27,6-40
overweight 23-27,5
Healthy / normal 18,5-22,9
underweight 15-18,4
Starving < 14,9
Name: .............................................
ANTHROPOMETRIC SKILLS CHECK LIST FOR TRAINING SESSION
BODY FAT PERCENTAGE
Case: Measure the patient on the biceps, triceps, infrascapula, and supraspinale skinfold.
Count the total of fourth skinfold consult the table and find the body fat percentage
No Feedback
Point of Adjustment
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure biceps skinfold properly
8. Measure triceps skinfold properly
9. Measure infrascapula skinfold properly
10. Measure suprailiaca / supraspinale skinfold properly
11. In measuring; Observer, instruments and subject in proper position
12. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
13. Three times measurement each parameter (repeat the procedure) and count
the average
Communicating the conclusion of examination result
14. Record the mark, and filled in the correct form and tell the result (average)to
the patient or observer
15. Conclusion
Negotiating treatment plan for patient with patient and patients family
15. Future plan
Item for Global Rating Scale Professionalism
No. Items Scale
1 2 3 4 5
1. Dealing with one-self: Demonstrating confidence as a health-professional
2. Dealing with others: Ethics (Respect the patient, demonstrate local values
and norms)
3. Dealing with task: Minimal Error during performing the skills (systematic in
procedures, harmless)
Item for Global Rating Scale Doctor-Patient Interaction
Scale
No. Skills Scientific basis and explanation 1 2 3 4 5
Unexpected Below Meet Exceeding Excellent
expectation expectation expectation
Case: Measure the patient on the biceps, triceps, infrascapula, and suprailiaca skinfold. Count
the total of fourth skinfold consult the table and find the body fat percentage
I. Identity
No Variable
1 Name of subject
2 Age
3 Sex
4 Race / Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time
Where D is obtained from the formulas shown in Table. (7) Fat-free body mass (FFM) is calculated as
follows:
FFM (kg) = body weight (kg) fat mass (kg)
Conclusion
Classified the % body fat = bad / enough / good / very good
=
Case: Measure the patient on waist and hip circumferences count the waist-hip ratio
No
Point of Adjustment Feedback
1. Introducing and build interpersonal relationship
Explaining the purpose of the procedure to patients
2. Mentioning the goal of measuring to the patient
3. Taking the identity and fill in the anthropometric form
Performing steps of procedural skills
4. Instruments preparation properly
5. Order to wear clothes minimized, put off shoes, giving proper instruction
6. Choose the right instruments
7. Measure waist circumferences properly
8. Measure hip circumferences properly
9. In measuring; Observer, instruments and subject in proper position
10. Before Read the completed unit and Record the mark, recheck the correct
position of patient and tool
11. Three times measurement each parameter (repeat the procedure) and count
the average
Communicating the conclusion of examination result
12. Record the mark, and filled in the correct form and tell the result (average)to
the patient or observer
13. Conclusion
Negotiating treatment plan for patient with patient and patients family
14. Future plan
Case: Measure the patient on waist and hip circumferences count the waist-hip ratio
I. Identity
No Variable
1 Name of subject
2 Age
3 Sex
4 Race/Ethnic
5 Measurer
6 Assistance
7 Place/Date/Time
Conclusion
WHR:
Over 0.9 : apple or android pattern
Under 0.9 : pear or gynecoid pattern
Male waist : over 40 inch is considered dangerous/risk for health problems
Female waist : over 35 inch is considered dangerous/ risk for health problems
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TABULATION DATA SHEET
(Average)
Group :
Date/time :
Place :
Measurer :
10
11
12