Method of Measurement
Approximately half of the total amount of fat tissue in the human body is located below the surface of
the skin.
This makes it possible to predict total body fat from skin-fold thicknesses with a relative high degree of
accuracy using a simple two-compartmental method.
This accuracy is confirmed by CT scan as well as ultrasonic and radiographic techniques used to
measure subcutaneous fat.
In general, when measuring skinfold thickness. The assessor, using the forefinger and the thumb,
grasps and lifts the subcutaneous tissue and skin from the underlying muscle.
Places the pincers of the skinfold caliper (Fig. 2D.3) applying a constant pressure, 2 cm below the
fingers at a depth of 1 cm.
Holds this position for 3–4 seconds.
Takes three measurements for accuracy.
Provides the actual skinfold thickness in mm.
Triceps Skinfold (TSF) (Fig. 2D.4)
A measure of subcutaneous fat stores taken at the midpoint of the posterior aspect of the humerus.
Correlates closely with percentage of body fat and with total body fat.
Triceps skinfold thickness varies between 6 mm and 12 mm in lean individuals and between 40 mm
and 50 mm in obese individuals.
Subject should be standing with arms hanging loosely at the sides.
Assessor to be positioned behind the subject.
To locate the triceps skinfold site, locate the site previously marked for the mid-arm
circumference (MAC) measurement.
The triceps skinfold site is on the posterior surface of the arm, midway between the shoulder and the
elbow.
Using the forefinger and the thumb the assessor grasps and lifts the subcutaneous tissue and
skin 2 cm above TSF site.
Place the pincers of the skinfold caliper at the TSF point at a depth of 1 cm.
Fig. 2D.3: Different types of skinfold calipers.
•
•
•
• •
Fig. 2D.4: Triceps skinfold (TSF).
Hold this position for 3–4 seconds.
Take three measurements for accuracy.
Provide the actual skinfold thickness in mm.
BODY MASS INDEX
Calculation
Formula is weight (kg)/Height (m2
)
Body Mass Index
World Health Organization (WHO) Southeast Asian Countries (SEAC)
Underweight <18.5 <18.5
Normal 18.5–24.9 18.5–22.9
Overweight 25–29.9 23–24.9
Preobese — 25–29.9
Obese ≥30 ≥30
Obese 1 30–40 30–40
Obese 2 (morbid) 40.1–50 40.1–50
Obese 3 >50 >50
Metabolic syndrome
National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) 2005* WHO 1999
Essential criteria
— Insulin resistance
Additional criteria
(≥3 of following) (≥2 of following)
Waist circumference (WC)
>90 cm (males)
Waist-hip ratio (WHR)
0.9 (males)
• •
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
>80 cm (females) >0.85 (females)
BMI ≥30
Glucose ≥100 mg/dL or on Rx
Triglyceride (TG) ≥150 mg/dL or on Rx TG ≥150 mg/dL
High-density lipoprotein (HDL)
<40 (males)
<50 (females) or on Rx
HDL
<35 (males)
<40 (females)
Hypertension (HTN) ≥130/85 or on Rx HTN ≥140/90
*Most commonly followed.
WAIST-HIP RATIO (FIG. 2D.5)
Method of Measurement
Waist Circumference
Locate the narrowest point between ribs and iliac crests.
Ensure that the tape measure is at the same height around the waist.
Measure and state the measurement correctly to the nearest centimeter.
≥90 cm (adult male) and ≥80 cm (adult female) considered having abdominal obesity for south
Asians.
Differences in cut points abdominal obesity for south Asians and Europids.
Abdominal obesity South Asians Europids
Men WC ≥90 cm WC ≥102 cm
Women WC ≥80 cm WC ≥88 cm
Hip Circumference
Hip measurement is taken at the widest lateral extension of the hips.
Ensure that the tape measure is horizontal.
Measure and state the measurement correctly to the nearest centimeter.
Calculate waist-hip ratio to two decimal places.
Clinical Implication
0.9 (males) or >0.85 (females) are criteria for metabolic syndrome.
MID-ARM CIRCUMFERENCE (FIGS. 2D.6 AND 2D.7)
Locate the midpoint of the arm.
Nondominant arm elbow flexed at 90° with palm facing upwards.
Measurer stands behind the subject and locates the lateral tip of the acromion and the most distal
point on the olecranon process.
Place a tape measure so that it passes between these two landmarks and mark the midpoint.
The subject stands erect with arms hanging freely at the sides and the palms facing the thighs.
Place the tape measure perpendicular to the long axis of the arm at the marked midpoint and
measure the circumference to the nearest mm (e.g. 18.1 cm).
Provide the actual MAC in cm.
•
•
Fig. 2D.5: Examination of waist-hip ratio.
Fig. 2D.6: Method of marking midpoint for measuring mid-arm
circumference.
Fig. 2D.7: Method of measuring mid-arm circumference.
NECK CIRCUMFERENCE
Neck circumference (NC) measurement, as a simple and time-saving screening measure, could be
used to identify overweight and obese population.
Measured on a plane as horizontal as possible, at a point just below the larynx (thyroid cartilage), and
perpendicular to the long axis of the neck (the tape line in front of the neck should be placed at the
same height as the tape line in the back of the neck).
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
1. 1.
Varies based on population. Among south Asians, an NC of >34.9 cm for men and >31.25 cm for
women were the best predictors for identifying metabolic syndrome.
NECK HEIGHT RATIO
Neck length was measured as the linear distance between two easily recognizable and fixed bony
points—the external occipital protuberance and the spinous process of C7 vertebra; with the patient
standing upright and neck held in neutral position.
Normal ratio of neck: height is 1:13 (Bird index).
Short neck is an important feature of conditions like Turner, Noonan, Klippel–Feil, and
mucopolysaccharidoses.
Neck height ratio (NHtR) has also been suggested to be a measure of upper body adiposity like NC.
MISCELLANEOUS TOPICS
Significant Weight Loss
>10% of body weight × 6 months
5 kg or more × 1 month
Cachexia
Complex metabolic syndrome associated with underlying illness and is characterized by the loss of
muscle with or without loss of fat mass.
Emaciation
Extreme weight loss and unnatural thinness due to a loss of the fatty, adipose tissue beneath the skin
and muscle throughout body.
Weight for Age (W/A)
General appreciation of nutritional status
For growth monitoring.
Height for Age (H/A)
Measure of linear growth deficit or stunting
Slow progress
Used for community diagnosis.
Weight for Height/Length (W/H)
Measure of weight deficit according to length
Measure of wasting
Used for individual and community diagnosis.
MARFAN’S SYNDROME: DIAGNOSTIC CRITERIA AND FEATURES (FIGS.
2D.8A TO D)
Diagnostic criteria (Modified Ghent criteria)
In the absence of family history of MFS, the presence of one
of any of the following criteria is diagnostic for MFS
In the presence of family history of MFS, the presence of one
of any of the following criteria is diagnostic for MFS
Aortic criterion and ectopia lentis Ectopia lentis
2. 2.
3. 3.
4.
•
•
Aortic criterion and a causal FBN1 mutation Systemic score ≥7 points
Aortic criterion and a systemic score ≥7 Aortic criterion
Ectopia lentis and a causal FBN1 mutation
Aortic Criteria
Aortic diameter Z score ≥2 (above 20 years old), Z score ≥3 (below 20 years), or aortic root dissection.
Figs. 2D.8A to D: Features of Marfan’s syndrome. (A) Wrist sign; (B) Thumb sign; (C) High-arched
palate; (D) Chest X-ray showing aortic root dilatation.
Systemic Scoring
A systemic score ≥7 indicates major systemic involvement.
Calculate based on the following table:
Features Points
Wrist AND thumb sign 3
Wrist OR thumb sign 1
Pectus carinatum deformity 2
Pectus excavatum or chest asymmetry 1
Hindfoot deformity 2
Plain pes planus 1
Pneumothorax 2
Dural ectasia 2
Protrusio acetabuli 2
Reduced upper segment/lower segment ratio AND increased arm span/height AND no severe scoliosis 1
Scoliosis or thoracolumbar kyphosis 1
Reduced elbow extension (≤170° with full extension) 1
Facial features [at least three of the following five features: dolichocephaly (reduced cephalic index or head width/length
ratio), enophthalmos, downslanting palpebral fissures, malar hypoplasia, retrognathia)
1
Skin striae 1
Myopia >3 diopters 1
Mitral valve prolapse (all types) 1
R
e
s
pir
a
t
o
r
y
S
y
s
t
e
m
E
x
a
min
a
tio
n
C
H
A
P
T
E
R
3
1.
2.
3.
•
•
•
•
–
–
–
•
•
•
•
•
•
–
–
–
•
•
•
•
•
–
–
–
A. CASE SHEET FORMAT
HISTORY TAKING
Name:
Age:
Sex:
Residence:
Occupation:
Chief complaints:
________ × days
________ × days
________ × days
History of presenting illness:
Cough:
Duration
Onset
Progression
Variation
Diurnal variation
Seasonal variation
Postural variation
Aggravating factors
Relieving factors
Expectoration:
Duration
Onset
Progression
Variation
Diurnal variation
Seasonal variation
Positional variation
Aggravating and relieving factors
Quantity of sputum
Color
Smell
Blood tinged
How often
Quantity
Fresh or altered
Dyspnea:
•
•
•
•
•
•
•
•
•
•
•
–
–
•
•
•
•
•
•
•
•
•
•
–
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
–
Comments
Post a Comment
اكتب تعليق حول الموضوع