# Nutrition and Growth and Measurement

Tape measure with millimeter markings

Standing platform scale with height attachment

Devices for measuring weight and height for infants

Calculator

Skinfold caliper

## EXAMINATION

TECHNIQUE FINDINGS
ANTHROPOMETRICS
Measure height and weight

Estimate desirable body weight (DBW)

Add 10% for large frame; subtract 10% for small frame.

EXPECTED:Women: 100 pounds for first 5 feet, plus 5 pounds for each inch thereafter. Men: 106 pounds for first 5 feet, plus 6 pounds for each inch thereafter.
Use growth charts for pediatric patients available at www.cdc.gov/growthcharts. EXPECTED:Child is following a growth curve pattern for height and weight. Height and weight are approximately same percentiles.
Calculate percent weight change

UNEXPECTED:Weight loss that equals or exceeds 1% to 2% in 1 week, 5% in 1 month, 7.5% in 3 months, 10% in 6 months.
Calculate body mass index (BMI) kg/m2

EXPECTED:18.5 to 24.9 for men and women.
UNEXPECTED:BMI less than 18.5 is classified as undernutrition. BMI of 25 to 29.9 is classified as overweight. BMI of 30 to 39.9 is obesity. BMI of 40 and higher is extreme obesity.
or
See nomogram below. Also, see an interactive BMI calculator on the website.

TECHNIQUE FINDINGS
Calculate waist-to-hip circumference ratio
Using tape measure with millimeter markings, measure waist at a midpoint between the costal margin and the iliac crest. Then measure hip at the widest part of the gluteal region. Divide waist circumference by hip circumference to obtain the ratio. EXPECTED:Ratio less than 0.9 in men and 0.8 in women.
UNEXPECTED:Ratios of greater than 1.0 in men and greater than 0.85 in women indicate increased central fat distribution and increased risk of disease.
24-hour diet recall
Food diary Use the MyPyramid guide at www.mypyramidtracker.gov to track and analyze individual eating patterns and to generate a dietary plan based on age, gender, and physical activity level.
Calculate estimates for energy needs
Use actual weight for healthy adults. Calories Kcal/kg
Weight loss 25
Use adjusted weight for obese patients. Weight maintenance 30
Weight gain 35
Hypermetabolic/malnourished 35-50
Estimate fat intake
25% to 35% of the daily calories consumed should come from fat, with a distribution of less than 7% saturated fat, less than 10% polyunsaturated fat, and the rest in monounsaturated fat (U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2005).
Estimate protein intake
An average of 0.8 g per kilogram body weight is sufficient to meet needs. Approximately 15% of daily calories consumed should come from protein.
Estimate carbohydrate intake
50% to 60% of the total calories consumed should come from carbohydrates, with selections predominantly coming from complex carbohydrates including grains, fruits, and vegetables.
Estimate fiber intake
14 g per 1000 calories consumed (U.S. Department of Health and Human Services and U.S. Department of Agriculture, 2005). In children ages 3 to 18 years, the formula “age +5 g” should be used to determine fiber needs.
SPECIAL PROCEDURES
Measure mid–upper arm circumference (MAC)
Place measuring tape around upper right arm, midway between tips of olecranon and acromial processes. Hold tape snugly and make the reading to nearest 5 mm. EXPECTED:Between 10th and 95th percentiles.
UNEXPECTED:Less than 10th or greater than 95th percentile (see table on p. 25).