The term for the science of size, proportion, weight, and height is ______________.

Direct anthropometry

Farkas was the first to apply medical anthropometry to children with repaired bilateral cleft lip.61 His reference book is invaluable.62 It contains normative values for 28 nasal and 18 labial linear/angular measurements in a North American Caucasian population from birth [0–5 months and 6–12 months] and each year up to age 18. Direct anthropometry requires training, practice, and patience. The tools are a sliding Vernier caliper and a Castroviejo caliper. Locating the soft-tissue landmarks and measuring nasolabial dimensions are usually easily accomplished in a child older than 5 years, but difficult to impossible in a younger child. Intraoperative anthropometry is used to assess severity of the deformity prior to the procedure and immediately after repair as a record of baseline nasolabial dimensions.6 In an analysis of 46 consecutive repairs of bilateral complete cleft lip, intraoperative anthropometry confirmed the strategy of design in three dimensions in anticipation of the fourth dimension. All fast-growing nasolabial features were set smaller than age and sex-matched normal infants. The only exception was central vermilion–mucosal height [median tubercle] that purposely was made overly full [on average 155% of normal]. The slow-growing features, nasal protrusion, and columellar height, were also constructed longer than normal, 130% and 167%, respectively.

Direct anthropometry can be repeated as the child grows and compared to normal values based on sex and age. This was shown in a retrospective longitudinal analysis of 12 children with bilateral complete cleft lip who underwent repair with the same procedure as described herein.4 Through age 4 years, nasal height and protrusion, as well as columellar length and width, were within 1 standard deviation of normal values. The interalar dimension was overly wide, about 1 standard deviation above normal. Nevertheless, the nose often did not appear wide because children with bilateral cleft lip tend to have minor orbital hypertelorbitism. The cutaneous lip was intentionally set short because this is less eye-catching than the typical long lip appearance in these patients. Thus, total lip height was 1–2 standard deviations below normal, whereas, height of the median tubercle was 1 standard deviation above normal at 4 years. Fullness of the central red lip usually falls below normal in older children. Depending on the show of the permanent incisors, the median tubercle either is augmented or excess mucosa is trimmed. An example of an 8-year-old boy with repaired bilateral complete cleft lip/palate is shown inFig. 22.19 with intraoperative and postoperative anthropometry.

Serial direct anthropometry in 32/48 patients with repaired bilateral incomplete cleft lip was compared to Farkas's normative values.63 Females, African-Americans, and Asians were excluded because of their small numbers, leaving 22 Caucasian males in the long-term study. Nasal measurements demonstrated: interalar dimension [al–al] widened in early childhood and followed line of normal growth thereafter; nasal tip protrusion [sn–prn] grew in parallel above the normal line; columellar height [sn–c] crossed the normal line in early childhood and remained slightly below into adulthood. Labial measurements showed: Cupid's bow width [cphi–cphi] was normal into late adolescence; upper philtral width [cphs–cphs] remained below the normal line; philtral height [sn–ls] stayed below the normal line; median tubercle [ls–sto] grew slowly, sometimes dropping below the normal line during adolescence; total labial height [sn–sto] closely approximated Farkas's normal line throughout childhood and adolescence.

Discussion

Anthropometry and anthroposcopy have been the most important research tools in biological and forensic anthropology. These two methods of observation and data collection can be made both on the living and on skeletonized human remains. As research tools, they have contributed to the analysis of human variation in terms of race, sex and body dimensions, such as stature. These areas of research have explained those dimensions and morphological features that describe sexual dimorphism, and the differences between sexes that may have been caused by social and physical environmental factors or simply by evolutionary mechanisms, such as selection. Many growth studies of the musculoskeletal system have been based on anthropometry of children. Predictions can be made from such studies; for example, to determine whether a child has the chromosomal mutation that will cause the Down syndrome, or what the predicted height will be at a given age.

Forensic anthropological anthropometric [and osteometric] dimensions have been used to develop many discriminant function formulae to determine sex and race from the skeleton. They are also used to estimate stature from long bones. These and other uses assist the police in identifying both the unknown victim and the culprit who may have committed the crime. The same dimensions in the study of a video recording of a crime scene, facial size and proportions of facial features can be estimated: for example, the length of a person's nose can be estimated from a video image and a photograph. Some anthropologists even attempt to estimate stature and the proportions of one part of the body to another in video surveillance images recorded during the commission of a crime.

Morphological analysis of unmeasurable features usually falls into the area of anthroposcopy. These features are assessed qualitatively [without using any measuring device] by an experienced person. While some anthropologists use models to compare morphological features, experience is extremely important because of the geographic diversity of the human species and resulting differences between them. Its use in forensic anthropology is mainly seen in the analysis of the skeletal remains rather than living individuals. An exception to this may be the evaluation of facial images in a photograph and video tapes. To these one may add the study of growth-related changes in the human body, especially when there is the question of age estimation from the picture of a person who was thought to be a child. Morphological assessment of osteological remains are important areas of observation in forensic osteology. It provides not only features of sex and race but also shows variation in the human skeleton that may be explained in terms of asymmetry, pathology or anomaly. Each of these features may provide information about age, pathology and trauma, time since death, effects of animals on the skeleton, and information as to whether a particular feature was caused ante mortem, perimortem or post mortem.

Anthropometry

Anthropometric techniques are those in which a quantitative measure of the size, weight, or volume of a body part is used to assess protein and calorie status. Historically, one of the most commonly used anthropometric parameters has been weight for height. This is a useful parameter when neither the patient nor family can provide reliable historical information, but it is less desirable than a history of unintentional weight loss, because it requires the patient’s weight to be judged against a normative standard that has been established in a large control population, and inter-individual variability in the population limits this method’s accuracy for correctly predicting PEM in one individual.Table 5.6 displays the 1959 Metropolitan Life Insurance Company “desirable body weights” that were established with prospective mortality data. The 1959 table remains preferable to the 1983 tables largely because of concerns that the latter did not include an adequate sampling of certain segments of the population, and was therefore biased. In the context of the Metropolitan table, desirable weight for height is defined as that figure associated with maximal longevity. In general, individuals whose weight is less than 85% of the standard can be considered to have a clinically significant degree of PEM. Of note is that desirable weights in this table are substantially less than average weights in North America.

Body mass index [Table 5.18], defined as weight [in kilograms] divided by height [in meters squared], has been supplanting the use of weight for height, in part because it precludes the need to use normative data tables. BMIs outside the desirable range [18.5 to 24.9 kg/m2] help identify patients at increased risk of adverse clinical outcomes. A BMI modestly above the desirable range has been shown to be predictive of adverse outcomes in the surgical management of many diseases76-78 and in the medical management of conditions like alcoholic liver disease.79 Similarly, a low BMI has been shown to be a robust independent risk factor in surgical and medical patients.80 Extremely underweight adult patients [BMI