brief
quipu
Derrick
in measuring
B. Jelliffe,
M.D.,
F.R.
CP.
and
malnutrition’
E. F. Patrice
Jelliffe,
M.P.H.
The mid-upper arm circumference was first used in survey work in a country-wide investigation into preschool malnutrition in Haiti in 1958 (1). Reasons for employing this measurement were that thin limbs are clinically obviOus in
malnutrition
and
probably
reflected
stores
of
protein (muscle) and energy (fat). The left mid-upper arm is easily accessible and approximately rounded. It is simply and rapidly measurable, with cheap easily transportable nonbreakable apparatus (e.g., a tape). Last, the upper arm is less affected by edema in kwashiorkor than are the legs (2). A symposium on the arm circumference as a public health index of malnutrition of early childhood in 1969 drew together existing information from widely separated regions (2), including East and West Africa, Tunisia, Malaysia. Lebanon. the Caribbean, and so on. Technically, tapes for measuring the arm circumference have received attention, including the need for a nonstretch, smoothly flexible 17
U
U
FIG.
Is
2.
recording
Inca
events.
quipu,
knotted
(Courtesy
cords
British
used
for
Museum.)
U
4 w #{176}0
tape
(such
as the
and,
more
recently,
of “insertion
3
tapes”
Sekisui the
fibre-glass development
model) by
(2), Zerfas
(3).
Anthropometrically,
in
young
children
the
circumference (being mainly composed of nutritionally labile muscle and fat) can be compared with nutritionally less affected skeletal measurements (height using the QUAC stick
arm
12 __________
II
0
2
36
24
48
60
(4) and the nities where
head circumference (5)) in commuprecise ages are not verifiable.
AGE (MONTHS). FIG. months
The
1. Mid-arm (smoothed
American
circumference Wolanski
Journal
of
curve)
Clinical
measurements,
0-60
Nutrition
‘From California,
(6).
28:
MARCH
1975,
the
School
Los
pp. 203-204.
Angeles,
of
Public California
Printed
Health,
University
of
90024.
in U.S.A.
203
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/3/203/4716310 by Midwestern University user on 13 January 2019
The
communications
204
JELLIFFE
AND
RED
DARK
PINK
BLUE
Anthropometnic
quipu-knotted
cord
used
However, it was noticed early on that the arm circumference alters little between 1-4 years (6) (Fig. 1), so that the use of a single standard for the second year of life (2) or even for the whole “preschool age” has been suggested (7). In fact, Bennett used the latter in screening young children in an emergency feeding program in Kivu Province of the Congo following civil disturbances there in 1966 (8). In 1964, the possibility of using a quipu was suggested for categorizing the nutritional state of young children by arm circumference measurements (9)-the name being taken from the knotted cords used by the Incas for recording purposes (Fig. 2). The anthropometric quipu is a cord with different colored knots showing 100% to 60% levels of standard arm circumference from preschool children (Fig. 3). A modification of this was employed subsequently by medical assistants in the health services in Kenya (D. B. Blankhart, personal communication). The independently developed three-colored cord of Shakir and Morley (9a) is a similar concept, but with simpler, more functional divisions (“normal,” “probable mild malnutrition,” “malnutrition”) and more symbolism in the “traffic light” color code used on the string. The arm circumference has developed from a
#{149}
70 for
80
measuring
LIGHT
DARK
BLUE
BLUE
90
100%
mid-arm
circumference
in young
children.
“hunch” based on clinical observation to an increasing degree of recognition in nutritional anthropometry, both alone and together with triceps fat fold measurements, when relative depletion of protein (muscle) and joules (energy) can be assessed (10, 11). El
References 1. JELLIFFE, D. B., AND E. F. P. JELLIFFE. Trop. 18: 1, 1961. 2. JELLIFFE, D. B., AND E. F. P. JELLIFFE.
Trop.Pediat. 3.
ZERFAS,
J.
15: 177, 1961. F. In press.
4. ARNHOLD, 5. KANAWATI, Nature
Acta
R. J. Trop. A. A.,
228:
573,
Pediat. 15: 243, 1961. AND D. S. McLAREN.
1970.
6. BURGESS, H. J. L., AND Trop. Pediat. 15: 189, 1969.
A. P. BURGESS.
7.
MORLEY,
8. 9.
9a
10.
KING,
M.,
F.
KING,
D.
C.
H.
J.
AND
Developing BENNETT, JELLIFFE, Nutritional East African
Countries, Nairobi, 1973. F. J. J. Trop. Pediat. 15: 238, 1969. D. B. “Has the Quipu a Role in Assessment?” Annual Conference of Association of Physicians, Makerere
School,
SHAKIR, 1974.
A.,
JELLIFFE,
Kampala, AND
D.
in
1964.
D. MORLEY.
B. World
Nutrition
L.
BURGESS
Medical
A. P. BURGESS.
J.
Health
Lancet
1: 758,
Organ.
Mono-
graph Sen. 1966, no. 53. 11.
GURNEY, Clin.
Nutr.
M., 26:
AND 912,
D. B. JELLIFFE. 1973.
Am.
J.
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/3/203/4716310 by Midwestern University user on 13 January 2019
3.
ORANGE
#{149}
60 FIG.
JELLIFFE
quipu
Derrick
in measuring
B. Jelliffe,
M.D.,
F.R.
CP.
and
malnutrition’
E. F. Patrice
Jelliffe,
M.P.H.
The mid-upper arm circumference was first used in survey work in a country-wide investigation into preschool malnutrition in Haiti in 1958 (1). Reasons for employing this measurement were that thin limbs are clinically obviOus in
malnutrition
and
probably
reflected
stores
of
protein (muscle) and energy (fat). The left mid-upper arm is easily accessible and approximately rounded. It is simply and rapidly measurable, with cheap easily transportable nonbreakable apparatus (e.g., a tape). Last, the upper arm is less affected by edema in kwashiorkor than are the legs (2). A symposium on the arm circumference as a public health index of malnutrition of early childhood in 1969 drew together existing information from widely separated regions (2), including East and West Africa, Tunisia, Malaysia. Lebanon. the Caribbean, and so on. Technically, tapes for measuring the arm circumference have received attention, including the need for a nonstretch, smoothly flexible 17
U
U
FIG.
Is
2.
recording
Inca
events.
quipu,
knotted
(Courtesy
cords
British
used
for
Museum.)
U
4 w #{176}0
tape
(such
as the
and,
more
recently,
of “insertion
3
tapes”
Sekisui the
fibre-glass development
model) by
(2), Zerfas
(3).
Anthropometrically,
in
young
children
the
circumference (being mainly composed of nutritionally labile muscle and fat) can be compared with nutritionally less affected skeletal measurements (height using the QUAC stick
arm
12 __________
II
0
2
36
24
48
60
(4) and the nities where
head circumference (5)) in commuprecise ages are not verifiable.
AGE (MONTHS). FIG. months
The
1. Mid-arm (smoothed
American
circumference Wolanski
Journal
of
curve)
Clinical
measurements,
0-60
Nutrition
‘From California,
(6).
28:
MARCH
1975,
the
School
Los
pp. 203-204.
Angeles,
of
Public California
Printed
Health,
University
of
90024.
in U.S.A.
203
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/3/203/4716310 by Midwestern University user on 13 January 2019
The
communications
204
JELLIFFE
AND
RED
DARK
PINK
BLUE
Anthropometnic
quipu-knotted
cord
used
However, it was noticed early on that the arm circumference alters little between 1-4 years (6) (Fig. 1), so that the use of a single standard for the second year of life (2) or even for the whole “preschool age” has been suggested (7). In fact, Bennett used the latter in screening young children in an emergency feeding program in Kivu Province of the Congo following civil disturbances there in 1966 (8). In 1964, the possibility of using a quipu was suggested for categorizing the nutritional state of young children by arm circumference measurements (9)-the name being taken from the knotted cords used by the Incas for recording purposes (Fig. 2). The anthropometric quipu is a cord with different colored knots showing 100% to 60% levels of standard arm circumference from preschool children (Fig. 3). A modification of this was employed subsequently by medical assistants in the health services in Kenya (D. B. Blankhart, personal communication). The independently developed three-colored cord of Shakir and Morley (9a) is a similar concept, but with simpler, more functional divisions (“normal,” “probable mild malnutrition,” “malnutrition”) and more symbolism in the “traffic light” color code used on the string. The arm circumference has developed from a
#{149}
70 for
80
measuring
LIGHT
DARK
BLUE
BLUE
90
100%
mid-arm
circumference
in young
children.
“hunch” based on clinical observation to an increasing degree of recognition in nutritional anthropometry, both alone and together with triceps fat fold measurements, when relative depletion of protein (muscle) and joules (energy) can be assessed (10, 11). El
References 1. JELLIFFE, D. B., AND E. F. P. JELLIFFE. Trop. 18: 1, 1961. 2. JELLIFFE, D. B., AND E. F. P. JELLIFFE.
Trop.Pediat. 3.
ZERFAS,
J.
15: 177, 1961. F. In press.
4. ARNHOLD, 5. KANAWATI, Nature
Acta
R. J. Trop. A. A.,
228:
573,
Pediat. 15: 243, 1961. AND D. S. McLAREN.
1970.
6. BURGESS, H. J. L., AND Trop. Pediat. 15: 189, 1969.
A. P. BURGESS.
7.
MORLEY,
8. 9.
9a
10.
KING,
M.,
F.
KING,
D.
C.
H.
J.
AND
Developing BENNETT, JELLIFFE, Nutritional East African
Countries, Nairobi, 1973. F. J. J. Trop. Pediat. 15: 238, 1969. D. B. “Has the Quipu a Role in Assessment?” Annual Conference of Association of Physicians, Makerere
School,
SHAKIR, 1974.
A.,
JELLIFFE,
Kampala, AND
D.
in
1964.
D. MORLEY.
B. World
Nutrition
L.
BURGESS
Medical
A. P. BURGESS.
J.
Health
Lancet
1: 758,
Organ.
Mono-
graph Sen. 1966, no. 53. 11.
GURNEY, Clin.
Nutr.
M., 26:
AND 912,
D. B. JELLIFFE. 1973.
Am.
J.
Downloaded from https://academic.oup.com/ajcn/article-abstract/28/3/203/4716310 by Midwestern University user on 13 January 2019
3.
ORANGE
#{149}
60 FIG.
JELLIFFE
