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Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal



Classification of infants into low birth weight (LBW, <2500 g) or very low birth weight (VLBW, <2000 g) categories is a crucial step in targeting interventions to high-risk infants.


To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants.

Subjects and setting:

Newborn infants (n=1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal.


Chest circumference, foot length and weight (SECA 727, precise to 2 g) of newborns were measured within 72 h after birth. The sensitivity, specificity and predictive values for a range of cutoff points of the anthropometric measures were estimated using the digital scale measurements as the gold standard.


Among LBW infants (469/1640, 28.6%), chest circumference measures <30.3 cm were 91% sensitive and 83% specific. Similar levels of sensitivity for foot length were achieved only with considerable loss of specificity (<45%). Foot length measurements <6.9 cm were 88% sensitive and 86% specific for the identification of VLBW infants.


Chest circumference was superior to foot length in classification of infants into birth weight categories. For the identification of VLBW infants, foot length performed well, and may be preferable to chest circumference, as the former measure does not require removal of infant swaddling clothes. In the absence of more precise direct measures of birth weight, chest circumference is recommended over foot length for the identification of LBW infants.


The National Institute of Child Health and Human Development; the Saving Newborn Lives Initiative, Save the Children – US and the Office of Heath and Nutrition, United States Agency for International Development (see Acknowledgements).

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This study was supported by grants from the National Institutes of Health, National Institute of Child Health and Human Development (HD44004 and HD38753); Save the Children – US through a grant from The Bill & Melinda Gates Foundation (810-2054); and cooperative agreements between the Johns Hopkins Bloomberg School of Public Health and the Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (HRN-A-00-97-00015-00, GHS-A-00-03-000019-00). We thank Vishwajeet Kumar for development and provision of the foot length boards used in this study.

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Correspondence to L C Mullany.

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Guarantor: LC Mullany.

Contributors: LCM – concept, design, implementation, quality control, data management, analysis, interpretation and writing of manuscript; GLD – concept, design, interpretation and writing of manuscript; SKK – design, implementation, quality control, review and approval of manuscript; SCL – design, implementation, quality control, review and approval of manuscript; JMT – concept, design, interpretation and writing of manuscript.

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Mullany, L., Darmstadt, G., Khatry, S. et al. Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal. Eur J Clin Nutr 61, 40–46 (2007).

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  • anthropometric surrogates
  • low birth weight
  • chest circumference
  • foot length
  • Nepal

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