Anthropometric Indicators Of Nutritional Status Research Articles

A comparison of anthropometric indices of nutritional status in Tukanoan and Achuar Amerindians

Anthropometric data from a Tukanoan population in the Vaupes region of Colombia and an Achuar population in the Ecuadorian Amazon were compared relative to international references. The Tukanoans exploit an oligotrophic blackwater ecosystem, whereas the Achuar inhabit a resource rich montane ecosystem. Given this ecological distinction, three hypotheses regarding nutritional statuses were proposed: (1) Tukanoans are significantly shorter than the Achuar, indicating a greater degree of stunting; (2) Tukanoans are significantly leaner, indicating a greater degree of wasting; and (3) Tukanaons have significantly lower upper arm muscle area, indicating lower lean body mass. Z-scores for height, weight-for-height, and estimated upper arm muscle area were determined and significant nutritional stress was assumed at z ≤ −2.0. Between population differences in z-scores for height-for-age (ZHT), weight-for-height (ZWH), and upper arm muscle area (ZUMA) were examined using analysis of variance with a subsequent Scheffe's test. Between-group differences in the frequencies of individuals with low z-scores (z ≤ −2.0) were assessed via chi-squared analysis. Both populations showed stunting in most age groups, but neither showed low ZWH or ZUMA. Significant differences between populations were found only for ZHT in children (females 1.0–4.9 and 5.0–9.9 years, and males 5.0–9.9 years). Tukanoans have significantly higher frequencies of stunting in all age-sex groups except females and males age 30–49.9 years. There were no significant between-population differences in the frequencies of individuals with low ZWH or ZUMA. These differences in nutritional status may reflect differences in resource availability. Am. J. Hum. Biol. 13:301–309, 2001. © 2001 Wiley-Liss, Inc.

Helminthic infection and anthropometric indicators in children from a tropical slum: Ascaris reinfection after anthelmintic treatment.

We evaluated helminthic infection and anthropometric indicators of nutritional status in a group of school-age children from a slum area of Caracas, Venezuela. The proportions of children at or below the 10th percentiles for height/age and weight/age were significantly higher in those presenting helminthiasis than in those uninfected. Although this could partially reflect a codependence of both helminthic infection and undernutrition or poverty, when the children were administered regular anthelmintic treatment for a year their anthropometric values improved significantly. When they were re-evaluated 8 months after the end of anthelmintic administration, the degree of reinfection by the most common helminth, Ascaris lumbricoides, was significantly higher in the growth-retarded children. These results confirm the relationship between helminthic infection and decreased growth rates in underprivileged populations, and indicate that children at nutritional risk are more susceptible to such infections, even after a prolonged parasite-free period.

Predictors of serum retinol in children with shigellosis

Low serum retinol can be useful as an indicator of depleted liver vitamin A stores, particularly in population-based studies. However, serum retinol concentrations decrease transiently during infection, independent of any changes in liver stores. The magnitude of the decrease in serum retinol is often proportional to indicators of disease severity. We examined the relation of serum retinol in children with culture-positive shigellosis with severity of illness, anthropometric indicators of nutritional status, urinary retinol excretion, and serum concentrations of C-reactive protein, alpha1-acid glycoprotein, retinol binding protein, and transthyretin. This was a prospective study assessing the clinical and laboratory measurements at admission and recovery of 90 children with dysentery (66 with shigellosis) hospitalized in Bangladesh. Serum retinol concentrations were low at admission but were significantly greater at discharge even though no vitamin A supplements were given during the illness (0.36 +/- 0.22 compared with 1.15 +/- 0.50 micromol/L, P < 0.001). Serum retinol concentrations were lower in children with Shigella dysenteriae type 1 infection than in children with shigellosis due to less virulent strains of Shigella. Low serum retinol was independently associated with S. dysenteriae type 1, high serum C-reactive protein concentrations, and low weight-forage in multiple regression analysis. This study showed that shigellosis was associated with a significant, transient decrease in serum retinol concentrations of approximately 0.8 micromol/L, and that this change was significantly associated with severity of disease and poor underlying nutritional status, particularly low weight-for-age.

Living on the edge: dietary strategies of economically impoverished women in Cali, Colombia.

Economically impoverished women in Cali, Colombia, have restricted access to food in a city where food is abundant. Ethnographic observations, interviews and 2 day food records were used to better understand the coping strategies used by a group of these women (n = 85) to maintain adequate levels of energy intake. Anthropometric indicators of nutritional status were normal for the group. Interview data revealed that the ability to purchase food was a concern for 58% of the women. When faced with a restricted ability to purchase food, the women indicated they made compromises in meal composition, reduced portion sizes, and/or reduced the number of meals. They also relied on relatives, friends, neighbors, store credit, or local government programs for access to food. Changes in meal composition were identified in 17.1% of all diet records (n = 509). Low energy intake (defined as energy intake < or = 1.27 x BMR) was identified in 17.1% of all diet records. Carbohydrate consumption was significantly greater on low-energy intake days. The adequate nutritional status of this group of women suggests that their coping strategies are usually adequate to maintain energy intake, but the presence of uncertainty, the frequency of compromises in diet composition, and the frequency of low-energy intake days suggest that these women are at risk for undernutrition.

Dietary patterns and dietary adequacy of highland Pwo and Sgaw Karen of northwest Thailand.

The Pwo and Sgaw Karen of the highlands of northwest Thailand occupy isolated villages in the same ecosystem, employ similar food acquisition and preparation techniques, and maintain a certain level of sociocultural homogeneity through their identification as Karen. However, despite these similarities, a preliminary examination of anthropometric indices of nutritional status indicates that Sgaw children tend to be better nourished than Pwo children. Findings are reported from a follow-up study conducted to confirm these initial findings and to identify what causes the observed differences between the two groups. Data were collected on individuals from 77 Pwo animist and 71 Sgaw Christian households, and used to compare the dietary patterns, dietary adequacy, and anthropometric indices of nutritional status of mothers and their weaned children at pre-harvest, harvest, and post-harvest. Pwo mothers and their weaned children tended to have significantly less diverse diets than their Sgaw counterparts. The post-harvest percentage of the FAO/WHO recommended daily intakes for calories, protein, and 7 nutrients were therefore all significantly greater among Sgaw mothers and their weaned children than among the Pwo. The level of stunting was high in both groups, but significantly more stunting was observed among the Pwo than among the Sgaw. The better nutritional status of the Sgaw seems to be due mainly to the combined effects of a higher socioeconomic status and a greater contact with modern society.

Anthropometric indicators of nutritional status and level of mortality.

The strength of the relationship between several anthropometric indicators of nutritional status, or more generally, standard of living, with overall mortality at the population level is compared. The anthropometic indicators examined include height, weight, weight-for-height, and weight-for-height2 at various ages. The results demonstrate that height is most closely associated with the level of mortality. Weight-for height2 , in contrast, has the weakest association with mortality. Of the ages examined, age 6 consistently has the strongest relationship with the level of mortality, whereas birthweight and adult measures have the lowest associations with the overall level of mortality, although the results for birthweight may be an artifact of biased data. Curiously, there is little or no sex difference in the slope of the relationship between anthropometric measure and level of mortality after correcting for smaller size and longer life expectancies of females compared to males. Overall, the anthropometric indicators are very highly correlated with mortality, exceeding 0.85 in some cases. This suggests that anthropometric dimensions may be a useful source of corroborative information when attempting to estimate demographic rates for populations where the demographic data are suspect. © 1995 Wiley-Liss, Inc.

Is Combination Therapy for Encopresis Nutritionally Safe?

Chronic constipation accounts for 3% to 5% of pediatric primary care outpatient visits. The most severely affected of this group develop a flaccid colon insensitive to distention, and encopresis. Laxatives and lubricants have been the standard therapeutic agents during the bowel decompression phase of encopretic therapy. Fiber has been the cornerstone of maintenance programs. Each of these agents is accompanied by considerable anxiety in the lay literature. This study evaluates the safety of combined high-fiber, laxative, and lubricant therapy on bowel movement frequency, fecal soiling, and nutritional status over a 6-month period. Blood chemistry values, dietary fiber intake, defecation pattern, and psychological profile were evaluated before and after the 6-month study. Biochemical and anthropometric indicators of nutritional status were not adversely affected by the therapy. Seventy-five percent of the children were able to remain free of soiling and the remaining 4 of 16 had soiling episodes reduced to a frequency of less than once a week. This study confirms that children with encopresis can respond to a combined program of increased fiber intake, laxatives, and mineral oil following a complete bowel cleanout, without experiencing deleterious effects.

Anthropometric indicators of nutritional status, socioeconomic factors and mortality in hospitalized children in Addis Ababa

The influence of some household and maternal variables on three anthropometric nutritional status indices of hospitalized children in Addis Ababa, Ethiopia, are examined. On admission, only 30% of these children can be classified as being of a normal overall nutritional status. There are no significant differences in weight-for-age of hospitalized children between those residing in Addis Ababa and those residing in the rural areas. Income and father's occupation appear to be the major household factors influencing the level of two of the three indices (weight-for-age and weight-for-height). Length of last closed birth interval and, to a lesser degree, maternal age appear to have significant effects on all three nutritional status indices. Upon admission to hospital, children who will in the end survive their hospital stay are on average nutritionally normal or in a mild state of malnutrition, whereas children who will die during their stay arrive in a moderate or severe state of malnutrition. The degree of malnutrition is positively related to the risk of mortality in respiratory disease patients.

Small but Healthy? Some Cultural Considerations

1976 Classification and Definition of Protein-Energy Malnutrition. In Nutrition in Preventive Medicine. G. H. Beaton and J. M. Bengoa, eds. Pp. 530-552. WHO Monograph Series No. 62, Geneva. 1986 Emerging Priorities for the Nutritional Sciences. In Nutrition Issues in Developing Countries for the 1980s and 1990s. Proceedings of a Symposium. Food and Nutrition Board, Commission on Life Sciences, National Research Council. Pp. 436 1. Washington, DC: National Academy Press. Waterlow, J . C., R. Buzina, W. Keller, J. M. Lane, M. Z. Nichaman, and J. M. Tanner 1977 The Presentation and Use of Height and Weight Data for Comparing the Nutritional Status of Groups of Children Under the Age of 10 Years. Bulletin of the World Health Organization 55: 489498. Waterlow, J. C., J. Cravioto, and J. M. L. Stephen 1960 Protein Malnutrition in Man. Advances in Protein Chemistry 15:131. WHO 1986 Use and Interpretation of Anthropometric Indicators of Nutritional Status. Report of a WHO working group. Bulletin of the World Health Organization 64:929-94 1.

La médecine et le déclin de la mortalité : indicateurs de l'état nutritionnel

The paper surveys ten years of research by historians, demographers and economists into the use of indicators of nutritional status in the description of the past. Initial understanding of the use of anthropometric indicators of nutritional status was flawed, but a decade of investigation and dialogue with human biologists has produced a number of studies which have illuminated the subject. They have shown periods of rising and falling height in the past, with a particularly interesting fall in average heights in Britain and the United States in the middle of the nineteenth century. The paper surveys the major findings of this research and discusses some drawbacks of the method and some problems of interpretation. It concludes that the use of data on human heights can help to illuminate the causes of the European mortality decline.

Physical growth of Ecuadorian Chachi Amerindians.

Measurments of height, weight, arm circumference, and triceps and subscapular skinfolds were collected on 457 Ecuadorian Chachi Amerindians between the ages of 4 and 64 years. Compared to US reference values, the Chachi are very small in terms of height-for-age, but have normal or above normal weight-for-height. The Chachi are also in the lower part of the distribution of body size among South American Indians. In terms of body composition, Chachi arm circumferences and triceps skinfolds are below the US 50th percentile. The estimated upper arm muscle area of Chachi males is below the US median, but Chachi females older than the age of 15 have arm muscle areas exceeding the US median. One reason for the greater arm muscle area of adult Chachi females may be that they perform much more physical activity involving the upper body than do US women. Problems in the interpretation of anthropometric indicators of nutritional status among South American Indian populations limit the conclusions about Chachi nutritional status that can be drawn from these results.

Effects of age misstatement on the utility of age-dependent anthropometric indicators of nutritional status in rural Bangladesh.

We report the effects of age error on use of weight-for-age and height-for-age for assessing and screening malnutrition, and for identifying factors of malnutrition in 679 children aged 22-59 months in Companiganj, in rural Bangladesh. Overreporting and random error in age and correlation of age error with each of the anthropometric indices are observed. As a result, the proportion of children having less than or equal to 60 per cent of median weight-for-age is overestimated by five percentage points and the proportion having less than 80 per cent of median height-for-age is overestimated by six points. Loss in sensitivity (proportion of malnourished children correctly identified) for the above cutoff points is 20 per cent for weight-for-age and 28 per cent for height-for-age, compared to the situation in the absence of age error. Although mother's education is not a significant determinant of weight-for-age and height-for-age, age error makes mother's education appear artifactually significant in the analysis of variance.

Homeostatic Mechanisms in the Utilization of Exogenous Iron in Children Recovering from Severe Malnutrition

We evaluated the role of initial iron stores on iron accumulation during recovery from severe edematous protein‐energy malnutrition in children. Twenty‐six preschool children were divided in two groups according to their initial iron reserves, as estimated from serum ferritin concentration, using a cutoff criterion of 30 ng/ml. The low ferritin (LF) group had a mean serum ferritin level of 12 ± 8 ng/dl, and the high ferritin (HF) group, 86 ± 32 ng/dl. Both groups had similar degrees of malnutrition and of anemia, as defined by hemoglobin concentration. All children received an adequate therapeutic diet and 60 mg iron daily as ferrous sulfate. The recovery of biochemical and anthropometric indicators of nutritional status, as well as of hemoglobin concentration, was similar in both groups. On the contrary, the LF group showed a marked increase in serum ferritin concentration from the onset of treatment, whereas the HF group had a net decline in this parameter by 30 days, and a stable level thereafter. The difference in serum ferritin concentration between groups was maintained until day 60, and both groups ended the study (90 days) with similar levels. Estimation of the utilization of exogenous iron from changes in total‐body iron during the first 60 days of recovery showed the LF group to retain an average of 9.3% of iron intake, whereas the HF group retained only 1.4%. These results confirm that similar degrees of anemia in severe malnutrition can be associated with markedly different iron reserves, and suggest that the homeostatic regulation of intestinal iron absorption by the storage iron pool may produce a lower utilization of oral iron supplements in malnourished children with high iron reserves at the onset of treatment.

Homeostatic mechanisms in the utilization of exogenous iron in children recovering from severe malnutrition.

We evaluated the role of initial iron stores on iron accumulation during recovery from severe edematous protein-energy malnutrition in children. Twenty-six preschool children were divided in two groups according to their initial iron reserves, as estimated from serum ferritin concentration, using a cutoff criterion of 30 ng/ml. The low ferritin (LF) group had a mean serum ferritin level of 12 +/- 8 ng/dl, and the high ferritin (HF) group, 86 +/- 32 ng/dl. Both groups had similar degrees of malnutrition and of anemia, as defined by hemoglobin concentration. All children received an adequate therapeutic diet and 60 mg iron daily as ferrous sulfate. The recovery of biochemical and anthropometric indicators of nutritional status, as well as of hemoglobin concentration, was similar in both groups. On the contrary, the LF group showed a marked increase in serum ferritin concentration from the onset of treatment, whereas the HF group had a net decline in this parameter by 30 days, and a stable level thereafter. The difference in serum ferritin concentration between groups was maintained until day 60, and both groups ended the study (90 days) with similar levels. Estimation of the utilization of exogenous iron from changes in total-body iron during the first 60 days of recovery showed the LF group to retain an average of 9.3% of iron intake, whereas the HF group retained only 1.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluación nutricional del paciente pediátrico hospitalizado

ABSTRACT A nutritional survey was conducted in order to establish the prevalence of malnutrion in patients from die medical and surgical wards. Data on anthropometric indicators of nutritional status were obtained on admission and at the time of the study. They included weight (WJ, height (H), arm circumference (AC) and triceps skinfold (TS). These values were expresed as % of the reference standard forage (A) (NCHS-USA). The study included 215 patients whose ages ranged from 2 months to 16 years, 58 were surgical and 157 medical patients; 113 were males and 102 females. On admission 25% were of normal W/A but at the time of the study only 19% were in this range. Sixty seven % of medical and 66% ot surgical patients had a W/A less than 90% and 29% had low H/A in both groups. The W/H was diminished in 42% of medical and in 15% ot'surgical patients whith a female predominance of low W/H A.C. was below normal in 65% of medical and in 43% of surgical patient; seventy three % of surgical patients presented T.S. below 90% of the standard. We analyzed the weight change of children under two years and related it to die lenght of hospitalization finding that 72% of patients were losing weight and the rest were gaining at rates below the expected for their ages. Based on this results we can conclude that there is a high prevalence of mar-asmic energy protein malnu­trition. The length of hospitalization relates to a deterioration ot nutritional status. Patients present predominantly signs of depletion ot the tat and muscle compartments

67 NUTRITIONAL STATUS OF PATIENTS IN A PEDIATRIC HOSPITAL. I ANTROPOMETRIC ASPECTS

A nutritional survey was conducted in order to establish the prevalence of malnutrition in patients from the medical and surgical wards. Data on anthropometric indicators of nutritional status were obtained on admission and at the time of the study. They included weight (W), Height (H), Arm Circumference (AC)and triceps skinfold (TS).These values were expresed as % of the re ference standard for age (A) (NCHS-USA). The study included 215 patients whose ages ranged from 2 months to 16 years, 58 were surgical and 157 medical patients; 113 were males and 102 females On admission 25% were of normal W/A butatthe time of the study only 19% were in this range. Sixty seven% of medical and 66% of surgical patients had a W/A less than 90% and 29% had low H/A in both groups.The W/H was diminished in 42% of medical and in 15% of surgical patients with a female predominance of low W/H. A.C. was below normal in 65% of medical and in 43% of surgical patient Seventy three% of medical and 71% of surgical patients presented T.S. below 90% of the standard.We analyzed the weight change of children under two years and related it to the lenght of hospitalization finding that 72% of patients were losing weight and the rest were gaining at rates below the expected for their ages. Based on this results we can conclude that there is a high prevalecence of marasmic energy protein malnutrition. The lengh of hospitalization relates to a deterioration of nutritional status. Patients present predominantly signs of depletion of the fat and muscle compartments.

Establishing guidelines for peer review of the clinical dietitian

Guidelines for peer review of clinical dietitians are needed. In this study, two areas relevant to such guidelines, i.e., data useful in assessing nutritional status of patients and written communications of the dietary staff with other health care staff, were explored. Admission height and weight and blood chemistries, as found on dietary cards for 119 randomly selected patients during 1973, were tabulated. In addition, pertinent information on dietary cards and in the medical records was compared. The findings indicated that the biochemical and anthropometric indicators of nutritional status were available in the medical records but were not being utilized by dietitians to the degree expected. The dietary card is the logical focus for peer review, but better documentation is needed in areas of dietary history recording, computation of ideal weights, utilization of laboratory data, and development of nutritional care plans.