Arm Fat Area Research Articles

Upper Arm Composition as an Indicator of Body Composition and Nutritional Status of Adolescent Boys Aged 10-18 Years

Introduction: The upper arm composition is usually assessed based on total upper arm area (TUA), upper arm muscle area (UMA), upper arm fat area (UFA) and arm fat index (AFI). It is closely associated with assessment of body composition and nutritional status. The present study aims to determine the age specific variations in upper arm composition and its usefulness in the assessment of body composition and nutritional status among adolescent boys.Materials and Methods: The study was conducted among 964 boys (aged 10 – 18 years) and belonging to the indigenous Rajbanshi population of West Bengal, India. The boys were selected from five different sub-urban government secondary schools located under Siliguri subdivision of Darjeeling district, West Bengal, India. The anthropometric measurements of height, weight, MUAC and TSF were recorded and upper arm composition was estimated based on TUA, UMA, UFA and AFI using standard procedures. The overall body composition was evaluated using body mass index (BMI).Results: There appears to be existence of significant age-specific variations in BMI, UMA and UFA as the boys approached higher ages. The age specific means of TUA, UMA and UFA increased with age. The adolescent boys were observed to be well below the 50th percentiles of the reference population in BMI, TUA, UMA, UFA and AFI. Age and sex-specific smooth percentile curves were derived for height, weight, TSF, BMI, UMA and UFA using the L, M and S modelling approach for further evaluation of body composition.Conclusion: The present study recommends the assessment of body composition and nutritional status to improve screening of nutritional status using upper arm composition, especially in community settings so as to accurately identify the risk of lower or greater adiposity and muscularity, and thereby proposing a major opportunity to improve health through proper intervention programmes.J Nepal Paediatr Soc 2015;35(2):152-161

Waist-to-height ratio, lean mass and fat mass in preschool children

Introduction: Abdominal fat and the proportion of lean body mass have both been independently considered as risk factors leading to insulin resistance and to an increased risk of developing chronic diseases later in life. Objective: To analyse the relationship between the waist-to-height ratio (WHtR) and other body composition indicators in children aged 2-6 years at public childcare centres. Methods: This study consisted of a random, probabilistic cluster sampling of 9 of the 59 existing childcare centres (Taubate-SP, Brazil), resulting in the evaluation of 950 preschool children. The body mass index z-score (zBMI) and internationally accepted cut-off points were used to evaluate their nutritional status. The z-score for the arm muscle area (zAMA) and arm fat area (zAFA) and the WHtR were used to evaluate their body composition. Analyses were performed using the parameters of central tendency, dispersion, proportions and correlations, adopting a significance level of 5%. Results: The data indicated a direct correlation between the WHtR and zBMI (r P = 0.78), zAMA (r P = 0.52), zAFA (r P = 0.66) and the percentage of AFA (r P =0.54), with p <0.0001. There was an inverse correlation between the WHtR and the percentage of AMA (r P = -0.54), with p <0.0001. Conclusion: In preschool children, as the WHtR increases, the amounts of both lean body mass and body fat mass also increase. However, an increase in the waist circumference is accompanied by a disproportionately greater increase in fat mass compared to lean mass, which could indicate an additional risk factor for future chronic diseases.

Physical performance and its association with anthropometric and body composition variables in the elderly.

The aging process leads to biological changes that affect the physical performance and nutritional status of older adults. The objective this study is to determine the association between physical performance and anthropometric and body composition variables in the elderly. This is a cross-sectional study. Were assessed: sex, age, handgrip strength (HGS), flexibility/mobility, balance, body mass index, waist and calf circumference, triceps skinfold thickness, arm fat area and arm muscle circumference. Multiple logistic regression was used (p<0.05). Overall, 420 elderly were evaluated. Malnourished individuals were more likely to show poor HGS. Elderly aged 70-79 years, 80 years or older and those malnourished were more likely to show poor balance. Older women were less likely to show poor flexibility/mobility. We conclude that lowercalf circumferencewas associatedwithworse performance inHGSand balance.The ageincreased the chanceof the elderlypresentinstability.The flexibility/mobilitydoesn't seem tobe influenced bychanges in body composition. Therefore, these resultsmay beimportantguidingspecific actionsto ensurehealthy aging.

Cardiovascular disease risk factor clustering among rural adult population in West Bengal, India

This study aimed to find out the prevalence of cardiovascular disease (CVD) risk factor clustering in a rural adult population of West Bengal, India. This cross-sectional study was carried out among 1007 participants (645 males and 362 females) aged ≥20 years in a rural community. All participants were grouped: Group I (20-39 years); Group II (40-59 years); Group III (≥60 years). Anthropometric measures were collected using standard techniques. Metabolic profiles and blood pressure were also measured. Mean of minimum waist circumference (MWC), waist-hip ratio (WHR), trunk-extremity ratio (TER), fat free mass (FFM), basal metabolic rate (BMR), intra-abdominal visceral fat (IVF) and arm muscle area (AMA) was found to be higher among males in comparison to females, whereas, the mean of body mass index (BMI), maximum hip circumference (MHC), waist-height ratio (WHtR), sum of four skinfolds (∑SF4), percentage of body fat (%BF), fat mass (FM), insulin, HOMA-IR and arm fat area (AFA) was higher in females. 37% of individuals (males 25% and females 49%) with high triglyceride (TG) also had low high density lipoprotein (HDL), whereas, 25% individuals (males 25% and females 24%) with overweight also had high fasting blood glucose (FBG). The prevalence of high systolic blood pressure (SBP) among individuals having high %BF was higher in the age groups of 40-59 years for both sexes. The study showed that prevalence of CVD risk factor clustering is high in the study population and warranted early intervention to safeguard the cardiovascular health of the nation.

Non-Invasive Bedside Estimation of Nutrition Accretion and Extracellular Water Volume in Preterm Neonates during the First Three Weeks of Life

Background: Evaluation of nutrients accretion and body water accumulation is critical but difficult in preterm neonates. There are minimal early postnatal anthropometry data available for this population. The newer sophisticated methods are too complex for routine use. Objective: To perform regional anthropometry and estimate extracellular water volume (ECW) in preterm infants during the first three weeks of life via Harpenden caliper application. Methods: Mid arm circumference ( MAC), arm fat area (AFA), arm muscle area (AMA), arm area (AA), arm water area (AWA) and extracellular water volume (ECW) were estimated in stable appropriate for gestational age preterm infants born consecutively during a designated study period with a Harpenden's caliper on days of life 10 and 21 under three weight groups: 500-1200 g, 1201 to 1800 g and 1801 to 2500 g. Students t and Kruskal - Wallis ranked tests and univariate regressions were performed for statistical analysis. Results: A total of 66 data were collected from 42 patients. All anthropometric variables increased transversely on days of life 10 and 21 among all weight groups, whereas, AWA/AA decreased. ECW decreased transversely between groups 1 and 3 on DOL 10 and 21. Highly significant and strong correlations were detected between body weight (BW) and AMA (0.88), BW and AFA (0.78), AFA and tricuspid skin fold thickness at 60 seconds of application (TSKF60 , 0.85), AMA and MAC (0.86) and AWA and tricuspid skin fold compressibility (∆TSKF, 0.56), yielding regression equations for dependent variables. Extrapolation of AFA and AMA regression lines predicted that fat and muscle tissues are not deposited in human fetus before 400 and 228.4 g of weight respectively. No side effects of the procedure were noted. Conclusion: The study presents the regression equations to calculate arm fat, lean body mass and water areas during early postnatal life in the extremely low birth weight and other preterm neonates via a simple bedside procedure, and documents their normative anthropometry reference data for ECW volume and caloric and lean body mass accretion. The extrapolated data reveal that fat and muscle tissues are not deposited in the human fetus before 400 g and 228.4 g of body weight.

Dietary patterns and maternal anthropometry in HIV-infected, pregnant Malawian women.

Diet is a modifiable factor that can contribute to the health of pregnant women. In a sample of 577 HIV-positive pregnant women who completed baseline interviews for the Breastfeeding, Antiretrovirals, and Nutrition Study in Lilongwe, Malawi, cluster analysis was used to derive dietary patterns. Multiple regression analysis was used to identify associations between the dietary patterns and mid-upper arm circumference (MUAC), arm muscle area (AMA), arm fat area (AFA), and hemoglobin at baseline. Three key dietary patterns were identified: animal-based, plant-based, and grain-based. Women with relatively greater wealth were more likely to consume the animal-based diet, which had the highest intake of energy, protein, and fat and was associated with higher hemoglobin levels compared to the other diets. Women with the lowest wealth were more likely to consume the grain-based diet with the lowest intake of energy, protein, fat, and iron and were more likely to have lower AFA than women on the animal-based and plant-based diets, but higher AMA compared to women on the animal-based diet. Pregnant, HIV-infected women in Malawi could benefit from nutritional support to ensure greater nutrient diversity during pregnancy, when women face increased nutrient demands to support fetal growth and development.

Arm anthropometry indices in Turkish children and adolescents: changes over a three-year period.

Objective: Time-related changes and comparisons for mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), arm fat area (AFA) are lacking for Turkish children and adolescents. To determine the arm anthropometry indices (MUAC, TSF, AFA) in children and adolescents and to also assess the changes in these indices over a 3-year time period.Methods: The data of the Anthropometry of Turkish Children Aged 0-6 Years (ATCA-06) study and the Second Study of Determination of the Anthropometric Measurements of Turkish Children and Adolescents (DAMTCA-II) were used to calculate the arm anthropometry percentiles in a total group of 6982 children and adolescents aged 28 days to 17 years. The 3rd-97th percentiles were computed by the LMS method. Results: In girls, 50th percentile MUAC values linearly increased with age. In boys, 50th percentile TSF values linearly increased until 10 years of age and decreased after age 11 years, while in girls, TSF values increased linearly with age. 50th percentile values for AFA showed a linear increase in both genders with age. Significant differences were found between the 5th, 50th and 95th percentile values for MUAC and AFA obtained in the two studies (DAMTCA-II and DAMTCA-I) in both boys and girls.Conclusions: The prominent finding was the significant and alarming increase in arm anthropometry indices in both genders within as short period of time as three years.

Apelin and nutritional status in children on dialysis

Background: We aimed to evaluate whether serum apelin could reflect the nutritional status of children on dialysis. Methods: Twelve patients on peritoneal dialysis (PD) and 20 patients on hemodialysis (HD) were enrolled. Patients received individualized diet for six months. Anthropometric and laboratory indices were measured at onset and the end of the study. Results: The anthropometric indices were all significantly lower in patients than in controls whereas similar in PD and HD patients. The protein catabolic rate (nPCR), height, mid-arm circumference (MAC), triceps skinfold thickness (TSF), arm muscle area (AMA) and arm fat area (AFA) z scores were significantly increased in dialysis patients after nutritional intervention. Weight z scores statistically increased in HD group whereas did not statistically change in PD group. Serum albumin levels were significantly improved in PD and HD patients. Apelin levels were similar in PD, HD and control groups. Post nutritional apelin values did not differ in each dialysis groups. On multivariate analysis, apelin was independently associated with age, weight, ESR and TG. Conclusions: Apelin seems to be not a useful indicator for monitoring the nutritional status in children on dialysis. However, the close link of apelin with inflammatory and lipid parameters suggested that apelin might be a novel target for slowing the atherogenic process in pediatric dialysis patients.

Los Indicadores Antropométricos del Brazo en los Niños Escolares del Perú

El objetivo del preseente estudio es conocer la situación nutricional en niños escolares, utilizando los indicadores antropométricos del brazo. Se estudiaron 1 625 niños de ambos sexos entre los 6 a 9 años de edad, dentro de la Evaluación del Estado Nutricional del Poblador Peruano (ENPPE), siendo una muestra representativa del Perú. Los indicadores son el Perímetro de Brazo (PB) y el Pliegue Celular Subcutáneo Tricipital (PCST) relacionados con la edad. Con ellos se halló el Área muscular (AM) y el Área Grasa (AG). Las medidas fueron tomadas siguiendo la metodología internacionalmente recomendada y se utilizó el patrón de Frisancho como referencia. Alrededor del 44% de niños tiene un PB debajo del 10p; el 23% tiene un PCST similar. En ambos indicadores, la prevalencia de niños por encima del 90p no excede del 3%. Para el AG, el 32,6% de niñas y el 25,9% de niños están por debajo del 10p. Con el AM la mayor prevalencia es en varones (32,3%; mujeres 27,7%). La prevalencia por encima del 90p no excede del 2%. Los promedios de PB y PCST según edades, se ubican entre el 10-25p y alrededor del 25p, respectivamente, del patrón de referencia. Para el diagnóstico de obesidad, se observa que el 16,3 y el 3,2% de niños se encuentra por encima del 85p de IMC y de PCST, respectivamente. Sólo el 1,8% de niños se encuentra por encima del 85p para ambos indicadores. PB, PCST, AM y AG son indicadores nutricionales de reserva, lo que indica que existe un fuerte detrimento de masa magra y grasa en una gran cantidad de niños. El PCST muestra prácticamente ausencia de obesidad.

Intensive nutritional support improves the nutritional status and body composition in severely malnourished children with cerebral palsy.

To demonstrate that a nutritional support intervention, via naso-enteral tube-feeding or gastrostomy, has a significant impact on the nutritional status and body composition in severely malnourished children with cerebral palsy spastic quadriplegia. Thirteen patients with moderate/severe malnutrition and cerebral palsy spastic quadriplegia who were fed via naso-enteral tube-feeding or gastrostomy were included in a cohort study. Anthropometric measurements and estimated body composition by bioelectric impedance analysis were obtained. ANOVA and Wilcoxon tests were used. During the four weeks of nutritional recovery, an average weight increase of 2700 g was achieved. There were significant increases in anthropometric indicators, including BMI and weight/length (p < 0.01). The increase in arm fat area was significantly higher than the increase in arm muscle area (104.5 vs 17.5%). Intensive nutritional support for four weeks had a significant effect on the nutritional status and body composition of severe and moderately malnourished children with cerebral palsy spastic quadriplegia.

Upper arm composition and nutritional status of school children and adolescents in Abeokuta, Southwest Nigeria

Upper arm composition is a reflection of body protein and calorie reserves. However, there is a paucity of data on upper arm composition of children from African countries, including Nigeria. This study aimed to determine the composition of upper arm and nutritional status of school children in Abeokuta, Nigeria and to compare with international reference standards. The sensitivity and specificity of upper arm muscle area by height (UAMAH) as a nutritional assessment tool was also determined. Five hundred and seventy children aged 5 to 19 years were selected from seven schools using multistage random sampling. Weight, height, mid-upper arm circumference (MUAC) and triceps skin fold thickness (TSF) were measured. Body mass index, upper arm muscle area (UAMA), upper arm fat area (UAFA), fat percentage and UAMAH were derived. The TSF, UAFA and fat percentage were significantly higher in females than males at each age group. MUAC and UAMA were significantly higher in female children aged 10-14 years, whereas UAMA was significantly higher in male children aged 15-19 years. UAMA and UAFA of the children were lower than those of Americans but similar to those of Zimbabweans, and higher than those of Indians. The sensitivity and specificity of UAMAH for detecting wasting were 80.8% and 63.9%, respectively, whereas the corresponding values for stunting were 32.2% and 58.2%, respectively. The school children studied have a combination of poor calorie and protein reserve. UAMAH may be a valuable tool for complete evaluation of the nutritional status of school children.

Association of television viewing time with central obesity status in rural Asian Indian Women: Santiniketan women study

The present community based cross-sectional study aimed to investigate anthropometric and body composition measures, and blood pressure characteristics by TV viewing times in rural women of Asian Indian Origin. A total of 343 apparently healthy rural Asian Indian women living in and around Santiniketan, West Bengal, India and aged between 25 and 65 years took part in the study. Anthropometric measures namely body mass index (BMI), percentages of body fat (PBF), basal metabolic rate (BMR), and intra-abdominal visceral fat (IVF) were measured using an Omron body fat analyzer. Fat mass (FM), fat free mass (FFM), arm muscle area (AMA), arm fat area (AFA), and arm muscle circumference (AMC) were calculated using standard techniques. Each individual was also asked how many minutes/day they spend watching TV. Comparison of central obesity status (CNO = waist circumference < 80 cm and CO = waist circumference ≥ 80 cm) by TV viewing times (categories) revealed a significant difference [χ(3)2 14.29] for central obesity status across the groups. Increased leisure-time activity was associated with central obesity status and warrant early intervention to prevent increasing incidences of cardiovascular disease in this population.

Nutritional evaluation of adolescent students from Extremadura based on anthropometric measurements

Nutrition is one of the pillars for proper body development and optimal nutritional status. Anthropometric methods are most commonly used for body composition analysis and are an essential part in the assessment of the nutritional status of individuals and population groups. This study aims to assess the nutritional status of adolescents from Extremadura (Spain); to determine variations in body composition according to the percentiles obtained; and to propose these values as a reference to the nutritional status of the adolescent population in Extremadura. A cross sectional study in the community of Extremadura was performed, including a total of 816 students of Secondary School Education of both sexes; and of all ages in the adolescence stage. The selected secondary schools belonged to populations of different sizes (less than 5,000 to more than 60,000 inhabitants). From the measurements taken, different anthropometric indices were determined and the percentiles 3, 10, 25, 50, 75, 90, 95 and 97 for weight, height and complexion were found. There were significant gender differences for height, weight, triceps skinfold, arm muscle area and arm fat area. Boys showed greater figures for height, weight and arm muscle area; however, the triceps skinfold and arm fat area was higher in girls. When compared to other national studies, the average height of our population was lower by about 3 cm in both sexes; the average weight was similar, but our adolescents had a higher proportion of fat in the arm. Extremadura girls seem to have a faster growth, reaching final height at an earlier age than the national average, although this height is below average. The boys had a continuous growth in all ages, maintaining national averages.

Effect of a dietary intervention on growth and energy expenditure in children with cystic fibrosis

BackgroundThe study aim was to determine the effect of a dietary intervention on growth, body composition and resting energy expenditure (REE) in children with cystic fibrosis (CF) and pancreatic insufficiency (PI) in a randomized, double blind, placebo-controlled trial. MethodsSubjects (5 to 17yrs) participated in a 12-month trial of the organized lipid matrix LYM-X-SORB™ (LXS) vs. placebo dietary supplements with similar calories, total fat and fatty acids. Dietary intake was assessed using 3-day weighed food records. Height (HAZ), weight (WAZ), BMI (BMIZ), mid-upper arm muscle (UAMAZ) and fat area (UAFAZ) Z-scores were calculated. Fat mass (FM) and fat-free mass (FFM) were obtained by whole body DXA. REE (kcal/d) was evaluated by indirect calorimetry at baseline, 3 and 12months and %REE calculated using Schofield equations. No growth or REE differences were observed between LXS and placebo groups so data were pooled for analysis. Results63 children (57% males, age 10.6±2.9yr, 43% receiving LXS) completed REE measurements. Caloric intake increased from a median of 2502 [1478, 4909] to 2616 [1660, 4125] kcal/d at 12months. HAZ, WAZ and UAMAZ increased (p<0.05) over 12months. Mean REE was 109±8% predicted at baseline and 107±9% at 12months (p<0.05). REE (kcal/d) adjusted for FFM and FM decreased over 12months ([mean±SE] −31±12kcals, p<0.01), significant only in males (−49±16kcals, p<0.01). ConclusionsOver a 12month nutrition intervention with either LXS or placebo, the growth status, muscle stores and REE improved. Sustained increased energy intake improved energy metabolism, growth and nutritional status in school age children with CF, PI and mild lung disease.

Body composition of preschool children and relation to birth weight.

to evaluate the relationship between body composition of preschool children suffering from excess weight and birth weight (BW). probabilistic sample, by conglomerates, with 17 daycare centers (of a total of 59) composing a final sample of 479 children. We used Z-score of Body Mass Index (zBMI) ≥ +1 and ≥ +2, respectively, to identify preschool children with risk of overweight and excess weight (overweight or obesity). The arm muscle area (AMA) and the arm fat area (AFA) were estimated from measurements of arm circumference, triceps skin fold thickness. the prevalence of risk of overweight was 22.9% (n=110) and excess weight was 9.3% (n=44). The risk of overweight and excess weight in children did not show correlation between BW and AFA, but it did with adjusted arm muscle area (AMAa) (rp= 0.21; p= 0.0107). The analysis of the group with excess weight alone also showed a positive correlation between BW and AMAa (rp= 0.42; p= 0.0047). among overweight children, lower BW is associated with a lower arm muscle area in early preschool age, regardless of the fat arm area presented by them.

Body composition analysis on elderly living in nursing homes

Body composition is a good indicator of an individual’s health and physical status. In addition to total body fat, fat distribution is a major risk factor for cardiovascular diseases and insulin resistance/diabetes in elderly. There are a limited number of studies focused on the body composition of elderly populations in Turkey.The primary objective of this study is to evaluate body composition in the Turkish elderly living in nursing homes.The sample included a total of 164 adults (91 females and 73 males), aged 65 years and over, living in Ankara nursing homes. According to the standard anthropometric protocols weight, height, skinfold thicknesses, and arm circumference were taken, and the body mass index (BMI), fat mass, fat free mass and arm fat area were calculated. The study results showed that males were significantly heavier and taller, whereas BMI were higher in females. The comparison of arm fat area between sexes showed that females have significantly (p&lt;0.001) greater values. Total body fat (kg) was higher in females and decreases with age for both sexes, where this decline is greater in elderly females.In conclusion, the body composition of elderly can provide information on the general health status, and support clinicians to understand more in their treatment progress.

Vitamin D Status among Pulmonary TB Patients and Non-TB Controls: A Cross-Sectional Study from Mwanza, Tanzania

BackgroundLittle is known about vitamin D status in low-income populations burdened with infectious diseases. Hence, there is a need for data on correlates of serum 25-hydroxy vitamin D (S-25(OH)D) and its validity during infections.ObjectiveTo assess the role of pulmonary TB (PTB) and HIV as correlates of S-25(OH)D.DesignAge-sex-matched cross-sectional study among PTB patients and non-TB controls.MethodsPTB patients were categorized as sputum negative (PTB−) and positive (PTB+) by culture. Non-TB controls were randomly selected among age-sex-matched neighbours to PTB+ patients. Height, weight, arm circumference and triceps skinfold were measured, and body mass index (BMI), arm fat (AFA) and muscle area (AMA) computed. HIV status, and S-25(OH)D, C-reactive protein (S-CRP) and α1-acid glycoprotein (S-AGP) were determined. Linear regression analysis with controls and PTB patients combined was used to identify correlates of S-25(OH)D.ResultsS-25(OH)D data were available on 97.8% (1570) of 1605 participants. Mean (SD) S-25(OH)D was 84.4 (25.6) nmol/L with 39.6% <75 nmol/L among 347 non-TB controls. Time of recruitment, sex, PTB and HIV, and elevated S-AGP were correlates of S-25(OH)D. S-25(OH)D was 24.8 (95% CI 18.6;30.9) nmol/L higher in PTB compared to controls among females, but only 9.8 (95% CI:4.5;15.2) nmol/L among males (interaction p<0.0001). Females had 13.8 (95% CI:8.2;21.9) nmol/L lower S-25(OH)D than males, and HIV infected individuals had 8.5 (95% CI:4.9;12.1) higher S-25(OH)D compared to uninfected. Elevated S-AGP was a positive correlate of S-25(OH)D. Low BMI was associated with S-25(OH)D, but not with infections or S-AGP in the model.ConclusionWhile S-25(OH)D may decline transiently during a mild acute phase response, it may increase if the acute phase response leads to loss of fat. The validity of S-25(OH)D as a marker of vitamin D status may be affected by infections.

Chronic undernutrition and traditional weaning foods are associated with fat stores in ariaal infants of Northern Kenya

The high proportion of human infant fat is hypothesized to protect infant brains by mobilizing against growth disturbances caused by acute nutritional and pathogen stress during weaning. However, individuals who experience chronic nutritional stress have been shown to store fat rather than mobilize fat stores, although this has not been demonstrated during infancy. This study investigated the relationship between fat development, diet, and nutritional status among 239 breastfeeding Ariaal infants, a group of settled pastoralists who experience both acute and chronic nutritional stress residing in Marsabit District, Kenya. This study had three goals: 1) To investigate the pattern of fat accumulation among Ariaal infants compared with a reference population; 2) to explore the relationship between chronic nutritional stress and fat deposits; and 3) to determine the relationship between traditional weaning foods, particularly cow's milk, and infant's fat. Infants, particularly infants experiencing chronic nutritional stress, were found to accumulate fat deposits in a manner that suggests reduced oxidation of fat stores. Infant upper arm fat area significantly increases with age over the weaning period compared with reference populations, who show a decline in body fat. Chronically undernourished infants were particularly likely to have increased levels of upper arm fat compared with normal infants or acutely undernourished infants. In addition, infants who consume cow's milk are significantly fatter than those that do not. These results suggest that Ariaal infants have both physiological and cultural mechanisms for fat storage in the face of their nutritionally stressed environment.

Nutritional status and dietary intake of children with acute leukaemia during induction or consolidation chemotherapy

The assessment of nutritional status among paediatric patients is important for the planning and execution of nutritional strategies that strive to optimise the quality of life and growth among sick children. The present study aimed to evaluate the nutritional status and dietary intake among children with acute leukaemia. This cross-sectional study included 53 paediatric patients aged 3-12years old, who were diagnosed with either acute lymphoblastic leukaemia or acute myelogenous leukaemia and were undergoing chemotherapy treatments (induction or consolidation phase). Patients were matched for sex, age (±6months) and ethnicity with healthy children as controls. Weight, height, body mass index, waist circumference, mid-upper arm circumference, triceps skinfold thickness, mid-upper arm muscle area and fat area were determined. Dietary intake was assessed using 3-day food records. Anthropometric variables were generally higher among patients compared to controls, although the differences were not statistically significant (P>0.05). The prevalence of overnutrition among patients according to body mass index-for-age, waist circumference-for-age, mid-upper arm circumference-for-age and triceps skinfold-for-age were 24.5%, 29.1%, 17.0% and 30.2%, respectively. Mean energy [5732±1958kJ (1370±468kcal) versus 6945±1970kJ (1660±471kcal), P<0.01], protein (50.0±19.7g versus 62.3±22.3g, P<0.01) and fat (43.6±18.9g versus 58.3±16.7, P<0.001) intakes of patients were significantly lower than controls. The prevalence of being overweight and obesity in children with acute leukaemia was higher despite lower energy intake compared to controls. Studies assessing physical activity, the complex interaction and the effects of treatment drugs are warranted to better manage malnutrition among paediatric patients.

Relationship of Body Mass Index and Arm Anthropometry to Outcomes after Pediatric Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancies

Although nutritional status may adversely affect various health outcomes, the relationship between anthropometry and outcomes after hematopoietic cell transplantation (HCT) has not been fully studied in children. We analyzed the impact of pre-HCT body mass index (BMI), arm muscle area, and arm fat area on outcomes in 733 patients age 2-18 years who underwent allogeneic HCT for a hematologic malignancy between 1985 and 2009. We evaluated these 3 variables according to patient group based on age- and sex-adjusted percentiles for BMI, arm muscle area (<5th, 5th-24th, 25th-94th, and ≥95th), and arm fat area (<25th, 25th-94th, and ≥95th). Cox proportional hazards regression models for event-free survival (EFS), relapse, and nonrelapse mortality (NRM) at 100 days and 3 years after HCT, as well as grade II-IV acute graft-versus-host disease (GVHD) and chronic GVHD, were performed using the 3 major variables and adjusted for covariates. BMI was <5th percentile in only 3% of patients and ≥95th percentile in 15% of patients, but outcomes for both groups were similar to those for the BMI 25th-94th percentile group. The BMI 5th-24th percentile group had lower EFS (P = .01) and higher relapse (P = .003) at day +100 post-HCT, but these associations did not hold at 3 years post-HCT. Arm muscle area was <5th percentile in 8% of patients, and arm fat area was <25th percentile in 10%. Analysis of arm muscle area showed that the <5th percentile group had lower EFS and higher NRM and relapse rate at day +100 (P = .002, .04, and .01, respectively) and 3 years (P = .0004, .008, and .01, respectively) post-HCT. Arm fat area <25th percentile was associated with lower EFS at day +100 (hazard ratio, 1.5; P = .05), but not at 3 years post-HCT. Anthropometry variables were not associated with acute or chronic GVHD. In conclusion, arm muscle area <5th percentile appears to be a stronger predictor than BMI of poor outcomes after HCT in children with hematologic malignancies.