Mid-arm Circumference Measurements Research Articles

Improving Pediatric Hypertension Screening in an Academic Primary Care Setting.

Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.

MO907ASSOCIATION OF ADIPOSITY AND SARCOPENIA WITH CARDIAC VALVE CALCIFICATION IN PATIENTS ON MAINTENANCE HEMODIALYSIS. A CROSS-SECTIONAL STUDY

Abstract Background and Aims Cardiac valve calcification (CVC) is a common disorder in patients with end stage kidney disease (ESKD) and is a predictor of cardiovascular disease and all-cause mortality. Several risk factors are related to CVC in patients with ESKD which include higher age, dyslipidemia, hypertension and diabetes as well as inflammation, bone mineral disease and malnutrition. Moreover, visceral adiposity is associated with disturbed lipid metabolism and proinflammatory activity which could predispose for CVC. Furthermore, sarcopenia and dynapenia is a state common in patients with ESKD. Thus, the aim of this cross-sectional study is to investigate the relationship of adiposity, components of sarcopenia and malnutrition with cardiac valves calcification in patients on chronic hemodialysis. Method Adult patients that were on maintenance hemodialysis were eligible for entering the study. Recruitment took place from March 2019 to September 2020. Exclusion criteria included, patients with less than 6 months on hemodialysis, patients with cancer, inflammatory bowel disease, severe infection, cardiac valve disease prior to dialysis initiation, history of parathyroidectomy and intravenous albumin administration 3 months prior to nutritional assessment. Calcification of heart valves and systolic and diastolic function was assessed by using two-dimensional echocardiography. Nutritional assessment was made using the Geriatric Nutritional Risk Index. Conicity Index, Waist to Height Ratio, the Visceral Adiposity Index, the Lipid Accumulation Product, the Height to Waist Phenotype were also calculated. Waist, calf and mid arm circumference measurement was performed in the end of a midweek dialysis session. Muscle strength was based on a measurement of hand grip strength using a hydraulic hand dynamometer in the non-fistula hand prior to dialysis session. Dynapenia was considered for values < 16 kg in females and < 27kg in males. Serum biochemistry parameters such as total protein, albumin, calcium, phosphate, total cholesterol, triglycerides, HDL, LDL, CRP and iPTH were also measured. Results Overall, 130 patients were included in the study with a mean age of 66±12.47 years (68.5% males) and an average dialysis duration of 4.37±4.95 years. No cardiac valve calcification was found in 34.6%, while both aortic and mitral valve calcification was found in 41.5% of patients. Calcification only of the aortic (AVC) or mitral (MVC) valve was found in 14.6% and 9.2% respectively. Compared to non AVC group, AVC group had significantly higher age, higher prevalence of diastolic dysfunction, CRP values and CRP/albumin ratio and lower albumin to total proteins ratio. Patients with MVC showed significantly higher prevalence of diastolic dysfunction, higher levels of iPTH, CRP/albumin ratio and lower albumin to total proteins ratio. Adiposity, nutritional, anthropometric indices and sarcopenia parameters such as creatinine index, muscle power and physical performance status did not show any difference between all CVC groups. Increased age [OR (95%CI):1.06 (1.00-1.12) p=0.05], diastolic dysfunction [OR (95%CI): 3.07 (1.05-8.92); p=0.04], CRP/albumin ratio were associated with increased risk of AVC, whereas the CRP/albumin ratio appeared as the most powerful risk factor for mitral and for any CVC [OR (95%CI): 3.41 (1.40-8.28); p=0.007, OR (95%CI): 7.98 (2.62-24.98) p<0.001, respectively]. ROC analysis indicated that increased values of CRP/albumin ratio are strong positive predictors of AVC [AUC, 95%CI 0.66 (0.56-0.75) p=0.002], MVC [AUC, 95%CI 0.642 (0.545-0.74) p=0.005] and calcification of any valve [AUC, 95%CI 0.71 (0.615-0.806) p<0.001]. Conclusion Adiposity, nutritional, anthropometric indices and sarcopenia did not show to correlate with CVC in patients with ESKD on hemodialysis. Factors, such as diastolic dysfunction and notably increased CRP/albumin ratio were strong predictors of CVC.

The use of mid-arm circumference for the estimation of adult body weight: A post mortem computed tomography approach

• The study translates a pre-hospital method for estimating an adult's body weight from the mid upper arm circumference to post mortem computed tomography. • The method showed a strong relationship between mid-arm circumference and post mortem body weight. • The mid-arm circumference measurement method using post mortem computed tomography yielded excellent intra- and inter-observer reliability. • The quick, easy and cost-effective post mortem computed tomography technique to estimate adult body weight may be useful if weighing equipment is unavailable or the body is incomplete. Cadaver body weight (BW) is to be documented, where possible, in all forensic autopsy examinations. However, it may not always be possible to ascertain an accurate BW if, for example, functioning weighing equipment is unavailable or the body is incomplete. This research aimed to translate an adult clinical prehospital method which uses a mid-arm circumference (MAC) measurement to estimate BW to establish a post mortem computed tomography (PMCT) technique for adult cadaver BW estimation. The clinical method was adapted for PMCT bone and soft tissue methods. Right and left MAC measurements were obtained by four independent observers from sixty-six (45 males and 21 females) consented research adult PMCT scans using the Osirix DICOM viewer. All observers rated MAC quality score on each arm from 0 (very poor) to 3 (good). In the final group of fifty-five with MAC quality score ≥ 1, MAC measurements correlated well with actual BW ( r =0.87) and yielded excellent intra- and inter-observer reliability. There were no statistical differences between the two MAC methods, sexes or side of arm. Mean estimated BW by previous study Equation, BW=(4×MAC)-50, was 0.47 kg greater than mean actual BW with limits of agreement of 12.7 kg; this would be reduced to 9.2 kg if an outlier were excluded. The study identifies a quick and easy PMCT technique to estimate adult BW using PMCT. However, the result remains only an estimation and caution should be expressed if a result is applied to medico-legal cases.

Identification of an anthropometric surrogate to low birth weight in newborns: a hospital based cross sectional study

Background: Low birth weight babies have less chances of survival during first year of life.Appropriate and timely care of a newborn especially if he is born with low birth weight is important but this is difficult in developing countries. There is a need to develop simple, inexpensive and practical methods to identify low birth weight newborns soon after birth.Methods: A hospital based Cross sectional study was carried out on 965 live born neonates who were born during one year period. All the anthropometric measurements are taken within 24 hours of birth. Pearson’s correlation was done to assess correlation of various anthropometric parameters with birth weight.Results: Out of 965 live born neonates, 510 (52.8%) were male babies and 455 (47.2%) were female babies. 289 (29.9%) babies had birth weight less than 2500 gms. The highest correlation among all measurements was observed between birth weight and mid arm circumference while the least correlation was between birth weight and crown heel length. AUC value for ROC curves is highest for Mid arm circumference (0.917) which shows that it is a better surrogate predictor of low birth weight (<2500 gms) in our study as compared to other anthropometric parameters.Conclusions: Measurement of mid arm circumference is easier, convenient and statistically superior to other anthropometrical parameters in detection of low birth weight newborn babies.

Development and validation of a method to estimate body weight in critically ill children using length and mid-arm circumference measurements: The PAWPER XL-MAC system.

Erroneous weight estimation during the management of emergency presentations in children may contribute to patient harm and poor outcomes. The PAWPER (Paediatric Advanced Weight Prediction in the Emergency Room) XL tape is an accurate length-based, habitus-modified weight estimation device, but is vulnerable to errors if subjective visual assessments of children's body habitus are incorrect or erratic. Mid-arm circumference (MAC) has previously been used as a surrogate indicator of habitus, and the objective of this study was to determine whether MAC cut-off values could be used to predict habitus scores (HSs) to create an objective and standardised weight estimation methodology, the PAWPER XL-MAC method. The PAWPER XL-MAC model was developed by creating MAC ranges for each HS in each weight segment of the tape. This model was validated against two samples, the National Health and Nutrition Examination Survey datasets and data from two previous PAWPER tape studies. The primary outcome measure was to achieve >70% of estimations within 10% of measured weight (PW10 >70%) and >95% within 20% of measured weight (PW20 >95%) for children aged 0 - 18 years. The PAWPER XL-MAC model achieved very high accuracy in the three validation datasets (PW10 79.2%, 79.0% and 81.9%) and a very low critical error rate (PW20 98.5%, 96.0% and 98.0%). This accuracy was maintained across all ages and in all habitus types, except for the severely obese. The PAWPER XL-MAC model proved to be a very accurate, fully objective, standardised system in this study. It has the potential to be accurate across a wide variety of populations, even when used by those not experienced in visual assessment of habitus.

O30. Diet and preeclampsia: A prospective multicentre unmatched case control study in Ethiopia

Background Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20–80% of maternal mortality in developing countries, including Ethiopia. For many years diet have been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results across studies, and this has not been studied in Ethiopia Objectives The objective of this study was to determine the effect of dietary habits on the incidence of preeclampsia Bahir Dar, Ethiopia Methods A prospective multicentre unmatched case- control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City Administration. Interviewer administered face to face interview, measurement of mid-arm circumference (MUAC) and document review were conducted using a standardized and pretested questionnaire. Data entry and cleaning was done by Epi.info version 3.5.3.The data were transported to SPSS version 20 for analysis. Both bivariate and multivariate logistic regression analyses were applied. Backward stepwise unconditional logistic regression analysis was employed to determine the putative association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P -value 0.05 was considered to declare statistically significant throughout the study. Result For every 1-cm increase of MUAC, there was an increase in the incidence rate of preeclampsia by a factor of 1.35 ( AOR = 1.35, 95%CI:1.21, 1.51). A higher incidence of preeclampsia was found in women who reported to have consumed coffee daily during pregnancy ( AOR = 1.78, 95%CI: 1.20, 3.05). Similarly for women who had anemia during the first trimester the incidence of preeclampsia 2.5 times higher than their counterparts ( AOR = 2.47, 95%CI: 1.12,7.61). This study also revealed consumption of fruit or vegetables at least three times a week during pregnancy to be protective against preeclampsia ( AOR = 0.51, 95%CI: 0.29, 0.91; AOR = 0.46, 95%CI: 0.24, 0.90, respectively). In addition compliance with IFA during pregnancy has shown a significant independent effect on the prevention of preeclampsia in this study ( AOR = 0.16, 95%CI: 0.08, 0.29) Conclusion and recommendation Adequate vegetable and fruit consumption and compliance to folate intake during pregnancy are independent protective factors of preeclampsia. On the other hand, higher mid upper arm circumference, anemia and daily coffee intake during pregnancy are risk factors for the development of preeclampsia. Audience specific education and promotion for the use of the protective factors identified in this study should be strengthened. The risk factors identified can be used for prediction and early diagnoses of preeclampsia allowing timely interventions to be performed to minimize deaths associated with severe preeclampsia/eclampsia.

Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study

Introduction: Preeclampsia is one of the most commonly encountered hypertensive disorders of pregnancy that accounts for 20% - 80% of maternal mortality in developing countries, including Ethiopia. For many years diet has been suggested to play a role in preeclampsia. However, the hypotheses have been diverse and often revealed inconsistent results across studies. Moreover, rarely were these hypotheses studied in Ethiopia. Therefore, this study aimed to explore whether the incidence of preeclampsia was related to nutrient or micronutrient deficiencies. Objectives: To describe the effect of nutrition and dietary habits on the incidence of preeclampsia. Methods: A facility based unmatched case-control study was conducted among 453 (151 cases and 302 controls) pregnant women attending antepartum or intrapartum care in public health facilities of Bahir Dar City Administration. Case-control incidence density sampling followed by interviewer administered face to face interview, measurement of mid-arm circumference (MUAC) and document review were conducted using a standardized and pretested questionnaire. Data entry and cleaning was done by Epi Info Version 3.5.3. The data were transported to SPSS Version 20 for analysis. Both bivariate and multivariate logistic regression analyses were applied. Backward stepwise unconditional logistic regression analysis was employed to determine the putative association of predictive variables with the outcome variable and to control for the effect of confounding variables. A P-value ≤ 0.05 was considered statistically significant at 95% confidence level throughout the study. Result: Those women having a MUAC value ≥ 25.6 cm were two times more likely than their counterparts to have preeclampsia (AOR = 2.49, 95% CI = 1.58, 3.94). Strikingly, higher odds of preeclampsia were found in women who reported to have taken coffee during pregnancy (AOR = 2.16, 95% CI = 1.32, 3.53). Similarly, those women who had anemia during the first trimester pregnancy were three times more likely than their counterparts to have incidence of preeclampsia (AOR = 2.80, 95% CI = 1.09, 7.21). The result in this study also revealed that taking fruit or vegetables during pregnancy was found to be protective of preeclampsia (AOR = 0.37, 95% CI = 0.19, 0.73, AOR = 0.45, 95% CI = 0.22, 0.91) respectively. In addition, folate intake during pregnancy has shown a significant independent effect on the prevention of preeclampsia in this study (AOR = 0.19, 95% CI = 0.10, 0.37). Conclusion and Recommendation: Vegetable and fruit consumption and folate intake during pregnancy are independent protective factors of preeclampsia. On the other hand, higher mid upper arm circumference, anemia and coffee intake during pregnancy are risk factors for the development of preeclampsia.

A study on relevance of mid arm circumference measurement among 13-60 months of children at urban field practice area of Alluri Sita Ramaraju Academy of Medical Sciences, Eluru

Background: Protein energy malnutrition commonly seen in 2 to 5 years of age group in developing countries like in India. This could be due to lack of awareness about nutritive value of foods, faulty feeding practices, ignorance plays a major role in the development of Protein malnutrition in early ages of life. This leads to hampering of physical and mental development of the child. Objectives of current study were: 1) To know the prevalence of protein energy malnutrition among 13-60 months of children. 2) To determine relevance of mid arm circumference measurement with WHO standards. 3) To study the demographic variables associated with Protein energy malnutrition. Methods: The present community based cross sectional study was conducted at urban area of Eluru during the period from Sep 2013 to December 2013. A total of 133 individuals were selected from the field practice area of Alluri Sita Ramaraju academy of medical sciences, Eluru. Results were analyzed and necessary statistical tests like proportions and chi square tests were applied. Results: Out of 133 individuals, the prevalence of severe malnutrition among 13-60 months children was 7.5%; prevalence of mild to moderate malnutrition was 24%. Among the severe malnutrition individuals, 60% from labourer occupation. Classification of mid arm circumference of 2-5 years children compared with World Health Organization weight standards, 87.9% were shown as normal and 70% matching of results with severe malnutrition individuals. Conclusion: Based on the above study results, need to give the training to gross root level workers regarding the measurement of arm circumference of children between the age group of 13-60 months children. Still we can consider mid arm circumference is one of the best tool for consideration of protein energy malnutrition detection at the basic level health point and this is cheap, easy and to be detected at early stage of life.

Nutrition Status of Elderly Female Patients in Long-term Care Hospital according to Meal Types and Eating Ability

Objectives: This study was carried out to determine nutritional status of elderly patients in a long-term care hospital according to meal type and eating ability. Methods: Subjects were 47 female patients aged over 65 (79.3 ± 7.1 years) who resided in a long-term care hospital in Seoul. Thirty seven patients who ate diet orally were grouped according to meal type (27 general diet and 10 soft diet) and eating ability (26 eating by oneself and 11 eaten with help) and 10 were on tube feeding. Nutritional status was determined by food consumption and mid-arm circumference. Results: The mean adequacy ratios (MARs) of 12 nutrients (protein, calcium, phosphorus, zinc, vitamin A, vitamin B , vitamin B , vitamin B , niacin, folic acid, vitamin C) were 0.687 for general diet, 0.565 for soft diet, 0.680 for eating by oneself and 0.677 for eaten with help, which were significantly lower than 0.982 for tube feeding (p < 0.05 or p < 0.01). The patients on tube feeding had significantly lower % arm circumference compared to those who ate general diet (84.0% vs. 95.4%, respectively, p < 0.05). Nutrients intakes, nutrient adequacy ratio (NAR) and index of nutritional quality (INQ) were not different between meal types as well as eating ability. The most insufficiently consumed nutrients by the patients on diet were folic acid, vitamin B , and calcium (NAR 0.334~0.453, 0.515~ 0.539, and 0.516~0.533, respectively). Conclusions: The results suggested that regardless of meal type or eating ability, the subjects who were on diets in this study might have inadequate intake of folic acid as well as vitamin B , and calcium, which need to be reflected on menu planning. The measurement of mid-arm circumference presented more risk of malnutrition of patients on tube feeding than those on diets, despite apparently better nutrient consumption.

Detection of Malnutrition in Older Infants by Measurement of Mid arm Circumference

Introduction- Mid-arm circumference (MAC) has been widely used as an age-independent indicator of undernutrition at 1-5 years of age. Its role below one year of age has no t been extensively studied. Growth faltering which predicts protein-energy malnutrition ( PEM ) usually begins between ages 6 and 12 month. This study aimed to determine the age-independent character of MAC within 7-11 month age group and search for a reliable cut off point. Methods- This institutional based, cross-sectional, observational study was done at th ree government hospitals including a teaching terti ary level hospital. Study variables were age, sex, height, body weight & mid arm circumference. Mid arm circumference was validated against weight for age percentage and Standard deviation score. Results- Mean MAC of the infants increased very little with age from 7- 11months. The cut off points from 13.0 to 12.5 cm s howed maximum diagnostic accuracy. Conclusions- MAC measurement is a simple and valid tool for detection of early P EM in this crucial age bracket However, further stu dies are suggested, preferably community based and in a larger sample t o establish the validity of MAC to detect PEM in in fants.

The economic divide in outcome following severe head injury

Background:Socioeconomic status is an important determinant of the standard of living and health status of people.Objectives:To assess the influence of economic status on the outcome following severe head injury.Materials and Methods:Adult patients of severe head injury, whose guardians' volunteered information on family income, were enrolled for the study. The family per capita income was then calculated. They were studied prospectively in relation to various factors and followed-up.Results:Among 99 patients, monthly per capita income of Rs. <500, 500-1000, 1000-2000, and >2000 were noted in 20, 43, 22, and 14 patients, respectively. The credibility of information on income was confirmed by positive correlation with patients' mid arm circumference measurements (P<0.001). They were divided into two groups (family monthly per capita income ≤Rs.1000 and >Rs.1000). The comparability of both groups based on age, Glasgow Coma Scale, systemic injury, and surgical intervention was confirmed (P>0.05). Mortality at one month was 49% among patients whose monthly per capita income ≤Rs.1000 compared with 17% of the rest (Odds ratio [OR] 4.0, P=0.003). Unfavorable outcome at three months was noted in 63% of patients whose monthly per capita income ≤Rs.1000, as compared with 35% of those with per capita income >Rs.1000 (OR 4.1, P=0.01). In multivariate analysis, family monthly per capita income ≤Rs.1000 emerged as an independent risk factor for unfavorable outcome at three months (P=0.02).Conclusion:In patients of severe head injury, lower economic status is significantly associated with unfavorable outcome at three months, independent of other factors.

P-462 - Nutritional status of the hospitalized elderly dementia patients and it’s relation with calf circumference

Dementia is a neurological disease mainly characterized by clinically significant cognitive deficit which includes memory. Behavioral changes may occur and lead to an autonomy loss and a decreased capacity to perform daily professional and social activities. Disease-related undernutrition leads to an increased number of clinical complications as with a negative outcome in the physical and psychological status. Hospitalization can worsen the status. The Full Mini Nutritional Assessment (MNA) ® is the golden standard for nutritional status evaluation and it is validated for Alzheimer Disease (AD). Undernutrition in AD patients has been also related to significant weakness, depression, increased susceptibility to other illness. Evaluate the Nutritional Status of the hospitalized elderly dementia patients in the Geriatric Ward - Hospital de Magalhães Lemos and it‘s relation with calf circumference. Cross-sectional study made between February to May of 2011. Full MNA ® was applied. Furthermore, the patients were subjected to weight, height, calf circumference and mid-arm circumference measurements and the body mass index was calculated. 22 patients were evaluated of which 31.8% were male and 68.2% female.Mean age was 74.9 (8.2) years.Full MNA ® revealed that 45.5% of the elderly dementia people were at risk of malnutrition, 4.5% did not show nutritional risk and 50% was malnourished.The calf circumference equal or superior to 31 cm showed to be more representative with 54.5%, while inferior to 31 cm showed 45.5%. This study revealed the major importance of assessing the nutritional status and the need to use the calf circumference as a parameter for that evaluation.

The value of mid-arm circumference measurements in a diabetic population

Gestational Diabetes Mellitus complicates 2-9% of pregnancies and is associated with obesity and hypertension. Accurate measurement of blood pressure requires the use of an arm cuff customised to the mid-arm...

Age-related Patterns of Upper Arm Muscle and Fat Area in Turkish Children and Assessment of Nutritional Status

Anthropometric estimation of midarm muscularity and fatness was employed as a general index of nutritional status in developing countries. The present study attempts to evaluate the sex- and age-related pattern of regional muscle and fat area characteristics in Turkish children. A cross-sectional study was carried out on 1,068 10- to 14-year-old children (583 boys and 485 girls) from junior high schools in Ankara, the capital city of Turkey. According to general anthropometric protocols, weight, height, triceps skinfold thickness, and midarm circumference measurements were taken and socioeconomic data were collected. Arm muscle area (AMA) and arm fat area (AFA) were calculated and centile curves were evaluated using least median squares method. Results showed significant sexual dimorphism in muscle and fat patterning. AFA was found to be higher among girls and AMA among boys. The present findings suggest that the different levels of socioeconomic status (SES) appeared to be more prevalent on muscularity among boys (p < 0.05) and adiposity among girls (p < 0.001).

US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988–2004

Mid-arm circumference measurement is a prerequisite for the selection of properly sized blood pressure cuffs for accurate blood pressure readings in children and youth. This study examined recent trends in the mid-arm circumference distribution and the distribution of corresponding recommended blood pressure cuff sizes using National Health and Nutrition Examination Survey III (1998-1994) and National Health and Nutrition Examination Survey 1999-2004 data. Both studies were complex, cross-sectional surveys providing nationally representative samples of the civilian noninstitutionalized US population. Children of 7-17 years of age were studied. A total of 2515 boys and 2596 girls participated in National Health and Nutrition Examination Survey III, and 3941 boys and 3917 girls in National Health and Nutrition Examination Survey 1999-2004. Mean mid-arm circumference and recommended National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents defined blood pressure cuff sizes were assessed by sex, age, and race/ethnicity. US boys aged 7-12 years and girls aged 7-12 and 13-17 years had significant increases in mid-arm circumference (P<0.05) across the two surveys. Moreover, from 1988-1994 to 1999-2004, there were statistically significant increases in the percentage of boys (age 7-12 and 13-17 years) and girls (age 13-17 years) needing large blood pressure adult cuffs (P<0.05). National Health and Nutrition Examination Survey 1999-2004 data show that both boys and girls aged 13-17 years had a mean mid-arm circumference > or =27 cm, which requires an adult blood pressure cuff fit. Furthermore, 52% boys and 42% girls aged 13-17 years, required a standard adult cuff fit. Mean mid-arm circumference has increased among US children and adolescents, with important implications for the accuracy of blood pressure measurement in clinical practice.

Polymorphisms in the Angiotensin Converting Enzyme Gene and Growth in the First Year of Life

Abnormal patterns of fetal and infant growth have been associated with an increased risk of cardiovascular disease in adulthood. Catch-up growth during the first year of life has been associated with a higher prevalence of type 2 diabetes mellitus, whereas a lack of catch-up growth tracks with a risk of hypertension. The role of genetic factors influencing both growth and blood pressure have not been explored. We genotyped cord blood samples from 530 singleton, Caucasian, uncomplicated pregnancies, drawn from a larger cohort of 1650 pregnancies, and related polymorphism in the angiotensin converting enzyme (ACE) gene (alleles insertion (I) or deletion (D)) with measures of size at birth and at age of 1 year. ACE genotype did not significantly influence size at birth, although there was a greater proportion of individuals with the D/D genotype born with a birth weight less than the 10th centile (P=0.004). The ACE I/I genotype was significantly associated with higher weight (p=0.001), body mass index (p=0.001) and mid arm circumference (p=0.001) at 1 year of age compared to the ACE D/D and I/D genotypes. Individuals with the I/I genotype displayed catch-up (gain from birth size of >or=0.6 Standard Deviation Score) in weight (p=0.04), body mass index (p=0.03) and mid arm circumference (p=0.03) compared to the D/D group, the majority of which showed no change or catch-down. The I/D genotype was distributed equally across the catch up/catch down/no change categories. The effect was more marked in males, but ACE genotype and sex of the infant contributed independently to mid arm circumference measurements and there was no interaction between the two. There was no effect of maternal or paternal ACE genotype on birth size. In a multiple linear regression model ACE genotype, socioeconomic status and sex of the infant explained 10.9% of the variance in body mass index SDS at 1 year of age. We conclude that the ACE I/I genotype is associated with a higher weight and body mass index SDS at 1 year of age, along with catch-up in terms of these measures from birth to 1 year. The D/D genotype is associated with a greater proportion of babies, born at term, that at small for gestational age. These results suggest that due consideration should be given to the underlying genotype of an individual when evaluating the association of early human growth with the development of risk factors for cardiovascular disease. The observation of independent effects of genotype, sex of the individual and socioeconomic status on postnatal growth suggests the need to develop methodologies for the integration of genetic and environmental factors in causality modelling.

Estimating equations and tables for adult mid-arm circumference based on measured height and weight: data from the third National Health and Nutrition Examination Survey (NHANES III) and NHANES 1999-2000.

Mid-arm circumference measurement is a prerequisite to selection of proper sized blood pressure (BP) cuffs and accurate BP readings. The purpose of this study was to develop practical prediction equations for estimating mid-arm circumference (AC) in adults using NHANES III & NHANES 1999-2000 data. Both surveys used a complex sample design to obtain nationally representative samples of the USA civilian non-institutionalized population. The analytic sample consisted of 5077 men and 5307 women from NHANES III and 2013 men and 2293 women from NHANES 1999-2000. Their height, weight, and mid-arm circumference were measured directly in both surveys. Weight, height, and age data from NHANES III were used for model building, and similar data from NHANES 1999-2000 were used for validation. An all-possible regressions procedure by gender was used to derive the prediction equations for AC. The final prediction equations for adult AC were as follows: for measured weight (wt) in kg and height (ht) in cm: Men, AC (cm)=31.76749+0.22626 x (wt) -0.10109 x (ht)+0.05092 x (age)-0.00081813 x (age), R=0.8; Women, AC (cm)=39.29946+0.26410 x (wt) -0.18230 x (ht) +0.01972 x (age)-0.00104 x (age) +0.00045901 x (wt x age) +0.00037509 x (ht x age), R=0.86. Tables of estimated arm circumference by age, weight and gender are presented. The prediction equations and tables provide for mid AC estimation using readily available clinical data to select the appropriate BP cuff.

Abnormal Eating Attitudes and Body Image in Older Undernourished Individuals

An anorexia nervosa-like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT-26) was administered to 183 male outpatients. Thirty-four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age-sex-height. Approximately 60% of malnourished subjects acknowledged inappropriate self-control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT-26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales. These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexia-like attitudes when caring for malnourished seniors.

Assessing nutritional state in inflammatory bowel disease.

Nutrient depletion is a common complication of inflammatory bowel disease, and some of the consequences can be severe. Although it is often easy to recognise the most severely undernourished subjects, those with lesser degrees of malnutrition may prove more difficult to detect. Measurements of many nutritional variables will be abnormal in patients with inflammatory bowel disease, especially in those with Crohn's disease, but are not always relevant to the clinical management of patients. Anthropometric means of assessment, in particular, measurement of mid arm circumference, can act as a simple, reproducible method of detecting those most at risk of appreciable undernutrition.

Some aspects of child health in an urban township Lusaka.

A random sample of 9 of the 235 sections in Lima Ward north of Lusaka have been studied. 8% of 213 households surveyed have been established in the last year. Each household has an average of 5.2 people but there are nearly 7 people to each house. There were 1118 people seen in these 9 sections of whom 48% were under 15 years old with 20.6% being under 5 years old. Over 22% were women of childbearing age and only 1.7% admitted to being 55 years or older. The birth rate was 59/1000 and the death rate 19.7/1000. Only 3/4 of the total adult population have received any education of whom there were many more men than women. There is no difference between the proportions of boys and girls presently at school. There was an estimated child loss of 166.7/1000 amongst women of parity 1 to 4 and 226.4/1000 for women of higher parity. Breastfeeding usually continues for 18 months or more although 11.7% of children reportedly stopped before a year old. Of 187 children of known immunization status 81% had received immunization against measles and 70.5% had received at least 2 doses of poliomyelitis vaccine. Nutritional status was difficult to quantify due to uncertainty of age. Considering weight for age nearly 18% were below 80% of average; height for age 21.2% were below 90% of average; but as regards weight for height only 1.7% were below 80% of average. This indicates that there is chronic malnutrition to which the children have become adjusted. Using mid-arm circumference measurements 6.5% of children were less than 80% of average. Measures are being explored to improve the collection of vital statistics in the Ward through cooperation with the Party Officials and to decrease mortality and morbidity due to diarrhea by instructing the people in the use of oral rehydration salts. (authors modified)