Mid-arm Circumference Research Articles

Key predictors of undernutrition among children 6–59 months in the Buea Health District of the Southwest region of Cameroon: a cross sectional community-based survey

BackgroundAccording to the 2018 Demographic and Health Survey, undernutrition remains a public health problem among Cameroonian children under-five. This varies across the country, greatest in areas with ongoing humanitarian crisis, such as the Southwest region. However, data on the burden of undernutrition in the Southwest region is sparse. This study aimed to assess the prevalence and predictors of undernutrition among children under-five in the Buea health district of the Southwest region of Cameroon.MethodsThis was a community based cross-sectional study of 321 children under-five/caretaker pairs, surveyed from households selected using multistage randomized sampling. Data were collected by trained data collectors, with the aid of a structured, pre-tested questionnaire that captured information on sociodemographic characteristics, food security, dietary diversity and anthropometric measurements. The weight, height/length and mid upper arm circumference (MUAC) were measured using standardized instruments. Stunting, Wasting and Underweight of children were calculated from Z-scores of Height-for-age (HAZ), Weight-for-height (WHZ) and Weight-for-age (WAZ) based on 2006 WHO standards. Data was analysed using SPSS version 27.0. Predictors of malnutrition were obtained using multivariate logistic regression, adjusting for potential confounders.ResultsOverall, 31.8% (102/321) of the children were undernourished (26.5% stunted, 1.6% underweight, 3.7% wasted). Drinking water from inappropriate sources (OR: 2.32, 95% CI: 1.30–4.15) and a Dietary Diversity Score < 4 (OR: 2.59, 95%CI: 1.46–4.61) were independently associated with increased risk of stunting. Children of the male sex were more likely to be wasted than females (OR: 5.34, 95%CI: 1.09–26.14).ConclusionChildhood undernutrition, particularly stunting is common in the Buea Health District. Risk factors of undernutrition identified are potentially modifiable, highlighting the need for nutrition specific and sensitive interventions to improve dietary diversity, and the need to improve access to safe drinking water, and educate caretakers on the importance of clean potable water, good sanitation and hygiene for the proper growth and development of their children.

Data mining approaches for type 2 diabetes mellitus prediction using anthropometric measurements

The aim of this study was to evaluate the anthropometric measurements most associated with type 2 diabetes mellitus (T2DM) using machine learning approaches. A prospective study was designed for a total population of 9354 (43% men and 57% women) aged 35-65. Anthropometric measurements include weight, height, demispan, Hip Circumference (HC), Mid-arm Circumference (MAC), Waist Circumference (WC), Body Roundness Index (BRI), Body Adiposity Index (BAI), A Body Shape Index (ABSI), Body Mass Index (BMI), Waist-to-height Ratio (WHtR), and Waist-to-hip Ratio (WHR) were completed for all participants. The association was assessed using logistic regression (LR) and decision tree (DT) analysis. Receiver operating characteristic (ROC) curve was performed to evaluate the DT's accuracy, sensitivity, and specificity using R software. Traditionally, 1461 women and 875 men with T2DM (T2DM group). According to the LR, in males, WC and BIA (p-value < 0.001) and in females, demispan and WC (p-value < 0.001) had the highest correlation with T2DM development risk. The DT indicated that WC has the most crucial effect on T2DM development risk, followed by HC, and BAI. Our results showed that in both men and women, WC was the most important anthropometric factor to predict T2DM.

Mid-Arm Muscle Circumference or Body Weight-Standardized Hand Grip Strength in the GLIM Superiorly Predicts Survival in Chinese Colorectal Cancer Patients.

Our objective was to identify the optimal method to assess reduced muscle mass (RMM) using the Global Leadership Initiative on Malnutrition (GLIM) approach and investigate the roles of the GLIM approach in nutrition assessment and survival prediction in colorectal cancer (CRC) patients. During a median follow-up period of 4.2 (4.0, 4.4) years, a development cohort of 3612 CRC patients with a mean age of 64.09 ± 12.45 years was observed, as well as an external validation cohort of 875 CRC patients. Kaplan−Meier curves and multivariate Cox regression were adopted to analyze the association between GLIM-diagnosed malnutrition and the overall survival (OS) of CRC patients. A nomogram predicting individualized survival was constructed based on independent prognostic predictors. The concordance index, calibration curve, and decision curve were applied to appraise the discrimination, accuracy, and clinical efficacy of the nomogram, respectively. Patients diagnosed with severe malnutrition based on either the mid-arm muscle circumference (MAMC) or body weight-standardized hand grip strength (HGS/W) method had the highest mortality hazard ratio (HR, 1.51; 95% CI, 1.34−1.70; p < 0.001). GLIM-defined malnutrition was diagnosed in 47.6% of patients. Severe malnutrition was an independent mortality risk factor for OS (HR, 1.25; 95% CI, 1.10−1.42; p < 0.001). The GLIM nomogram showed good performance in predicting the survival of CRC patients and was clinically beneficial. Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting OS in CRC patients.

Cardiac valve calcification in patients on maintenance dialysis. The role of malnutrition-inflammation syndrome, adiposity andcomponents of sarcopenia. A cross-sectional study

Cardiac valve calcification (CVC) is a predictor of cardiovascular disease and all-cause mortality in end stage kidney disease (ESKD) patients. Several risk factors are related to CVC in patients with ESKD including traditional ones as well as inflammation, bone mineral disease and malnutrition. Adiposity is associated with dyslipidemia and proinflammatory activity which could predispose for CVC. Sarcopenia or dynapenia is a state common in patients with ESKD. This study aimed to investigate the relationship of adiposity, sarcopenia and malnutrition-inflammation markers with CVC in patients on maintenance hemodialysis. CVC in aortic (AVC), mitral valves (MVC) and systolic and diastolic dysfunction (DD) were assessed by using two-dimensional echocardiography. Nutritional, adiposity and anthropometric assessments were made using several indices respectively. Creatinine index and muscle strength measurements were also performed. Biochemical parameters such as total proteins, albumin, calcium, phosphate, plasma lipoproteins, C-Reactive Protein and parathyroid hormone were also measured. Adiposity, nutritional, and sarcopenia parameters did not show any difference between patients with or without CVC. Age ≥ 65 years [PR: 1.47 p=0.012], DD [PR: 2.31, p=0.005], high CRP/albumin ratio [PR: 1.46, p=0.01], mid arm circumference (MAC)<26cm [PR: 1.37, p=0.03] were associated with increased prevalence of AVC, while DD [PR: 1.97 p=0.02], high CRP/albumin ratio [PR: 1.56, p=0.02], and MAC < 26cm [PR: 1.52, p=0.01], showed positive correlation with MVC. Age ≥ 65 years [PR: 1.33, p=0.028], DD [PR: 1.72, p=0.01], high CRP/albumin ratio [PR: 1.53, p=0.003], and MAC < 26cm [PR: 1.4, p=0.006], related to greater prevalence of calcification at any valve. Ageing, diastolic dysfunction, MAC and increased CRP/albumin ratio were powerful predictors of CVC in patients on hemodialysis.

Protocol for a case–control prospective study to investigate the impact of Hepatic Encephalopathy on Nutritional Intake and Sarcopenia status in patients with end-stage LIVer disease: HENS-LIV study

IntroductionHepatic encephalopathy (HE) is a debilitating symptom of end-stage liver disease (ESLD), but there remains a paucity of evidence regarding its impact on nutritional status, nutritional intake, compliance with nutritional...

Nutritional Status of Pre-School Children Attending Anganwadi Centres in Chittoor, Andhra Pradesh, India

Context/Background: Malnutrition among children is a long-standing public health problem in India. Objective: To assess the nutritional status of pre-school children and to identify the socio-demographic determinants of malnutrition. Methodology: In this community-based cross-sectional study, 194 under-five children were recruited from rural and urban areas of Chittoor district, Andhra Pradesh. Anthropometric measurements including weight, and mid upper arm circumference were measured and age standardized weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated. The proportion of under nutrition (WAZ &lt;-2 standard deviation (SD)), stunting (HAZ &lt;-2SD), and wasting (WHZ &lt;-2SD) were calculated along with the determinants. Results: The mean age of the participants was 40.5 months (SD- 9.1 months), 101 (52.1%) were from rural areas, and 96 (495%) female. The median z-scores for WAZ, HAZ, and WHZ were -1.22, -0.98, and -0.78respectively. The HAZ values were significantly low in- urban children (-0.81; 95% CI: -0.4, -1.21), among the non-Hindu children (-0.92; 95% CI: -0.35, -1.5). The overall prevalence of underweight, stunting, and wasting were- 13.4% (95% CI: 8.5%, 18.3%), 23.7% (95% CI: 17.6%, 29.8%), and 19.6% (95% CI: 11.9%, 25.3%) respectively. There were a total 16 (8.3%, 95% CI: 5.6%, 11.0%) severely malnourished children. Urban residence (OR 6.75; 95% CI: 3.03 – 15.04) was a strong predictor of stunting. Conclusion: Malnutrition remains to be a public health problem in this area. Strengthening of existing program implementation coupled with evidence generation on malnutrition can be the key strategies in combating malnutrition.

Kidney size in Children of Post-Weaning age: Does Nutrition have an Effect?

Introduction: This study was undertaken to evaluate the effect of nutrition on kidney size and to determine the correlation between renal parameters and different anthropometric parameters. Methods: This hospital-based descriptive observational study has been done in a tertiary care centre of Kolkata, West Bengal, India. Fifty malnourished children &amp; 50 healthy children (Controls) within the age group of six months to five years were included in the study. Anthropometric parameters (e.g. weight, height, mid-arm circumference, skinfold thickness etc.) were measured manually and bilateral kidney sizes were measured by ultrasound. Results: Malnourished children had significantly lower weight, mid arm circumference, skinfold thickness, body mass index and body surface area [p &lt; 0.001], but the difference in height / length was not significant (p = 0.074). The length, width, depth and volume of both left and right kidneys and relative renal volume were significantly lower in the malnourished children (p &lt; 0.001). But, the same significance has not been found with kidney width, thickness or volume. Conclusions: Malnutrition adversely affects kidney growth in children of post-weaning age.

Measurement mid arm circumference and study its correlation with the birth weight of the babies

Background: To know the correlation between birth weight and mid arm circumference (MAC). To test the sensitivity and specificity of cut off limits of MAC for the identification of low-birth-weight babies &lt;2000 gm and &lt;2500 gm.Methods: In this observational study, 300 children were enrolled. Birth weight was measured using electronic weighing scale of accuracy 10 grams within 24 hours of life. Right MAC was measured using non-stretchable tap to the nearest of 0.1 cm at the midpoint between tip of olecranon process of ulna and the acromian process of scapula. Data was analyzed using SPSS. Different cut offs for MAC and their sensitivity, specificity to identify LBW babies &lt;2.5 kg was analyzed through ROC. The study was approved by the institutional ethics committee.Results: MAC highly correlated with weight (p&lt;0.001). A MAC of &lt;10 cm, predicts a birth weight of ≤2500 gm, with a sensitivity of 93% and specificity of 49% MAC of ≤9 cm, predicts a birth weight of ≤2000 gm, with a sensitivity of 95% and specificity of 87%. Regression values were analyzed and formula for detecting birth weight for the given MAC was derived.Conclusions: A positive correlation existed between midarm circumference and birth weight (p&lt;0.001). A cut off value of 10 cm of MAC for identification of low-birth-weight babies weighting ≤2500 gm and 9 cm of MAC for identification of low-birth-weight babies ≤2000 gm with optimum sensitivity and specificity.

Nutrition-related parameters of maintenance haemodialysis patients.

Maintaining good health in haemodialysis patients is a challenging task that helps to reduce morbidity and mortality. The prevalence of nutrition-related complications is uncertain in Sri Lankan maintenance haemodialysis population. This study was carried out as a baseline study to identify the common nutrition-related complications in maintenance haemodialysis patients. A single-centre cross-sectional study was carried out on adult patients on maintenance haemodialysis in a tertiary care centre in the central part of Sri Lanka. Simple random sampling was used, and patients' clinical, anthropometric, body composition via bioelectrical impedance analysis (BIA), laboratory parameters and muscle power were assessed. We evaluated 114 patients, 87 (76.3%) were males, and the mean age was 52.6 (±12.3) years. Only 9 (7.9%) patients were underweight in the sample population, 77.2% had normal mid-upper arm circumference (MUAC), 81.6% had high muscle mass percentage in BIA analysis, and all patients had normal mid-arm muscle circumference (MAMC). But in 80.5% of patients hand grip power was lower than the cut off for sarcopenia according to EWGSOP2 recommendations. The prevalence of low serum albumin is 33.3% and 60.5% had anaemia. The majority had normocytic normochromic anaemia with high serum ferritin levels. Vitamin D deficiency or insufficiency was 91.2% and electrolyte abnormalities were very common; 57.9% had hypocalcaemia, 61.4% had hyperphosphatemia and all patients had hyperkalaemia. Muscle mass was preserved in most patients in this population, but the muscle power was significantly low, along with a high prevalence of hypoalbuminaemia, anaemia, vitamin D deficiency or insufficiency, hypocalcaemia, hyperphospatemia and hyperkalaemia.

Childhood Stunting and Wasting Following Independence in South Sudan.

South Sudan has experienced ongoing civil and environmental problems since gaining independence in 2011 that may influence childhood nutritional status. To estimate the prevalence of undernutrition among children in South Sudan in 2018 and 2019 compared to the prevalence in 2010. Data on height and weight were collected using a 2-stage stratified sample framework in which households were randomly selected at the county level and nutritional status was calculated for all children under 5 years of age to determine height-for-age, weight-for-height, and weight-for-age Z-scores (HAZ, WHZ, and WAZ) and the prevalence of stunting, wasting, and underweight. Linear and logistic regression analyses were used to determine factors associated with nutritional status and the odds ratio for nutritional outcomes. In 2010, the mean HAZ, WHZ, and WAZ was -0.78, -0.82, and -1.15, respectively, and the prevalence of stunting, wasting, and underweight was 30%, 23%, and 32%, respectively. In 2018 and 2019, the mean HAZ, WHZ, and WAZ was -0.50, -0.70, -0.77 and -0.53, -0.77, -0.76, respectively. The prevalence of stunting, wasting, and underweight in 2018 and 2019 was 17%, 14%, 15% and 16%, 16%, 17%, respectively. Age was negatively associated with all nutritional indices and girls had higher HAZ, WHZ, and WAZ and a lower mid upper arm circumference (P < .01) compared to boys. The risk of poor nutritional outcomes was associated with vaccine status and varied by state of residence. Following independence in 2010, the prevalence of undernutrition in South Sudan decreased, but the risk for undernutrition varied by state and efforts to address food security and health need to ensure equitable access for all children in South Sudan.

Association of sociodemographic variables with nutritional status among the college girls of Howrah, West Bengal, India

Nutritional status of young adult girls is very essential since they are future mothers, and their nutritional requirements increase tremendously compared to the preceding years of growth. The present study was an endeavour to assess the nutritional status and to find an association between sociodemographic variables and nutritional status among young adult college girls of Howrah, West Bengal. The study included a total of 140 college girls aged between 18 to 20 years. The sociodemographic data were collected by the interview method using a pretested standard structured schedule. The anthropometric data were measured by the standard protocol. For the comparison of anthropometric data, growth charts of the Centre for Disease Control and Prevention (CDC) were used. The anthropometric measures like weight, mid upper arm circumference (MUAC), waist circumference (WC), hip circumference (HC), suprailiac skinfold, body mass index (BMI), waist-hip ratio (WHR) and waistheight ratio (WHtR) show an increasing trend according to age groups. Based on BMI, 25.7% of the young adult college girls were found to be underweight (BMI &lt; 18.5 kg/m2), which includes chronic energy deficiency (CED) grade I (13.6%), chronic energy deficiency (CED) grade II (7.9%) and chronic energy deficiency (CED) grade III (4.3%). BMI for age (&lt; 5th percentile) or thinness showed a significant difference (p &lt; 0.01) according to age. Similarly, stature for age (&lt; 5th percentile) or stunting shows a significant association (p &lt; 0.05) with father’s education, and underweight (BMI &lt; 18.5 kg/m2) shows a significant association (p &lt; 0.05) with monthly family household income. The results of linear regression show that sociodemographic variables and food habits were significant predictors of various anthropometric measures. Monthly family income and frequency of eating fast food per week were significant predictors of BMI and MUAC, and the age of the participant and the education of the mother were significant predictors of WHR, and family income per month and the age of the participant were significant predictors of WHtR. Thus, the present study provides a podium for further studies to combat the effect of undernutrition among future mothers and instigates effective nutritional intervention strategies entailing this vulnerable group.

The effects of synbiotic supplementation on enteral feeding tolerance, protein homeostasis, and muscle wasting of critically ill adult patients: a randomized controlled trial

BackgroundEnteral feeding intolerance, energy-protein malnutrition, and muscle wasting are common conditions in the critical care setting. The primary aim of this study was to investigate the effect of synbiotic supplementation on enteral feed volume, energy and protein homeostasis, and muscle mass maintenance in critically ill adult patients.MethodsA consecutive of 42 patients admitted to the Edalatian Medical ICU, requiring enteral nutrition (EN), were prospectively randomized to receive the synbiotic capsule (containing a combination of Lactobacillus, Bifidobacterium, Streptococcus, and fructooligosaccharides) or placebo (21 patients in each group) for a maximum of 14 days. Enteral intolerance and energy homeostasis were evaluated on a daily basis. Nitrogen balance and 24-h urine creatinine excretion were recorded on days 1 and 14. Mid-arm circumference was recorded every 3 days.ResultsMean EN volume, energy, and protein intake per day were 962.5 ± 533.82 ml, 770 ± 427.05 kcal, and 38.5 ± 21.35 g (fourth day) vs. 590 ± 321.1 ml, 472 ± 256.81 kcal, and 23.6 ± 12.84 g (first day) in the synbiotic group (p < 0.05). Changes in the placebo group were not statistically significant. On day 1, nitrogen balance (NB) was − 19.84 ± 8.03 in the synbiotic vs. − 10.99 ± 9.12 in the placebo group (p = 0.003). On day 14, NB was − 14.18 ± 13.05 in the synbiotic and − 9.59 ± 7.71 in the placebo group (p = 0.41). Mid-arm circumference (MAC), 24-h urine creatinine, and creatinine-height index were almost steady in the synbiotic group, while they decreased in the placebo group.ConclusionOverall, it can be concluded that enteral nutrition supplemented with synbiotics has no statistically significant effect on energy and protein homeostasis and muscle mass maintenance of critically ill patients on day 14, but it can increase enteral feed volume and energy and protein intake during the first 4 days of ICU admission.Trial registrationThe trial protocol has been approved in Iranian Registry of Clinical Trials on March 17, 2019. The registration reference is IRCT20190227042857N1.

Association Between Anthropometric Indices and Skeletal-Muscle Atrophy in Chinese Patients with Stable Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

PurposeAnthropometric indices are simple indicators of patient nutritional status. However, the association between these indices and skeletal-muscle atrophy in patients with stable chronic obstructive pulmonary disease (COPD) has not been fully investigated. In this study, we evaluated this association.Patients and MethodsWe recruited 123 outpatients with stable COPD from a general hospital in China from 2020 to 2021. We recorded their demographic characteristics, including age, sex, course of illness, dyspnea score, body mass index (BMI), force expiratory volume in 1 second (FEV1), forced vital capacity (FVC), smoking status, and severity grading. In addition, patients’ anthropometric indices, including fat-free mass index (FFMI) and appendicular skeletal-muscle mass index (ASMI), were measured using a body composition analyzer, and measurements were taken of the triceps skinfold (TSF), midarm circumference (MAC), and calf circumference (CC). We drew and analyzed a receiver operating characteristic (ROC) curve to identify the best intercept point value for the assessment of skeletal-muscle atrophy.ResultsThe TSF, MAC, CC, FFMI, and ASMI of COPD patients were 1.08 ± 0.44 cm, 26.39 ± 2.92 cm, 34.5 ± 3.06 cm, 17.49 ± 1.86 kg/m2, and 8.17 ± 0.90 kg/m2, respectively. These anthropometric indices had a significant positive correlation with skeletal-muscle mass (correlation values, 0.481–0.820). CC was strongly correlated with both FFMI and ASMI. The ROC curve showed an area-under-the-curve (AUC) value of 0.873–0.959.ConclusionAnthropometric indices were correlated with skeletal-muscle mass. CC showed the best diagnostic value in COPD patients, suggesting its effectiveness as a simple method for assessing skeletal-muscle atrophy and identifying patients with a noticeable reduction in muscle mass. Such patients require early, multidisciplinary intervention.

Impact of Sarcopenia on Short-Term Complications and Survival After Liver Transplant.

Sarcopenia is a common entity in cirrhosis with significant morbidity and mortality. However,the effects of sarcopenia on the risk of complications and survival after liver transplant remain controversial.We aimed to evaluate the effect of sarcopenia on survival and complications after liver transplant. Our study cohort included 61 adult patients with hepatitis C-related cirrhosis who underwent living donor liver transplant. Pretransplant clinical and anthropometric assessments included body mass index, hand grip, mid-arm circumference, triceps skin fold thickness, and gait speed. Sarcopenia was determined by computed tomography using the skeletal muscle index at the third lumbar vertebra cut-off value of <38.5 cm2/m2 for women and <52.4 cm2/m2 for men; these patients were then followed up for 6 months after transplant to determine survival and complications. At time of liver transplant, sarcopenia was present in 27/61 patients (44.3%). At follow-up after transplant, sarcopenia was found in 14 patients (30.4%) among 46 survivors; all patients who survived were male patients. Among patients with sarcopenia posttransplant, 12 had sarcopenia before transplant and 2 developed sarcopenia after transplant. Liver dysfunction, lower triceps skin fold thickness, recent infections, and sarcopenia pretransplant were associatedwithposttransplant complications, especially infection(42.8%) and prolonged intensive careunit stay. Age and pretransplant sarcopenia were found to be independent predictors of posttransplant mortality. Sarcopenia is a common entity in patients with cirrhosis who are on liver transplant wait lists and may continue after liver transplant. De novo sarcopenia after liver transplant is also a common finding. Sarcopenia can affect patient outcomes, including prolonged intensive care unit stay and poor short-term survival.

Outcome Evaluation of Community Management of Severe Acute Malnutrition in Some Selected Outpatient Therapeutic Programme Centres of Katsina State, Nigeria

Severe acute malnutrition remains a major public health problem, especially in developing countries. In this study, a retrospective and on-site assessment of the effectiveness of the community management of acute malnutrition (CMAM) program in four (4) Outpatient Therapeutic Programme (OTP) centres of Katsina and Daura Local Government Areas of Katsina State was carried out from January 2021 to December 2021. Assessment of CMAM performance indicators, anthropometric indices, oedema, the biochemical and haematological status of children with severe acute malnutrition (SAM) and a follow-up assessment of probable relapse 8 weeks after discharge was carried out. The result indicated that both the treatment (87.90% and 94.44% at Katsina and Daura OTPs respectively) and geographical coverage (20.00% at both Katsina and Daura OTPs) in the present study were higher than the values for the retrospective study. Outcome measures of CMAM in the Katsina OTPs showed a cure rate of 95.0% and 97.3% in the retrospective and current studies, respectively. While in Daura OTPs, the cure rates were 86.8% and 93.52% respectively for the retrospective and the present study. Result for the growth performance and recovery indices have shown higher percentages in normal range values for mid upper arm circumference, weight for height and Oedema among the SAM children at the point of discharge over the values at the admission. In fact, all the children that presented with oedema in both OTPs at admission did not have oedema at the point of discharge. In addition, there was a significant improvement in biochemical and hematologic indices in SAM children at discharge compared to the values at admission ​​(p &lt; 0.05). Findings of the study have indicated a good performance of CMAM program in OTP centers of Katsina and Daura Local Government Areas of Katsina State as prescribed by the SPHERE standard.

Validating the diagnostic performance of MUAC in screening moderate acute malnutrition and developing an optimal cut-off for under five children of different regions in Ethiopia

Valid and reliable anthropometric indicator is useful for early detection and treatment for under nutrition. Although, mid upper arm circumference (MUAC) is used for screening of children with moderate acute malnutrition in Ethiopia, its performance for the different ethnic groups has not been evaluated. To determine the diagnostic performance of MUAC for determination of moderate wasting among children of different ethnic background and develop optimal cut-off. A community based cross-sectional study was conducted among under five children of the three regions namely: Somalia, Amhara and Gambella Regions. The diagnostic performance of MUAC was validated using weight for height Z-score< -2 as a gold standard binary classifier. Test variable is mid upper arm circumference (MUAC< 12.5cm) and weight for height Z-Score (WHZ) is standard variable. ROC analysis performed based on the assumptions of MUAC value lower the cut-off point indicates the undernutrition. Area under the curve and validity measures (sensitivity and specificity) was generated as parameter estimated. The results were presented using tables and ROC curves. Except in the Gambella region, there was fair agreement between MUC<12.5cm and Weight for Height Z score<-2 in diagnosing wasting in Somali (Sensitivity = 29.3%, Kappa = 0.325, P<0.001) and in Gambella regions (Sensitivity = 16.7%, Kappa = 0.19, P<0.001). In Amhara region there was fair agreement between the two measures in diagnosing moderate acute malnutrition (MAM) (Sensitivity = 16%, Kappa = 0.216). For the Overall sample, the sensitivity of MUAC<12.5cm was 20.6% (Kappa = 0.245, P<0.001. Based on ROC analysis, the optimal cutoff value of MUAC for diagnosing moderate acute malnutrition for the two regions namely for Gambella and Amhara was 13.85cm with sensitivity of 0.99 and 1.00, respectively. However, for Somali Region the optimal cut was 13.75cm (Sensitivity = 0.98 cm and specificity = 0.71). Findings revealed that the inter reliability of measurement for MUAC< 12.5cm and WHZ<-2 for diagnosing MAM was low among different ethnic groups with the cut-off varying in each region. The existing cutoff point is less sensitive for diagnosis of MAM. As Ethiopia is home of diverse ethnic groups with different body frame and environmental conditions, the new cut off points developed for each region recommended to be used for screening moderate acute malnutrition to prevent relapse of MAM and reduce chronic malnutrition.

Metabolic Profiling of Pregnant Women with Obesity: An Exploratory Study in Women at Greater Risk of Gestational Diabetes.

Gestational diabetes mellitus (GDM) is one of the most prevalent obstetric conditions, particularly among women with obesity. Pathways to hyperglycaemia remain obscure and a better understanding of the pathophysiology would facilitate early detection and targeted intervention. Among obese women from the UK Pregnancies Better Eating and Activity Trial (UPBEAT), we aimed to compare metabolic profiles early and mid-pregnancy in women identified as high-risk of developing GDM, stratified by GDM diagnosis. Using a GDM prediction model combining maternal age, mid-arm circumference, systolic blood pressure, glucose, triglycerides and HbA1c, 231 women were identified as being at higher-risk, of whom 119 women developed GDM. Analyte data (nuclear magnetic resonance and conventional) were compared between higher-risk women who developed GDM and those who did not at timepoint 1 (15+0–18+6 weeks) and at timepoint 2 (23+2–30+0 weeks). The adjusted regression analyses revealed some differences in the early second trimester between those who developed GDM and those who did not, including lower adiponectin and glutamine concentrations, and higher C-peptide concentrations (FDR-adjusted p < 0.005, < 0.05, < 0.05 respectively). More differences were evident at the time of GDM diagnosis (timepoint 2) including greater impairment in β-cell function (as assessed by HOMA2-%B), an increase in the glycolysis-intermediate pyruvate (FDR-adjusted p < 0.001, < 0.05 respectively) and differing lipid profiles. The liver function marker γ-glutamyl transferase was higher at both timepoints (FDR-adjusted p < 0.05). This exploratory study underlines the difficulty in early prediction of GDM development in high-risk women but adds to the evidence that among pregnant women with obesity, insulin secretory dysfunction may be an important discriminator for those who develop GDM.

Prevalence of malnutrition in under five age group of the tribals in Wayanad district of Kerala, South India: a community based cross-sectional study

Background: Malnutrition is one of the major causes for childhood mortality among under-five children in India. The tribal community accounts for 8.6% of India's population. In India, nutritional as well as socio-economic inequalities are most intensely experienced by the tribal population when compared with the rest of the population. The objective of the study is to estimate the prevalence of malnourishment among tribal children (0-59 months) in the Wayanad district of Kerala.Methods: A community-based cross-sectional survey was conducted among 319 tribal children (0-59 months) of Noolpuzha panchayat, Wayanad district using a semi-structured, pretested questionnaire to collect the socio-demographic profile (age, gender, education, occupation, type of tribe, type of house, type of family) from mother/caretaker and anthropometric measurements (height, weight, and mid-arm circumference) was recorded and compared with WHO growth standards. Quantitative variables were summarized using the Mean (SD). Children below -2SD are considered malnourished in terms of being underweight, stunted, and wasted. Results: The mean age of the children were 29 months±16 SD of which 168 (52.7%) were male, and 151 (47.3%) were females. The prevalence of underweight, stunting, and wasting was 175 (54.8%), 165 (51.7%) and 99 (31%) respectively of which 111 (34.7%) were severely underweight, 88 (27.6%) were severely stunted and 57 (17.8%) were severely wasted.Conclusions: Malnourishment in the form of stunting, wasting, and underweight is very high among under-five tribal children of Noolpuzha panchayat resulting in the need for a multidisciplinary approach to identifying the reasons for malnourishment existing among these marginalized communities.

Mid upper arm circumference as screening tool of overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia

BackgroundOverweight or obesity is an excessive fat accumulation that impairs the health and wellbeing of the adult population throughout the world. Recently Mid upper arm circumference (MUAC) was suggested as a screening index for overweight or obesity among adolescents, but its utilization for the assessment of overweight or obesity in the adult population is not clear yet. In addition, little is known about the screening ability of MUAC for overweight or obesity in the adult population of Ethiopia. Therefore, this study aimed to evaluate the utility of MUAC for screening overweight or obesity among adult employees of Mizan Tepi University, Southwest Ethiopia. MethodA Facility -based cross-sectional study was carried out from February 21 to March 20, 2020, at Mizan Tepi University. About 585 study participants were selected by gender-based stratified sampling technique. Anthropometric data like weight, height, and MUAC were collected. Pearson's correlation between MUAC, body mass index (BMI), and age was calculated to see a relationship between them. The Receiver operating characteristics (ROC) curve was calculated to identify the screening ability of MUAC for overweight or obesity. The appropriate MUAC cutoff point for both men and women established using the Youden index. Additionally, sensitivity, specificity, positive, and negative predictive values were calculated. ResultThe prevalence of overweight and obesity among the study participants was 18.1% and 4.8%, respectively. MUAC had a strong positive correlation with BMI, r = 0.65 (95% CI; 0.56–0.69). According to ROC analysis, MUAC is an excellent screening tool for male and female employees with excellent accuracy (AUC = 0.9 with 91.4% sensitivity and 76.4% specificity) and good accuracy (AUC = 0.83 with 67.2% sensitivity and 83.5% specificity), respectively. Based on the youden index, the cutoff point of MUAC to screen overweight or obesity among male and female employees was 26.91cm. ConclusionMid-upper arm circumference (MUAC) has an equal ability with BMI to screen overweight or obesity among adults. Therefore, MUAC can be utilized as an alternative index to screen overweight and obesity in resource-limited setups.

Relationship between serum sodium, serum potassium levels and ankle reflex grades in malnourished children

Background: Malnutrition among children is a major health issue in South East Asia presenting with stunting and wasting. Many research studies have been conducted to establish the signs, symptoms, corresponding effects of malnutrition on child health, growth and development and the current study focusses more specifically on the effects of electrolyte levels on ankle reflex grades in malnourished children.Methods: This is an observational case-control type of study conducted in two teaching hospitals in India. Cases of protein-energy malnutrition (PEM) (n=30), children with mid upper arm circumference (MUAC) lesser than 12.5 along with control group of normal healthy children (n=30), all aged between 1 and 5 years were selected. Ankle reflexes were noted using a knee hammer on three consecutive days and graded based on the NINDS reflex grading scale for cases and controls and noted against the corresponding serum sodium and serum potassium values obtained from the children.Results: A Chi square test performed and p=0.379 obtained for serum sodium and 0.026 for serum potassium for cases.Conclusions: A conclusion could be drawn that serum sodium levels and ankle reflex grades have no statistically significant relationship in cases of controls, while serum potassium levels and ankle reflex grades have statistically significant relationship in cases but not in control group indicating a plausible cause for hyporeflexia in the patients.