Mid-upper Arm Fat Research Articles

Older adults, appendicular anthropometric measurements, and poor functional performance are predictors of sarcopenia in individuals with head and neck squamous cell carcinoma.

To identify predictors of sarcopenia (demographical, anthropometric measurements, tumor-related clinical characteristics, performance status, and serum C-reactive protein (CRP) and albumin levels in individuals with head and neck squamous cell carcinoma (HNSCC). This cross-sectional study selected diagnosed with HNSCC (n = 125). Sarcopenia was defined as low muscle strength and low physical performance. Association between sarcopenia and anthropometric assessments (weight, height, body mass index, triceps skinfold, mid-upper arm circumference [MUAC], mid-upper arm muscle circumference, mid-upper arm fat area [UFA], mid-upper arm bone free muscle area, calf circumference, and appendicular skeletal muscle mass and index), tumor clinical characteristics (anatomical site, tumor size, and cervical metastasis), performance status scale (Eastern Cooperative Oncology Group Performance Status [ECOG-PS]), and CRP and albumin levels was analyzed using binary logistic regression models. The diagnosis of sarcopenia was identified in 28 (22.4%) individuals with HNSCC. Being an older adult increases the odds of association with sarcopenia in individuals with HNSCC (odds ratio [OR] = 1.05). Increments in MUAC measurement reduce the odds of association with sarcopenia (OR = 0.69), while the increase in the UFA measurement increases the odds of association with sarcopenia (OR = 1.33). Poor ECOG-PS scores increase the odds of association with sarcopenia in individuals with HNSCC (OR = 5.54). Early identification of easy-to-perform, cost-effective predictors of sarcopenia tends to favor the implementation of personalized therapeutic and supportive interventions in individuals with HNSCC.

Anthropometric measures and arsenic methylation among pregnant women in rural northern Bangladesh

IntroductionArsenic methylation converts inorganic arsenic (iAs) to monomethyl (MMA) and dimethyl (DMA) arsenic compounds. Body mass index (BMI) has been positively associated with arsenic methylation efficiency (higher DMA%) in adults, but evidence in pregnancy is inconsistent. We estimated associations between anthropometric measures and arsenic methylation among pregnant women in rural northern Bangladesh. MethodsWe enrolled pregnant women (n = 784) (median [IQR] gestational week: 14 [13, 15]) in Gaibandha District, Bangladesh from 2018 to 2019. Anthropometric measures were BMI, subscapular and triceps skinfold thicknesses, and mid-upper arm circumference (MUAC), fat area (MUAFA), and muscle area (MUAMA). Arsenic methylation measures were urinary iAs, MMA, and DMA divided by their sum and multiplied by 100 (iAs%, MMA%, and DMA%), primary methylation index (MMA/iAs; PMI), and secondary methylation index (DMA/MMA; SMI). In complete cases (n = 765 [97.6%]), we fitted linear, beta, and Dirichlet regression models to estimate cross-sectional differences in iAs%, MMA%, DMA%, PMI, and SMI per IQR-unit difference in each anthropometric measure, adjusting for drinking water arsenic, age, gestational age, education, living standards index, and plasma folate, vitamin B12, and homocysteine. ResultsMedian (IQR) BMI, subscapular skinfold thickness, triceps skinfold thickness, MUAC, MUAFA, and MUAMA were 21.5 (19.4, 23.8) kg/m2, 17.9 (13.2, 24.2) mm, 14.2 (10.2, 18.7) mm, 25.9 (23.8, 28.0) cm, 15.3 (10.5, 20.3) cm2, and 29.9 (25.6, 34.2) cm2, respectively. Median (IQR) iAs%, MMA%, DMA%, PMI, and SMI were 12.0 (9.3, 15.2)%, 6.6 (5.3, 8.3)%, 81.0 (77.1, 84.6)%, 0.6 (0.4, 0.7), and 12.2 (9.3, 15.7), respectively. In both unadjusted and adjusted linear models, all anthropometric measures were negatively associated with iAs%, MMA%, and PMI and positively associated with DMA% and SMI. For example, fully adjusted mean differences (95% CI) in DMA% per IQR-unit difference in BMI, subscapular skinfolds thickness, triceps skinfold thickness, MUAC, MUAFA, and MUAMA were 1.72 (1.16, 2.28), 1.58 (0.95, 2.21), 1.74 (1.11, 2.37), 1.45 (0.85, 2.06), 1.70 (1.08, 2.31), and 0.70 (0.13, 1.27) pp, respectively. ConclusionsAnthropometric measures were positively associated with arsenic methylation efficiency among pregnant women in the early second trimester.

Late Preterm Infant Growth and Body Composition at Corrected Term Gestation: A Cohort Study

Introduction: Worldwide major proportion of preterm births is late preterm infants. Preterm infants are deprived of optimal in-utero nutrition leading to immediate consequences of growth failure and long-term complications like adverse neurodevelopment outcomes whereas preterm infants with fast catch up growth after birth have health consequences like obesity and hypertension in adulthood. Aim: To assess growth of late preterm infants at their term equivalent Gestational Age (GA) and compare their growth and body composition with term infants. Materials and Methods: This was a cohort study of late preterm (34 0/7 to 36 6/7 weeks) infants that were Appropriate for Gestational Age (AGA) and controls that were AGA term infants (39 0/7 to 40 6/7 weeks). All enrolled late preterm infants were followed-up at term equivalent (39 0/7 to 40 6/7 weeks). Growth plotted on Fenton’s chart and body composition were calculated using pre-defined formula for total mid-upper arm area (cm2), mid-upper arm muscle area (cm2), mid-upper arm fat area (cm2), and the Arm Fat Index (AFI) (%). The data was analysed using Epi info (version 7.2) with student t-test for continuous variables and chi-square test for dichotomous variables. A p-value of <0.05 was considered statistically significant. Results: Out of the 135 infants enrolled, 45 were late preterm and 90 were term born infants. Median GA of the case cohort was 35 (IQR 35-36) weeks and in the control cohort it was 39 (IQR 39-40) weeks. Total 45.7% (N=35) of the late preterm infants (after excluding loss to follow-up) were below 10th percentile (EUGR) at term GA. At term follow-up, mean weight and length of late preterm infants compared to term born infants was less and statistically significant. The mean Skin Fold Thickness (SKT) (cm) at triceps level 0.55 (SD 0.07) vs. 0.49 (SD 0.06), mean of calculated AFI (%) 31.25 (SD 3.08) vs. 28.19 (SD 2.5) and among late preterm infants at follow-up was more than in term infants and was statistically significant. Conclusion: Failure to thrive is common among the late preterm infants at term equivalent GA. Late preterm infants show postnatal growth characterised by predominant fat mass accretion and less lean mass.

Correlation of different anthropometric parameters with handgrip strength in football players

Background: The anthropometric measurements and handgrip dynamometry test express the physical capacity of a football player, and they can be used for comparisons with other sports. Aims and Objectives: The aims of the study were to found out for correlation of body mass index (BMI), mid-upper arm circumference, mid-upper arm area (MUAA), tricep skinfold thickness, corrected mid-upper arm muscle area (CMUAMA), mid-upper arm fat area (MUAFA), and arm fat index (AFI) with handgrip strength in Football players. Materials and Methods: A total of 30 healthy football players aged 15–25 years, from district sports academy, practicing from 3 years. They may not have any upper arm defects or any neurological problems. The Sahen’s digital handgrip dynamometer is used to test handgrip strength. MUAA determined by the normal formula circumference of the mid-upper arm 2/4π. Mid-upper arm circumference measured by measuring tape. Harpenden caliper used for tricep skinfold thickness measurement. Standard formula used for measurement of CMUAMA, MUAFA, and AFI. Pearson correlation coefficient used for correlation. Results: Statistically, there was a positive correlation between MUAC, BMI, mid-upper arm circumference, MUAA, corrected mid-upper arm muscle area, mid-upper arm fat area in football players with handgrip strength, and a negative correlation between tricep skinfold thickness, and AFI in football players with handgrip strength. Conclusion: Proper training to maintain MUAC, BMI, mid-upper arm circumference, midupper arm area, mid-upper arm muscle area, and mid-upper arm muscle area corrected, the strength of handgrip will improve in the mid-upper arm fat area. In football, it will further contribute to better strength and results.

Triage for Malnutrition Risk among Pediatric and Adolescent Outpatients with Cystic Fibrosis, Using a Disease-Specific Tool.

Malnutrition prevails in considerable proportions of children with Cystic Fibrosis (CF), and is often associated with adverse outcomes. For this, routine screening for malnutrition is pivotal. In the present cross-sectional study, we aimed to assess the risk for malnutrition in pediatric outpatients with CF. A total of 76 outpatients (44 girls, 11.9 ± 3.9 years old, 39.5% adolescents) were recruited and anthropometric, clinical, dietary and respiratory measures were collected. All outpatients were screened for malnutrition risk with a validated disease-specific instrument. Most children exhibited a low risk for malnutrition (78.9%), whereas none of the participants were characterized as having a high malnutrition risk. In the total sample, malnutrition risk was positively associated with age (r = 0.369, p = 0.001), and inversely related to the body mass index (r = −0.684, p < 0.001), height z-score (r = −0.264, p = 0.021), and forced expiratory volume (FEV1%, r = −0.616, p < 0.001). Those classified as having a low malnutrition risk were younger (p = 0.004), heavier (p < 0.001) and taller (p = 0.009) than their counterparts with a moderate risk. On the other hand, patients in the moderate risk group were more likely pubertal (p = 0.034), with a reduced mid-upper arm fat area (p = 0.011), and worse pulmonary function (p < 0.001). Interestingly, none of the children attaining ideal body weight were classified as having a moderate malnutrition. risk, whereas 37.5% of the patients allocated at the moderate risk group exhibited physiological lung function. In this cohort of outpatients with CF that were predominantly well-nourished and attained physiological lung function, malnutrition risk was identified only in small proportions of the sample. Our data support that patients that are older, pubertal, or have diminished fat mass are at greater risk for malnutrition.

Nutrition and Neurodisability Edited by Peter BSullivan, Guro LAndersen, and Morag JAndrewLondon: Mac Keith Press,2020£55.00 (Softback), pp 208. ISBN: 9781911612254

This practical, evidence-based handbook is for all health professionals who care for children with feeding, nutritional, and gastrointestinal problems that derive from neurological disability, particularly cerebral palsy. This is a new revision of two previous books on this topic by the same editor (published in 1996 and 2009), and arises from the growing interest and research in this field during the last decade. The authors are some of the world’s leading experts in the field from Europe, Australia, and North America. They have contributed their extensive knowledge and expertise, and have reviewed all the recent studies and guidelines in order to address the most important aspects of this challenging topic. These include oral sensorimotor dysfunction, gastrointestinal problems, nutritional status definition, and nutritional impairment, as well as feeding and nutritional management strategies. The perspective of the handbook is practical, useful for both clinicians new in the field and those more experienced. Many of the chapters have included the description of clinical cases to enhance the key messages. Thanks to nutritionists and gastrointestinal pediatrician pioneers in this field (with a special mention to Prof Sullivan) and the progressive support of the multidisciplinary community in the field of childhood-onset neurodisability, nutrition is now part of the preventive program for any child with neurological disability. Early intervention and ongoing support are necessary to prevent undernutrition, defined by one or more of the so-called ‘nutritional red flags’, such as weight-for-age z-score <–2; triceps skinfold thickness <10th centile for age and sex; mid-upper arm fat or muscle area <10th centile; faltering weight and/or failure to thrive; and physical signs of undernutrition.1, 2 A skilled multidisciplinary clinical team is fundamental in assessing and managing children with neurological impairment and feeding difficulties. This includes the prescription and administration of interventions, as well as ongoing monitoring and adjustment of treatments as required. The main tools of interventions are detailed in the book, including oral nutrition support and/or enteral tube feeding. Oral nutrition support strategies include managing the child’s mealtime environment and positioning, offering modified food or fluid textures, and using adaptive equipment, caregiver behavioral techniques, and sensorimotor therapy. Despite modest evidence, the book also mentions emerging treatment options, such as robotic assistive feeding devices, intraoral appliances, and neuromuscular electrical stimulation.3 Whether and when to insert a gastrostomy feeding tube is one of the most important decisions in managing a child with neurodisability. It should take into account the interplay between outcomes of safety, efficiency, skill development, and mealtime stress, considered in the socio-cultural context in which the child lives.1, 2 Moreover, as increasing numbers of children with neurological impairment are undergoing gastrostomy placement and are now surviving beyond childhood into adulthood, the question arises as to whether long-term benefit could be achieved by starting enteral tube feeding earlier in life. Children and their families need to be at the centre of the team’s efforts. Families will require support and collaboration, working to reduce the impact on their lives of their child’s eating and drinking difficulties, including use of tube feeding.4 All members of the multidisciplinary team should be well informed about the indications for and advantages and disadvantages of tube feeding, so that a consistent message is conveyed to parents. Working in partnership with families of children with neurodisability has been shown to lead to improved outcomes.5 Understanding parents’ perceptions will help health professionals to develop effective, family-centered, patient-appropriate intervention and adherence strategies for tube-fed children with neurodisability. All these topical questions are dealt with in an instructive and persuasive way in this excellent handbook.

The effect of nutritional support on nutritional status and quality of life as well as on inflammatory markers and cardiac functions in patients with cardiac cachexia due to chronic heart failure

Objective: Cardiac cachexia (CC) is defined as a loss of at least 6% of total body weight in 6 months due to chronic heart failure (CHF). The prevalence of CC in patients with NYHA class II-IV is estimated to be approximately 12%-15%. There are only a few studies that demonstrate the effects of malnutrition treatment on nutrition, physical activity, quality of life (QoL), and clinical course of the disease. This study aimed to evaluate the effect of nutrition treatment on anthropometric measurements, fat free mass (FFM), muscle strength, physical performance, and QoL together with cardiac functions and immunity in patients with CC. Method: This was a prospective clinical intervention study. Patients with NYHA stage II-IV CHF (n=725) followed-up in Internal Medicine and Cardiology Departments were screened for CC. Eighteen patients with CC were enrolled in the study. The control group included 18 healthy adults. Nutritional status assessment, anthropometric measurements, gait speed, muscle strength, bioelectrical impedance analysis (BIA Tanita, Japan), biochemical analyses, and cytokine measurements were performed. Cardiac functions were assessed by echocardiography. Nutrition support treatment was given to patients with CC, and they were followed-up for next 3 months. QoL was measured with “Ferrans and Powers” Quality of Life Index (cardiac version). Similar studies were repeated after follow-up. Results: After excluding all other reasons for cachexia, the prevalence of CC was 2.5% in our patients with CHF. The patients with CC had higher serum C-Reactive Protein (CRP) and IL-6 levels than the healthy controls. After nutrition support treatment, the QoL scores and visceral fat level significantly increased in patients with CC. Although mid-upper arm circumference (MUAC), handgrip strength, FFM, fat mass, and serum albumin levels increased, they were not statistically significant. Conclusion: When compared to previous studies, our CC prevalence rate was lower. Nutrition support therapy can reverse weight loss in patients with CC, which can also improve QoL. An important limitation to the study is the low number of patients that is related with the exclusion criteria regarding every type of inflammatory disease, acute medical problems, and cancer. Therefore, further studies with more patients are needed.

Physical Growth and Body Composition of Controlled Versus Uncontrolled Type 1 Egyptian Diabetic Children

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic endocrine disorders of childhood. Data on growth parameters of diabetic children is scarce. AIM: To assess growth and body composition in a group of diabetic children. SUBJECTS AND METHODS: 427 T1DM children (age 2-10 years) were recruited from Diabetic Paediatric Unit, outpatients' clinic of Abou El-Rish Hospital. Anthropometric and body composition parameters were taken and HbA1c was measured for all subjects. RESULTS: Highly significant difference was detected between controlled and uncontrolled groups as regard to weight/age z-score, height/age z-score, BMI z-score, triceps skin fold thickness, subscapular skin fold thickness, midupper arm circumference, fat mass, fat %, lean mass, and body water (p < 0.001). All values are higher in the controlled group than in the uncontrolled group. Uncontrolled subjects were significantly more at risk of being underweight and short, with odds ratio of 15.131 and 16.877 and 95% confidence interval 1.972-116.130 and 3.973-71.694 respectively. However, controlled subjects were significantly more at risk of being obese than the uncontrolled with an odds ratio 0.116 and 95% confidence interval 0.045-0.302. CONCLUSION: Growth was compromised in uncontrolled T1DM children. This is of utmost importance since most of the clinical features are reversible with better glycemic control and appropriate insulin management.

Physical Growth and Body Composition of Controlled Versus Uncontrolled Type 1 Egyptian Diabetic Children

BACKGROUND: Type 1 Diabetes Mellitus (T1DM) is one of the most common chronic endocrine disorders of childhood. Data on growth parameters of diabetic children is scarce.AIM: To assess growth and body composition in a group of diabetic children.SUBJECTS AND METHODS: 427 T1DM children (age 2-10 years) were recruited from Diabetic Paediatric Unit, outpatients' clinic of Abou El-Rish Hospital. Anthropometric and body composition parameters were taken and HbA1c was measured for all subjects.RESULTS:Â Highly significant difference was detected between controlled and uncontrolled groups as regard to weight/age z-score, height/age z-score, BMI z-score, triceps skin fold thickness, subscapular skin fold thickness, midupper arm circumference, fat mass, fat %, lean mass, and body water (p &lt; 0.001). All values are higher in the controlled group than in the uncontrolled group. Uncontrolled subjects were significantly more at risk of being underweight and short, with odds ratio of 15.131 and 16.877 and 95% confidence interval 1.972-116.130 and 3.973-71.694 respectively. However, controlled subjects were significantly more at risk of being obese than the uncontrolled with an odds ratio 0.116 and 95% confidence interval 0.045-0.302.CONCLUSION: Growth was compromised in uncontrolled T1DM children. This is of utmost importance since most of the clinical features are reversible with better glycemic control and appropriate insulin management.

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.

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.

Early invitation to food and/or multiple micronutrient supplementation in pregnancy does not affect body composition in offspring at 54 months: follow‐up of theMINIMat randomised trial,Bangladesh

Growth patterns in early life are associated with later health. The effect of nutrition during in utero development on later body composition is unclear. We evaluated whether prenatal early invitation to food and/or multiple micronutrient supplementation (MMS) in pregnancy has an effect on offspring body composition at 54 months of age. In Maternal and Infant Nutrition Interventions in Matlab trial (ISRCTN16581394) in Bangladesh, 4436 pregnant women were randomised into six equally sized groups: double-masked supplementation with capsules of either 30 mg Fe and 400 μg folic acid, or 60 mg Fe and 400 μg folic acid, or MMS (15 micronutrients), was combined with a randomised early invitation (around 9 weeks) or a usual invitation (around 20 weeks) to start food supplementation (608 kcal 6 days per week). At 54 months, the body composition of the offspring was assessed by leg-to-leg bioelectrical impedance analysis. Of the 3267 live singletons with birth anthropometry, 2290 children were measured at 54 months, representing 70% of the live births. There was no interaction between the food and micronutrient supplementation on body composition outcomes. There were no significant differences in a range of anthropometric and body composition measurements, including weight, height, mid-upper arm circumference, head circumference, skinfold thickness, and fat mass and fat-free mass between the different prenatal food and micronutrient groups using an intention-to-treat analysis. This analysis shows that early invitation to food supplementation and MMS provided to rural Bangladeshi women during pregnancy did not affect offspring body composition at 54 months of age.

Anthropometric measures: poor predictors of body fat in children with moderate to severe cerebral palsy

This purpose of our study was to assess and compare anthropometric measures of adiposity and direct measurement of percentage body fat by dual emission X-ray absorptiometry (DXA) in children with cerebral palsy (CP). We also compared our results in children with CP with results from a national sample of typically developing children from the National Health and Nutrition Examination Survey. Anthropometry and DXA were obtained from 58 participants with CP (25 females, 33 males; Gross Motor Function Classification System levels III-V; mean age 13 y 1 mo [SD 3 y], range 8-18 y). Height was estimated from knee height, which was measured with knee height calipers; weight was measured on a sitting scale. The relation between percentage body fat measured by DXA and z-scores of each of the anthropometric measures (body mass index, mid-upper arm circumference, triceps skinfold, and mid-upper arm fat area) was assessed by linear models. Agreement analysis was performed to assess the ability of each anthropometric measure to predict percentage body fat by DXA. None of the anthropometric measures were adequately associated with percentage body fat by DXA. All anthropometric methods tended to underestimate percentage body fat in children with CP. Single anthropometric measures do not perform well in predicting percentage body fat in children with or without CP. Further work is needed to develop clinically useful and simple assessments that will predict percentage body fat and to determine the relation between percentage body fat and health to guide clinical practice.

Estado nutricional de crianças com paralisia cerebral

OBJETIVO: Avaliar o estado nutricional de 114 crianças com paralisia cerebral, entre 2 e 12,9 anos de idade. MÉTODO: Estudo transversal incluindo crianças atendidas nos ambulatórios de gastropediatria, ortopedia e neuropediatria de um hospital terciário universitário. Os indicadores nutricionais antropométricos estudados foram: peso, altura, índice de massa corporal, área muscular e de gordura do braço. RESULTADOS: A frequência de comprometimento nutricional (Escore-Z &lt;-2), de acordo com os indicadores antropométricos para a idade e a média com o desvio-padrão, foram: 50,9% para peso, com média de -2,19 (DP=2,48), 38,6% para altura, média: -1,66 (DP=1,50), 45,6% para índice de massa corporal, média: -1,74 (DP=2,75), 29,8% para área muscular do braço, média: -1,03 (DP=1,73) e 35,1% para área de gordura do braço, média: -1,15 (DP=1,41). CONCLUSÃO: A desnutrição foi frequente em crianças com paralisia cerebral. As crianças com paralisia cerebral do tipo tetraparético apresentaram os indicadores antropométricos mais comprometidos: peso e índice de massa corporal, com 72,4% e 73,1% das crianças com Escore-Z &lt;-2 respectivamente.

Subcutaneous fat stores related to weight in full-term neonates

Background: Subcutaneous fat stores in newborns have been related to weight (W) and skinfolds (SK); both are influenced by gestational age (GA) and there are few studies analysing the association between them.Aim: The present study assessed fat storage in term newborns that are appropriately nourished.Subjects: Subjects were 1259 singleton term newborns, with appropriate weight for GA.Methods: A cross-sectional observational study was utilized where weight, length, tricipital skinfold (TSK), subscapular skinfold (SSK) and mid upper arm (MUA) circumference were measured at birth. MUA areas and the TSK/W and SSK/W ratios were calculated. Data were analysed according to gender and GA.Results: Weight and length were higher in males, while TSK, SSK, MUA fat area, MUA fat percentage, TSK/W and SSK/W were higher in females. Weight and length increased with GA in both genders. SK did not increase with GA, except the TSK in males. The TSK/W and SSK/W ratios decreased significantly with GA age in both genders. Percentiles of TSK/W and SSK/W ratios are presented.Conclusion: The study provides a new perspective to the idea that fat storage increases continuously during the last period of gestation. The data presented showed that this phenomenon is not clearly demonstrated for full-term infants with appropriate weight for GA.

Body Composition and Resting Energy Expenditure of IndividualsWith Duchenne and Becker Muscular Dystrophy

The relationship between body composition and resting energy expenditure (REE) was investigated in two boys and two men with Duchenne muscular dystrophy (DMD) (ages 11 to 22.4 years) and two boys with Becker muscular dystrophy (BMD) (ages 7.75 and 13.75 years). The REE was assessed by indirect calorimetry; body composition indices (weight, height, skinfolds, and mid-arm circumference) were measured using standardized techniques and compared with healthy reference data. Those with DMD had reduced corrected mid-upper-arm muscle area (C-MUMA) in comparison with healthy peers, and approximately twice the subcutaneous fat levels of subjects with BMD and healthy peers. Boys with BMD had remarkably lower muscle status than did boys with DMD and healthy peers. In both groups, REE was lower than in healthy peers; REE was associated with body weight (r=0.85), height (r=0.92), mid-upper arm fat area (MUFA) (r=0.97), and C-MUMA (r=0.65). Individuals with muscular dystrophy (MD) exhibit considerable disease-specific alterations in body composition. The REE had a stronger relationship with growth (weight and height) and subcutaneous body fat composition and a weaker association with C-MUMA. Understanding the effect of MD on body composition and REE will allow dietitians to individualize energy recommendations.

‘Nutritional status of children with cerebral palsy in a Brazilian tertiary‐care teaching hospital’

SIR–Malnutrition is a common and worldwide medical problem in children with cerebral palsy (CP).1–5 Pediatric gastroenterologists and nutritionists have seen an increasing number of patients with CP requiring nutritional support in Brazilian clinics in the last few years. Any evaluation of current nutritional condition in children with CP should take into consideration the fact that these children are usually smaller than children at the same age due to their muscle hypotrophy and contracture. There is a lack of information regarding the nutritional status of Brazilian children with CP. This study reports data on growth parameters recorded in patients with CP seen at gastroenterology, orthopaedic, and neurology pediatric units in a Brazilian tertiary-care teaching hospital, between January 2004 and March 2006, from 58 cities of three states of Brazil. Data and the anthropometric measurements were obtained by a trained nutritionist observer with validity measurements after Review Board approval and the caregivers gave informed consent. The weight, height, triceps skinfold thickness (TST), mid-upper arm muscle area (AMA), and mid-upper arm fat area (MAFA) were converted into z-scores, and malnutrition was defined when the z-score was ≤–2.6,7 Data were recorded in the SPSS. Most of the children (80.7%) were unable to assume and upright posture. Some of them had scoliosis, involuntary muscle spasms, and poor cooperation so the height was estimated on the basis of knee height.1 One hundred and fourteen children were measured, 65 (57%) males and 49 (43%) females, aged from 2 to 12 years 11 months (median age 7y 4mo). Spastic quadriplegic CP was the most frequent type, found in 78 (68.4%) children. Fifteen (13.2%) patients were neurologically classified as mixed type, 10 (8.8%) children had spastic hemiplegia CP, eight (7%) had spastic diplegia CP, and three (2.6%) were classified as athetoid. The ataxic type of CP was found only in children with the mixed type of CP. According to the Gross Motor Function Classification System,8 96 (84.2%) were classified as Level V, eight (7%) as Level IV, six (5.3%) as Level I, and four (3.5%) as Level II. Anthropometric indicators (z-scores) mean and standard deviation were: –2.19 (SD 2.48) for weight; –1.66 (SD 1.50) for height; –1.04 (SD 1.34) for TST: –1.03 (SD 1.73) for AMA; and –1.15 (SD 1.41) for MAFA. Children with quadriplegia showed the most frequent malnutrition: 42 (72%) for weight; 31 (68.9%) for height; 25 (71.4%) for TST; 24 (68.6%) for AMA; and 31 (75.6%) for MAFA. Mean weight/age z-scores were significantly lower in children with the athetoid and mixed type of CP. However the mean height/age z-scores were significantly higher in children with hemiplegic CP. Children with athetoid CP presented the lowest MAFA values (p<0.001), whereas no significant difference was found for mid upper AMA. There was no significant difference in the anthropometric indicators for sex. This study showed that Brazilian children with CP are severely malnourished when compared to children with CP in other countries.4,9,10 Weight, height, and MAFA were lower compared to the National Center for Health Statistics reference curves. Weight/age z-score ≤–2 was observed in 50.9% of the children, height in 38.6%, and adipose tissue in 35.1%. One-third of the children presented with malnutrition in other anthropometric parameters, including TST (30.7%) and mid upper AMA (29.8%). Malnutrition was more severe in quadriplegic children with dysphagia, as reported by others studies.11,12 Two other situations contributed to the malnutrition in this study: the socioeconomic status, which was more frequently in D class with 53 children (46.5%), and the use of gastrostomy feeding, which was very low, with only seven children (6.2%).

Weight-for-Height Values and Limb Anthropometric Composition of Tube-Fed Children With Quadriplegic Cerebral Palsy

Research has shown that growth retardation among children with quadriplegic cerebral palsy (CP) is often attributed to feeding dysfunction and malnutrition. The study compared weight-for-height values and limb anthropometric composition of nasogastric and gastrostomy tube-fed children with quadriplegic CP with those of orally fed children with quadriplegic CP and normal children, to examine the plausible effects of tube feeding on weight-for-height, fat, and muscle values for children with quadriplegic CP. Triceps, anterior mid-thigh, and medial calf skinfold thicknesses and the corresponding circumferences of the right or less affected side were measured. The subjects consisted of 119 normal children and 62 orally fed and 48 tube-fed children with quadriplegic CP. Body weight and height were recorded. For children with CP whose height could not be measured, height was estimated from the ulna length. Weight-for-height z scores, limb skinfold thicknesses, fat areas, skinfold-corrected muscle girths, and muscle areas of the children were compared. Tube-fed children with CP had normal mean weight-for-height z scores. Weight-for-height z scores of the orally fed children with CP were significantly below those of normal children and tube-fed children with CP. For children with CP, whereas triceps skinfold thickness seemed to predict the mid-upper arm fat area correctly, leg skinfold thicknesses seemed to overestimate the corresponding fat areas. Stepwise multiple regression analysis showed that triceps skinfold thicknesses had good correlation (r = 0.86) and the presence of CP had nonsignificant correlation with mid-upper arm fat areas. Multiple regression analysis of fat areas with skinfold thicknesses and the presence of CP, however, showed that CP was correlated negatively (partial correlation of CP: thigh, -0.45; calf, -0.53) with thigh and calf fat areas. Although skinfold-corrected mid-upper arm muscle girths of children with CP were quite similar to those of normal children, leg muscle girths were much reduced for both orally fed and tube-fed children with CP. The apparent thickening of leg skinfold thicknesses among children with CP probably was attributable to disproportional leg muscle wasting, with resulting reduced internal circumference of the subcutaneous fat layer. For tube-fed children with CP, skinfold thicknesses and fat areas were increased significantly, although their leg skinfold-corrected muscle girths and areas remained reduced. Skinfold thickness may overestimate the fat area in the affected limb with significant muscle wasting for children with CP. The condition was particularly obvious in the leg, where muscle wasting was prominent. Because leg muscles represent approximately one quarter of the normal body weight, low weight-for-height values among children with CP can be caused by leg muscle wasting attributable to disuse atrophy, which is unlikely to be correctable with tube feeding. Tube feeding may improve body weight mainly through fat deposition.

Anthropometric indices in rural Malawians aged 45–75 years

Objective: The aim of this cross-sectional study was to assess anthropometric parameters of rural people aged 45–75 years in the Southern Region of Malawi.Subjects and methods: 97 males and 101 females aged 45–75 years were selected from 10 villages in Balaka district using a stratified cluster sampling method. Most responders were small-scale farmers growing maize and vegetables for household consumption. The anthropometric measurements taken were height, weight, triceps skinfold (TSK) and mid-upper arm circumference (MUAC). The derivatives from anthropometric measurements included body mass index (BMI), mid-upper arm muscle area (MUAMA) and mid-upper arm fat area (MUAFA). Weight status of Malawian subjects was estimated using WHO (1995) categories for BMI values, and height, weight, TSK, MUAC, MUAMA and MUAFA were compared with NHANES reference data for black sample.Results: Correlation between age of subjects and the anthropometric indices was weak and insignificant. Males were generally taller and lighter than females. All anthropometric indices of Malawian subjects were considerably lower than NHANES medians. However the mean values of height, weight, MUAC and MUAMA of females were closer to the reference values than those of males. It was found that 9.1% of Malawian subjects had mild thinness (BMI 17.0–18.4 kg m−2), 13.6% had moderate thinness (BMI 16.0–16.9 kg m−2) and 18.2% exhibited severe thinness (BMI<16.0 kg m−2). The proportion of thin persons was higher (χ2 = 9.58, n = 1, p<0.01) among males than females (50.0% versus 35.7%).Conclusions: This study indicates that undernutrition is a serious problem among rural Malawians aged 45–75 years.

Identification of malnutrition in children with cerebral palsy: poor performance of weight-for-height centiles.

This study aims to evaluate the use of the United States National Center for Health Statistics (NCHS) weight-for-height centiles (WHC) in screening children with cerebral palsy (CP) for depleted body fat and to identify an alternate screening method. Growth data from 276 children aged from 3 to 12 years with CP were analyzed retrospectively. Height or a proxy for height, mid-upper arm circumference, weight, and skinfold thicknesses were recorded. Mid-upper arm fat area was calculated for each participant. The sensitivities and specificities of WHC and a number of alternative anthropometric screening methods for identifying participants with severely depleted fat stores were determined. WHC <10th centile failed to identify 45% of children with severely depleted fat stores. Triceps skinfold thickness <10th centile identified 96% of malnourished children. WHC standards lack adequate sensitivity for identification of severely depleted fat stores in children with CP. Use of triceps skinfold thickness, using cut-off value of <10th centile for age and sex, is recommended to screen for suboptimal fat stores in children with CP.