Prevalence of small for gestational age term neonates and its surrogate marker

Background: The incidence of low birth weight babies continues to be high in India at about 30% in contrast to 5-7% in developed countries. Perinatal, neonatal and infant mortality as well as morbidity is associated with low birth weight (LBW) neonates of which, it is the Small for Gestational Age (SGA) neonates that are at increased risk. Henceforth, it becomes important to study the prevalence of SGA babies and to compare various anthropometric measurements among term neonates for assessing as to which of these could be taken as surrogate markers of small for gestational age babies.Methods: It was a cross sectional study conducted over a period of 2 years among 100 term neonates delivered in a private medical college in Puducherry, India.Results: The prevalence of low birth weight babies and small for gestational age was found to be 40% and 30% respectively. Using mid arm circumference as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value of SGA was found to be 100%, 57.14%, 50% and 100% respectively. Using MAC/HC ratio as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value was found to be 46.67%, 100%, 100% and 81.4% respectively.Conclusions: In predicting SGA babies, mid arm circumference has the highest sensitivity whereas MAC/HC ratio has the highest specificity followed by mid arm circumference. Present study concluded that mid arm circumference and ratio of MAC/HC are very helpful in identifying SGA neonates among term neonates.

Association of Obesity and Mid-Arm Circumferences with Dietary Life of Elderly Residing in Chungcheong Province

The purpose of this study was to compare the dietary status of elderly people according to the degree of obesity and mid-arm circumference in order to provide individualized and efficient nutrition management according to the physical condition of the elderly. Among the total 328 subjects, 72.2% were female, and the mean age and body mass index of the subjects were 76.5 years and 23.4 kg/m₂, respectively. The distribution of obesity degree was 47.9% for the normal group, 23.5% for the overweight group, and 28.7% for the obesity group. The distribution of mid-arm circumference was 18.0% for the under-21 cm group, 37.2% for the 21~22 cm group, and 44.8% for the over-22 cm group. About 82.9% of the subjects were consumed at least three meals a day, and 67.8% of the subjects regularly ate alone. The responses for meal time, regular meal, and meal reduction for 3 months were highest in the 10~20 min. (43.4%), yes (79.3%), and no (58.5%) group, respectively. The responses for eating alone were significantly highest in the overweight group (97.4%), followed by the normal group and obesity group according to the degree of obesity (P<0.05). There were no significant differences in preference for five flavors according to the degree of obesity and mid-arm circumference. Among the dietary habits, 31.1% of all subjects ate milk and dairy products more than once a day, and the response for eating vegetables and fruits more than three times a day was highest in the over-22 cm group (61.9%) while the drinking rate was highest in the under-21 cm group (27.1%; P<0.05). In conclusion, the degree of obesity was related to eating ability, and mid-arm the circumference was related with fruit and vegetable consumption and drinking rate.

Mid Arm Circumference: An Alternate Anthropometric Index of Obesity in Type 2 Diabetes and Metabolic Syndrome.

Aim: To evaluate alternate anthropometric index for obesity in type 2 diabetes and metabolic syndrome. Study Design: This is a cross sectional study. Place and Duration of the Study: Department of Medicine, Kasturba medical college-hospital, Mangalore, Manipal university, between January 2012 - July 2015. Methodology: We recruited 207 type 2 diabetic and 101 metabolic syndrome subjects with their age and sex matched controls. Anthropometric parameters like BMI, Waist circumference and mid arm circumference (MAC) were measured. Biochemical details were collected from case record. Results: The mean differences in anthropometric and biochemical parameters were compared between cases and controls by independent T test. MAC was correlated with clinical parameters in control subjects by Karl pearson’s correlation and multiple linear regression analysis. There was significant difference in MAC between metS and their control subjects (31.35±4.21 vs 28.04±2.86, P<.001). There was significant positive linear correlation of MAC with BMI (P<.001), WC (P<.05), post prandial blood sugar (P<.05) and HbA1c (P<.05) in controls. Further multivariate analysis after adjusting for conventional risk factors showed a significant association of MAC with BMI (β=0.611, P<.001). Conclusion: These findings show that MAC can be useful as an alternate index for obesity in South Indians.

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

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 B1, vitamin B2, vitamin B6, 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 B2, 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 B2, 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.

A study of pupil cycle time (PCT) in altered state of nutrition in Indian male.

Pupil cycle time (PCT) is a simple way to measure the parasympathetic activity in the eye. This is a sensitive and specific test for the study of parasympathetic function. The cardiac parasympathetic tone is a good indicator to predict morbidity and mortality in an individual. The PCT is correlated with cardiac parasympathetic tone. In the present study we have aimed to look at the PCT in different nutritional status in human subjects. Sixty-three healthy adult male volunteers in the age group of 18–50 yrs were studied. They were divided in three groups based on their BMIs as undernourished, normal and preobese/obese. The mid-arm circumference (MAC) and waist- hip ratio (W:H) are incorporated as adjuvant to strengthen that they are divided into three different nutritional groups. The PCTs of undernourished (818±145 ms), normal control (904±63 ms) and overweight (991±106 ms) is expressed as mean and SD (P<0.001). A linear regression analysis was performed taking BMI, MAC, W:H and PCT as parameters, which shows a positive linear correlation. The results showed that the PNS activity in the eye is greatly modulated in different states of nutrition. Pupil cycle time is a simple, noninvasive investigative tool to assess and differentiate the PNS function in obese and chronic undernourished subjects.

Comparison of cardiac autonomic activity between malnourished and healthy children.

Severe malnutrition can significantly compromise autonomic nervous system. However, less is known about the cardiac autonomic activity in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of mild/moderate malnutrition on heart rate variability (HRV), a non invasive tool to estimate the cardiac autonomic activity. A cross sectional, community based study was conducted in which 35 malnourished children (mean age: 6.06±2.04 yrs), on the basis of anthropometric parameters, were enrolled in the study group by random samplings, who were the children of urban slum dwellers and 35 age and sex matched healthy children, were taken as controls. Grading of malnutrition was done according to Indian Academy of Pediatrics (IAP) classification. Anthropometry, basal heart rate (BHR), blood pressure were determined. Time domain and frequency domain indices of HRV were assessed using RMS Polyrite D (version 2.4). Weight, height, mid arm circumference (MAC) and body mass index (BMI) were found to be statistically lower in the study group. There was a strong negative correlation between MAC and LF component (P<0.01). BHR was found to be increased in the malnourished group (P=0.027). Low frequency (LFnu) & LF-HF ratio were found to be increased (P=0.000 & P=0.001 respectively) while high frequency (HFnu) component was decreased (P=0.000) in malnourished group. Our results suggested that impaired cardiac autonomic nerve function characterized by sympathetic over activity may occur in malnourished children. This study also enables us to compare, in future works, HRV in pediatric subjects with different grades of malnutrition.

Efectividad de la circunferencia del brazo para el despistaje nutricional de niños en atención primaria / Mid-Arm Circumference Effectiveness for the Nutritional Screening of Children in Primary Care

Para evaluar el impacto del uso de diferentes valores de referencia y puntos de corte sobre la efectividad de la circunferencia del brazo en el despistaje de la malnutrición por déficit y exceso, se estudiaron 148 menores de 5 años, sin antecedentes de prematuridad, ni patologías crónicas. El estado nutricional se evaluó con 2 métodos: 1.- Se utilizó la circunferencia del brazo para edad aplicando diferentes valores de referencia y puntos de corte, 2.- Se aplicó el diagnóstico clínico integral que constituyó el patrón de oro. Para el análisis estadístico se calcularon estadísticos descriptivos, concordancias, kappa, sensibilidad, especificidad, valor predictivo positivo y negativo, razón de verosimilitud positiva y negativa e índice de Youden. Con OMS 2006 el percentil 90 resultó el mejor para la identificación del riesgo de exceso en niños (sensibilidad: 90%; especificidad: 92,1%, razón de verosimilitud positiva: 12,67 y negativa: 0,00; Youden: 0,92) y el percentil 85 en niñas (valores de 100%; 84,3%; 6,38; 0,00 y 0,84 para los estadísticos anteriores), respectivamente. Para déficit, los puntos de corte estudiados no resultaron aceptables. Se recomienda usar los percentiles 90 y 85 de la referencia OMS 2006 para la circunferencia del brazo en la identificación del riesgo de exceso en niños y niñas menores de cinco años, respectivamente. No se recomienda su uso en la identificación del riesgo de déficit en el mismo grupo de edad, se requiere el análisis de su efectividad con percentiles 16 al 20 y validar este estudio a nivel poblacional(AU)

In order to assess the impact of using different reference values and cut-off points on the effectiveness of mid-arm circumference measurements in malnutrition screening for deficit and excess, 148 children under 5 years, without prematurity backgrounds or chronic pathologies, were studied. The nutritional status was evaluated using 2 methods: 1.- Arm circumference measurement, applying different reference values and cut-off points; 2.-An integral clinical diagnosis as the gold standard. Descriptive statistics, concordances, kappa, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the Youden index were applied. The WHO 2006 p90 (sensitivity: 90%; specificity: 92.1%; positive likelihood ratio: 12.67 and negative likelihood ratio: 0.00; Youden index: 0.92) resulted best for identifying excess risk in boys. In girls, only the WHO 2006 p85 resulted effective with the following values: 100%; 84.3%; 6.38; 0.00; and 0.84 for the previous statistics. As for deficit, the studied cut-off points resulted unacceptable. We recommend using percentiles 90 and 85 of the WHO 2006 reference for arm circumference effectiveness in identifying excess risk in boys and girls, respectively, but we do not recommend using the traditional percentiles to identify the risk of deficit in the same age group. The latter requires percentiles 16 to 20 to analyze its effectiveness, and the study must be validated at a population level(AU)

Evaluation of risk factors for antituberculosis treatment induced hepatotoxicity.

Background & objectives: Antituberculosis (anti-TB) drug induced hepatotoxicity (DIH) is the most common side effect leading to interruption of therapy. Wide variations have been found in the reported incidence of hepatotoxicity during short-course chemotherapy. Several risk factors for hepatotoxicity have been suggested in previous studies. We undertook a prospective case-control study to assess the role of these putative risk factors in the development of DIH in patients receiving anti-TB treatment. Methods: One hundred and seventy five consecutive cases with a diagnosis of anti-TB DIH were compared with 428 consecutive controls who took anti-TB drugs for the full duration of chemotherapy without clinical or biochemical evidence of hepatitis. Cases positive for markers of acute viral hepatitis were carefully excluded. Cases and controls were compared with respect to age, sex, site of tuberculosis, radiological extent of disease on chest radiograph, body mass index (BMI), mid-arm circumference (MAC) and liver function at baseline which included serum bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), serum total protein and serum albumin. Results: Univariate logistic regression revealed that the risk of developing DIH was greater in older patients. Significantly greater percentage of cases had extrapulmonary tuberculosis (TB) (P<0.01). Also, a significantly higher percentage of cases had moderate to far advanced disease severity on chest radiograph (P<0.01). On multivariate logistic regression, the adjusted odds were significant (P<0.01) for age >35 yr, MAC <20 cm and hypoalbuminaemia (albumin <3.5 g/dl). Interpretation & conclusions: Older age, poor nutritional status including baseline hypoalbuminaemia were independent predictors of occurrence of anti-TB DIH. Clinicians should be vigilant for occurrence of hepatotoxicity in this high risk group.

Prediction Equations for Body-fat Percentage in Indian Infants and Young Children Using Skinfold Thickness and Mid-arm Circumference.

The objective of the study was to develop prediction equations for fat-mass percentage in infants in India based on skinfold thickness, mid-arm circumference, and age. Skinfold thicknesses and mid-arm circumference of 46 apparently-healthy infants (27 girls and 19 boys), aged 6-24 months, from among the urban poor attending a well baby clinic of a hospital in Kolkata were measured. Their body-fat percentage was measured using the D2O dilution technique as the reference method. Equations for body-fat percentage were developed using a stepwise forward regression model using skinfold thicknesses, mid-arm circumference, and age as independent variables, and the body-fat percentage was derived by D2O dilution as the dependent variable. The new prediction equations are: body-fat percentage=-69.26+5.76×B- 0.33×T2+5.40×M+0.01×A2 for girls and body-fat percentage=-8.75+3.73×B+2.57×S for boys, where B=biceps skinfold thickness, T=triceps skinfold thickness, and S=suprailiac skinfold thickness all in mm, M=mid-arm circumference in cm, and A=age in month. Using the D2O dilution technique, the means (SD) of the calculated body-fat percentage were 17.11 (7.25) for girls and 16.93 (6.62) for boys and, using the new prediction equations, these were 17.11 (6.25) for girls and 16.93 (6.02) for boys. The mean of the differences of paired values in body-fat percentage was zero. The mean (SD) of the differences of paired values for body-fat percentage derived by the D2O technique and the new equations, applied on an independent sample of 23 infants (11 girls and 12 boys) were -0.93 (6.56) for girls and 1.14 (2.43) for boys; the 95% confidence limits of the differences of paired values for body-fat percentage were -2.03 to +3.89 for girls and -0.26 to +2.54 for boys. Given that the trajectories of growth during infancy and childhood are a major risk factor for a group of diseases in adulthood, including coronary heart disease and diabetes, these predictive equations should be useful in field studies.