A systematic review and meta-analysis of the accuracy of weight estimation systems used in paediatric emergency care in developing countries

Introduction :When weight cannot be measured during the management of medical emergencies in children, a convenient, quick and accurate method of weight estimation is required, as many drug doses and other interventions are based on body weight. Many weight estimation methodologies in current use have been shown to be inaccurate, especially in low- and middle-income countries with a high prevalence of underweight children. This meta-analysis evaluated the accuracy of weight estimation systems in children from studies from low- and middle-income countries. Methods : Articles from low- and middle-income countries were screened for inclusion to evaluate and compare the accuracy of existing systems and the newer dual length- and habitus-based methods, using standard meta-analysis techniques. Results:The 2D systems and parental estimates performed best overall. The PAWPER tape, parental estimates, the Wozniak method and the Mercy method were the most accurate systems with percentage of weight estimates within 10% of actual weight (PW10) accuracies of 86.9%, 80.4%, 72.1% and 71.4% respectively. The Broselow tape (PW10 47.1%) achieved a moderate accuracy and age-based estimates a very low accuracy (PW10 11.8­47.5%). Conclusions:The PAWPER tape, the Wozniak method and the Mercy method achieved an acceptable level of accuracy in studies from low- and middle-income countries and should preferentially be used and further advanced for clinical emergency medicine practice. Parental estimates may be considered if the regular caregiver of the child is present and a recent measured weight is known. The Broselow tape and age-based formulas should be abandoned in low- and middle-income country populations as they are potentially dangerously inaccurate

Weight homeostasis & its modulators in hyperthyroidism before & after treatment with carbimazole.

Background & objectives: Hyperthyroidism is associated with increased food intake, energy expenditure and altered body composition. This study was aimed to evaluate the role of adipocytokines in weight homeostasis in patients with hyperthyroidism. Methods: Patients (n=27, 11men) with hyperthyroidism (20 Graves’ disease, 7 toxic multinodular goiter) with mean age of 31.3±4.2 yr and 28 healthy age and body mass index (BMI) matched controls were studied. They underwent assessment of lean body mass (LBM) and total body fat (TBF) by dual energy X-ray absorptiometer (DXA) and blood sample was taken in the fasting state for measurement of leptin, adiponectin, ghrelin, insulin, glucose and lipids. Patients were re-evaluated after 3 months of treatment as by that time all of them achieved euthyroid state with carbimazole therapy. Results: The LBM was higher (P<0.001) in healthy controls as compared to hyperthyroid patients even after adjustment for body weight (BW), whereas total body fat was comparable between the two groups. Serum leptin levels were higher in patients with hyperthyroidism than controls (22.3±3.7 and 4.1±0.34 ng/ml, P<0.001), whereas adiponectin levels were comparable. Plasma acylated ghrelin was higher in patients than in controls (209.8±13.3 vs 106.2±8.2 pg/ml, P<0.05). Achievement of euthyroidism was associated with significant weight gain (P<0.001) and significant increase in lean body mass (P<0.001). The total body fat also increased but insignificantly from 18.4±1.8 to 19.9±1.8 kg. There was significant decrease (P<0.05) in serum leptin and acylated ghrelin but adiponectin levels remained unaltered after treatment. Serum leptin positively correlated with TBF and this correlation persisted even after adjustment for BW, BMI, gender and age (r=0.62, P=0.001). However, serum leptin and acylated ghrelin did not correlate with the presence or absence of hyperphagia. Interpretation & conclusion: Patients with hyperthyroidism predominantly had decreased lean body mass which increased after achievement of euthyroidism with carbimazole. The hyperphagia and the alterations in weight homeostasis associated with hyperthyroidism were independent of circulating leptin and ghrelin levels.

Indice de masa corporal (peso Kg/m2) / Body mass index (weight Kg/m2)

Se presentan los percentiles del indice de Masa Corporal (P/T2) derivados de los valores de peso y talla del Estudio Transversal de Caracas (ETC), recomendando como norma de referencia provisional para Venezuela. La muestra corresponde a 2.793 varones y 2.599 niñas pertenecientes a los estratos sociales I+II+III (Graffar, modificado por H. Méndez Castellano) entre los 0 y los 18 años. Se calcularon los percentiles por desviaciones estandard y por posición, se escogieron éstos últimos debido a que la variable no sigue la distribución normal. Se desarrolló un Programa en Fortram IV y se ajustaron los percentiles por el método de los promedios móviles para suavizar las curvas. Se realizó un análisis comparativo con resultados reportados por otros investigadores. La amplitud entre los percentiles varió de acuerdo a la edad y al sexo y fué mayor entre los percentiles que se ubican por encima de la mediana. La mediana de los varones superó a la de las niñas hasta los diez años, entre esta edad y los dieciséis años se observó el predominio femenino puberal, que alcanzó a 0,9 Kg/m2 a los doce años, el dimorfismo sexual a los dieciocho años fué de 0,8 Kg/m2 a favor de los hombres. Se recomienda usar estos percentiles en conjunto con la distribución centilar de peso y talla, derivadas del Estudio Transversal de Caracas. Palabras Claves:-Peso para la talla-Composición Corporal-Malnutrición