Obesity and malnutrition in children: profile of a low-income community

OBJECTIVE: To establish the nutritional diagnosis of children living in a low-income community through anthropometric evaluation, detecting insufficient nutrition (low weight-for-age, wasting and stunting) and excessive nutrition (overweight and obesity). METHODS: A community-based survey identified children below 11 years living in a low-income community. Their weight and height (or lengths) were measured. The National Center for Health Statistics growth curve was used as reference. The cut-off points used were: low-weight-for-age z score of < -2 (weight-for-age), wasting (weight-for-height) and stunting (height-for-age); respective overweight and obesity z scores of +1 to +2 and of > +2, according to weight-for-height. RESULTS: Prevalence rates were 3.8% for low weight for age, and 24% for low-weight-for-age risk factors; 1.2% for wasting, and 21.6% for wasting risk factors; 5% for stunting, and 14.3% for stunting risk factors; 10.1% for overweight, and 4.6% for obesity. CONCLUSIONS: Main nutritional issues were present in children from that community, with simultaneous occurrence of chronic malnutrition and obesity.     

Intra-abdominal fat measurement by ultrasonography: association with anthropometry and metabolic syndrome in adolescents

ObjectiveTo associate intra-abdominal fat thickness measured by ultrasonography to the factors related to metabolic syndrome and to determine cutoff points of intra-abdominal fat measurement associated with a greater chance of metabolic syndrome in adolescents.MethodsThis was a cross-sectional study, with 423 adolescents from public schools. Intra-abdominal fat was measured by ultrasonography. Anthropometric data were collected, and biochemical analyses were performed.ResultsIntra-abdominal fat was measured by ultrasonography, showing a statistically significant association with the diagnosis of metabolic syndrome (p = 0.037), body mass index (p < 0.001), elevated triglyceride levels (p = 0.012), decreased plasma HDL levels (p = 0.034), and increased systemic blood pressure values (p = 0.023). Cutoff values of intra-abdominal fat thickness measurements were calculated by ultrasound to estimate the individuals most likely to develop metabolic syndrome. In the logistic regression models, the cutoff values that showed the highest association with metabolic syndrome in males were 4.50, 5.35, 5.46, 6.24, and 6.50 cm for the ages of 14, 15, 16, 17, and 18/19 years, respectively. In the female gender, the cutoff values defined for the same age groups were 4.46, 4.55, 4.45, 4.90, and 6.46 cm. In an overall analysis using the ROC curve, without gender and age stratification, the cut-off of 3.67 cm showed good sensitivity, but low specificity.ConclusionUltrasonography is a useful method to estimate intra-abdominal adipose tissue in adolescents, which is associated with the main factors related to obesity and metabolic syndrome.     

Physical activity as a clinical tool in the assessment of malnutrition

Objective

To measure physical activity in children with wasting and to look for association between poor physical activity and wasting.

Methods

Physical activity was measured in 56 children with wasting, using Children’s Activity Rating Scale, and compared with age- and sex-matched controls.

Results

A significant association was found between poor physical activity and malnutrition as determined by weight-for-height Z Score <-2 (P=0.001) and midupper-arm circumference (P=0.002).

Conclusion

Physical activity can be used as clinical parameter to assess malnutrition.     

Color Doppler ultrasonography in the assessment of vesicoureteric reflux in children with bladder dysfunction

To determine whether color Doppler ultrasound (DUS) evaluation of ureteric jets could predict vesicoureteric reflux (VUR) in children with non-neuropathic and neuropathic bladder/sphincter dysfunction, 129 children were evaluated to identify the vesicoureteric orifice and measure the distance from the orifice to the midline of the dorsal bladder wall (MVU distance). The type of bladder dysfunction was determined by urodynamic studies. Forty-two children with no history of kidney or bladder disease were examined by DUS as a control group. MVU distances were compared between several groups of children with different urodynamic findings, and the significance was tested. Jets were visualized in 81% of children. MVU distances were significantly lower in children without VUR compared to those with VUR. No statistically significant differences were observed between children without VUR and those with VUR and more severe urodynamic disturbances like dysfunctional voiding. In children with neuropathic bladders, jets were visible in only 57% of refluxive units and the range of MVU distances was very wide (5–22 mm). If a cut-off point of 10 mm is used, in children without bladder dysfunction the sensitivity of MVU measurement in the diagnosis of VUR was 87.5% and the specificity 97%. However, in children with non-neuropathic and neuropathic bladder dysfunction, the sensitivity was only 55% and the specificity 79%. Color Doppler (DUS) and measurement of the MVU distance proved useful in predicting VUR only in children with normal bladder function. In children with neuropathic and non-neuropathic bladder dysfunction it can be used to visualize ureteric jets, but cannot replace radiographic or radionuclide voiding cystourethrography. Accepted: 21 March 2001     

Estimation of body fat in children with intellectual disability: development and cross-validation of a simple anthropometric method

ObjectivePopulation-level monitoring of body composition requires accurate, biologically-relevant, yet feasible methods for estimating percent body fat (%BF). The aim of this study was to develop and cross-validate an equation for %BF from Body Mass Index (BMI), age, and sex among children with intellectual disability (ID). This study further aimed to examine the performance of an existing BMI-based equation (Deurenberg equation) for %BF in children with ID.MethodParticipants were 107 children (63 boys; aged 6-15 years) with ID randomly allocated to development (n = 81) and cross-validation (n = 26) samples. Dual-Energy X-Ray Absorptiometry provided the criterion %BF.ResultsThe model including BMI, age, and sex (0 = male; 1 = female) had a significant goodness-of-fit in determining %BF (p < 0.001; R² = 0.69; SEE =5.68%). The equation was: %BF = – 15.416 + (1.394 × BMI) + (4.538 × age) – (0.262 × age²) + (5.489 × sex). The equation was cross-validated in the separate sample based on (i) strong correlation (r = 0.82; p < 0.001) and non-significant differences between actual and predicted %BF (28.6 ± 9.6% and 30.1 ± 7.1%, respectively); (ii) mean absolute error (MAE) = 4.4%; and (iii) reasonable %BF estimations in Bland-Altman plot (mean: 1.48%; 95% CI: 12.5, -9.6). The Deurenberg equation had a large %BF underestimation (mean: -7.1%; 95% CI: 5.3, -19.5), significant difference between actual and estimated %BF (28.6 ± 9.7% and 21.5 ± 7.0%, respectively; p < 0.001), and MAE = 8.1%.ConclusionsThe developed equation with BMI, sex, and age provides valid %BF estimates for facilitating population-level body fat screening among children with ID.     

Evaluation of abdominal lymphadenopathy in children by ultrasonography

Background. There may be uncertainty as to whether enlarged abdominal lymph nodes (LNs) in children are normal or abnormal. Objective. To compare, by ultrasonography (US), enlarged abdominal LNs in healthy children with those in children with acute abdominal pain or acute gastroenteritis. Materials and methods. One hundred and twenty-two asymptomatic children were selected by questionnaire and compared with 44 children with acute abdominal pain of unknown origin and 27 children with acute gastroenteritis. The number of LNs, their location, their shape and the presence of tenderness as detected by finger compression of each LN were evaluated. The children were divided into four groups according to age: 0–2, 3–6, 7–10, and 11–15 years. Results. LNs were detected in the ileo-caecal and/or para-aortic areas in almost all of the asymptomatic children. The number of large LNs ( > 10 mm) in the para-aortic areas was higher in the older children (≥ 7 years of age) than in the younger children ( ≤ 6 years of age) (P < 0.05). The number of spindle-shaped LNs (ratio of long- to short-axis diameter ≥ 2.0) was increased in the older children. The number of LNs was not increased in the children with acute abdominal pain. The size of the LNs was largest in the children with acute gastroenteritis, followed by the children with acute abdominal pain and the asymptomatic children (P < 0.001). Although the shape of the LNs was no different among the three groups of children, the frequency of round-shaped LNs (ratio of long- to short-axis diameter < 2.0) was greater in the older children with acute abdominal pain or acute gastroenteritis than in the asymptomatic children (P < 0.01). The number of LNs with tenderness detected by finger compression was significantly greater in the children with acute abdominal pain and acute gastroenteritis than in the asymptomatic children (P < 0.0001). Conclusion. The number of large and round-shaped LNs with tenderness tended to be increased in the children with acute gastroenteritis and acute abdominal pain. There is no clear specificity of LN enlargement in the children with acute abdominal pain, and the main challenge is to diagnose or estimate the organic pathology by US, regardless of the presence of lymphadenopathy. Received: 15 January 1997 Accepted: 23 June 1997     

Protein malnutrition: correlation between anthropometric and biochemical assessment

Three hundred and eighty-six children aged 12-59 months, suffering from protein-calorie malnutrition were studied. Middle arm circumference and triceps skin-fold measurements were taken and from these values, middle arm muscular circumference was calclated. Simultaneously, the serum amino-acid balance was determined. The same measurements were carried out in 132 healthy control children of the same age group. These showed that middle arm muscular circumference does not change within the age groups studied, and with its value the amino-acid balance showed an inverse correlation. It is concluded that the severity of protein imbalance in malnutrition can be estimated on the basis of both middle arm muscular circumference and amino-acid balance. In view of its simple technique the former parameter is given preference.     

Serum lipids in malnutrition of children

Indian Journal of Pediatrics -     

Oral fat loading test: a reliable procedure for the study of fat malabsorption in children.

Oral triglyceride (TG) loading tests were performed in four groups of children: normal controls, patients with chronic nonspecific diarrhoea (CND), biopsy-proved mucosal pathology (MP), and disturbed intraluminal fat malabsorption (IFM). The rise of plasma TG levels greater than or equal to 55 mg/100 ml (greater than or equal to 0.6 mmol/l) can discriminate between patients with gastrointestinal disease and normal controls or patients with functional disturbances. The postmeal plasma TG rise correlates well with the coefficient of fat absorption (CFA) in normal subjects, patients with CND, and patients with IFM, but not in patients with MP who showed a disproportionally low plasma TG rise compared with their CFA. This test can serve as a useful tool in diagnosis and clinical evaluation for children with gastrointestinal disorders.     

Prenatal diagnosis and assessment of fetal malformations by ultrasonography in India

A multicentre study to assess the status of prenatal diagnosis of fetal malformation in India was conducted. Questionnaires were sent to the teaching hospitals and to centres in the private sector involved with ultrasonography in all the four zones. Data were obtained from 13 centres. Basic level scans were performed on all pregnant women in 64% centres, whereas level II or targeted scans were performed as routine in 42% centres. Obstetricians performed level II scans in only 35% of cases while rest were performed by radiologists. Malformations of the central nervous system were commonest, accounting for 35–69% of all malformations, followed by genitourinary and gastrointestinal malformations. Malformations of the cardiovascular system were detected in 9. 3% as abnormal four chamber view and outlet tract abnormalities, subsequently confirmed on fetal echocardiography. Invasive prenatal diagnosis by fetal blood sampling, chorion villus sampling and amniocentesis for chromosomal analysis of malformed fetuses was performed at 40% centres. At the All India Institute of Medical Sciences, approximately 11, 042 ultrasound scans were performed by obstetricians as routine in all pregnant women. A total of 543 malformations were detected accounting for a 4. 9% incidence of structural anomalies. A total of 98 cardiovascular malformations were detected in high and low risk pregnant women on fetal echocardiography. No database or registry exists in India to give an actual insight into the problem of congenital malformation and their prenatal diagnosis. It is important to train obstetricians in level I and II ultrasonography, to recognise centres and institutions at national and regional level, and to integrate a network of diagnostic testing. Close liaison between geneticists, radiologists, pediatric surgeons, pediatricians and obstetricians is a must for prenatal diagnosis and management of fetal malformations.     

Anthropometry and moderate malnutrition in preschool children

OBJECTIVE: For years it has been shown that more children die from moderate malnutrition (MM) than severe. Till yet few studies deal specifically with identifying these children. This study attempts to statistically determine the appropriate anthropometric measures and cut-off points for diagnosing moderate malnutrition in preschool children. METHODS: Anthropometric measurements were obtained from 609 preschool children from the cities of Adigrat, Ethiopia; Janampet, India; San Paulo, Brazil. The values were used to determine the sensitivity, specificity, positive predictive value (PPV) and likelihood ratio (LR) of each index studied. The optimum cutoff point for each index was considered to be the cutoff point with the maximum Kappa coefficient for efficiency. The McNemar Test for the significance of changes was used to determine if these findings were in agreement when applied to this data. RESULTS: Weight for height (WFH) at each site had the highest PPV and LR of 4 but was not signficant by the McNemar Test. Mid-upper arm circumference (MUAC) in India had the same PPV (77%) as WFH but a LR of 2. MUAC in India, Brazil and Ethiopia tested significantly for the McNemar Test. The cut-off point for MUAC in India and Brazil was determined to be <15.5 cm in India and Brazil but was <15 cm in Ethiopia. Waist circumference in India tested a significantly PPV of 64%, and a LR of 2. CONCLUSION: These results show that WFH and MUAC could be used with WFA to identify the MM child. The cut-off points for MUAC may vary per location. WC positive data suggests further study is warranted. The McNemar findings yielded significant evidence that statistically determined indicators can be established to identify MM. With further study these methods may prove to be an important component in the efforts to improve child survival.     

Anthropometry and moderate malnutrition in preschool children

Objective: For years it has been shown that more children die from moderate malnutrition (MM) than severe. Till yet few studies deal specifically with identifying these children. This study attempts to statistically determine the appropriate anthropometric measures and cut-off points for diagnosing moderate malnutrition in preschool children.Methods: Anthropometric measurements were obtained from 609 preschool children from the cities of Adigrat, Ethiopia; Janampet, India; San Paulo, Brazil. The values were used to determine the sensitivity, specificity, positive predictive value (PPV) and likelihood ratio (LR) of each index studied. The optimum cutoff point for each index was considered to be the cutoff point with the maximum Kappa coefficient for efficiency. The McNemar Test for the significance of changes was used to determine if these findings were in agreement when applied to this data.Results: Weight for height (WFH) at each site had the highest PPV and LR of 4 but was not signficant by the McNemar Test. Mid-upper arm circumference (MUAC) in India had the same PPV (77%) as WFH but a LR of 2. MUAC in India, Brazil and Ethiopia tested significantly for the McNemar Test. The cut-off point for MUAC in India and Brazil was determined to be <15.5 cm in India and Brazil but was <15 cm in Ethiopia. Waist circumference in India tested a significantly PPV of 64%, and a LR of 2.Conclusion: These results show that WFH and MUAC could be used with WFA to identify the MM child. The cut-off points for MUAC may vary per location. WC positive data suggests further study is warranted. The McNemar findings yielded significant evidence that statistically determined indicators can be established to identify MM. With further study these methods may prove to be an important component in the efforts to improve child survival.     

Diuretic renography in children: a non-invasive method for the assessment of upper urinary tract pathologies.

Thirty-eight kidneys from 20 children were studied with diuretic renography and the findings in 32 kidneys were compared with the results obtained using IVP. The diuretic renography findings were consistent with those of the IVP in 72 percent of the patients. The main disparity was the dilated nonobstructed pattern observed in the kidneys with normal IVP's, which is pointed out as being an asset of diuretic renography in revealing the functional status of kidneys. The sensitivity in detecting true obstruction was found to be 67 percent (4/6), and the specificity 95 percent (20/21). The accuracy of the technique was 85 percent with a false (+) rate of 5 percent (1/21) and false (-) rate of 33 percent (2/6). Diuretic renography is a simple, safe, non-invasive technique, easily applied to children with high specificity in excluding obstruction in a dilated renal pelvis.