Methods for measuring body composition in newborns--a comparative analysis.

The complexity of nutritional support in infants now makes it necessary to use body-composition methods for accurate nutritional assessment. For this goal a variety of methods of determining body composition have been introduced in research on human nutrition. The purpose of this paper is to review the background and to describe the precision of established techniques, focusing on the results obtained in newborns and infants. The ideal method for assessing newborns' and infants' body composition should be non-invasive, reproducible, accurate, and also relatively inexpensive. In addition, we summarize in this paper data on body composition obtained in normal and pathological newborns by using dual X-ray absorptiometry, one of the reference techniques.     

Nutritional status at diagnosis in children with cancer I. An assessment by dietary recall--compared with body mass index and body composition measured by dual energy X-ray absorptiometry

The nutritional status of children with cancer is clinically important. In an effort to separate the influences of disease and treatment, we studied children at the time of diagnosis. A total of 99 children underwent assessment by 24 hours dietary recall, measurement of body mass index (BMI), and analysis of body composition by dual energy x-ray absorptiometry (DXA scan). The group averages for calorie intake and BMI were close to the median population norms but ranged widely among individuals. As a group the study participants exceeded the Dietary Reference Intake for protein. Nine children (9%) had a BMI 相似文献   

Validation of percent body fat indicators in pediatric oncology nutrition assessment

BACKGROUND: Given the high prevalence of malnutrition and potential impact nutritional status can have on a child undergoing treatment for cancer, it is vital that oncology centers regularly assess nutritional status. It is important that simple noninvasive anthropometric nutrition assessment measures correlate to more accurate body composition measures. OBJECTIVES: The aim of this study was to determine the relationship between anthropometric measures and percent body fat determined via air displacement plethysmography in the children being treated in a pediatric oncology and hematology department. DESIGN: This cross-sectional study measured height, weight, percent ideal body weight (%IBW), mid arm circumference, triceps skinfolds, and mid upper arm fat area in 23 children. These anthropometric variables were compared against the reference measure of percent body fat via air displacement plethysmography. RESULTS: Correlational analysis and general linear models showed that there was a significant statistical relationship between percent body fat and body mass index Z score, %IBW, mid arm circumference, triceps skinfolds, and arm fat area. CONCLUSIONS: Simple anthropometric measurements of %IBW and triceps skinfolds are good indicators of percent body fat and should be incorporated into regular nutrition assessment of the pediatric oncology patient.     

儿童营养状况评估研究进展

儿童营养不良不是单一疾病,而是一种异常的状态,包括营养低下和营养过度。但多数国家学者描述儿童营养不良时仍是指儿童能量-蛋白质营养低下。根据体格发育指标判断儿童营养不良有低体重、生长迟缓和消瘦三种情况。身长（高）的改善比体重的增加更能衡量营养补充状况,体重增加应与身长（高）成比例。因此,近年WHO建议以体重/身长（高）判断儿童人群营养不良流行强度和个体儿童营养不良状况以及评估干预情况。评价儿童营养状况包括人体测量（“A”）、实验室或生化检查（“B”）、临床表现（“C”）、膳食分析（“D”）。营养不良儿童要求保证食物摄入Ⅰ类（功能性、预防性营养素）和Ⅱ类（生长营养素）等30余种营养素使生长加速至正常水平。     

Diagnosis of child and adolescent nutritional status

OBJECTIVE: To present a review on the methods for the assessment of child and adolescent nutritional status, emphasizing anthropometry and the various methods for the assessment of body composition; pointing out their advantages, limitations and risks. METHODS: Chapters of textbooks, theses, and articles relevant to the topic, as well as personal files and authors previous publications were selected. RESULTS: Anthropometry, which consists of the assessment of physical dimensions and global composition of the human body, has been regarded as the most frequently used isolated method for nutritional diagnosis, especially in childhood and adolescence, due to its ease of use, low cost and innocuousness. The most frequently adopted measurements aim at determining body mass, expressed by weight; linear dimensions, especially height; body composition and reserves of energy and proteins, estimated through subcutaneous fat and muscle mass. Laboratorial methods especially developed for the assessment of body composition are presented here. The justification for the use of methods that expose children and adolescents to ionizing radiation is also presented. CONCLUSIONS: On defining methods for the assessment of nutritional status, we should select those that better detect the nutritional deficiencies we want to correct, also taking into consideration their costs, level of personal skill required for their proper application, necessary time for application, acceptability by the studied population and possible health risks.     

Calories count. Improved weight gain with dietary intervention in congenital heart disease.

OBJECTIVES--We assessed the nutritional status of patients with congenital heart disease (CHD) to evaluate the role of dietary intake in impaired weight for patient length. Underweight patients with CHD underwent nutritional counseling to evaluate the role of this intervention in improvement of weight for length. RESEARCH DESIGN--We prospectively evaluated a clinical protocol for nutritional assessment and counseling in patients with CHD. Eligible patients were enrolled from a cardiology clinic during a 13-month period. Initial anthropometric measurements and measurements of dietary intake of underweight and normal-weight patients were compared. Initial and follow-up measurements of underweight patients who received nutritional counseling were compared. PATIENTS--Nineteen underweight patients with CHD and 16 normal-weight patients with CHD, aged 1 month to 2 years, were studied. Exclusion criteria included noncardiac factors that could affect growth (eg, low birth weight, Down syndrome, gastrointestinal deficit, and any severe abnormality of the central nervous system). Seventeen of the 19 underweight patients underwent nutritional counseling in the presence of a parent every 2 months for 6 months. Caloric and protein intakes were maximized using high-calorie formulas. MEASUREMENTS AND RESULTS--Baseline dietary intake was lower in underweight patients than in normal-weight patients (mean percentage of the recommended daily allowance of calories, 89% vs 108%). Follow-up evaluation in normal-weight patients showed no change in percentage of ideal body weight for length. Follow-up evaluation in underweight patients showed improvement in mean dietary intake (from 90% to 104% of the recommended daily allowance of calories) and in mean percentage of ideal body weight for length after intervention (from 83.1% to 88.3%). CONCLUSION--Nutritional evaluation of patients with CHD demonstrated that underweight children had inadequate diets. Underweight patients with CHD who received nutritional counseling showed increased dietary intake and improved anthropometric measurements on follow-up.     

Measuring the body composition of preterm and term neonates: from research to clinical applications

Assessment of body and weight gain composition is one of the major keys for the evaluation of nutritional requirements in preterm and term infants. The changes in body composition during the first years of life seem to play an important role in the nutritional programming of adult morbidity. Noninvasive and indirect techniques are the most suitable methods for measuring body composition in preterm and term infants. Most of these techniques are used in clinical practice, whereas others are used mainly for research.     

Pediatric office nutrition.

The pediatrician continues to devote more time to office evaluation of patients. The office assessment of nutritional status will be extremely rewarding to the physician who acquires several simple measuring devices and who instructs his assistants in the proper use of those devices. The nutritional evaluation of the patient emphasizes the physical examination, anthropometric measurements and the use of laboratory studies. The information gained from these areas may allow for early correction of growth abnormalities before permanent stigma or residuals can develop.     

Assessment of the nutritional status of Brazilian adolescents by body mass index

The assessment of nutritional status of adolescents is not an easy task because it should take into account sex, age, weight, stature and sexual maturation of the adolescents. In addition, an adequate classification should also be related to subsequent health-related outcomes during adult life. On the other side, screening for overweight and underweight among adolescents is highly desirable since nutritional status during adolescence correlates with adult body habitus. The objective of this study was to propose a classification for screening the nutritional status of Brazilian adolescents based on the body mass index (kg/m(2)) provided by the Pesquisa Nacional sobre Saúde e Nutri??o-PNSN, a national survey of the Brazilian population carried out on 1989. We defined as cutoff the 10th and 90th percentile of the body mass index distribution and the 10th percentile for stature.     

Subjective global assessment of nutritional status in children

This study was aimed to compare the subjective and objective nutritional assessments and to analyse the performance of subjective global assessment (SGA) of nutritional status in diagnosing undernutrition in paediatric patients. One hundred and forty children (aged 2-12 years) hospitalized consecutively in Tabriz Paediatric Hospital from June 2008 to August 2008 underwent subjective assessment using the SGA questionnaire and objective assessment, including anthropometric and biochemical measurements. Agreement between two assessment methods was analysed by the kappa (κ) statistic. Statistical indicators including (sensitivity, specificity, predictive values, error rates, accuracy, powers, likelihood ratios and odds ratio) between SGA and objective assessment method were determined. The overall prevalence of undernutrition according to the SGA (70.7%) was higher than that by objective assessment of nutritional status (48.5%). Agreement between the two evaluation methods was only fair to moderate (κ = 0.336, P < 0.001). The sensitivity, specificity, positive and negative predictive value of the SGA method for screening undernutrition in this population were 88.235%, 45.833%, 60.606% and 80.487%, respectively. Accuracy, positive and negative power of the SGA method were 66.428%, 56.074% and 41.25%, respectively. Likelihood ratio positive, likelihood ratio negative and odds ratio of the SGA method were 1.628, 0.256 and 6.359, respectively. Our findings indicated that in assessing nutritional status of children, there is not a good level of agreement between SGA and objective nutritional assessment. In addition, SGA is a highly sensitive tool for assessing nutritional status and could identify children at risk of developing undernutrition.     

The nutritional status of healthy children using bioelectrical impedance and anthropometric measurement

ObjectiveMonitoring of healthy children should include precise assessment of their nutritional status to identify children and adolescents at risk of nutrition disorders. Therefore, the aim of this study was to assess the nutritional status of healthy children using different nutritional risk screening tools.MethodThe study sample consisted of 550 participants within the age range of 7–15 years. Anthropometric characteristics (body mass, height, body mass index) were collected using standard procedures. In addition, the following parameters were analyzed: fat mass, fat-free mass, body cell mass, and total body water.ResultsThe results revealed that variables such as children's age and sex significantly differentiated the values of selected components of the body composition.ConclusionsThis observation suggests that it is necessary to use different methods to evaluate nutritional status among healthy children.     

Nutritional assessment in preterm infants with special reference to body composition

In recent years, improvements in care have significantly improved survival in preterm and, particularily, the very low birth weight infant (VLBW). While immediate survival can be directly related to pulmonary maturity, several studies stress the importance of timely and adequate nutrition in these high-risk infants on a short- and long-term [1]. Yet, nutritional support remains a very controversial issue in these high-risk infants. Early provision of adequate intakes may be limited by clinical instability and immaturity. At the same time, nutritional requirements and methods of nutritional assessment are not well defined. The aim of this paper is to outline some of the methods used during nutritional assessment in preterm infants with special reference to the measurement of body composition.     

APPRAISAL OF THE STATE OF NUTRITION OF LOW BIRTH WEIGHT BABIES

A technique is described for assessment of the nutritional response of low birth weight babies to pooled human milk, based upon measurement of external body dimensions and serial daily metabolic balance studies.     

Outcomes of a nutrition audit in a tertiary paediatric hospital: implications for service improvement

OBJECTIVE: To examine the process of anthropometric assessment of nutritional status in a tertiary paediatric hospital, to identify the barriers and to make recommendations for service improvement. METHODS: The accuracy of height and weight scales in wards was checked. Dietitians measured height and weight of a representative sample of 245 inpatients and checked whether these measurements had been recorded on bed charts. Patients were classified as overweight, obese or under-nourished. Diagnoses and procedures were obtained for each patient. Funding implications were modelled for inappropriate coding of nutritional status. RESULTS: The barriers to nutritional assessment and management of nutritional comorbidities were: (i) inaccurate height scales in seven out of 12 wards; (ii) under-recording of height and weight on patient bed charts (73% height missing, 12% both height and weight missing); (iii) under-reporting of obesity and under-nutrition in medical notes (one of eight obese patients, and none of 28 undernourished patients, reported); and (iv) low referral rate of obese or under-nourished children to dietetic services (two of 42 overweight/obese patients referred, five of 28 undernourished patients referred). Funding simulation showed that if under-nourished patients were correctly diagnosed then the potential facility reimbursement would have increased by $A52 326. CONCLUSIONS: Barriers to nutritional assessment can lead to failure to diagnose and treat both over- and under-nutrition, thereby affecting quality of patient care, and may have financial implications for hospitals. Suggestions for service improvement include provision of accurate equipment, adequate training of staff undertaking nutritional assessments and clear definitions of staff responsibilities in all aspects of the process.     

Nutritional regulation of host resistance and predictive value of immunologic tests in assessment of outcome

In this review, the authors describe the current information on nutrition modulation of immunity, enumerate the various immunologic tests that are potentially useful in nutritional assessment, examine the reliability of tests predicting disease and complications, and discuss how immunologic evaluation may help in the decision process regarding nutritional support.     

A critique of the expression of paediatric body composition data.

There is increasing interest in body composition in paediatric research, as distinct from growth and nutritional status, as almost all diseases have adverse effects on either fatness or the fat-free mass. However, the approaches used to assess growth and nutritional status are not appropriate for separate evaluations of body fatness and lean mass. Traditional measurements such as body mass index and skinfold thickness do not measure fat in accurate quantitative terms. Various techniques have been used in recent years which divide body weight into fat mass and fat-free mass; however, the data tend not to be appropriately expressed. Body fatness is generally expressed as a percentage of weight, while fat-free mass typically remains unadjusted for size. A more appropriate approach is to normalise both body fatness and fat-free mass for height. This recommendation is relevant both to studies comparing patients with controls and to the expression of new reference data on body composition which are needed to allow informative comparisons. The same approach is appropriate for the classification of childhood obesity.     

Oropharyngeal dysfunction and gastroesophageal dysmotility are present in girls and women with Rett syndrome.

BACKGROUND: Feeding impairment frequently complicates the course of children with neurologic disorders and places them at risk for malnutrition and growth failure. Although feeding abnormalities have been reported in female patients with Rett syndrome, the mechanisms that account for these findings have not been elucidated fully. This study was designed to characterize the clinical features of oropharyngeal and gastroesophageal dysfunction and their impact on the dietary intake and nutritional status of female subjects with Rett syndrome. METHODS: The clinical features of oropharyngeal and gastroesophageal dysfunction in 13 female patients with Rett syndrome, (age range, 3.7 to 25.7 years) were characterized by an oral feeding assessment, swallowing function study, and upper gastrointestinal series. Growth, nutritional status, and body composition were determined by stadiometry and anthropometry. Dietary intakes were determined from 3-day food records. RESULTS: Oropharyngeal dysfunction and gastroesophageal dysmotility were present in 100% and 69%, respectively, of the study patients with Rett syndrome. The scope and severity of these abnormalities were apparent only by videofluoroscopy. Abnormalities of oropharyngeal function included poor tongue mobility, reduced oropharyngeal clearance, and laryngeal penetration of liquids and solid food during swallowing. Esophageal dysmotility included absent primary or secondary waves, delayed emptying, atony, the presence of tertiary waves, spasm, and gastroesophageal reflux. Gastric dysmotility included diminished peristalsis or atony. Lower dietary energy intakes were associated with persistence of residue in the valleculae and pyriform sinuses and less body fat. CONCLUSION: The prevalence of oropharyngeal dysfunction and gastroesophageal dysmotility warrants early diagnostic evaluation and intervention strategies to improve the nutritional status of girls and women with RS.     

危重患儿营养不良的评估

营养不良是较为常见的临床问题,一些危重患儿存在基础疾病,机体代谢率增高,营养不良发生率较普通患儿更高.营养不良在一定程度上可降低危重患儿机体免疫力,增加感染风险及并发症,延长病程,影响疾病转归,增加病死率.尽早对危重患儿进行有效营养评估,及时发现其营养不良状态,早期指导临床营养支持方式,可促进病情恢复,改善疾病预后.目前国内外营养评估主要是从体格测量、实验室检查及营养风险筛查等几个方面进行,但不同营养评估方法各有其适应性及优缺点.     

A critique of the expression of paediatric body composition data

There is increasing interest in body composition in paediatric research, as distinct from growth and nutritional status, as almost all diseases have adverse effects on either fatness or the fat-free mass. However, the approaches used to assess growth and nutritional status are not appropriate for separate evaluations of body fatness and lean mass. Traditional measurements such as body mass index and skinfold thickness do not measure fat in accurate quantitative terms. Various techniques have been used in recent years which divide body weight into fat mass and fat-free mass; however, the data tend not to be appropriately expressed. Body fatness is generally expressed as a percentage of weight, while fat-free mass typically remains unadjusted for size. A more appropriate approach is to normalise both body fatness and fat-free mass for height. This recommendation is relevant both to studies comparing patients with controls and to the expression of new reference data on body composition which are needed to allow informative comparisons. The same approach is appropriate for the classification of childhood obesity.