Impact of integrated preventive and curative health package on nutritional status of children under 2 years of age in the health area of Tama, Tahoua region (Niger).

Background: Niger, relevant in light of current political coup, is one of the countries with the worst human development indicators, characterized by high fertility rates and extremely high infant mortality rates. Food insecurity in the region is alarming, leading to high malnutrition rates in children. This study aimed to evaluate an integral preventive-curative health program targeting children aged under 2 years in the health area of Tama, district of Bouza, Tahoua. Methodology: Anthropometric follow-up data of 6,962 children aged under 2 years were included in this study. These children received complete vaccination and malaria chemoprevention, and those older than 6 months received nutritional supplementation with a small quantity of lipid-based nutrient supplements. Fundamental growth indicators (height-for-age, weight-for-height, weight-for-age, and middle-upper arm circumference) and the Composite Index of Anthropometric Failure were calculated at the beginning and end of the program (mean time spent in the program: 14.5 ± 6.6 months) The evolution of these indicators was compared with those of a sample from a vertical vaccination program conducted in the neighboring region of Madarounfa on similar dates. Results: The proportion of children without anthropometric failure decreased from 59.5 to 40.2% (p < 0.001), with the categories that included stunting increasing the most. When analyzing the anthropometric indicators according to the months of compliance with the program, there was a slight improvement in the indicators of acute malnutrition, whereas those of chronic malnutrition worsened significantly. However, when compared with the Madarounfa sample, the children in the present study registered a significantly lower worsening in all three indicators: height-age (-0.46 vs. -2.44; p < 0.001), weight-height (+0.31 vs. -0.55; p < 0.001) and weight-age (-0.03 vs. -1.63; p < 0.001) difference. Conclusion: The comprehensive preventive-curative health program slightly slows the worsening of cumulative malnutrition in the early years of life in complex contexts, such as southern Niger.

Differences in wasting assessment through Middle-Upper Arm Circumference (MUAC) adjusted by sex, age and geographic origin for children aged 6-59 months: New reference based on anthropometric surveys from 22 low-and-middle-income countries.

OBJECTIVES: The Middle Upper Arm Circumference (MUAC) bracelet is a widely used instrument in public health assessments and humanitarian assistance projects. The WHO guidelines present a universal cut-off point of 115 mm to determine whether a child has severe acute malnutrition. The objective of this study is to analyze the existing differences in the MUAC for boys and girls aged between 6 and 59 months, from 22 countries distributed in three different continents, in contrast to the use of this single cut-off point. In addition, the creation of MUAC growth charts is presented for reference use. MATERIALS AND METHODS: This study was carried out with a database developed by Action Against Hunger, composed, after the data pre-processing phase, of 97 921 individuals without anthropometric failure from African, Asian, and American continents. MUAC measurements were compared between countries, dividing by sex and age groups. A k-means method was used to create country clusters to allow comparisons and the variability was resumed using a Principal Component Analysis. For each cluster, growth curves were created and smoothed using the LOESS method. RESULTS: Our research has revealed the existence of differences in the MUAC between countries in both, males and females, although with different trends. The evidence was confirmed with the creation of two clusters using the k-means method, which, when graphically represented by the Principal Component Analysis, showed that the MUAC was clearly different. There were also differences between males and females within each cluster, where growth curves did not overlap in any age group. CONCLUSIONS: All statistical analysis indicate that there are differences in the MUAC values for children without anthropometric failure between countries, but also between sexes. With this research, a new reference is proposed that consider the existing variability between human populations to improve the precision in the determination of severe acute malnutrition in children.

Public Health Implications of Wasting and Stunting Relationship in Children under Five Years Highly Vulnerable to Undernutrition in Guatemala: The REDAC Study.

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.

Hand grip strength in boys and girls from summer school camps in Spain, 1900-1925. A comparison with 21st century data.

OBJECTIVES: The Spanish National Pedagogic Museum (Museo Pedagógico Nacional, MPN), founded by La Institución Libre de Enseñanza, organized the first summer school camps in Spain and their initiative was followed by other institutions in this country. MPN prepared anthropological forms for those sojourns, which included information about both metric and physiological measurements of the schoolchildren. The aim of the current work is to analyze hand grip strength data and to compare them with recent values. METHODS: The initial sample included 2418 schoolchildren from 6 to 16 years old (1467 males, 951 females) attending the camps, but after preliminary analyses, the study was restricted to 1073 boys and 818 girls in the 1900-1925 interval. Three time periods were established and 13 categories of height at camp entry, every 5 cm. Normality tests were run as well as contrasts of means, and both average values and percentiles were calculated for hand grip strength in both hands, as a function of age and height categories. RESULTS: The 1900-1925 interval was chosen since there were no significant differences among hand grip data within that period. Results show that children attending the camps had dynamometry values in both hands well below the current ones, both with reference to their height and to their age. CONCLUSIONS: Camp attendees displayed very low values of height and hand grip strength in both hands. Both are significantly lower than contemporary values, manifesting a secular effect.

Variation of the cormic index since the onset of summer school camps in Spain (1887) up to present days.

OBJECTIVES: To assess a secular change in proportion between lower limbs and torso, we analyzed the evolution of cormic index in schoolchildren attending summer camps organized by the Spanish National Pedagogic Museum between 1887 and 1924, also comparing to later studies up to the present. SUBJECTS AND METHODS: Unpublished primary data for height and sitting height were collected from 805 individuals of both sexes. Data were pooled in cohorts according to age and year of measurement. Additionally, the analysis included comparison with published data from both national and international populations. RESULTS: Among males, a noteworthy decrease of the cormic index is perceived from the first to the last camps, while in females this is only seen for the group under 11 years old. With data from published Spanish references (1900-2019) a decrease is observed for the male series but is not evident for females. Cormic index values from the camps overlap among the international references, despite the former being from much earlier years. CONCLUSION: The cormic index decreased among Spanish male children along the decades.

Historical recollection of anthropometric data from schoolchildren attending summer camps from 1887 to 1934 in Spain: Interpretations and comparison with coetaneous and modern references.

OBJECTIVES: Around the aim of gaining knowledge on the secular trends in nutritional status of the Spanish population, we found a collection of historical records compiled by La Institución Libre de Enseñanza and their alumni association along 47 years. These data had been collected from boys and girls attending summer camps, with a policy of improving health of children with unfavorable socioeconomic conditions. The objective is to extract all possible information about growth changes, and eventually any interpretation related to status of the originating families. MATERIALS AND METHODS: Primary data were collected from both unpublished manuscripts containing the original records and publications of the organizing institutions. They had been gathered from 86 summer camps in Spain from 1887 to 1934. In these camps, detailed anthropometric data were collected from every attendee, including body height and weight. The sample population amounts to 1,791 boys and 1,281 girls, between 7 and 16 years of age. RESULTS: Body height and weight, pooled by camp year, age and sex, displayed variable secular increases. A similar observation appears for the body mass index (BMI). As a complement, a comparison was done to contemporary published references from both Spanish and international studies. DISCUSSION: Height, weight, and BMI from the camps may be judged as retardation of growth and malnutrition by modern standards but it is not the case when coetaneous references are considered: no overall significant differences were found with respect to several publications from Spanish and European populations.

Comparative study of mid-upper arm circumference, arm muscle area and arm fat area percentiles in Argentinean and US children aged 4-14 years.

INTRODUCTION: Background: mid-upper arm circumference (MUAC), subcutaneous fat and muscle measurements are an alternative method to diagnose overweight and evaluate growth as well as protein and energy reserves. Aim: to compare MUAC, arm muscle area (AMA) and arm fat area (AFA) measurements of Argentinean boys and girls (Sa) with reference curves for US boys and girls (R). Subjects and methods: data from 22,736 school-children aged 4-14 years from six Argentinean provinces were collected. MUAC and triceps skinfold thickness were measured and the derived AMA and AFA measures were calculated. Analyses were performed with GAMLSS using the R software. Differences in mean values of Sa and R were compared in percentiles 3, 50 and 97. Results: mean values of MUAC and AMA in boys and girls were higher in R than in Sa at all ages; conversely, AFA values were lower. Conclusions: our results confirm differences in upper arm anthropometry of Argentinean school-children with respect to the US reference. The higher adipose tissue and lower skeletal muscle mass observed in Argentinean children could be partly associated with the different ethnic origin of both populations. However, differences should be interpreted in the context of an obesogenic environment, which has favored a calorie-protein imbalance.

INTRODUCCIÓN: Antecedentes: la medición de la circunferencia del brazo (MUAC), así como la estimación de la grasa subcutánea y muscular constituyen un método alternativo para diagnosticar el sobrepeso y evaluar el crecimiento y las reservas proteicas y energéticas. Objetivo: comparar las mediciones de MUAC, área muscular (AMA) y área grasa (AFA) del brazo de niños y niñas argentinos (Sa) con curvas de referencia para niños y niñas de Estados Unidos (R). Sujetos y métodos: se recopilaron datos de 22,736 escolares de 4 a 14 años de edad de seis provincias argentinas. Se obtuvieron medidas de MUAC y pliegue subcutáneo tricipital y se calcularon AMA y AFA. Los análisis se realizaron con GAMLSS utilizando el software R. Las diferencias en los valores medios de Sa y R se compararon para los percentiles 3, 50 y 97. Resultados: a todas las edades los valores medios de MUAC y AMA en niños y niñas fueron más altos en R que en Sa; por el contrario, los valores de AFA fueron más bajos. Conclusiones: nuestros resultados confirman la existencia de diferencias en la antropometría mesobraquial de los niños argentinos con respecto a los de la referencia. La mayor cantidad de tejido adiposo y menor de tejido muscular observada en los niños argentinos de ambos sexos puede ser parcialmente asociada con el diferente origen étnico de ambas poblaciones. Sin embargo, las diferencias podrían interpretarse en el contexto de un ambiente obesogénico, el cual habría favorecido el desbalance proteico-calórico.

Describing the children's body shape by means of Geometric Morphometric techniques.

INTRODUCTION: Large shape variations take place during the growth process of children, including quantitative mass and size increase plus qualitative changes in their body shape. The aim of the present study is to apply Geometric Morphometric techniques in order to visualize and quantify such body shape differences in healthy children aged 6-59 months with optimal nutritional status. MATERIALS AND METHODS: Anthropometrical measurements of weight, height, and middle-upper arm circumference were used to assess nutritional status on a sample of 258 Senegalese (n = 154) and Spanish (n = 104) children. A set of 36 anatomical and/or osteologically-based landmarks were identified on the body of the children along with 108 semi-landmarks used to capture curvature attributes on the frontal view of the body image. A specific method was developed to place and photograph children, as well as to locate landmarks, treat images and calculate semi-landmarks. Shape differences among children were analyzed in terms of age, sex, and population origin, taking into consideration allometry effects. RESULTS: Our results indicate significant differences in shape and size for all the three factors under study before removing size effect (p < .0001), and in shape after the size correction (p < .01). Only the ontogenetic effect persisted in the size of studied individuals after size-effects correction (p < .0001). Morphometric significant differences were described regarding age for PC1 and population origin in PC2 before removing size effect. Between-population morphometric differences were sorted along PC1 after size correction. DISCUSSION: Geometric Morphometric techniques are useful to study morphometric changes in the anterior whole-body view of children under 5 years old, allowing a precise description of shape changes observed when age and population origin are considered.

Influence of malnutrition upon all-cause mortality among children in Swaziland.

OBJECTIVE: To analyze the effect of the type of malnutrition, sex, age and the presence of edema upon all-cause mortality in children under 5 years of age. MATERIAL AND METHODS: A cross-sectional study was conducted during 2010 and 2011 in Swaziland. Sex, age, weight and height were taken to classify nutritional status according to the 2006 WHO growth standards: stunting (low height for age), wasting (low weight for height or low body mass index for age) and underweight (low weight for age). The sample (309 boys and 244 girls under 5 years of age) was analyzed by sex and age groups (under and equal/over 12 months). The association between variables was evaluated using the χ2 test. Cox regression analysis (HR, 95% CI) was used to assess the likelihood of mortality. RESULTS: The mortality risk in malnourished children under one year of age was lower among females and increased in the presence of severe edema. Wasting combined with underweight increased the mortality risk in children under 12 months of age 5-fold, versus 11-fold in older children. The combination of stunting, wasting and underweight was closely associated to mortality. Stunting alone (not combined with wasting) did not significantly increase the mortality risk. CONCLUSIONS: Sex, severe edema and wasting are predictors of mortality in malnourished children. Regardless of these factors, children with deficiencies referred to weight for height and weight for age present a greater mortality risk in comparison with children who present stunting only.

Migration and nutritional status of Tarahumara schoolchildren from Chihuahua State (México).

OBJECTIVE: The Tarahumara ethnic group is composed of indigenous people from the Sierra Madre Occidental of Mexico. Conditions of isolation and poverty compel them to migrate to the city in search of better opportunities. This work aims to explore the influence of migration on the growth and nutritional status of Tarahumara schoolchildren. METHODS: One hundred Tarahumara students were analyzed (50 rural with a mean age of 9.78 ± 1.25 years; 50 urban aged 10.0 ± 1.04 years), comparing anthropometric indicators and body composition (T-Student, U-Mann-Whitney Tests). RESULTS: Twenty percent of rural girls and 35% of rural boys showed stunted growth compared to only 9% of the urban girls (no stunted growth among urban boys). Migrants showed greater body size, skinfold thickness, and fat percentage. Weight excess, understood as an increase in the prevalence of overweight and obesity, was detected in 17.8% of urban boys and 13.6% of urban girls compared to 10.0% of boys and 3.3% of girls of the rural series. CONCLUSION: Migration reduces stunting and increases adiposity.

Altitude effect on birth weight and prematurity in the Province of Catamarca (Argentina).

OBJECTIVES: To analyze the effect of altitude on weight and prematurity at birth in the Province of Catamarca (Argentina), between the years 1994 and 2003. METHODS: Records of 22,628 newborns were collected from the vital statistics of the census of Catamarca. Weight was recategorized to include low birth weight (<2,500 g), and gestational age was divided into births that had occurred before or after 37 weeks (preterm or at term births). Altitude was also recategorized (<1,500 m, 1,500-2,000 m, and > 2,000 m). Nonparametric statistical tests were performed. RESULTS: Differences were found in birth weight between sexes and in the incidence of low birth weight depending on altitude. This pattern changed according to gestational age, because those sexual differences were nonexistent or lower in preterm neonates with certain advantages for females. Moreover, it was found that the effects of hypoxia were not reflected in birth weight until later stages of intrauterine development. CONCLUSIONS: To be female appears to be a benefit under conditions of prematurity and high altitude. The increased incidence of prematurity due to altitude increase may reflect an adaptive advantage of preterm birth under these conditions.

[Utility of self-reported anthropometric data for evaluation of obesity in the Spanish population; study EPINUT-ARKOPHARMA]. / Utilidad de los datos antropométricos auto-declarados para la evaluación de la obesidad en la población española; estudio EPINUT-ARKOPHARMA.

INTRODUCTION: Epidemiological studies frequently use weight and height collected by questionnaires, but the inaccuracy of self-reported data may bias the evaluation result. The aim of this study is to validate the self-report in Spanish adult population emphasizing the effect of age and nutritional status of the subjects. METHODS: The sample consist of 9,294 adults (8,072 women and 1,222 men) recruited from dietetic counselling centers dependents of Arkopharma laboratories in 46 Spanish provinces. Weight and height were asked and subsequently measured, calculating differences between self-reported and real parameters. Error in the estimation of body mass index (BMI) was evaluated considering the effect of age and nutritional status (T-test and multiple linear regression). Correlation between the classification based on self-reported BMI and anthropometric was analyzed using the Kappa test. RESULTS AND DISCUSSION: Using the self-reported data, BMI was underestimated (2.62% in men, 3.10% in women). The error increases with age and extreme nutritional categories. The agreement between self-reported and real BMI in the nutritional assessment was good and correctly classified 74.71% of the males and 89.5% of women (Kappa: 0.695 and 0.782 respectively). CONCLUSIONS: Considering the effect of age and nutritional status on the self-awareness of body size, we recommend caution in the use of questionnaires for epidemiological assessment.

Introducción: En epidemiología es frecuente recabar el peso y talla mediante cuestionario, pero la inexactitud de los datos auto-referidos puede sesgar el resultado de la evaluación. El objetivo es validar el auto-reporte en población adulta española enfatizando el efecto de la edad y la condición nutricional de los sujetos. Material y métodos: La muestra consta de 9.294 adultos (8.072 mujeres y 1.222 varones) reclutados en centros de orientación dietética dependientes de los laboratorios Arkopharma en 46 provincias españolas. Se preguntaron peso y talla midiéndose posteriormente y calculando las diferencias entre parámetros auto-referidos y reales. Se evaluó el error en la estima del Índice de Masa Corporal (IMC) considerando el efecto de la edad y la condición nutricional (T de Student y regresión lineal múltiple). Se analizó la concordancia entre la clasificación realizada a partir del IMC auto-referido y antropométrico mediante el test de Kappa. Resultados y discusión: Utilizando datos auto-referidos, el IMC se infravalora (2,62% en varones; 3,10% en mujeres). El error aumenta con la edad y en las categorías nutricionales extremas. El acuerdo en la evaluación nutricional a partir del IMC auto-referido y real es bueno, clasificándose de manera correcta el 74,71% de los varones y el 89,5 % de las mujeres (Kappa: 0,695 y 0,782 respectivamente). Conclusiones: Teniendo en cuenta el efecto de la edad y de la condición nutricional sobre el auto-conocimiento del tamaño corporal, se recomienda cautela en el empleo de cuestionarios encaminados a la valoración epidemiológica.

Anthropometric parameters in screening for excess of adiposity in Argentinian and Spanish adolescents: evaluation using receiver operating characteristic (ROC) methodology.

BACKGROUND: Various anthropometric parameters have been proposed for defining overweight in adolescence, but few studies have evaluated their diagnostic accuracy in comparative terms, using samples from different regions. AIM: To compare the performance of anthropometric parameters in determining the excess of adiposity in Argentinian and Spanish adolescents. SUBJECTS AND METHODS: The sample is composed of 1781 Argentinian and 1350 Spanish subjects, aged 12-17 years. Excess adiposity was defined as percentage BF in the 90th percentile or higher. ROC curves established the validity of parameters to define excess adiposity. RESULTS: Descriptive statistics showed differences between the Argentinian and Spanish samples. ROC curves indicate that all the parameters analysed had, in the Spanish and Argentinian samples, a positive and elevated association with excess of adiposity. The waist-to-height ratio had the highest value of the area under ROC curve (AUC), while conicity index and waist-to-hip ratio had the lowest. CONCLUSIONS: Differences exist with respect to size and body composition between the Argentinian and Spanish samples. ROC curves reflect a general pattern of variation. Waist-to-hip ratio and conicity index are less desirable in the diagnosis of excess adiposity and the most desirable is waist-to-height ratio.

[Diagnostic accuracy of waist to height ratio in screening of overweight and infant obesity]. / Precisión diagnóstica del índice cintura-talla para la identificación del sobrepeso y de la obesidad infantil.

BACKGROUND AND OBJECTIVE: To explore the sensitivity and specificity of waist to height index as indicator of overweight and obesity in pediatric age and to obtain cut-off points to simplify the diagnosis. SUBJECTS AND METHODS: Two thousand and three hundred and nineteen schoolchildren between 6 and 14 years were analyzed. Anthropometric measures were taken (height, weight, waist circumference and skinfolds thickness), and waist to height ratio (WHR), BMI and fat percentage were calculated. ANOVA test was used to evaluate the performance of anthropometric variables during the growth period. ROC curve analysis (Receiver Operating Characteristics) was applied using WHR as test variable and overweight and obesity status as criterion variable. Overweight and obesity were defined by BMI standards and adiposity references. The sensitivity and specificity values, areas under the curve (AUC), confidence intervals 95%, and cut-offs points were obtained. The statistical and graphical procedure was performed using SPSS(®) 18.0. RESULTS: WHR does not vary with age. AUC ranged from 0.786 to 0.953 indicating that the WHR has a high predictive power to identify the subjects previously classified as overweight or obese using both considered criteria. CONCLUSION: WHR proved to be an appropriate and effective predictor of overweight and obesity in children between 6 and 14 years. Cut-offs points of WHR that identify obesity are: 0.51 in males and 0.50 in girls. For the overweight, cut-offs range between 0.47 and 0.48 depending on sex and the criterion variable.

Patrón de actividad física, composición corporal y distribución de la adiposidad en adolescentes venezolanos / Physical activity pattern, body composition and fat patterning in venezuelan adolescents

La composición corporal y la distribución de la adiposidad son indicadores útiles para el diagnóstico temprano de factores de riesgo de enfermedades cardiovasculares. Se evaluó composición corporal, distribución de adiposidad y relación con actividad física en 300 adolescentes venezolanos (2006-2007), mediante el índice de masa corporal (IMC), áreas grasa (AG) y muscular (AM), distribución tronco/extremidad y actividad física (Test Krece Plus) y técnicas multivariantes. Se encontró: IMC: déficit 6,7% y exceso 11,7%. AG: 3,3% déficit y 12,7% exceso. AM 11,3% déficit y 19% exceso, 56% presentó nivel de actividad física malo, 33% regular y 11% bueno. En los adolescentes con sobrepeso la actividad física fue mala o regular. El primer clúster agrupó individuos de 13 años, normales y actividad física regular a buena; hombres 5,5 h mujeres 2,3h. El 2do clúster agrupó el déficit, y 3ro y 4to normales y exceso. Los varones practicaron más actividad física que las niñas (6,6-3,4)-(4,1-2,3). La edad caracterizó comportamiento en los clúster y se relacionó con la distribución de grasa. El test de actividad física contribuyó muy poco en la construcción de los ejes factoriales y fue débil su asociación con composición y distribución de grasa. Los jóvenes practican poca actividad física que se asocia a una distribución central y/o periférica de la adiposidad, ambos considerados factores de riesgo negativos para la salud de los adolescentes. La poca actividad física y las alteraciones en el patrón de distribución, pueden ser factores de riesgo modificables como parte de una política de atención integral al adolescente(AU)

Body composition and fat patterning are considered as predictor tools for an early diagnosis of risk of cardiovascular diseases. A study was conducted in 300 male and female Venezuelan adolescents (2006-2007) to explore body composition, and fat patterning, related to physical activity. Subjects were categorized based on body mass index (BMI), arm fat area (AFA), arm muscle area (AMA), central and peripheral distribution of fat and physical activity by Krece Plus questionnaire. Multivariante techniques were applied. According to BMI categories 6.7% were categorized as low and 11.7% as high; AFA classified 12.7% as high and 3.3% as low. AMA found 11.3% as low and 19% as high, 56% of adolescents did not archive a moderate or good physical activity. Overweight adolescents showed poor physical activity. The first cluster grouped most of the normal subjects, average age 13 years, and moderate and intense physical activity (5.5 /2.3 hours for males and females). The second cluster depicted subjects with deficit, normal and high ones were located on the third and four clusters. Boys were more active (6.6-3.3) than girls (4.1-2.3). Age was a variable that characterized the profile of the clusters and was related to body fat distribution. The physical test was not strong enough to the conformation of the factorial axes and was weakly associated with body composition and its distribution. The youngest were more sedentary linked to centralized and peripheral body fat distribution, both components recognized as contributing factors to a number of medical conditions, even during adolescence. A poor physical activity level and impairment of fat distribution could be considered modifiable risks factors as elements of integral policies for adolescents(AU)