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Uchida S, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Yamashita M, Noda T, Ueno K, Hotta K, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Prognostic Utility of Skeletal Muscle Mass Metrics in Patients With Heart Failure. Can J Cardiol 2023; 39:1630-1637. [PMID: 37574130 DOI: 10.1016/j.cjca.2023.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Sarcopenia is associated with risks of various adverse outcomes, and the assessment of skeletal muscle mass is necessary for its diagnosis. However, heart failure (HF) is a syndrome characterised by fluid retention, which affects muscle mass measurements. Different measurement methods have been reported to have different prognostic implications. We investigated the association between skeletal muscle mass metrics measured with the use of bioelectrical impedance analysis (BIA) and anthropometric measures and prognosis in patients with HF. METHODS The findings of 869 consecutive patients with HF were reviewed. We investigated the skeletal muscle mass index (SMI) measured with the use of BIA, the mid-upper arm circumference (MUAC), the arm muscle circumference (AMC), and the calf circumference (CC), and the patients were divided into 3 groups according to the sex-specific tertiles of the skeletal muscle mass metrics. The end points were all-cause death and readmission due to HF. RESULTS The high MUAC and AMC groups showed significantly better prognoses than their respective low groups (combined events: high MUAC group hazard ratio [HR] 0.559, 95% confidence interval [CI] 0.395-0.789 [P < 0.01]; high AMC group HR 0.505, 95% CI 0.359-0.710 [P < 0.01]), although high SMI and high CC were not associated with better prognoses. CONCLUSIONS Among patients with HF, MUAC and AMC are more associated with prognosis than SMI and CC, which are recommended in preexisting sarcopenia guidelines. MUAC and AMC may also be useful measures in sarcopenia assessments.
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Affiliation(s)
- Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Division of Research, ARCE, Sagamihara, Kanagawa, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kensuke Ueno
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Kazuki Hotta
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Shibata K, Yamamoto M, Kameshima M, Fujiyama H, Sano T, Kagase A, Tokuda T, Adachi Y, Yamaguchi R, Shimura T, Iritani N, Murase K, Koyama Y. Impact of arm circumference on clinical outcomes in patients undergoing transcatheter aortic valve replacement. IJC HEART & VASCULATURE 2022; 40:101049. [PMID: 35601527 PMCID: PMC9118512 DOI: 10.1016/j.ijcha.2022.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Kenichi Shibata
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
- Corresponding author at: Department of cardiology, Toyohashi Heart Canter, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi 441-8530, Japan.
| | - Masataka Kameshima
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Hiroaki Fujiyama
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Taisei Sano
- Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Canter, Nagoya, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Canter, Toyohashi, Japan
| | | | - Naoki Iritani
- Department of Cardiac Rehabilitation, Toyohashi Heart Canter, Toyohashi, Japan
| | - Kazuma Murase
- Department of Cardiac Rehabilitation, Toyohashi Heart Canter, Toyohashi, Japan
| | - Yutaka Koyama
- Department of Cardiovascular Surgery, Gifu Heart Center, Gifu, Japan
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Northuis CA, Murray TA, Lutsey PL, Butler KR, Nguyen S, Palta P, Lakshminarayan K. Body mass index prediction rule for mid-upper arm circumference: the atherosclerosis risk in communities study. Blood Press Monit 2022; 27:50-54. [PMID: 34534134 PMCID: PMC8734618 DOI: 10.1097/mbp.0000000000000567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Electronic health records (EHR) are a convenient data source for clinical trial recruitment and allow for inexpensive participant screening. However, EHR may lack pertinent screening variables. One strategy is to identify surrogate EHR variables which can predict the screening variable of interest. In this article, we use BMI to develop a prediction rule for arm circumference using data from the Atherosclerosis Risk in Communities (ARIC) Study. This work applies to EHR patient screening for clinical trials of hypertension. METHODS We included 11 585 participants aged 52-75 years with BMI and arm circumference measured at ARIC follow-up visit 4 (1996-1998). We selected the following arm circumference cutpoints based on the American Heart Association recommendations for blood pressure (BP) cuffs: small adult (≤26 cm), adult (≤34 cm) and large adult (≤44 cm). We calculated the sensitivity and specificity of BMI values for predicting arm circumference using receiver operating characteristic curves. We report the BMI threshold that maximized Youden's Index for each arm circumference upper limit of a BP cuff. RESULTS Participants' mean BMI and arm circumference were 28.8 ± 5.6 kg/m2 and 33.4 ± 4.3 cm, respectively. The BMI-arm circumference Pearson's correlation coefficient was 0.86. The BMI threshold for arm circumference≤26 cm was 23.0 kg/m2, arm circumference≤34 cm was 29.2 kg/m2 and arm circumference≤44 cm was 37.4 kg/m2. Only the BMI threshold for arm circumference≤34 cm varied significantly by sex. CONCLUSIONS BMI predicts arm circumference with high sensitivity and specificity and can be an accurate surrogate variable for arm circumference. These findings are useful for participant screening for hypertension trials. Providers can use this information to counsel patients on appropriate cuff size for BP self-monitoring.
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Affiliation(s)
- Carin A. Northuis
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Thomas A. Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
| | - Kenneth R. Butler
- Department of Medicine, University of Mississippi Medical Center, University of Mississippi, Jackson, Mississippi
| | - Steve Nguyen
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Priya Palta
- Division of General Medicine, Department of Medicine, Columbia University Irving Medical Center, Columbia University, New York, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
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Nutrition Assessment in Crohn’s Disease using Anthropometric, Biochemical, and Dietary Indexes: A Narrative Review. J Acad Nutr Diet 2020; 120:624-640. [DOI: 10.1016/j.jand.2019.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 12/25/2022]
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Almuneef AR, Almajwal A, Alam I, Abulmeaty M, Bader BA, Badr MF, Almuammar M, Razak S. Malnutrition is common in children with cerebral palsy in Saudi Arabia - a cross-sectional clinical observational study. BMC Neurol 2019; 19:317. [PMID: 31823743 PMCID: PMC6905047 DOI: 10.1186/s12883-019-1553-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is considered as the main cause of severe physical impairment and malnutrition in children. This cross-sectional study intended to survey the nutritional status of children cerebral palsy in Riyadh, Saudi Arabia. METHODS We examined 74 children (age: 1-10 yrs) with CP, who attended Sultan Bin Abdulaziz Humanitarian City (SBAHC), Riyadh Saudi Arabia. Data on age, general demographics, nutritional status, and dietary intake were collected. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for his/her weight for age, weight for height, height for age and body mass index for age were ≤ -2.0 standard deviation (SD) using WHO growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. RESULTS More than half (56.4%) of the children with cerebral palsy were malnourished as they had z-score below <-2 SD in at least one of the four indicators. Thinness (50%) was the most common form of malnutrition, followed by underweight, stunting, and wasting. Arm anthropometrics gave similar results on the percent number of malnourished children. Factors that were independently associated with malnutrition with an adjusted OR (aOR) were as follow: age ≤ 5 yrs. (aOR: 4.29); presence of cognitive impairment (aOR: 4.13); presence of anemia (aOR: 3.41) and inadequate energy intake (aOR: 4.86) (p, for all trends <0.05). CONCLUSION Children with cerebral palsy of the current study have impaired growth and nutritional status as assessed by all four common nutritional status indicators. Further large-scale community-based studies for in-depth evaluation of nutritional status and growth patterns in children with CP are needed.
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Affiliation(s)
- Abdul Rahman Almuneef
- Sultan Bin Abdulaziz Humanitarian City, P.O. Box: 10219, Riyadh, KSA, 11433, Saudi Arabia.,Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Ali Almajwal
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia.
| | - Iftikhar Alam
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Mahmoud Abulmeaty
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Bader Al Bader
- Sultan Bin Abdulaziz Humanitarian City, P.O. Box: 10219, Riyadh, KSA, 11433, Saudi Arabia
| | - Mohamed Farouq Badr
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - May Almuammar
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
| | - Suhail Razak
- Clinical Nutrition Program, Department of Community Health Sciences, College of Applied Medical sciences. King Saud University, Riyadh, Saudi Arabia
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Chao YP, Kao TW, Chang YW, Peng TC, Chen WL, Wu LW. Utilization of anthropometric parameters as a novel tool for detection of insulin resistance. Clin Nutr 2019; 39:2571-2579. [PMID: 31812468 DOI: 10.1016/j.clnu.2019.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anthropometric parameters have been widely applied in evaluating muscle mass, insulin resistance (IR), and cardiometabolic diseases. Arm circumference (AC) and calf circumference (CC) are used as informative markers for sarcopenia. However, few studies concern the correlation between AC, CC and IR. The aim of the present survey is to investigate the relationship between AC, CC and homeostatic model assessment of insulin resistance (HOMA-IR). METHODS This cross-sectional observational study included 11,527 participants aged 40-85 years from the National Health and Nutrition Examination Survey (NHANES), 1999 to 2006. We divided the participants into male and female groups. Each group was then divided into four subgroups depending on their AC and CC levels. RESULTS After adjustment for multiple covariates, we observed a significant negative correlation between the CC and HOMA-IR. This study showed a significant positive correlation between the AC and HOMA-IR after multiple adjustments. Subjects in the highest CC quartiles tended to have the lowest HOMA-IR in both male and female group (P for trend <0.001 in all models). CONCLUSIONS CC may be a novel tool to guide public health policy and clinical predictor of IR in middle-aged and older people.
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Affiliation(s)
- Yuan-Ping Chao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yaw-Wen Chang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Dent E, Hoogendijk EO, Visvanathan R, Wright ORL. Malnutrition Screening and Assessment in Hospitalised Older People: a Review. J Nutr Health Aging 2019; 23:431-441. [PMID: 31021360 DOI: 10.1007/s12603-019-1176-z] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
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Affiliation(s)
- E Dent
- Elsa Dent, Torrens University Australia, Level 1, 220 Victoria Square, Adelaide, Australia 5000, Phone: +61 8 8 113 7823,
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Kamiya K, Masuda T, Matsue Y, Hamazaki N, Matsuzawa R, Tanaka S, Nozaki K, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Ako J. Prognostic Usefulness of Arm and Calf Circumference in Patients ≥65 Years of Age With Cardiovascular Disease. Am J Cardiol 2017; 119:186-191. [PMID: 27823596 DOI: 10.1016/j.amjcard.2016.09.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/27/2023]
Abstract
Current diagnostic criteria for sarcopenia require measurement of muscle function (MF) and muscle mass. Mid upper arm circumference (AC) and calf circumference (CC) are currently used as metrics of muscle mass. This study was performed to compare the prognostic predictive capabilities of AC and CC in older patients with cardiovascular disease (CVD). The study population consisted of 599 admitted patients aged ≥65 years (74.8 ± 6.3 years, 392 men) with CVD. We measured MF (gait speed and grip strength), AC, and CC before hospital discharge. The end point was all-cause mortality. During follow-up (median 1.63 years, interquartile range 2.09 years), 72 deaths occurred. Both high AC and high CC were associated with better outcome; however, only AC (adjusted hazard ratio per SD increase 0.56, p = 0.023), but not CC (adjusted hazard ratio per SD increase 0.91, p = 0.696), showed significant independent prognostic capability after adjusting for other prognostic factors. Moreover, adding AC to MF (0.71 vs 0.62, p = 0.005) but not CC to MF (0.67 vs 0.62, p = 0.188) significantly increased the area under the curve on receiver operating characteristic curve. In conclusion, a high AC, but not CC, was an independent predictor of survival and could be a readily available and simple metric for risk stratification in older patients with CVD.
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Bedside nutrition evaluation and physical assessment techniques in critical illness. Curr Opin Crit Care 2016; 22:303-7. [DOI: 10.1097/mcc.0000000000000324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kamiya K, Masuda T, Matsue Y, Inomata T, Hamazaki N, Matsuzawa R, Tanaka S, Nozaki K, Maekawa E, Noda C, Yamaoka-Tojo M, Matsunaga A, Izumi T, Ako J. Complementary Role of Arm Circumference to Body Mass Index in Risk Stratification in Heart Failure. JACC-HEART FAILURE 2016; 4:265-73. [DOI: 10.1016/j.jchf.2015.11.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 11/27/2022]
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Kakooza‐Mwesige A, Tumwine JK, Eliasson A, Namusoke HK, Forssberg H. Malnutrition is common in Ugandan children with cerebral palsy, particularly those over the age of five and those who had neonatal complications. Acta Paediatr 2015; 104:1259-68. [PMID: 26088908 PMCID: PMC5042112 DOI: 10.1111/apa.13089] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/15/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
Aim Poor growth and malnutrition are frequently reported in children with cerebral palsy in developed countries, but there is limited information from developing countries. We investigated the nutritional status of Ugandan children with cerebral palsy and described the factors associated with poor nutrition. Methods We examined 135 children from two to 12 years with cerebral palsy, who attended Uganda's national referral hospital. A child was considered underweight, wasted, stunted or thin if the standard deviation scores for their weight for age, weight for height, height for age and body mass index for age were ≤−2.0 using World Health Organization growth standards. Multivariable logistic regression identified the factors associated with nutritional indicators. Results Over half (52%) of the children were malnourished, with underweight (42%) being the most common category, followed by stunting (38%), thinness (21%) and wasting (18%). Factors that were independently associated with being malnourished were as follows: presence of cognitive impairment, with an adjusted odds ratio (aOR) of 4.5, being 5 years or older (aOR = 3.4) and feeding difficulties in the perinatal period (aOR = 3.2). Conclusion Malnutrition was common in Ugandan children with cerebral palsy and more likely if they were 5 years or more or had experienced neonatal complications.
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Affiliation(s)
- Angelina Kakooza‐Mwesige
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
| | - James K. Tumwine
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
| | - Ann‐Christin Eliasson
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
| | - Hanifa K. Namusoke
- Department of Paediatrics & Child Health Makerere University College of Health Sciences and Mulago Hospital Kampala Uganda
| | - Hans Forssberg
- Neuropaediatric Unit Department of Women's & Children's Health Karolinska Institute Stockholm Sweden
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Sensitivity and Specificity of Malnutrition Screening Tools Used in the Adult Hospitalized Patient Setting. TOP CLIN NUTR 2015. [DOI: 10.1097/tin.0000000000000046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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The relationships between height and arm span, mid-upper arm and waist circumferences and sum of four skinfolds in Ellisras rural children aged 8-18 years. Public Health Nutr 2015; 19:1195-9. [PMID: 26395228 DOI: 10.1017/s136898001500258x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Height is required for the assessment of growth and nutritional status, as well as for predictions and standardization of physiological parameters. To determine whether arm span, mid-upper arm and waist circumferences and sum of four skinfolds can be used to predict height, the relationships between these anthropometric variables were assessed among Ellisras rural children aged 8-18 years. DESIGN The following parameters were measured according to the International Society for the Advancement of Kinathropometry: height, arm span, mid-upper arm circumference, waist circumference and four skinfolds (suprailiac, subscapular, triceps and biceps). Associations between the variables were assessed using Pearson correlation coefficients and linear regression models. SETTING Ellisras Longitudinal Study (ELS), Limpopo Province, South Africa. SUBJECTS Boys (n 911) and girls (n 858) aged 8-18 years. RESULTS Mean height was higher than arm span, with differences ranging from 4 cm to 11·5 cm between boys and girls. The correlation between height and arm span was high (ranging from 0·74 to 0·91) with P<0·001. The correlation between height and mid-upper arm circumference, waist circumference and sum of four skinfolds was low (ranging from 0·15 to 0·47) with P<0·00 among girls in the 15-18 years age group. CONCLUSIONS Arm span was found to be a good predictor of height. The sum of four skinfolds was significantly associated with height in the older age groups for girls, while waist circumference showed a negative significant association in the same groups.
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Barr R, Nayiager T, Gordon C, Marriott C, Athale U. Body composition and bone health in long-term survivors of acute lymphoblastic leukaemia in childhood and adolescence: the protocol for a cross-sectional cohort study. BMJ Open 2015; 5:e006191. [PMID: 25603918 PMCID: PMC4305072 DOI: 10.1136/bmjopen-2014-006191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Success in the treatment of young people with cancer, as measured conventionally by survival rates, is mitigated by late effects of therapy that impose a burden of morbidity and limit life expectancy. Among these adverse sequelae are altered body composition, especially obesity, and compromised bone health in the form of osteoporosis and increased fragility. These outcomes are potentially reversible and even preventable. This study will examine measures of body composition and bone health in long-term survivors of acute lymphoblastic leukaemia (ALL) in childhood and adolescence. These measures will be complemented by measures of physical activity and health-related quality of life (HRQL). METHODS AND ANALYSIS Survivors of ALL who are at least 10 years from diagnosis, following treatment on uniform protocols, will undergo measurements of body mass index; triceps skin fold thickness and mid-upper arm circumference; fat mass, lean body mass, skeletal muscle mass and bone mineral density by dual energy X-ray absorptiometry; trabecular and cortical bone indices and muscle density by peripheral quantitative CT; physical activity by the Habitual Activity Estimation Scale; and HRQL by Health Utilities Index instruments. Descriptive measures will be used for continuous variables and number (percent) for categorical variables. Associations between variables will be assessed using Fisher's exact t test and the χ(2) test; correlations will be tested by the Pearson correlation coefficient. ETHICS AND DISSEMINATION The study is approved by the institutional research ethics board and is supported by a competitive funding award. Dissemination of the results will occur by presentations to scientific meetings and publications in peer-reviewed journals, and by posting summaries of the results on websites accessed by adolescent and young adult survivors of cancer.
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Affiliation(s)
- Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Trishana Nayiager
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Christopher Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christopher Marriott
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology-Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
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15
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Madden AM, Smith S. Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables. J Hum Nutr Diet 2014; 29:7-25. [PMID: 25420774 DOI: 10.1111/jhn.12278] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.
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Affiliation(s)
- A M Madden
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - S Smith
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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16
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Allen VJ, Methven L, Gosney MA. Use of nutritional complete supplements in older adults with dementia: Systematic review and meta-analysis of clinical outcomes. Clin Nutr 2013; 32:950-7. [DOI: 10.1016/j.clnu.2013.03.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/08/2013] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
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17
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Irena AH, Ross DA, Salama P, Collins S. Anthropometric predictors of mortality in undernourished adults in the Ajiep Feeding Programme in Southern Sudan. Am J Clin Nutr 2013; 98:335-9. [PMID: 23803891 DOI: 10.3945/ajcn.112.055095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Various nutritional assessment tools are available to assess adult undernutrition, but few are practical in poorly served areas of low-income countries. OBJECTIVE The objective was to assess the relation between midupper arm circumference (MUAC), weight, body mass index (BMI), and clinical assessment for edema in predicting mortality in adults with severe acute undernutrition. DESIGN Demographic and anthropometric data that were collected in an observational study of 197 adults were analyzed. Participants were aged 18-59 y and were admitted to a therapeutic feeding center in Ajiep, Southern Sudan, during the height of the 1998 famine. Receiver operating curves were calculated and compared. RESULTS The mean (±SD) age of the participants was 40.1 ±10.8 y, and the mean (±SD) MUAC, weight, and BMI (in kg/m(2)) were 16.4 ± 1.3 cm, 35.1 ± 5.2 kg, and 12.6 ± 1.5, respectively. The area under the receiver operating curve for MUAC (0.71) was higher (P = 0.01) than those of BMI (0.57) and weight (0.51). Mean age, weight, and BMI on admission did not differ between survivors and nonsurvivors (P > 0.17). MUAC and edema were independently associated with mortality. For every 1-cm increase in admission MUAC, the odds of subsequent mortality decreased by 58% (adjusted OR: 0.42; 95% CI: 0.28, 0.63; P < 0.001). CONCLUSIONS In this study, which was conducted at the height of a major famine among adults with extremely severe grades of undernutrition, MUAC and edema were better indicators of short-term prognosis than was BMI. Further studies are needed to define a critical MUAC threshold for the diagnosis of acute adult undernutrition.
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Affiliation(s)
- Abel H Irena
- Valid International, 841 Northampton Drive, Silver Spring, MD 20903, USA.
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Aukner C, Eide HD, Iversen PO. Nutritional status among older residents with dementia in open versus special care units in municipal nursing homes: an observational study. BMC Geriatr 2013; 13:26. [PMID: 23496975 PMCID: PMC3607901 DOI: 10.1186/1471-2318-13-26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 02/26/2013] [Indexed: 11/23/2022] Open
Abstract
Background Undernutrition is widespread among institutionalised elderly, and people suffering from dementia are at particularly high risk. Many elderly with dementia live in open units or in special care units in nursing homes. It is not known whether special care units have an effect on the nutritional status of the residents. The aim of this study was therefore to examine the nutritional status of residents with dementia in both open units and in special care units. Methods Among Oslo’s 29 municipal nursing homes, 21 participated with 358 residents with dementia or cognitive impairment, of which 46% lived in special care units. Nutritional status was assessed using the Malnutrition Universal Screening Tool and anthropometry. Results We found no differences (p > 0.05) in risk of undernutrition, body mass index, mid-upper arm muscle circumference or triceps skinfold thickness between residents in open units and those in special care units. Residents in special care units were significantly younger and stronger when measured with a hand-grip test. Conclusions We found no difference in nutritional status between nursing home residents with dementia/cognitive impairment in open units versus in special care units.
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Wijnhoven HAH, de Boer MR, van Maanen MJ, van Dongen DM, Kraaij SF, Smit T, Visser M. Reproducibility of measurements of mid-upper arm circumference in older persons. J Hum Nutr Diet 2012; 26:24-31. [DOI: 10.1111/jhn.12010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. A. H. Wijnhoven
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - M. R. de Boer
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - M. J. van Maanen
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - D. M. van Dongen
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - S. F. Kraaij
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - T. Smit
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
| | - M. Visser
- Department of Health Sciences; EMGO Institute for Health and Care Research; VU University; Amsterdam The Netherlands
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam The Netherlands
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20
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de Hollander EL, Bemelmans WJE, de Groot LCPGM. Associations between changes in anthropometric measures and mortality in old age: a role for mid-upper arm circumference? J Am Med Dir Assoc 2012; 14:187-93. [PMID: 23168109 DOI: 10.1016/j.jamda.2012.09.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/19/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES In elderly individuals, little is known about changes in different anthropometric measures with respect to mortality. We examined the association between changes in eight anthropometric measures and mortality in an elderly population. DESIGN Longitudinal study including baseline measurements in 1988-1990 and repeated measures in 1993. SETTING European towns. PARTICIPANTS A total of 1061 older adults born in 1913-1918 from the Survey in Europe on Nutrition and the Elderly, A Concerted Action study were included in this study. MEASUREMENTS Weight, body mass index, waist circumference, waist to hip ratio, waist to height ratio, mid-upper arm circumference (MUAC), triceps skinfold thickness, and corrected arm muscle area were taken during both measurements. RESULTS A Cox regression model was used to examine the association between anthropometric changes (divided into quintiles, smallest change = reference category) and all-cause and cardiovascular disease mortality over approximately 6 years of follow-up, adjusted for baseline measurement of application, age, sex, smoking, education, physical activity, and major chronic diseases. A decrease in weight (≥3.2 kg), waist circumference (≥3.1 cm), and MUAC (≥1.6 cm and 0.6-1.6 cm) were (near) significantly associated with an all-cause mortality risk of 1.48 (95% CI: 0.99-2.20), 1.52 (95% CI: 1.01-2.31), 1.81 (95% CI: 1.17-2.79), and 1.66 (95% CI: 1.10-2.49), respectively. Also for MUAC, an increase (≥1.3 cm) was significantly associated with an increased all-cause and cardiovascular disease mortality risk [hazard ratio, 1.52 (95% CI: 1.00-2.31) and 1.94 (95% CI: 1.00-3.75), respectively]. CONCLUSION Associations were observed for decreases in only 3 of 8 anthropometric measures and all-cause mortality. Decreases in MUAC had the strongest association with mortality and was the only measure in which an increase also was associated with mortality. This suggests a role for MUAC in the prediction of mortality in elderly individuals.
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Affiliation(s)
- Ellen L de Hollander
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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21
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Mid-arm and calf circumferences (MAC and CC) are better than body mass index (BMI) in predicting health status and mortality risk in institutionalized elderly Taiwanese. Arch Gerontol Geriatr 2012; 54:443-7. [DOI: 10.1016/j.archger.2011.05.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 05/08/2011] [Accepted: 05/09/2011] [Indexed: 11/23/2022]
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22
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Sheard JM, Ash S, Silburn PA, Kerr GK. Prevalence of malnutrition in Parkinson's disease: a systematic review. Nutr Rev 2011; 69:520-32. [DOI: 10.1111/j.1753-4887.2011.00413.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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23
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The effectiveness of BMI, calf circumference and mid-arm circumference in predicting subsequent mortality risk in elderly Taiwanese. Br J Nutr 2010; 105:275-81. [DOI: 10.1017/s0007114510003429] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BMI, mid-arm circumference (MAC) and calf circumference (CC) are anthropometric indicators often included in geriatric health measurement scales. However, their relative effectiveness in predicting long-term mortality risk has not been extensively examined. The present study aimed to evaluate the relative effectiveness of these anthropometrics in predicting long-term mortality risk in older adults. The study prospectively analysed the ability of these indicators in predicting 4-year follow-up mortality risk of a population-representative sample of 4191 men and women, 53 years of age or older in the ‘Survey of Health and Living Status of the Elderly in Taiwan’. Cox regression analyses were performed to evaluate the association of follow-up mortality risk with low ( < 21 kg/m2) or high ( ≥ 27 kg/m2) BMI, low MAC ( < 23·5/22 cm for men/women) and low CC ( < 30/27 cm) respectively, according to Taiwanese-specific cut-off points. Results showed that low CC and low MAC were more effective than low BMI in predicting follow-up mortality risk in 65–74-year-old elderly. But low CC and low BMI were more effective than low MAC in ≥ 75-year-old elderly, and low BMI was more effective than low MAC or low CC in 53–64-year-old persons. High BMI was not effective in predicting mortality risk in any of these age ranges. These results suggest that in elderly adults, CC is more effective than BMI in predicting long-term mortality risk. Thus, more consideration to CC and MAC in designing geriatric health or nutritional measurement scales is recommended.
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Tomoum HY, Badawy NB, Hassan NE, Alian KM. Anthropometry and body composition analysis in children with cerebral palsy. Clin Nutr 2010; 29:477-81. [DOI: 10.1016/j.clnu.2009.10.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 10/06/2009] [Accepted: 10/29/2009] [Indexed: 11/24/2022]
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Wijnhoven HAH, van Bokhorst-de van der Schueren MAE, Heymans MW, de Vet HCW, Kruizenga HM, Twisk JW, Visser M. Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci 2010; 65:1107-14. [PMID: 20547497 PMCID: PMC3304296 DOI: 10.1093/gerona/glq100] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background. Low body mass index is a general measure of thinness. However, its measurement can be cumbersome in older persons and other simple anthropometric measures may be more strongly associated with mortality. Therefore, associations of low mid-upper arm circumference, calf circumference, and body mass index with mortality were examined in older persons. Methods. Data of the Longitudinal Aging Study Amsterdam, a population-based cohort study in the Netherlands, were used. The present study included community-dwelling persons 65 years and older in 1992–1993 (n = 1,667), who were followed until 2007 for their vital status. Associations between anthropometric measures and 15-year mortality were examined by spline regression models and, below the nadir, Cox regression models, transforming all measures to sex-specific Z scores. Results. Mortality rates were 599 of 826 (73%) in men and 479 of 841 (57%) in women. Below the nadir, the hazard ratio of mortality per 1 standard deviation lower mid-upper arm circumference was 1.79 (95% confidence interval, 1.48–2.16) in men and 2.26 (1.71–3.00) in women. For calf circumference, the hazard ratio was 1.45 (1.22–1.71) in men and 1.30 (1.15–1.48) in women and for body mass index 1.38 (1.17–1.61) in men and 1.56 (1.10–2.21) in women. Excluding deaths within the first 3 years after baseline did not change these associations. Excluding those with a smoking history, obstructive lung disease, or cancer attenuated the associations of calf circumference (men) and body mass index (women). Conclusions. Based on the stronger association with mortality and given a more easy assessment in older persons, mid-upper arm circumference seems a more feasible and valid anthropometric measure of thinness than body mass index in older men and women.
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Affiliation(s)
- Hanneke A H Wijnhoven
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, the Netherlands.
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Oliveira MRM, Fogaça KCP, Leandro-Merhi VA. Nutritional status and functional capacity of hospitalized elderly. Nutr J 2009; 8:54. [PMID: 19919711 PMCID: PMC2781024 DOI: 10.1186/1475-2891-8-54] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 11/17/2009] [Indexed: 11/18/2022] Open
Abstract
Background The nutritional status of the aging individual results from a complex interaction between personal and environmental factors. A disease influences and is influenced by the nutritional status and the functional capacity of the individual. We asses the relationship between nutritional status and indicators of functional capacity among recently hospitalized elderly in a general hospital. Methods A cross-sectional study was done with 240 elderly (women, n = 127 and men, n = 113) hospitalized in a hospital that provides care for the public and private healthcare systems. The nutritional status was classified by the MNA (Mini Nutritional Assessment) into: malnourished, risk of malnutrition and without malnutrition (adequate). The functional autonomy indicators were obtained by the self-reported Instrumental Activity of Daily Living (IADL) and Activity of Daily Living (ADL) questionnaire. The chi-square test was used to compare the proportions and the level of significance was 5%. Results Among the assessed elderly, 33.8% were classified as adequate regarding nutritional status; 37.1% were classified as being at risk of malnutrition and 29.1% were classified as malnourished. All the IADL and ADL variables assessed were significantly more deteriorated among the malnourished individuals. Among the ADL variables, eating partial (42.9%) or complete (12.9%) dependence was found in more than half of the malnourished elderly, in 13.4% of those at risk of malnutrition and in 2.5% of those without malnutrition. Conclusion There is an interrelationship between the nutritional status of the elderly and reduced functional capacity.
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Affiliation(s)
- Maria R M Oliveira
- Institute of Biosciences, UNESP - São Paulo State University, Botucatu, Brazil.
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Wu BW, Yin T, Cao WX, Gu ZD, Wang XJ, Yan M, Liu BY. Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World J Gastroenterol 2009; 15:3542-9. [PMID: 19630112 PMCID: PMC2715983 DOI: 10.3748/wjg.15.3542] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the role of subjective global assessment (SGA) in nutritional assessment and outcome prediction of Chinese patients with gastrointestinal cancer. METHODS A total of 751 patients diagnosed with gastrointestinal cancer between August 2004 and August 2006 were enrolled in this study. Within 72 h after admission, SGA, anthropometric parameters, and laboratory tests were used to assess the nutritional status of each patient. The outcome variables including hospital stay, complications, and in-hospital medical expenditure were also obtained. RESULTS Based on the results of SGA, 389 (51.8%), 332 (44.2%), and 30 (4.0%) patients were classified into well nourished group (SGA-A), mildly to moderately malnourished group (SGA-B), and severely malnourished group (SGA-C), respectively. The prevalence of malnutrition classified by SGA, triceps skinfold thickness (TSF), mid-upper arm muscle circumference (MAMC), albumin (ALB), prealbumin (PA), and body mass index (BMI) was 48.2%, 39.4%, 37.7%, 31.3%, 21.7%, and 9.6%, respectively. In addition, ANOVA tests revealed significant differences in body mass index (BMI), TSF, PA, and ALB of patients in different SGA groups. The more severely malnourished the patient was, the lower the levels of BMI, TSF, PA, and ALB were (P < 0.05). Chi2 tests showed a significant difference in SGA classification between patients receiving different types of treatment (surgery vs chemotherapy/radiotherapy). As the nutritional status classified by SGA deteriorated, the patients stayed longer in hospital and their medical expenditures increased significantly. Furthermore, multiple regression analysis showed that SGA and serum ALB could help predict the medical expenditures and hospital stay of patients undergoing surgery. The occurrence of complications increased in parallel with the increasing grade of SGA, and was the highest in the SGA-C group (23.3%) and the lowest in the SGA-A group (16.8%). CONCLUSION SGA is a reliable assessment tool and helps to predict the hospital stay and medical expenditures of Chinese surgical gastrointestinal cancer patients.
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Affiliation(s)
- Bei-Wen Wu
- Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Miller M, Wong WK, Wu J, Cavenett S, Daniels L, Crotty M. Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees? Arch Phys Med Rehabil 2008; 89:2031-3. [PMID: 18929034 DOI: 10.1016/j.apmr.2008.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2008] [Revised: 03/15/2008] [Accepted: 03/28/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics. DESIGN Cross-sectional study. SETTING Prosthetics clinic in Australia. PARTICIPANTS Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL). RESULTS There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541-.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (beta=-.132; P=.030) and MNA (beta=-.561; P=.017). CONCLUSIONS For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.
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Affiliation(s)
- Michelle Miller
- Flinders Centre for Clinical Change and Health Care Research, Flinders University, Adelaide, Australia.
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Beghetto MG, Luft VC, Mello EDD, Polanczyk CA. Avaliação nutricional: descrição da concordância entre avaliadores. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2007. [DOI: 10.1590/s1415-790x2007000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo objetivou avaliar a concordância interobservadores de medidas antropométricas e avaliação subjetiva do estado nutricional em adultos hospitalizados. Pacientes internados em um hospital geral universitário tiveram peso atual, peso usual, altura, circunferência do braço, prega cutânea tricipital, percentual de perda de peso, Índice de Massa Corporal, circunferência muscular do braço e Avaliação Nutricional Subjetiva Global obtidos por avaliadores independentes. A concordância foi avaliada pelo coeficiente kappa, teste t pareado e coeficiente de correlação intraclasse (ICC). Foram avaliados 102 pacientes, com idade de 53±15 anos. Foi obtida boa correlação entre observadores para todos os métodos antropométricos (ICC>0,86) e diferenças médias de pequena magnitude. As variáveis categorizadas mostraram concordância ótima para o Índice de Massa Corporal (kappa=0,98; IC95%: 0,95-1,0), fraca para a Avaliação Nutricional Subjetiva Global (kappa=0,46; IC95%: 0,31-0,60) e moderada para os percentis 5 e 10 da circunferência do braço (kappa=0,78; IC95%: 0,65-0,91), circunferência muscular do braço (kappa=0,73; IC95%: 0,54-0,92) e prega cutânea tricipital (kappa=0,65; IC95%: 0,48-0,82). Para muitos pacientes houve discrepâncias clinicamente relevantes no percentual de perda de peso, circunferência do braço, prega cutânea tricipital e circunferência muscular do braço. Embora estatisticamente a reprodutibilidade dos métodos antropométricos tenha sido boa, deve-se ser prudente ao empregá-los no contexto hospitalar, visto as diferenças encontradas, em especial na antropometria do braço e na Avaliação Nutricional Subjetiva Global.
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Affiliation(s)
| | | | | | - Carísi Anne Polanczyk
- Universidade Federal do Rio Grande do Sul; Hospital de Clínicas de Porto Alegre; Universidade Federal do Rio Grande do Sul
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Elkan AC, Engvall IL, Tengstrand B, Cederholm T, Hafström I. Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. Eur J Clin Nutr 2007; 62:1239-47. [PMID: 17637600 DOI: 10.1038/sj.ejcn.1602845] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data. SUBJECTS AND METHODS Study subjects include 60 in-ward patients (83% women, median age 65 years). Anthropometric measures and the nutritional tools Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening tool 2002 (NRS-2002). Body composition was determined by dual-energy X-ray absorptiometry and fat-free mass index (FFMI; kg/m(2)) and fat mass index (FMI; kg/m(2)) were calculated. RESULTS Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m(2), respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m(2), that is, the cutoff value for malnutrition. FFMI indicated 52% of the women and 30% of the men to be malnourished. The sensitivity and specificity for BMI to detect malnutrition according to FFMI were 27 and 100%, whereas for arm muscle circumference the sensitivity was 36% and the specificity 89% and for triceps skin fold 43 and 93%, respectively. For MNA, sensitivity was 85% and specificity 39% and for SGA 46 and 82%. Both MUST and NRS-2002 had sensitivity of 45% and specificity of 19%. CONCLUSION A large proportion of in-ward RA patients had reduced FFMI. Concurrent elevation of fat mass made BMI a non-reliable tool to detect malnutrition. Of the tested clinical evaluation tools, MNA might be used as a screening instrument, but because of its low specificity it should be followed by body composition determination.
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Affiliation(s)
- A-C Elkan
- Department of Rheumatology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Barbosa-Silva MCG, Barros AJD. Indications and limitations of the use of subjective global assessment in clinical practice: an update. Curr Opin Clin Nutr Metab Care 2006; 9:263-9. [PMID: 16607126 DOI: 10.1097/01.mco.0000222109.53665.ed] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. RECENT FINDINGS Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. SUMMARY Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.
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