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Becker P, Abdel-Rahman S, Nemet D, Marino LV, Noritz G, Fisberg M, Beretich K. Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations. Nutr Clin Pract 2024. [PMID: 39292197 DOI: 10.1002/ncp.11208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 07/19/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.
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Affiliation(s)
- Patricia Becker
- Neonatal Intensive Care Unit/Nutrition Clinic, Dayton's Children's Hospital, Dayton, Ohio, USA
| | | | - Dan Nemet
- Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Luise V Marino
- University Hospital Southampton, NHS Foundation Trust, and Faculty of Medicine and Health Sciences, University of Southampton, Southampton, UK
| | - Garey Noritz
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Mauro Fisberg
- CENDA-Instituto PENSI-Sabará Children's Hospital Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kaitlan Beretich
- Medical Affairs & Research, Abbott Nutrition, Dallas-Fort Worth, Texas, USA
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Ly JJ, Sosa A, Heidman M, Dixon MF, Ostolaza C, Dallabrida SM. Assessment of the reliability of at-home caregiver-collected anthropometric measurements. Front Pediatr 2024; 12:1441321. [PMID: 39296667 PMCID: PMC11408210 DOI: 10.3389/fped.2024.1441321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/14/2024] [Indexed: 09/21/2024] Open
Abstract
Introduction Anthropometric measurements provide valuable information about infant growth patterns and can help identify nutrition, growth, and developmental concerns. With the increasing use of telehealth and decentralized clinical trial approaches, there is potential for caregivers to collect anthropometric measurements at home via teleconference with healthcare providers (HCPs) to monitor infant growth, which indirectly reflects health status. This study aimed to evaluate whether telehealth-guided caregivers can utilize standardized methods and home-use measurement equipment to collect reliable anthropometric measurements compared to HCPs and study nurses. Methods The study compared the weight, length, and head circumference measurements collected by caregivers (n = 8 pairs), pediatric HCPs (n = 7), and study nurses (n = 4), who served as the gold standard comparator group. Four silicone dolls with varied anthropometrics were used as surrogates for human infants. Results Caregiver inter- and intra-observer technical errors of measurement (TEMs) were all equal to or below the maximum allowed error (MAE). For HCPs, only intra-observer TEM for length and inter-observer TEM for HC and length were within the MAE. There was no evidence of bias for either caregiver or HCP measurements compared to the gold standard. Coefficients of reliability (R) were greater than 0.96 for all measurements. Discussion Preliminary results from this study demonstrate that telehealth-guided caregivers can capture accurate and reliable anthropometric measurements compared to HCPs. The results suggest that remote measurement collection allows for more frequent monitoring while reducing the burden on patients and caregivers in primary care and clinical trials such as infant formula growth monitoring studies.
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Affiliation(s)
- Jenny J Ly
- SPRIM PRO, Indian Harbour Beach, FL, United States
| | - Ana Sosa
- SPRIM PRO, Indian Harbour Beach, FL, United States
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Patel D, Vesely SK, Dev DA, Guseman EH, Hord N, Eliot K, Sisson SB. Accuracy of Parent-Measured Weight and Height of Preschool Children at Home With Increasing Levels of Instruction. Child Obes 2024; 20:346-353. [PMID: 37967393 PMCID: PMC11302217 DOI: 10.1089/chi.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Background: The purpose of this study was to determine how accurately parents measure their preschool child's weight and height with increasing levels of instruction. Methods: Parents measured their child's (n = 30 dyads) weight (own weight scale) and height (soft tape measure) using three levels of instruction: instructional guide (level 1); guide, demonstration video (level 2); and guide, video, and virtual monitoring (level 3), which were compared to researcher measurements (electronic weight scale, Stadiometer). Paired t-tests were used to determine differences between researcher and parent measurements and between the three parent levels. Inaccurate classifications were calculated using parent-measured values for the four categories (underweight, healthy, overweight, obese). Results: Raw mean parent-measured weights (17.4 ± 2.3 kg) differed from researcher by 0.2 kg (level 1), 0.3 kg (level 2), and 0.1 kg (level 3). Raw mean parent-measured heights (104.0 ± 5.9 cm) differed from researcher by 0.9 cm (level 1, p = 0.005), 0.4 cm (level 2, NS), and 0.3 cm (level 3, NS). Across all levels, 48.9% and 65.5% parents overmeasured their children's weights and heights, respectively. Using parent-measured values, 29.4% of children were classified high while 70.5% were classified low. Parents were more likely to make errors if their children were on the borderline between any of the two weight categories. Conclusion: Findings indicate that an instructional guide with demonstration video is helpful in improving the parents' accuracy of their children's weights and heights. More research is needed to determine accuracy in population other than White parents with high education levels and children under overweight and obese category.
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Affiliation(s)
- Divya Patel
- Department of Nutritional Sciences, College of Allied Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sara K. Vesely
- Department of Biostatistics, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dipti A. Dev
- Department of Child, Youth, and Family Studies, College of Education and Human Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Emily H. Guseman
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Norman Hord
- Department of Nutritional Sciences, College of Allied Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kathrin Eliot
- Department of Nutritional Sciences, College of Allied Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, College of Allied Health, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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4
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Pare SM, Gunn E, Morrison KM, Miller AL, Duncan AM, Buchholz AC, Ma DWL, Tremblay PF, Vallis LA, Mercer NJ, Haines J. Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study. JMIR Res Protoc 2024; 13:e48549. [PMID: 38900565 PMCID: PMC11224706 DOI: 10.2196/48549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/15/2023] [Accepted: 04/11/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. OBJECTIVE The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. METHODS The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child's height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child's physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child's mental health, as well as a 1-day dietary assessment for their child. RESULTS Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study's sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children's mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. CONCLUSIONS Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. TRIAL REGISTRATION ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48549.
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Affiliation(s)
- Shannon M Pare
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - Elizabeth Gunn
- Centre for Metabolism, Obesity & Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Centre for Metabolism, Obesity & Diabetes Research, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Alison L Miller
- Department of Health Behaviour and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Alison M Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Andrea C Buchholz
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
| | - David W L Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Paul F Tremblay
- Department of Psychology, University of Western Ontario, London, ON, Canada
| | - Lori Ann Vallis
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Nicola J Mercer
- Wellington-Dufferin-Guelph Public Health, Guelph, ON, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON, Canada
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Sanchez J, Trofholz A, Berge JM. Best Practices and Recommendations for Research Using Virtual Real-Time Data Collection: Protocol for Virtual Data Collection Studies. JMIR Res Protoc 2024; 13:e53790. [PMID: 38743477 PMCID: PMC11134243 DOI: 10.2196/53790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and the subsequent need for social distancing required the immediate pivoting of research modalities. Research that had previously been conducted in person had to pivot to remote data collection. Researchers had to develop data collection protocols that could be conducted remotely with limited or no evidence to guide the process. Therefore, the use of web-based platforms to conduct real-time research visits surged despite the lack of evidence backing these novel approaches. OBJECTIVE This paper aims to review the remote or virtual research protocols that have been used in the past 10 years, gather existing best practices, and propose recommendations for continuing to use virtual real-time methods when appropriate. METHODS Articles (n=22) published from 2013 to June 2023 were reviewed and analyzed to understand how researchers conducted virtual research that implemented real-time protocols. "Real-time" was defined as data collection with a participant through a live medium where a participant and research staff could talk to each other back and forth in the moment. We excluded studies for the following reasons: (1) studies that collected participant or patient measures for the sole purpose of engaging in a clinical encounter; (2) studies that solely conducted qualitative interview data collection; (3) studies that conducted virtual data collection such as surveys or self-report measures that had no interaction with research staff; (4) studies that described research interventions but did not involve the collection of data through a web-based platform; (5) studies that were reviews or not original research; (6) studies that described research protocols and did not include actual data collection; and (7) studies that did not collect data in real time, focused on telehealth or telemedicine, and were exclusively intended for medical and not research purposes. RESULTS Findings from studies conducted both before and during the COVID-19 pandemic suggest that many types of data can be collected virtually in real time. Results and best practice recommendations from the current protocol review will be used in the design and implementation of a substudy to provide more evidence for virtual real-time data collection over the next year. CONCLUSIONS Our findings suggest that virtual real-time visits are doable across a range of participant populations and can answer a range of research questions. Recommended best practices for virtual real-time data collection include (1) providing adequate equipment for real-time data collection, (2) creating protocols and materials for research staff to facilitate or guide participants through data collection, (3) piloting data collection, (4) iteratively accepting feedback, and (5) providing instructions in multiple forms. The implementation of these best practices and recommendations for future research are further discussed in the paper. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53790.
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Affiliation(s)
- Jasmin Sanchez
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Jerica M Berge
- Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Potts BA, Wood GC, Bailey-Davis L. Agreement between parent-report and EMR height, weight, and BMI among rural children. Front Nutr 2024; 11:1279931. [PMID: 38496791 PMCID: PMC10940382 DOI: 10.3389/fnut.2024.1279931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Remote anthropometric surveillance has emerged as a strategy to accommodate lapses in growth monitoring for pediatricians during coronavirus disease 2019 (COVID-19). The purpose of this investigation was to validate parent-reported anthropometry and inform acceptable remote measurement practices among rural, preschool-aged children. Methods Parent-reported height, weight, body mass index (BMI), BMI z-score, and BMI percentile for their child were collected through surveys with the assessment of their source of home measure. Objective measures were collected by clinic staff at the child's well-child visit (WCV). Agreement was assessed using correlations, alongside an exploration of the time gap (TG) between parent-report and WCV to moderate agreement. Using parent- and objectively reported BMI z-scores, weight classification agreement was evaluated. Correction equations were applied to parent-reported anthropometrics. Results A total of 55 subjects were included in this study. Significant differences were observed between parent- and objectively reported weight in the overall group (-0.24 kg; p = 0.05), as well as height (-1.8 cm; p = 0.01) and BMI (0.4 kg/m2; p = 0.02) in the ≤7d TG + Direct group. Parental reporting of child anthropometry ≤7d from their WCV with direct measurements yielded the strongest correlations [r = 0.99 (weight), r = 0.95 (height), r = 0.82 (BMI), r = 0.71 (BMIz), and r = 0.68 (BMI percentile)] and greatest classification agreement among all metrics [91.67% (weight), 54.17% (height), 83.33% (BMI), 91.67% (BMIz), and 33.33% (BMI percentile)]. Corrections did not remarkably improve correlations. Discussion Remote pediatric anthropometry is a valid supplement for clinical assessment, conditional on direct measurement within 7 days. In rural populations where socioenvironmental barriers exist to care and surveillance, we highlight the utility of telemedicine for providers and researchers.
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Affiliation(s)
| | | | - Lisa Bailey-Davis
- Center for Obesity and Metabolic Research, Geisinger Health System, Danville, PA, United States
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Kostopoulou E. The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic? Horm Metab Res 2024; 56:181-192. [PMID: 37673081 DOI: 10.1055/a-2152-4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
As an increased body of COVID-19 related research is now available, it becomes apparent that the effects of COVID-19 extend beyond that of the respiratory system. Among others, the endocrine system is particularly vulnerable to perturbation from the COVID-19 infection. The present scoping review summarizes the bidirectional relationship between COVID-19 and endocrine system in children and adolescents, by describing both the possible susceptibility of children and adolescents without endocrinopathies to endocrine disorders following COVID-19 infection, but also the potential susceptibility to COVID-19 infection and severe infection, or the aggravation of endocrine dysfunction in patients with pre-existing endocrine diseases. Data suggest increased obesity and diabetes rates, as well as increased severity and frequency of diabetic ketoacidosis following COVID-19 infection. Conversely, patients with diabetes and obesity may experience a more severe course of COVID-19 infection. However, in the majority of cases, children and adolescents with well-managed and regulated endocrine disorders do not appear to be at increased risk of infection or severe infection from COVID-19. Thus, adhering to the appropriate "sick day management rules", maintaining adequate supply of medications and supplies, keeping close contact with the therapeutic team and seeking medical help without delay when needed, are the main recommendations for a safe outcome. Additional lessons learnt during the pandemic include the risk for mental health diseases caused by children's disrupted routine due to COVID-19 related protective measures and the importance of adopting alternative communication options, such as telehealth visits, in order to ensure uninterrupted endocrine care.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece
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Fink G, Chembe M, Henderson S, Rockers PC, Parkerson D. Feasibility of caregiver-administered anthropometric measurements of children under age 5: evidence from Zambia. Popul Health Metr 2024; 22:2. [PMID: 38297266 PMCID: PMC10829329 DOI: 10.1186/s12963-024-00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Accurate measurement of children's anthropometry is of central importance for the assessment of nutritional status as well as for the evaluation of nutrition-specific interventions. Social distancing requirements during the recent Covid-19 pandemic made administration of standard assessor-led measurement protocols infeasible in many settings, creating demand for alternative assessment modalities. OBJECTIVE To assess the feasibility and reliability of caregiver-administered anthropometric assessments of children under age 5. DESIGN We compared standard and caregiver-administered assessments within an ongoing nutrition trial in Zambia (NCT05120427). We developed a "no-contact" protocol whereby trained staff verbally instruct caregivers from an appropriate distance to measure the height, weight and MUAC of their children. We captured measurements of height, weight and MUAC among a sample of caregivers and infants in Zambia using both the "no-contact" protocol and a standard assessor-led protocol. We analyzed each anthropometric variable, comparing means between protocol group, the proportions yielding standardized z-scores outside the plausible ± 6SD range and the proportions of children classified stunted, underweight and wasted. RESULTS Anthropometric measurements were captured for 76 children using both the no-contact protocol and the standard protocol. An additional 1430 children were assessed by the standard protocol only and an additional 748 children by the no-contact protocol only. For the 76 children measured by both methods, we find no differences in average height, weight and MUAC between caregivers and interviewer assessments. The estimated kappa for the binary stunting and underweight classifications were 0.84 and 0.93, respectively. In the larger samples measured only following one protocol, we find no differences in average outcomes after adjusting for child, caregiver and household characteristics. CONCLUSIONS Anthropometric measurement protocols administered by caregivers with verbal instruction from trained assessors are a promising alternative to standard protocols in situations where study staff are unable to come in close contact with study participants. Clinical trials registration This study was conducted within a larger trial registered at clinicaltrials.gov as trial NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427 .
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Affiliation(s)
- Günther Fink
- Swiss Tropical and Public Health Institute and University of Basel, Kreuzstrasse 2, 4123, Allschwil, Basel, Switzerland.
| | - Mpela Chembe
- Innovations for Poverty Action Zambia, Lusaka, Zambia
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Zhang E, Davis AM, Jimenez EY, Lancaster B, Serrano-Gonzalez M, Chang D, Lee J, Lai JS, Pyles L, VanWagoner T, Darden P. Validation of remote anthropometric measurements in a rural randomized pediatric clinical trial in primary care settings. Sci Rep 2024; 14:411. [PMID: 38172325 PMCID: PMC10764753 DOI: 10.1038/s41598-023-50790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Rural children are more at risk for childhood obesity but may have difficulty participating in pediatric weight management clinical trials if in-person visits are required. Remote assessment of height and weight observed via videoconferencing may provide a solution by improving the accuracy of self-reported data. This study aims to validate a low-cost, scalable video-assisted protocol for remote height and weight measurements in children and caregivers. Families were provided with low-cost digital scales and tape measures and a standardized protocol for remote measurements. Thirty-three caregiver and child (6-11 years old) dyads completed remote (at home) height and weight measurements while being observed by research staff via videoconferencing, as well as in-person measurements with research staff. We compared the overall and absolute mean differences in child and caregiver weight, height, body mass index (BMI), and child BMI adjusted Z-score (BMIaz) between remote and in-person measurements using paired samples t-tests and one sample t-tests, respectively. Bland-Altman plots were used to estimate the limits of agreement (LOA) and assess systematic bias. Simple regression models were used to examine associations between measurement discrepancies and sociodemographic factors and number of days between measurements. Overall mean differences in child and caregiver weight, height, BMI, and child BMIaz were not significantly different between remote and in-person measurements. LOAs were - 2.1 and 1.7 kg for child weight, - 5.2 and 4.0 cm for child height, - 1.5 and 1.7 kg/m2 for child BMI, - 0.4 and 0.5 SD for child BMIaz, - 3.0 and 2.8 kg for caregiver weight, - 2.9 and 3.9 cm for caregiver height, and - 2.1 and 1.6 kg/m2 for caregiver BMI. Absolute mean differences were significantly different between the two approaches for all measurements. Child and caregiver age were each significantly associated with differences between remote and in-person caregiver height measurements; there were no significant associations with other measurement discrepancies. Remotely observed weight and height measurements using non-research grade equipment may be a feasible and valid approach for pediatric clinical trials in rural communities. However, researchers should carefully evaluate their measurement precision requirements and intervention effect size to determine whether remote height and weight measurements suit their studies.Trial registration: ClinicalTrials.gov NCT04142034 (29/10/2019).
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Affiliation(s)
- E Zhang
- Department of Occupational Therapy Education, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth Yakes Jimenez
- College of Population Health and Departments of Pediatrics and Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Brittany Lancaster
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Monica Serrano-Gonzalez
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Di Chang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeannette Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lee Pyles
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
| | - Timothy VanWagoner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul Darden
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Forseth B, Davis AM, Bakula DM, Murray M, Dean K, Swinburne Romine RE, Fleming K. Validation of remote height and weight assessment in a rural randomized clinical trial. BMC Med Res Methodol 2022; 22:185. [PMID: 35818033 PMCID: PMC9272872 DOI: 10.1186/s12874-022-01669-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study is to describe and assess a remote height and weight protocol that was developed for an ongoing trial conducted during the SARS COV-2 pandemic. METHODS Thirty-eight rural families (children 8.3 ± 0.7 years; 68% female; and caregivers 38.2 ± 6.1 years) were provided detailed instructions on how to measure height and weight. Families obtained measures via remote data collection (caregiver weight, child height and weight) and also by trained staff. Differences between data collection methods were examined. RESULTS Per absolute mean difference analyses, slightly larger differences were found for child weight (0.21 ± 0.21 kg), child height (1.53 ± 1.29 cm), and caregiver weight (0.48 ± 0.42 kg) between school and home measurements. Both analyses indicate differences had only minor impact on child BMI percentile (- 0.12, 0.68) and parent BMI (0.05, 0.13). Intraclass coefficients ranged from 0.98 to 1.00 indicating that almost all of the variance was due to between person differences and not measurement differences within a person. CONCLUSION Results suggest that remote height and weight collection is feasible for caregivers and children and that there are minimal differences in the various measurement methods studied here when assessing group differences. These differences did not have clinically meaningful impacts on BMI. This is promising for the use of remote height and weight measurement in clinical trials, especially for hard-to reach-populations. TRIAL REGISTRATION Clinical. Registered in clinicaltrials.gov ( NCT03304249 ) on 06/10/2017.
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Affiliation(s)
- Bethany Forseth
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, CDU 2036, Kansas City, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA. .,Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, CDU 2036, Kansas City, USA.
| | - Dana M Bakula
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Megan Murray
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, CDU 2036, Kansas City, USA
| | - Kelsey Dean
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | | | - Kandace Fleming
- Life Span Institute, University of Kansas, Lawrence, Kansas, USA
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Yang Y, Zhang M, Yu J, Pei Z, Sun C, He J, Qian T, Luo F, Zhang S, Xu Z. Nationwide Trends of Pediatric Obesity and BMI z-Score From 2017-2021 in China: Comparable Findings From Real-World Mobile- and Hospital-Based Data. Front Endocrinol (Lausanne) 2022; 13:859245. [PMID: 35721754 PMCID: PMC9204322 DOI: 10.3389/fendo.2022.859245] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Lifestyle changes including COVID-19 lockdown cause weight gain and may change obesity trends; however, timely changes are largely unknown and monitoring measures are usually lack. This first large-scale study aimed to analyze the real-world national trends of obesity prevalence of Chinese children in the past five years, and the impact of COVID-19 pandemic on pediatric obesity development through both mobile- and hospital-based data. METHODS This study included children aged 3 to 19 years old all over China from January 2017 to April 2021. Hospital-measured and parent-reported cases from XIGAO database were analyzed. Body mass index (BMI) z-score calculation and obesity status evaluation were made according to Chinese standards. We evaluated obesity/overweight prevalence over the past five years and the changes of BMI z-score during COVID-19 lockdown. RESULTS A total of 656396 children from 31 provinces were involved, including 447481 hospital-measured cases and 208915 parent-reported cases. The obesity and overweight prevalence were 8.05% (95%CI 7.76%-8.39%) and 10.06% (95%CI 10.79%-11.55%), comparable to those of China National Nutrition Surveys during 2015-2019. Northern China had the highest obesity prevalence. Parent-reported data had higher obesity/overweight prevalence than hospital-measured data (18.3% [95%CI 17.7%-18.9%] vs. 21.7% [95%CI 20.7%-23.0%]). The trend of obesity prevalence remained stable with slight decrease, but COVID-19 lockdown caused a significant increase of 1.86% in 2020. Both mobile- and hospital-based data showed weight gain in the first half of 2020. High BMI z-score increase were found among primary and junior middle school children, and children in northeast area during lockdown. CONCLUSION Weight gain during COVID-19 among Chinese children had regional differences and mainly affect primary and junior middle school children, thus warrants targeted interventions. The mobile growth assessment based on parent-reported data was a feasible, efficient and timely way for obesity monitoring among Chinese children, especially during epidemic.
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Affiliation(s)
- Yan Yang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Miao Zhang
- Shijiazhuang Xigao Technology Co. Ltd., Shijiazhuang City, China
| | - Jian Yu
- Department of Integrative Medicine, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Zhou Pei
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Chengjun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Jingwei He
- Department of Integrative Medicine, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Tian Qian
- Department of Clinical Nutrition, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
- *Correspondence: Feihong Luo, ; Shaoyan Zhang, ; Zhenran Xu,
| | - Shaoyan Zhang
- Shijiazhuang Xigao Technology Co. Ltd., Shijiazhuang City, China
- *Correspondence: Feihong Luo, ; Shaoyan Zhang, ; Zhenran Xu,
| | - Zhenran Xu
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
- *Correspondence: Feihong Luo, ; Shaoyan Zhang, ; Zhenran Xu,
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Haddad EN, Kojaoghlanian T, Comstock SS. Moving Toward Remote, Parent-Reported Measurements in Pediatric Anthropometrics for Research and Practice. Front Pediatr 2022; 10:838815. [PMID: 35350270 PMCID: PMC8957848 DOI: 10.3389/fped.2022.838815] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eliot N Haddad
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
| | - Tsoline Kojaoghlanian
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY, United States
| | - Sarah S Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, United States
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