Stature estimated from knee height in elderly Japanese Americans

Association of Body Water Balance, Nutritional Risk, and Sarcopenia with Outcome in Patients with Acute Ischemic Stroke: A Single-Center Prospective Study

In the present study, we examined the inter-relationships between body water balance, nutritional risk, sarcopenia, and outcome after acute ischemic stroke (AIS) in patients who were living independently. We defined abnormal body water balance as overhydration, with an extracellular fluid/total body water ratio > 0.390. A geriatric nutritional risk index (GNRI) < 98 was considered low GNRI. Sarcopenia was defined according to the 2019 Asian Working Group for sarcopenia criteria. Poor outcome was defined as a modified Rankin scale (mRS) score ≥ 3 at discharge. Among 111 eligible patients (40 females, median age: 77 years), 43 had a poor prognosis, 31 exhibited overhydration, 25 had low GNRI, and 44 experienced sarcopenia. Patients with poor outcomes had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores, which were significantly more common with overhydration, low GNRI, and sarcopenia (p < 0.001 for all). Concomitant overhydration, low GNRI, and sarcopenia were associated with poorer outcomes. In multivariate analysis, overhydration [odds ratio (OR) 5.504, 95% confidence interval (CI) 1.717-17.648; p = 0.004], age (OR 1.062, 95%CI 1.010-1.117; p = 0.020), and NIHSS score (OR 1.790, 95%CI 1.307-2.451; p < 0.001) were independent prognostic factors for poor outcome. The results indicated that the combination of overhydration, low GNRI, and sarcopenia predict poor outcomes following AIS. Overhydration was particularly associated with poor outcomes.

Validation of anthropometric equations for predicting body mass and height in older women

Abstract To investigate the cross-validity of two equations widely used in national research to predict body mass and height in older Brazilians. Additionally, the importance of possible differences between observed and predicted BMI will be investigated with the help of equations. BM and HEI were measured using mechanical scales and portable stadiometers in a sample of 200 older women (66.6 ± 5.43 years) living in Maceió / AL - Brazil. To verify the validity of equations, the following variables were used: Student's t-test, constant error (CE), total error (TE) and standard error of estimation (SEE). To verify agreement between actual and predicted values, the Bland-Altman test was used. The comparison between BM and HEI values obtained through equations and those verified in measurements showed statistically significant differences (p <0.05). CE between predicted and measured values, TE of tested equations, as well as SEE for the prediction of variables: BM (1.66; 0.11 and 6.33), HEI (-0.02; 0.02 and 0.10) and BMI (1.47; 0.10 and 3.24) allowed determining relative values very close to actual ones (2.6%, 1.31% and 5.3% for BM, HEI and BMI respectively); however, values were not statistically significant. The equations analyzed should not be used in a general way for the population of older Brazilian women with characteristics similar to those analyzed in this study. Therefore, further studies should be carried out with the objective of constructing specific equations for the population of older women and hospitalized patients, especially the most fragile ones.

Altura do joelho como medida alternativa confiável na avaliação nutricional de idosos

Objetivo:Avaliar o uso da altura do joelho como medida alternativa confiável na avaliação nutricional de idosos atendidos em um ambulatório de geriatria.Métodos:Estudo transversal com idosos atendidos em ambulatório de geriatria de um hospital universitário, entre novembro de 2009 e novembro de 2010. Variáveis investigadas: gênero, idade, peso, estatura, altura do joelho, estatura estimada através das equações de Chumlea, índice de massa corporal para as medidas de estatura aferida e estimada e classificado segundo Lipschitz, e dados sociodemográficos. Na análise descritiva dos dados foram usadas medidas de tendência central, dispersão e proporção; a homogeneidade entre as medidas foi verificada através do coeficiente de correlação intraclasse e do gráfico de Bland e Altman e a concordância entre a avaliação nutricional baseada no índice de massa corporal calculado a partir da estatura aferida e a avaliação nutricional baseada no índice de massa corporal calculado a partir da estatura estimada foi avaliada através do coeficiente Kappa ponderado com pesos quadráticos.Resultados:Foram avaliados 186 idosos com média de idade de 74,3±7,1 anos. A média do índice de massa corporal aferido e estimado foi 28,96±5,86 kg/m2e 27,95±5,47 kg/m2, respectivamente, e a prevalência de sobrepeso foi de 59,7% para o índice de massa corporal aferido e 53,2% para o estimado. Foi observada uma boa concordância (Kappa=0,79; p<0,001) entre as duas avaliações.Conclusão:Os resultados mostraram ser possível utilizar a altura do joelho na estimativa da estatura para cálculo do índice de massa corporal em idosos atendidos em ambulatório, alternativa útil para aqueles que apresentam limitações na aferição das medidas, sendo esta uma medida alternativa importante na avaliação nutricional de idosos.

Agreement between different versions of MNA

Malnutrition occurs frequently in the elderly with important clinical and functional consequences. Moreover, the treatment of malnutrition in the elderly may be effective if clinical and nutritional interventions are performed in the early stages. Therefore the early identification of the risk of malnutrition using validated and handy tools plays a pivotal role in terms of clinical outcome. Mini Nutritional Assessment (MNA) was validated for this purpose since many years but it is still ongoing the debate over whether the use of different items in certain clinical conditions can be effective without affecting the validity of the nutritional status evaluation. The aim of this study was to assess the agreement between different versions of MNA in the evaluation of nutritional risk in elderly subjects.

METHODS

522 subjects, 345 women and 177 men, were recruited from nursing homes or were free living in three different regions in Italy. All subjects underwent a multidimensional geriatric evaluation, addressed especially to nutritional status. We compared three different versions of MNA: the "original" version; a "proportional" MNA (MNA- P) in which the total MNA score was replaced by the ratio between the maximum score that each subject could obtain without including the body mass index (BMI) and the total original MNA score; and a third version in which calf circumference (CC) and mid- upper arm circumference (MAC) were used instead of BMI.

RESULTS

According to the original MNA, a high prevalence of malnutrition was found out in both genders (26% of women and 16.3% of men); both the versions of MNA, in which BMI was not considered, showed a good predictive value compared to original MNA. In particular, the MNA- P. showed an overall efficiency equal to 89,1% with specificity and positive predictive value respectively equal to 97.5% and 95.2%. MNA- CC- MAC showed even better results in terms of overall efficiency (91.4%), sensitivity (81.1%), specificity (97.1%), positive and negative predictive values (94.2% and 94.4%, respectively).

CONCLUSION

The different versions of MNA gave similar results in the classifications of subjects and in comparison with nutritional and biochemical parameters. Moreover MNA versions that did not considered BMI seem to be more effective in singling out subjects with risk factors related to malnutrition (disability, reduced strength and calf circumference, anaemia).

Different equations for determining height among the elderly: the Bambuí Cohort Study of Aging

The aim of this study was to compare measured height with estimates of height derived from equations using half arm-span measurements and assess how this affects the calculation of the body mass index (BMI) among elderly individuals. Direct height measurements of a subsample of elderly individuals from the baseline sample of the Bambuí Project were compared with estimates of height derived from equations proposed by Bassey and the WHO. The data was analyzed using the McNemar test, Lin concordance correlation coefficient (CCC) and Bland-Altman method (p < 0.05). Estimates of height using the WHO method showed a low CCC in relation to measured height. For BMI, the concordance was greater. However, with this method height was found to be underestimated so leading to the overestimation of BMI. The Bassey equation showed high concordance with measured height in elderly people over 80 years of age. With respect to BMI, the WHO method resulted in a much greater prevalence of overweight, whereas the estimates derived from the Bassey method did not differ from the results obtained from direct height measurement. Height estimates using the Bassey equation were similar to the results obtained from direct measurements, suggesting that this method is applicable.

[Development of weight-estimation formulae for the bedridden elderly requiring care]

AIM

Bedridden elderly persons requiring care need special body-weight measurement implements, and body-weighting assumes more difficult if they live at their own homes. Therefore, we tried to design a new weight-estimation formulae using various anthropometric variables.

METHOD

The subjects were 33 male and 132 female elderly inpatients certified to be at care level 4 or 5. The body composition included height, body weight, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, calf circumference, and waist circumference.

RESULTS

We studied the correlation between the body weight and each anthropometric variable and age. In men, the highest correlation with body weight was shown by waist circumference (r=0.891, p<0.0001), followed by age (r=0.779, p<0.0001) and calf circumference (r=0.614, p<0.0001). The variables that showed the highest correlation with body weight in women were waist circumference (r=0.806, p<0.0001), followed by triceps skinfold thickness (r=0.723, p<0.0001) and arm circumference (r=0.662, p<0.0001). The weight estimation formulae were obtained by multiple regression analysis. Formulae for men: body weight=0.660×waist circumference (cm)+0.702×calf circumference (cm)+0.096×age (years)-26.917 (R(2)=0.862, p<0.001); formulae for women: body weight=0.315×waist circumference (cm)+0.684×arm circumference (cm)+0.183×height (cm)-28.788 (R(2)=0.836, p<0.001).

CONCLUSION

We successfully developed gender-specific weight-estimation formulae with high coefficients of determination. The results suggest that waist circumference, which is an index of visceral fat, is an effective anthropometric variable to estimate the body weight of bedridden elderly patients requiring care.

Estimation of stature by measuring fibula and ulna bone length in 2443 older adults

Estimation of Stature by Measuring Fibula and Ulna Bone Length in 2443 Older Adults.

OBJECTIVES

Knee height has been commonly used to estimate stature but may not always be possible in the frail older adults with compromised posture. Measurement of fibula and ulna bone length could be an alternative method. We attempted to develop and validate regression models to predict measured and reported height using age, fibula length, ulna length, hip circumferences and body weight.

DESIGN

A cross-sectional survey.

SETTING

The study was conducted in the Jockey Club Centre for Osteoporosis Care and Control, School of Public Health, The Chinese University of Hong Kong.

PARTICIPANTS

Two thousand four hundred and forty three community-dwelling older Chinese aged from 65 to 98 years were recruited.

MEASUREMENTS

The standing height, fibula length, ulna length, hip circumference and body weight were measured and the reported height was recorded. Three separate multiple linear regression models were developed to predict measured-height and reported-height respectively.

RESULTS

In predicting measured-height by the bone-length model, the mean errors were +0.52 cm (over-estimation) in men and +0.45 cm (over-estimation) in women and the SDs were +/- 3.5 cm in both genders. The 95% limits of agreement were: -6.65 to +7.70 cm for men and -6.59 to +7.49 cm for women.

CONCLUSION

The accuracy and precision of stature estimation by fibula and ulna bone length is comparable to that by knee height. This may be an acceptable alternative method when knee height measurement is difficult or when the knee height caliper is not available.

Validity of Stature-predicted Equations using Knee Height for Elderly and Mobility Impaired Persons in Koreans

OBJECTIVES

This study aimed to establish a stature-predicted equation using knee height, and perform a clinical validation on a Korean population.

METHODS

Using nationwide data obtained from 'Size Korea 2004', a stature-predicted equation was drawn and cross validation was performed using knee height in 5,063 subjects (2,532 males, 1,785 premenopausal females, and 746 postmenopausal females) who were aged between 20 and 69 yr. The formula was then applied to an elderly group (7 males and 26 females) and a mobility-impaired group (25 males and 14 females) in a real clinical setting. A stature-predicted equation was estimated using knee height and age based on multiple linear regression analysis. Cross validation was performed using paired t-test, and validation using clinical data was performed using Wilcoxon signed rank test.

RESULTS

In three groups (males, premenopausal females, and postmenopausal females), a cross validation was performed for a stature-predicted equation which was drawn using knee height and age. There were no significant differences between recorded height and estimated height in the elderly group (mean difference±interquartile range (IQR): male 0.65±4.65 cm, female -0.10±3.65 cm) and the mobility-impaired group (mean difference±IQR: male -0.23±5.45 cm, female 1.64±5.36 cm).

CONCLUSION

If several limitations could be overcome, the Korean-specific equations using knee height drawn from this study could be applied to actual clinical settings with Korean elderly or mobility-impaired people.

Estimation of height in elderly Japanese using region-specific knee height equations

Two knee height equations to predict standing height of Japanese elderly were cross-validated with Joetsu City elders. One equation was derived with Hawaiian residents of Japanese ancestry and the other with elders from the Kumamoto Prefecture in Japan. Subjects included 40 men and 39 women free-dwelling, healthy elders with mean ages of 68.0 +/- 2.2 years and 68.0 +/- 2.7 years, respectively. Heights of the subjects were representative of Japanese elderly. Experienced nurses, trained to measure knee height, also measured standing height with an automatic stadiometer. A pilot study refined measurement skills. Differences between actual and predicted heights for both equations were significant. Multiple linear regression was used to derive knee height equations specific for elderly males and females living in Joetsu City: women, 63.06 + (2.38 x knee height in cm) -(0.34 x age in years); men, 71.16 + (2.61 x knee height in cm) - (0.56 x age in years). Geographic-specific knee height equations for Japanese elderly and cross-validation with other locations are suggested to facilitate the accurate use of knee height in nutritional assessment of Japanese elders.

Equations for predicting height for elderly Mexican Americans are not applicable for elderly Mexicans

Common indices for the assessment of nutritional status take height into account. Elderly individuals are frequently unable to assume the position needed for this measurement. Therefore, equations have been developed for predicting height in elderly American Whites, American Blacks, and Mexican Americans using knee height as a predictor. These equations may not be applicable for the elderly in other populations. A sample of 736 individuals was studied (186 males, 550 females) with a mean age of 74.7 +/- 8 years. Height and knee height (without shoes) were measured in millimeters. Multiple regression and cross-validation was performed. The correlation between knee height and standing height was similar in women (r = 0.86; P < 0.0001) and men (r = 0.83; P < 0.0001). The equations obtained were as follows: men (height in cm) = 52.6 + (2.17 x knee height in cm) and women (height in cm) = 73.7 + (1.99 x knee height in cm) - (0.23 x age in years). Cross-validation showed that the pure error was less than the root mean square error (RMSE) in both sexes. Mean heights, based on the equations of Chumlea et al. (1998) for Mexican Americans significantly differ from the reference values for females and males. Therefore, the equations developed by Chumlea et al. (1998) for elderly Mexican Americans do not appear to be applicable for elderly Mexicans.

Development of sex-specific equations for estimating stature of frail elderly Hispanics living in the northeastern United States

BACKGROUND

The accurate measurement of stature is not possible in many frail elderly persons because of problems affecting their ability to stand straight. In such cases, knee height may be used to estimate stature.

OBJECTIVE

This study was designed to explore the applicability of published regression equations to estimate stature of Puerto Rican and other Hispanic elderly persons living in the northeastern United States and to formulate ethnicity-specific equations for these persons.

DESIGN

The study subjects (60-92 y of age) included 569 Hispanics and a comparison group of 153 non-Hispanic whites. Equations to estimate stature of Hispanics and Puerto Ricans living in the northeastern United States were developed with regression models in a randomly selected subgroup of the Hispanics. These equations were tested with the remaining Hispanic subgroup.

RESULTS

The published equations significantly overestimated stature of our Hispanic subjects. Equations developed for Massachusetts Hispanics and Puerto Ricans provided estimates of stature that did not differ significantly from measured stature. We found further that equations for non-Hispanic whites published in 1985 predicted statures of our relatively low-income, non-Hispanic white subjects better than did newer 1998 equations developed from a national sample.

CONCLUSIONS

The stature of elderly Hispanics from the northeastern United States can be estimated by using equations derived from the same population. These, or similar equations, should be used to estimate stature of frail elderly persons for whom standing height cannot be taken accurately. Socioeconomic status as well as ethnicity may affect results when knee height equations are used.