Reliability of anthropometric measures in a longitudinal cohort of patients initiating ART in West Africa

Advancing microbiome research through standardized data and metadata collection: introducing the Microbiome Research Data Toolkit

Microbiome research has made significant gains with the evolution of sequencing technologies. Ensuring comparability between studies and enhancing the findability, accessibility, interoperability and reproducibility of microbiome data are crucial for maximizing the value of this growing body of research. Addressing the challenges of standardized metadata reporting, collection and curation, the Microbiome Working Group of the Human Hereditary and Health in Africa (H3Africa) consortium aimed to develop a comprehensive solution. In this paper, we present the Microbiome Research Data Toolkit, a versatile tool designed to standardize microbiome research metadata, facilitate MIxS-MIMS and PhenX reporting, standardize prospective collection of participant biological and lifestyle data, and retrospectively harmonize such data. This toolkit enables past, present and future microbiome research endeavors to collaborate effectively, fostering novel collaborations and accelerating knowledge discovery in the field. Database URL: https://doi.org/10.25375/uct.24218999.v2.

Dietary Intake Correlated to Waist-To-Hip Ratio in Patients on Maintenance Hemodialysis

OBJECTIVE

Individuals with end-stage kidney disease (ESKD) receiving maintenance hemodialysis (MHD) are at risk for protein-energy wasting (PEW). Inadequate dietary intake and altered anthropometrics are two criteria of the PEW diagnosis. This study explored whether individuals with ESKD on MHD meet the National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-KDOQI) 2020 guidelines for nutritional adequacy on a dialysis treatment day (DD) and explored the relationship between dietary energy [DEI] and protein [DPI] intake and anthropometrics.

METHODS

This was a secondary analysis of clinical and demographic data for 142 adults from the Rutgers Nutrition and Kidney Disease database. The study assessed the relationships between DEI, DPI, and anthropometrics, including body mass index (BMI), BMI category, waist circumference, and waist-to-hip ratio (WHR) using Pearson's or Spearman's correlation and one-way ANOVA.

RESULTS

The sample had a median age of 55.7 years; 58% were male, 83.8% were Black/African American, with a median dialysis vintage of 42.0 months (e.g., 3.5 years). Seventy-five percent of the data sample were overweight or obese. The WHR was 1.0 ± 0.8 cm for males and 0.9 ± 0.1 for females. DEI and DPI on a DD did not meet the NKF-KDOQI 2020 guidelines. Median DEI was 17.6 ± 8.4 kcal/kg and DPI was 0.7 ± 0.4 g/kg. In the total sample, significant positive correlations were found between DEI (r = 0.74, P = 0.03) and DPI (r = 0.18, P = 0.037) and WHR. In females, a significant positive correlation was identified between DPI and WHR (r = 0.26, P = 0.046).

CONCLUSIONS

These findings suggest that the nutritional intake of individuals with ESKD receiving MHD is inadequate to meet NKF-KDOQI 2020 guidelines on a DD. WHR may be a useful tool to assess alterations in anthropometrics related to DEI or DPI in this population, but more research is warranted.

The accuracy and reliability of three instruments used to assign school furniture

BACKGROUND: Students spend a high number of hours being seated while at school. In order to find the correct adjustment between school furniture and the anthropometric characteristics, specific knowledge and tools are necessary. OBJECTIVE: The objective of the study is to evaluate the accuracy and reliability of the measurers with different instruments, as well as contrast the differences between the values that were obtained by the different examiners. METHODS: Measurements were taken independently by one expert examiner and two inexperienced teachers from the school. They used a measuring tape, a segmometer and an anthropometer for the anthropometric measurements. The statistical tests conducted: Kolmogorov-Smirnov test, Intraclass Correlation Coefficient, Bland and Altman method, Standard Error of Measurement, Technical Error of Measurement and relative TEM with a level of significance of ρ ≤ 0.05. RESULTS: A total of 108 students (8.87±1.67 years; 40.7% girls) participated in the study. The non-expert measurers had good accuracy and reliability, but they far exceeded the error percentages of the expert, obtaining the worst results in the shoulder measurement. The instrument with the lowest affinity between the inexperienced measurers was the anthropometer CONCLUSIONS: In order to assign furniture in the schools, the experts should continue using the anthropometer. The inexperienced measurers can use more accessible instruments in the school environment such as a measuring tape and segmometer.

Evaluation of the child growth monitoring programme in two Zimbabwean provinces

Background

The child growth monitoring (CGM) programme is an important element of nutrition programmes, and when combined with other child health programmes, it can assist in successful management and control of malnutrition in children.

Aim

This study aimed to assess the extent to which the CGM programme is able to identify instances of childhood malnutrition and how much this contributes towards malnutrition reduction in Zimbabwe.

Setting

The study was conducted in Manicaland and Matabeleland South provinces of Zimbabwe. The two provinces were purposively selected for having the highest and least proportion of children affected by stunting in the country.

Methods

The CGM programme in Zimbabwe was evaluated using the logic model to assess the ability of the programme to identify growth faltering and link children to appropriate care.

Results

Records from 60 health facilities were reviewed. Interviews were conducted with 60 nurses, 100 village health workers (VHWs) and 850 caregivers (300 health facility exit interviews, 450 community based). Nearly all (92%) health facilities visited had functional measuring scales. Twelve health facilities (20%) had no functional height board, with five using warped height boards for measuring children’s height. Less than a quarter (21%) of the children had complete records for weight for age and height for age. A large proportion of children eligible for admission for the management of moderate (83%) and severe malnutrition (84%) were missed.

Conclusion

The CGM programme in Zimbabwe is not well equipped for assessing child height for age and management of children identified with malnutrition, thus failing to timely identify and manage childhood stunting.

A method for increasing 3D body scanning's precision: Gryphon and consecutive scanning

The fashion industry cannot use 3 D Body Scanning to create custom garment patterns because its measurements fail to meet ISO 20685:2010's tolerances. To advance 3 D Body Scanning's precision, we present Gryphon: an algorithm that removes the two most extreme measurements from five body scans; removing potentially erroneous data. We assess Gryphon's precision against current industry practice, determine if consecutive and non-consecutive data capture influences precision, and determine 3 D Body Scanning's inherent imprecision inherent. We analyse 97 participants over 121 industry-standard measurements for consecutive and non-consecutive data-capture through MANOVA statistical analysis. Under current industry practice, only one measurement meets ISO 20685. However, under Gryphon and consecutive scanning, 97.5% of measurements meet ISO 20685. We also prove that the body's in-scan movement does not affect reliability. Ultimately, we offer the fashion industry, ergonomists, and practitioners an accessible method to increase 3 D Body Scanning's precision at a level unavailable under previous methods. Practitioner Summary: Ergonomists need precise data, yet we prove 0% of 3 D Body Scanning's measurements meet ISO 20685's tolerances. Our analysis of 97 participants scans, shows consecutive scanning is necessary to achieve data suitable for anthropometric applications. We develop the Gryphon process with consecutive scanning, making 97.3% of measurements meet ISO 20685. Abbreviations: ISO: International Organisation for Standards; Three Dimensional: 3D; MANOVA: Multivariate analysis of variance.

A Prospective Review of Preoperative Nutritional Status and Its Influence on the Outcome of Abdominal Surgery

Aim

To assess the incidence of malnutrition in a surgical gastroenterology unit and analyze its impact on postoperative complication rates.

Method

Data were prospectively accrued from patients admitted for emergency or elective surgery to the gastrointestinal surgery unit at Jaslok Hospital between May 2013 and May 2014. The nutritional status was preoperatively assessed by using anthropometric parameters like body mass index (BMI), midarm circumference (MAC), and tissue skinfold thickness (TSFT). In addition, a subjective global assessment scale (SGA), serum albumin, and absolute lymphocyte count (ALC) were used. Patients with BMI <18.5, MAC <24 cm in males and <22 cm in females, and TSFT <10 mm were considered malnourished. Patients with serum albumin between 3 and 3.5 g/dl were considered mild, 2.4-2.9 g/dl was moderate, and <2.4 g/dl were severely malnourished. Patients with ALC between 1200 and 2000/cm were labelled mild, between 800 and 1199/cm were moderate, and <800/cm were severely malnourished. As per SGA, well-nourished had less than 5% weight loss or if more than 5%, with recent gain and improved appetite, mild/moderately malnourished had 5% to 10% weight loss with no gain, mild subcutaneous fat loss, and those severely malnourished had more than 10% weight loss, severe subcutaneous fat loss, and muscle wasting. Postoperative complications were graded as per the Clavien-Dindo classification. Patients with grades 1 and 2 complications were labelled as minor and the rest as major.

Result

Men in the age group of 40-60 years comprised the majority of the study population. The most frequent reason for admission was cholelithiasis. The overall incidence of malnutrition was 22.16%. Out of the 96 patients who had complications, 45 had minor and 41 had significant complications. Amongst the well-nourished, the incidence of complications was 26.62% of which the majority were minor complications. Severely malnourished patients had a high complication rate (63.38%); 32% out of the 63.38% developed significant complications. The majority of the patients suffering from severe malnutrition belonged to the sub-group with chronic pancreatitis and carcinoma of the pancreas. According to the chi-square analysis of the data, ALC, serum albumin, and SGA correlate with the postoperative complication rate with a p-value <0.05 as significant. On the contrary, BMI, MAC, and TSFT did not correlate with postoperative complications.

Conclusion

Preoperative malnutrition is common among patients undergoing abdominal surgeries in the urban private health care sector. Although there have been studies that have analyzed the incidence of malnutrition in patients undergoing oncological surgeries, there is limited literature on malnutrition among patients subjected to gastrointestinal surgeries. We conclude that simple bedside nutritional assessment tools like serum albumin, absolute lymphocyte count, and SGA can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.

Identification of "Digital Sarcopenia" Can Aid the Detection of Pancreatic Exocrine Insufficiency and Malnutrition Assessment in Patients with Suspected Pancreatic Pathology

BACKGROUND

Pancreatic exocrine insufficiency (PEI) and subsequent malnutrition can be difficult to diagnose but lead to sarcopenia and increased mortality and morbidity even in benign disease. Digital skeletal muscle analysis has been increasingly recognised as a tool to diagnose sarcopenia.

OBJECTIVE

The aim of the study was to assess the prevalence of sarcopenia in patients with PEI secondary to benign disease using novel skeletal muscle recognition software.

METHODS

Prospective recruitment of patients referred for endoscopic ultrasound (EUS) with suspected pancreatic pathology. Patients with suspected pancreatic cancer on initial computed tomography (CT) were excluded. The diagnosis of chronic pancreatitis (CP) was based on CT and EUS findings. PEI was assessed with faecal elastase-1. Digital measurement of skeletal muscle mass identified sarcopenia, with demographic and comorbidity data also collected.

RESULTS

PEI was identified in 45.1% (46/102) of patients recruited, and 29.4% (30/102) had changes of CP. Sarcopenia was significantly more prevalent in PEI 67.4% (31/46) than no-PEI 37.5% (21/56) (37.5%), regardless of CP changes (p < 0.003). The prevalence of sarcopenia (67% vs. 35%; p = 0.02) and sarcopenic obesity (68.4% vs. 25%; p = 0.003) was significantly higher when PEI was present without a radiological diagnosis of CP. Multivariate analysis identified sarcopenia and diabetes to be independently associated with PEI (odds ratio 4.8 and 13.8, respectively, p < 0.05).

CONCLUSION

Sarcopenia was strongly associated with PEI in patients undergoing assessment for suspected benign pancreatic pathology. Digital skeletal muscle assessment can be used as a tool to aid identification of sarcopenia in patients undergoing CT scan for pancreatic symptoms.

Diagnostic Concordance between Random Upper Arm Circumference and Mid Upper Arm Circumference Measurements among Children Aged 6-59 Months in South Ethiopia: A Community-Based Cross-Sectional Study

Random upper arm circumference (RUAC) is frequently used for malnutrition screening among children aged 6-59 months. However, inadequate evidence exists regarding its agreement with mid upper arm circumference (MUAC). This study examined diagnostic concordance between RUAC and standard MUAC measurements and tested RUAC's ability for screening malnutrition among children aged 6-59 months. A cross-sectional study was conducted from April 30 to May 30/2015 in Ethiopia. Data were taken from a sample of 819 children aged 6-59 months with a simple random sampling technique. The data were analyzed using SPSS version 22 software. The kappa agreement level, sensitivity, and specificity were calculated. The receiver operating curve was prepared to determine the optimal cutoff RUAC for the sensitivity and specificity. With National Center for Health Statistics (NCHS) cutoff (12 cm), the performance of RUAC measurements in terms of sensitivity was low (44%). The kappa agreement level between the two measurements was 0.551 (p value < 0.001). With the new WHO cutoff (12.5 cm), however, RUAC was improved in validity (sensitivity 81%), specificity 96.9%, and kappa agreement level (K = 0.807; p < 0.001).

Classification Tree-Based Machine Learning to Visualize and Validate a Decision Tool for Identifying Malnutrition in Cancer Patients

BACKGROUND

The newly proposed Global Leadership Initiative on Malnutrition (GLIM) framework is promising to gain global acceptance for diagnosing malnutrition. However, the role of machine learning in facilitating its application in clinical practice remains largely unknown.

METHODS

We performed a multicenter, observational cohort study including 3998 patients with cancer. Baseline malnutrition was defined using the GLIM criteria, and the study population was randomly divided into a derivation group (n = 2998) and a validation group (n = 1000). A classification and regression trees (CART) algorithm was used to develop a decision tree for classifying the severity of malnutrition in the derivation group. Model performance was evaluated in the validation group.

RESULTS

GLIM criteria diagnosed 588 patients (14.7%) with moderate malnutrition and 532 patients (13.3%) with severe malnutrition among the study population. The CART cross-validation identified 5 key predictors for the decision tree construction, including age, weight loss within 6 months, body mass index, calf circumference, and the Nutritional Risk Screening 2002 score. The decision tree showed high performance, with an area under the curve of 0.964 (κ = 0.898, P < .001, accuracy = 0.955) in the validation group. Subgroup analysis showed that the model had apparently good performance in different cancers. Among the 5 predictors constituting the tree, age contributed the least to the classification power.

CONCLUSION

Using the machine learning, we visualized and validated a decision tool based on the GLIM criteria that can be conveniently used to accelerate the pretreatment identification of malnutrition in patients with cancer.

Varying the Order of Combinations of Single- and Multi-Joint Exercises Differentially Affects Resistance Training Adaptations

Brandão, L, de Salles Painelli, V, Lasevicius, T, Silva-Batista, C, Brendon, H, Schoenfeld, BJ, Aihara, AY, Cardoso, FN, de Almeida Peres, B, and Teixeira, EL. Varying the order of combinations of single- and multi-joint exercises differentially affects resistance training adaptations. J Strength Cond Res 34(5): 1254-1263, 2020-Our study aimed to compare the effects of multi-joint (MJ) and single-joint (SJ) exercises, either isolated or in combination, and in different orders, on cross-sectional area (CSA) of the pectoralis major (PM) and different heads of the triceps brachii (TB), as well as on the one-repetition maximum (1-RM) in the bench press and lying barbell triceps press. Forty-three young men were randomly assigned to one of 4 possible RT protocols: barbell bench press plus lying barbell triceps press (MJ + SJ, n = 12); lying barbell triceps press plus barbell bench press (SJ + MJ, n = 10); barbell bench press (MJ, n = 10); or lying barbell triceps press (SJ, n = 11). Results showed significant within-group increases in 1-RM bench press for MJ, MJ + SJ, and SJ + MJ but not for SJ. Conversely, significantly greater within-group increases in elbow extension 1-RM were noted for SJ, MJ + SJ, and SJ + MJ but not for MJ. Significantly greater increases in PM CSA were observed for MJ, MJ + SJ, and SJ + MJ compared with SJ. Significant increases in TB CSA were noted for SJ, MJ + SJ, and SJ + MJ, but not for MJ, without observed between-group differences. Individual analysis of TB heads showed significantly greater CSA increases in the lateral head for MJ, MJ + SJ, and SJ + MJ compared with SJ. Alternatively, significantly greater increases in the long head were observed for SJ, MJ + SJ, and SJ + MJ compared with MJ. CSA increases for the medial head were statistically similar between conditions. Our findings indicate that muscular adaptations are differentially affected by performance of MJ and SJ exercises.

Precision of Measurements Performed by a Cadre of Anthropometrists Trained for a Large Household Nutrition Survey in Ethiopia

BACKGROUND

Well-trained anthropometrists are essential for the delivery of high-quality anthropometric data used to evaluate public health nutrition interventions. Scant data are currently available on the precision of data collected by large teams of anthropometrists employed for nutrition surveys in low-income country settings.

OBJECTIVES

The purpose of this study was to assess the precision of child midupper arm circumference (MUAC) and length/height measurements taken by fieldworkers training for nutrition survey deployment.

METHODS

Following 3 d of training, an anthropometry standardization exercise was conducted in small teams of trainees at 7 sites in the Amhara region of Ethiopia. In groups of 2-4, trainee anthropometrists (n = 79) each measured 16 children aged 6-47 mo (n = 336) twice for MUAC and length/height. Both intraobserver and interobserver precision were analyzed using technical error of measurement (TEM), relative TEM, coefficient of reliability (R), and repeatability metrics. Bland-Altman limits of agreement were calculated for intraobserver measurements.

RESULTS

Intraobserver TEM was between 0.00 and 0.57 cm for MUAC (Bland-Altman 95% limits of agreement: -0.50 to 0.54 cm) and between 0.04 and 2.58 cm for length/height measurements (Bland-Altman 95% limits of agreement: -1.43 to 1.41 cm). Interobserver TEM was between 0.09 and 0.43 cm for MUAC and between 0.06 and 2.98 cm for length/height measurements. A high proportion of trainees achieved intraobserver R >0.95 (MUAC: 95%; length/height: 97%). Most teams also achieved interobserver R >0.95 (MUAC: 90%; length/height: 95%).

CONCLUSIONS

Large numbers of anthropometrists (>75) in low-income settings can attain satisfactory precision in anthropometry following training and standardization. These protocols permit researchers to assess trainees, identify individuals who have not achieved the desired level of precision, and retrain or adjust roles prior to survey deployment.

Educational level and its relationship with body height and popliteal height in Chilean male workers

A secular trend in body height has been experienced in many nations and populations, hypothesized to be the result of better living conditions. Educational level has been shown to be closely associated with body height. This study examined the changes in body height and popliteal height in a group of adult Chilean male workers by age cohort and the relationship of these with educational level. The body heights and popliteal heights of 1404 male workers from the Valparaíso and Metropolitan regions of Chile were measured in 2016. The sample was grouped by level of education (primary, secondary, technical and university) and age (21-30, 31-40 and 41-50 years). Robust ANOVA and post-hoc analyses using a one-step modified M-estimation of location were conducted based on bootstrap resampling. Both body height and popliteal height increased from the older to the younger age cohort. The largest increase was from the 41-50 to the 21-30 group, with a 1.1% increase in body height and 1.7% increase in popliteal height. When educational level was introduced into the analysis there was a marked increase in both body height and popliteal height for each cohort, but only in primary- and secondary-educated workers. Despite showing an overall increase in body height and popliteal height, younger workers with the highest levels of education showed fewer differences between them than did older workers with less education. The differences were larger in the older than in the younger cohorts. Similarly, this trend was less clear in workers with higher levels of education (technical and university), probably because of a dilution effect caused by increased access to higher education by workers in the lower income quintiles.

Thinness, overweight, and obesity in indigenous school children and youth in Mexico

Background: The prevalence of overweight (OWT) and obesity (OB), defined by the body mass index (BMI, kg/m²) among children and youth has increased worldwide in the last 30-40 years.Aim: To evaluate the weight status, defined by the BMI, of indigenous school children and youth resident in different regions of MexicoSubjects and methods: Students 6-18 years (31,448 boys, 27,306 girls) were enrolled in bilingual schools for indigenous children and youth in Mexico in 2012. Height and weight were measured; the BMI was calculated. The BMI of each student was classified relative to International Obesity Task Force (IOTF) age- and sex-specific criteria as thin (three grades), normal, overweight (OWT) or obese (OB). The sample was divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Age- and sex-specific prevalence, 95% confidence intervals, and Chi-square tests were calculated.Results: Prevalence of OWT + OB was highest in the South-Gulf, South-Pacific and South-Southeast regions and lowest in the North and Central regions, while thinness was most prevalent in the North and Central regions.Conclusion: Prevalence of severe and moderate thinness was relatively low, while the combined prevalence of OWT + OB was generally more prevalent in indigenous boys than girls. However, the prevalence of thinness, OWT + OB among indigenous children and youth was lower than in the general population of children and youth in Mexico.

Three-dimensional camera anthropometry to assess risk of cephalopelvic disproportion-related obstructed labour in Ethiopia

Cephalopelvic disproportion (CPD)-related obstructed labour requires delivery via Caesarean section (C/S); however, in low-resource settings around the world, facilities with C/S capabilities are often far away. This paper reports three low-cost tools to assess the risk of CPD, well before labour, to provide adequate time for referral and planning for delivery. We performed tape measurement- and three-dimensional (3D) camera-based anthropometry, using two 3D cameras (Kinect and Structure) on primigravida, gestational age ≥ 36 weeks, from Addis Ababa, Ethiopia. Novel risk scores were developed and tested to identify models with the highest predicted area under the receiver-operator characteristic curve (AUC), detection rate (true positive rate at a 5% false-positive rate, FPR) and triage rate (true negative rate at a 0% false-negative rate). For tape measure, Kinect and Structure, the detection rates were 53%, 61% and 64% (at 5% FPR), the triage rates were 30%, 56% and 63%, and the AUCs were 0.871, 0.908 and 0.918, respectively. Detection rates were 77%, 80% and 84% at the maximum J-statistic, which corresponded to FPRs of 10%, 15% and 11%, respectively, for tape measure, Kinect and Structure. Thus, tape measurement anthropometry was a very good predictor and Kinect and Structure anthropometry were excellent predictors of CPD risk.

Geographic variation in the growth status of indigenous school children and youth in Mexico

OBJECTIVE

To analyze variation in the growth status of indigenous children and youth attending bilingual schools, escuelas albergues, for the indigenous population in México.

MATERIALS AND METHODS

The children and youth attended escuelas albergues in 1,009 localities in 21 Mexican states in 2012. Heights and weights of 31,448 boys and 27,306 girls 6-18 years of age were measured by trained staff at each school; the BMI was calculated. The students were divided into five geographic regions for analysis: North, Central, South-Gulf, South-Pacific, and South-Southeast. Growth status was compared to United States reference percentiles (P).

RESULTS

Mean heights of children and youth from the five regions varied between P10 and P5 of the reference until about 13 years (girls) and 14 years (boys); subsequently, heights were ≤P5. Mean weights in both sexes were at P25 of the reference between 6 and 12 years, and then varied between P25 and P10 in boys and were ≥P25 in girls. Given the elevated weights relative to heights compared to the reference, mean BMIs of indigenous boys and girls were at or above the reference medians. Children and youth in the North and Central regions were, on average, taller than those in the South-Pacific and South-Southeast regions, while heights of those in the South-Gulf region were generally intermediate. In contrast, mean weights and BMIs differed negligibly among the regions.

CONCLUSIONS

The geographic gradient in heights of indigenous children and youth was consistent with a north-to-south pattern noted among indigenous adults in studies spanning 1898 through 2013. Variation in height among children and youth likely reflected ethnic-specific and geographic variation interacting with economic and nutritional factors.

A safe, low-cost, easy-to-use 3D camera platform to assess risk of obstructed labor due to cephalopelvic disproportion

Cephalopelvic disproportion (CPD)-related obstructed labor is accountable for 3-8% of the maternal deaths worldwide. The consequence of CPD-related obstructive labor in the absence of a Caesarian section (C/S) is often maternal or perinatal mortality or morbidity to the mother and/or the infant. Accurate and timely referral of at-risk mothers to health facilities where C/S is a delivery option could reduce maternal mortality in the developing world. The goal of this work was to develop and test the feasibility of a safe, low-cost, easy-to-use, portable tool, using a Microsoft Kinect 3D camera, to identify women at risk for obstructed labor due to CPD. Magnetic resonance imaging (MRI) scans, 3D camera imaging, anthropometry and clinical pelvimetry were collected and analyzed from women 18-40 years of age, at gestational age ≥36+0 weeks with previous C/S due to CPD (n = 43), previous uncomplicated vaginal deliveries (n = 96), and no previous obstetric history (n = 148) from Addis Ababa, Ethiopia. Novel and published CPD risk scores based on anthropometry, clinical pelvimetry, MRI, and Kinect measurements were compared. Significant differences were observed in most anthropometry, clinical pelvimetry, MRI and Kinect measurements between women delivering via CPD-related C/S versus those delivering vaginally. The area under the receiver-operator curve from novel CPD risk scores base on MRI-, Kinect-, and anthropometric-features outperformed novel CPD risk scores based on clinical pelvimetry and previously published indices for CPD risk calculated from these data; e.g., pelvic inlet area, height, and fetal-pelvic index. This work demonstrates the feasibility of a 3D camera-based platform for assessing CPD risk as a novel, safe, scalable approach to better predict risk of CPD in Ethiopia and warrants the need for further blinded, prospective studies to refine and validate the proposed CPD risk scores, which are required before this method can be applied clinically.

A literature review of anthropometric studies of school students for ergonomics purposes: Are accuracy, precision and reliability being considered?

BACKGROUND

Despite offering many benefits, direct manual anthropometric measurement method can be problematic due to their vulnerability to measurement errors.

OBJECTIVE

The purpose of this literature review was to determine, whether or not the currently published anthropometric studies of school children, related to ergonomics, mentioned or evaluated the variables precision, reliability or accuracy in the direct manual measurement method.

METHODS

Two bibliographic databases, and the bibliographic references of all the selected papers were used for finding relevant published papers in the fields considered in this study.

RESULTS

Forty-six (46) studies met the criteria previously defined for this literature review. However, only ten (10) studies mentioned at least one of the analyzed variables, and none has evaluated all of them. Only reliability was assessed by three papers. Moreover, in what regards the factors that affect precision, reliability and accuracy, the reviewed papers presented large differences. This was particularly clear in the instruments used for the measurements, which were not consistent throughout the studies. Additionally, it was also clear that there was a lack of information regarding the evaluators' training and procedures for anthropometric data collection, which are assumed to be the most important issues that affect precision, reliability and accuracy.

CONCLUSIONS

Based on the review of the literature, it was possible to conclude that the considered anthropometric studies had not focused their attention to the analysis of precision, reliability and accuracy of the manual measurement methods. Hence, and with the aim of avoiding measurement errors and misleading data, anthropometric studies should put more efforts and care on testing measurement error and defining the procedures used to collect anthropometric data.

Single camera multi-view anthropometric measurement of human height and mid-upper arm circumference using linear regression

Background

Manually measured anthropometric quantities are used in many applications including human malnutrition assessment. Training is required to collect anthropometric measurements manually, which is not ideal in resource-constrained environments. Photogrammetric methods have been gaining attention in recent years, due to the availability and affordability of digital cameras.

Objective

The primary goal is to demonstrate that height and mid-upper arm circumference (MUAC)–indicators of malnutrition–can be accurately estimated by applying linear regression to distance measurements from photographs of participants taken from five views, and determine the optimal view combinations. A secondary goal is to observe the effect on estimate error of two approaches which reduce complexity of the setup, computational requirements and the expertise required of the observer.

Methods

Thirty-one participants (11 female, 20 male; 18–37 years) were photographed from five views. Distances were computed using both camera calibration and reference object techniques from manually annotated photos. To estimate height, linear regression was applied to the distances between the top of the participants head and the floor, as well as the height of a bounding box enclosing the participant’s silhouette which eliminates the need to identify the floor. To estimate MUAC, linear regression was applied to the mid-upper arm width. Estimates were computed for all view combinations and performance was compared to other photogrammetric methods from the literature—linear distance method for height, and shape models for MUAC.

Results

The mean absolute difference (MAD) between the linear regression estimates and manual measurements were smaller compared to other methods. For the optimal view combinations (smallest MAD), the technical error of measurement and coefficient of reliability also indicate the linear regression methods are more reliable. The optimal view combination was the front and side views. When estimating height by linear regression of the distance from the head to the floor, the mean MAD was 10.51 mm ± 6.52 mm SD, and when estimating height from the bounding box using the reference object, the mean MAD per participant was 11.53 mm ± 6.43 mm SD. When estimating MUAC from the mid-upper arm radius using the reference object, the mean MAD was 7.24 mm ± 4.79 mm SD. The mean MAD for all methods when using camera calibration was 2–3 mm smaller.

Conclusions

Applying linear regression to distance measurements from photos of adults taken from multiple view angles has been shown to accurately estimate height and MUAC to within the accuracy required for nutrition assessment. Future work will focus on automating the landmark detection, and validating the methods on populations that include undernourished adults and children of all nutrition statuses. These future works will improve the practicality of this method as a potential tool for nutrition assessment by novice users.

Assessing Community Health: An Innovative Tool for Measuring Height and Length

Anthropometric measurements, including height and length, are routinely needed for health research worldwide. Measurement boards are the current gold standard for obtaining the height and length of children. In community-based research, however, the size and weight of the measurement boards make them difficult and cumbersome to carry in the field. In addition, children and infants may express an unwillingness to be placed onto the measurement board. Electronic measuring tools commonly used in industry and contracting work are precise and portable. This study piloted a protocol to use an adapted laser measurement tool, the anthropometric measurement assist (AMA), to obtain height and recumbent length in children in Western Kenya. Intra- and inter-observer variability were determined and compared with measurement board measurements. Results of this initial pilot indicated that the AMA may be a viable alternative to measurement boards. The AMA can measure height/length accurately and reliably, is portable and is equivalent in price to measuring boards, making it a viable option for fieldwork in low-resourced countries.

Reliability of length measurements collected by community nurses and health volunteers in rural growth monitoring and promotion services

Background

Length measurements are important in growth, monitoring and promotion (GMP) for the surveillance of a child’s weight-for-length and length-for-age. These two indices provide an indication of a child’s risk of becoming wasted or stunted, and are more informative about a child’s growth than the widely used weight-for-age index (underweight). Although the introduction of length measurements in GMP is recommended by the World Health Organization, concerns about the reliability of length measurements collected in rural outreach settings have been expressed by stakeholders. Our aim was to describe the reliability and challenges associated with community health personnel measuring length for rural outreach GMP activities.

Methods

Two reliability studies (A and B), using 10 children less than 24 months each, were conducted in the GMP services of a rural district in Ghana. Fifteen nurses and 15 health volunteers (HV) with no prior experience in length measurements were trained. Intra- and inter-observer technical error of measurement (TEM), average bias from expert anthropometrist, and coefficient of reliability (R) of length measurements were assessed and compared across sessions. Observations and interviews were used to understand the ability and experiences of health personnel with measuring length at outreach GMP.

Results

Inter-observer TEM was larger than intra-observer TEM for both nurses and HV at both sessions and was unacceptably (compared to error standards) high in both groups at both time points. Average biases from expert’s measurements were within acceptable limits, however, both groups tended to underestimate length measurements. The R for lengths collected by nurses (92.3%) was higher at session B compared to that of HV (87.5%). Length measurements taken by nurses and HV, and those taken by an experienced anthropometrist at GMP sessions were of moderate agreement (kappa = 0.53, p < 0.0001).

Conclusions

The reliability of length measurements improved after two refresher trainings for nurses but not for HV. In addition, length measurements taken during GMP sessions may be susceptible to errors due to overburdened health personnel and crowded GMP clinics. There is need for both pre- and in-service training of nurses and HV on length measurements and procedures to improve reliability of length measurements.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2909-0) contains supplementary material, which is available to authorized users.

Accuracy of anthropometric measurements by general practitioners in overweight and obese patients

Background

We recently showed that abdominal obesity measurements (waist and hip circumference, waist-to-hip ratio) were inaccurate when performed by general practitioners (GPs). We hypothesise that measurement error could be even higher in overweight and obese patients due to difficulty in locating anatomical landmarks. We aimed to estimate GPs’ measurement error of general (weight, height and body mass index (BMI)) and abdominal obesity measurements across BMI subgroups.

Methods

This cross-sectional study involved 26 GPs in Geneva, Switzerland. They were asked to take measurements on 20 volunteers within their practice. Two trained research assistants repeated the measures after the GPs (“gold standard”). The proportion of measurement error was computed by comparing the GPs’ values (N = 509) to the average value of two measurements taken in turn by the research assistants and stratified by BMI subgroup (normal/underweight: <25 kg/m², overweight: 25 ≤ BMI < 30 kg/m², obese: ≥30 kg/m²).

Results

General obesity measurements were less prone to measurement error than abdominal obesity measurements, regardless of the BMI subgroup. The proportions of error increased across BMI subgroups (except for height), and were particularly high for abdominal obesity measurements in obese patients.

Conclusions

Abdominal obesity measurements are particularly inaccurate when GPs use these measurements to assess overweight and obese patients. These findings add further strength to recommendations for GPs to favour use of general obesity measurements in daily practice, particularly when assessing overweight or obese patients.

Evaluating the Consistency, Repeatability, and Reproducibility of Osteometric Data on Dry Bone Surfaces, Scanned Dry Bone Surfaces, and Scanned Bone Surfaces Obtained from Living Individuals

Applying dry bone osteometrics to virtual bone surfaces obtained via medical imaging raises the question of consistency between the variables. Variables obtained from virtual bone surfaces also need to be sufficiently repeatable and reproducible to be valid for anthropological studies. This is also true for the landmarks defining these variables and for their acquisition. The consistency between variables taken directly from dry bones and from the virtual surfaces of dry bones was tested on 40 clavicles. 30 virtual surfaces of iliae, fifth lumbar vertebrae, and clavicles reconstructed from computed tomography scans of living individuals were used to test the repeatability and reproducibility of 16 landmarks and 19 variables. Statistical tests, graphical and quantitative error evaluations, and intraclass correlation coefficients were applied. The differences between all variables taken on dry and virtual clavicles were less than ±1 mm. Bland–Altman plots showed more than 95% reliability between variables obtained on dry bone and their virtually reconstructed surfaces, confirming their consistency and thus validating their use in osteometric studies independently of the medium of study. Although not all landmarks were repeatable and reproducible, most variables were. To assess intra- or inter-observer errors, graphical representations or coefficients are more precise and accurate than statistical tests. These two evaluation methods should be given priority to test the repeatability and reproducibility of osteometric variables.

Local spatial clustering of stunting and wasting among children under the age of 5 years: implications for intervention strategies

OBJECTIVE

The present study aimed to evaluate the clustering of undernutrition indicators of children under the age of 5 years in relation to different scales.

DESIGN

A community-based cross-sectional study design was employed. We collected anthropometric data, geographic locations/elevations of households and other data from visited households. We used a retrospective purely spatial Poisson probability model to identify and locate clusters (high rates) of stunting and wasting using the software SaTScan™ version 9·1·1. We ran a logistic regression model to help evaluate the causes of clustering. Settings Six villages in the Meskane Mareko District (38·45763°E, 8·042144°N) of southern Ethiopia.

SUBJECTS

We surveyed 2371 children aged <5 years, who were found in 1744 households.

RESULTS

We found a micro-level variation in the risk of stunting and wasting within the studied district. We found the most likely significant clusters for wasting and severe wasting in two of the six villages. For stunting, a single large cluster size of 390 cases (304·19 expected) in 756 households was identified (relative risk=1·48, P<0·01). For severe stunting, a single cluster size of 106 cases (69·39 expected) in 364 households was identified (relative risk=1·69, P=0·035).

CONCLUSIONS

We conclude that the distribution of wasting and stunting was partly spatially structured. We identified distinct areas within and between villages that have a higher risk than the underlying at-risk population. Our analysis identified the spatial locations of high-risk areas for stunting that could be an input for geographically targeting and optimizing nutritional interventions.

Measurement of delayed bathing and early initiation of breastfeeding: a cross-sectional survey exploring experiences of data collectors in Ethiopia

Background

Delayed bathing and early initiation of breastfeeding are among the essential interventions recommended to save newborn lives. Although survey coverage reports are key to monitoring these interventions, few studies investigated whether such reports accurately reflect the proportion of mothers and children who received these interventions. In order to gather accurate data, guidance on how to interview and probe mothers is provided. In this study, we investigated experiences of data collectors when asking mothers survey questions that assessed delayed bathing and early initiation of breastfeeding.

Methods

In November 2013, using a self-administered semi-structured questionnaire, we interviewed data collectors who had taken part in a population-based newborn health household survey in Ethiopia during October-November 2013. A total of 130 out of 160 invited data collectors completed and returned the self-administered questionnaire. Descriptive statistics were used to analyse quantitative data using SPSS software version 19. Qualitative data showing the variety of probes used by data collectors was analysed by listing, screening to identify common themes, and grouping by category.

Results

Most data collectors reported that, in their opinion, mothers were able to understand the meaning of the question about newborn bathing (n = 102, 79%) and breastfeeding initiation (n = 106, 82%) without the need for probes. However, fewer mothers were able to recall the event for either newborn behaviours and describe it in minutes, hours or days without the need for probes. Overall, only 26% (n = 34) and 34 % (n = 44) of all data collectors reported that they did not need any probing for the questions related to newborn bathing and breastfeeding initiation questions, respectively. We identified a variety of probes used by data collectors and present examples.

Conclusion

Considerable probing was necessary to facilitate maternal recall of the events and approximate their responses of time regardless of mothers’ age, level of education and parity. This could potentially lead to inaccurate coverage reports due to subjective and inconsistent interpretation of the indicators. Therefore, we recommend inclusion of standard probes or follow-on questions to the existing survey tools assessing the two indicators. Data collectors also require further guidance in using appropriate probes to gather accurate maternal responses.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-015-0350-7) contains supplementary material, which is available to authorized users.

Distinct gender differences in anthropometric profiles of a peri-urban South African HIV population: a cross sectional study

Background

Highly active antiretroviral therapy (HAART) has extended life expectancy and enhanced the well-being of HIV-positive individuals. Since there are concerns regarding HAART-mediated onset of cardio-metabolic diseases in the long-term, we evaluated the anthropometric profile of black HIV-infected individuals in a peri-urban setting (Western Cape, South Africa).

Methods

A cross sectional study design was followed to describe the gender differences in different HAART treatment groups. HIV-positive patients (n = 44 males, n = 102 females; 20–40 years) were recruited for three groups: 1) control (HIV-positive, HAART-naïve), 2) HIV-positive (<3 years HAART), and 3) HIV-positive (>3 years HAART).

Results

All participants underwent comprehensive anthropometric and bio-electrical impedance analyses. No significant differences were observed in the male treatment groups. HAART-naïve females are mostly overweight (73.90 ± 2.79). This is followed by a period of muscle wasting seen in the triceps skinfold (29.30 ± 2.19 vs 20.63 ± 1.83; p < 0.01), muscle mass (22.23 ± 0.46 vs 19.82 ± 0.54; p < 0.01), and fat free mass (49.40 ± 1.08 vs 44.16 ± 1.21; p < 0.01) upon HAART initiation (<3 years HAART). Thereafter all parameters measured had levels similar to that seen for the female HAART-naïve group. Females on <3 years HAART exhibited significantly decreased body cell mass (p < 0.01), protein mass (p < 0.01), muscle mass (p < 0.01), fat free mass (p < 0.01), and fat mass (p < 0.001) versus matched HAART-naïve controls. The W:H ratio for the female treatment groups placed the females overall at a higher risk for developing cardiovascular disease compared to the males.

Conclusions

This study found striking gender-based anthropometric differences in black South African HIV-positive individuals on HAART. We also conclude from this observational study that no significant differences were found in the different male treatment groups. All female body composition parameters initially showed lower values (<3 years HAART). The female treatment group (>3 years HAART) displayed values similar to that seen in the HAART-naïve group. Higher W:H ratios in females receiving longer-term HAART potentially increases their risk for the future onset of cardio-metabolic complications.

HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings

Introduction

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.

Methods

We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.

Results and Discussion

Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.

Conclusions

Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.

Musculoskeletal sequelae in patients with obstetric fistula - a case-control study

Background

Obstetric fistula is essentially a result of pelvic injury caused by prolonged obstructed labour. Foot drop and walking difficulties in some of these women signify that the injury may extend beyond the loss of tissue that led to the fistula. However, these aspects of the pelvic injury are scarcely addressed in the literature. Here we specifically aimed at assessing musculoskeletal function in women with obstetric fistula to appreciate the extent of the sequelae of their pelvic injury.

Methods

This case–control study compared 70 patients with obstetric fistula with 100 controls matched for age and years since delivery. The following was recorded: height, weight, past and present walking difficulties, pain, muscle strength and joint range of motion, circumference and reflexes. Differences between groups were analysed using independent sample t-test and chi-square test for independence.

Results

A history of leg pain was more common among cases compared to controls, 20% versus 7% (p = 0.02), and 29% of the cases had difficulties walking following the injuring delivery compared to none of the controls (p ≤ 0.001). Of these, four women reported spontaneous recovery. Cases had 7° less range of motion in ankle dorsal flexion (95%CI: −8.1, −4.8), 8° less ankle plantar flexion (95%CI: −10.6, −6.5), 12° less knee flexion (95%CI: −14.1, −8.9), and 4° less knee extension (95%CI: 2.9, 5.0) compared to controls. Twelve % of the cases had lower ankle dorsal flexion strength (p = 0.009). Foot drop was present in three (4.3%) compared with none among controls. Women with fistula had 4° greater movement in hip extension (95%CI: −5.9, −3.1), 2° greater hip lateral rotation (95%CI: 0.7, 3.3) and 9° greater hip abduction (95%CI: 6.4, 10.7). Twelve % of the cases had stronger medial rotation in the hip (p = 0.04), 20% had stronger hip lateral rotation (p ≤ 0.001), 29% had stronger hip extension (p ≤ 0.001), and 15% had stronger hip abduction (p = 0.04) than controls.

Conclusions

Women with obstetric fistula commonly experienced walking difficulties after the delivery, had often leg pain and reduced function in the ankle and knee joints that may have been compensated by increased motion and strength in the hip.

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-014-0136-3) contains supplementary material, which is available to authorized users.

Effect of antenatal multiple micronutrient supplementation on anthropometry and blood pressure in mid-childhood in Nepal: follow-up of a double-blind randomised controlled trial

Background

In 2002–04, we did a randomised controlled trial in southern Nepal, and reported that children born to mothers taking multiple micronutrient supplements during pregnancy had a mean birthweight 77 g greater than children born to mothers taking iron and folic acid supplements. Children born to mothers in the study group were a mean 204 g heavier at 2·5 years of age and their systolic blood pressure was a mean 2·5 mm Hg lower than children born to mothers in the control group. We aimed to follow up the same children to mid-childhood (age 8·5 years) to investigate whether these differences would be sustained.

Methods

For this follow-up study, we identified children from the original trial and measured anthropometry, body composition with bioelectrical impedance (with population-specific isotope calibration), blood pressure, and renal dimensions by ultrasound. We documented socioeconomic status, household food security, and air pollution. Main outcomes of the follow-up at 8 years were Z scores for weight-for-age, height-for-age, and body-mass index (BMI)-for-age according to WHO Child Growth Standards for children aged 5–19 years, and blood pressure. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN88625934.

Findings

Between Sept 21, 2011, and Dec 7, 2012, we assessed 841 children (422 in the control group and 419 in the intervention group). Unadjusted differences (intervention minus control) in Z scores were 0·05 for weight-for-age (95% CI −0·09 to 0·19), 0·02 in height-for-age (−0·10 to 0·15), and 0·04 in BMI-for-age (−0·09 to 0·18). We recorded no difference in blood pressure. Adjusted differences were similar for all outcomes.

Interpretation

We recorded no differences in phenotype between children born to mothers who received antenatal multiple micronutrient or iron and folate supplements at age 8·5 years. Our findings did not extend to physiological differences or potential longer-term effects.

Funding

The Wellcome Trust.

Measurement of breastfeeding initiation: Ethiopian mothers' perception about survey questions assessing early initiation of breastfeeding

BACKGROUND

Although breastfeeding is almost universal in Ethiopia, only 52% newborns benefited from early initiation in 2011. Early initiation is one of the recommended interventions for saving newborn lives but its potential seems not yet realized for Ethiopian newborns and there is a need for continued efforts to increase coverage. To do so, it is also relevant to focus on consistent and accurate reporting of coverage in early initiation. WHO recommends the question "how long after birth did you first put [name] to the breast?" in order to assess coverage in early initiation. It is designed to measure the time after birth when the mother attempted to initiate breastfeeding regardless of whether breast milk had arrived or not. However, it is unclear how mothers perceive this question and what their responses of time refer to. In this study, we assessed Ethiopian mothers' perception about the question assessing early initiation.

METHODS

Cognitive interviews were conducted between April and May 2013 with eligible mothers in Basona and Debrebirhan woredas (districts), 120 km away from Addis Ababa, Ethiopia.

RESULTS

A total of 49 mothers, most from Basona (n = 36) and the rest from Debrebirhan woredas (n = 13) were interviewed. No probes or follow on questions were required for mothers to understand what the WHO recommended question was about. However, further probing was needed to ascertain what maternal responses of time refer to. Accordingly, mothers' response about the timing of early initiation was related to the first time the newborn received breast milk rather than their first attempt to initiate breastfeeding. In addition, considerable probing was required to approximate and code responses of time based on the WHO coding format because some mothers were unable to assess time in minutes or hours.

CONCLUSION

The existing question is not adequate to identify intended attempts of mothers to initiate breastfeeding. We recommend revising the question as "how long after birth did you first put [name] to the breast even if your breast milk did not arrive yet?" Standard probes or follow on questions are required to avoid subjective interpretation of the indicator.

Effects of nutrition counseling and monitoring on the weight and hemoglobin of patients receiving antiretroviral therapy in Ebonyi State, Southeast Nigeria

Introduction

The relationship between human immunodeficiency virus (HIV) and malnutrition is easily explained, and the etiology of malnutrition in HIV disease is believed to be multifactorial.

It therefore follows that ongoing assessment of nutritional and medical status is crucial to quality nutrition care for every person living with HIV. The aim of this study was to find out the effect of nutritional counseling and monitoring, using personalized dietary prescriptions, on the body mass index (BMI) and hemoglobin of patients who are HIV-infected and also receiving highly active antiretroviral drugs.

Methods

A total of 84 patients were selected using simple random sampling and allocated into intervention and control groups. Nutritional counseling and monitoring was done for the intervention group, while only weight, height, and hemoglobin concentration were monitored for the control group. At the end of 6 months, the differences in mean body mass index (BMI) and hemoglobin concentrations of the intervention and control groups were compared using the Student’s t-test. Statistical level of significance was put at P<0.05.

Results

Among respondents, 30.96% were males and 69.04% were females, and the mean age of the intervention group was 33.8 years and was 35.3 in the control group. After 6 months of study, the difference in the mean BMI among the males of both groups (24.9 kg/m² [intervention] and 24.3 kg/m² [control]) was not significant (P=0.53) but was significant among the females (24.9 kg/m² [intervention group] versus 21.8 kg/m² [control group]) (P=0.0005). The difference in mean hemoglobin concentration between the intervention and control groups for both males and females were statistically significant (12.2 mg/dL for males in the intervention group and 11.0 mg/dL for males in the control group [P=0.005]; 11.9 mg/dL for females in the intervention group and 11.0 mg/dL for females in the control group [P=0.010

Conclusion

Nutrition intervention is important in the management of people living with HIV/acquired immunodeficiency disease (AIDS) while on antiretroviral therapy. This can be achieved through nutritional counseling and monitoring.

Quantitative method for evaluation of aesthetic results after laser treatment for birthmarks

Subjective assessment of results after laser treatment for birthmarks does not provide a validated method for clinicians. Previous reports concerning objective evaluation using L*a*b color coordinates were only partially successful due to difficulties in standardizing and comparing colors from pre- and posttreatment photographs. The study aimed to present a reliable and clinically applicable method of aesthetic result assessment after laser treatment for birthmarks. All 48 patients, included in the study, were treated for birthmarks on the face or neck using laser. Each pre- and posttreatment photograph was subjected to triple objective comparative assessment of color fading with use of a computer program, as well as to subjective evaluation by three core physicians and three laypeople. Objective analysis was based on an innovative method using combined L*a*b and hue saturation value color coordinates. Accuracy was higher between objective assessment with the computer program and subjective evaluation by core physicians than by laypeople. Repeatability of results was higher with the use of the computer program than among core physicians or among laypeople. In conclusion, our method may be considered for objective assessment of the results after laser treatment of vascular and pigmented birthmarks.

Measurement error of waist circumference: gaps in knowledge

Objective

It is not clear whether measuring waist circumference in clinical practice is problematic because the measurement error is unclear, as well as what constitutes a clinically relevant change. The present study aimed to summarize what is known from state-of-the-art research.

Design

To identify the magnitude of the measurement error of waist circumference measurements from the literature, a search was conducted in PubMed from 1975 to February 2011.

Results

The measurement error may vary between 0·7 cm and 15 cm. Taking a realistic range of measurable waist circumference into account (60–135 cm), we argue that a short-term clinically relevant change in waist circumference of 5 % may lie between 3·0 and 6·8 cm and a maintained clinically relevant change of 3 % between 1·8 and 4·1 cm.

Conclusions

Based on these results, we conclude it may be difficult to distinguish clinically relevant change from measurement error in individual subjects, due to the large measurement error and unclear definition of clinically relevant change. More research is needed to address these gaps in knowledge. To minimize measurement error, we recommend using a uniform measurement protocol, training and repeated measurements.