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PubMed1997

Objective techniques for craniofacial assessment: what are the choices?

The approach to an individual with unusual facial appearance has traditionally involved a subjective assessment coupled with a few craniofacial measurements. Our ability to describe facial morphology has improved in recent years through the development of new techniques such as computerized tomography, magnetic resonance imaging, ultrasound studies, and stereoscopic imaging. However, the relatively simpler techniques of anthropometry, cephalometry, and photogrammetry, developed prior to the advent of microchips and imaging software, continue to provide unique advantages not afforded by these technically more sophisticated methods. These objective methods should enhance pattern recognition, particularly in rare syndromes, and allow for earlier diagnosis.

Anthropometry↗
PubMed2000

Quantitative approach to identifying abnormal variation in the human face exemplified by a study of 278 individuals with five craniofacial syndromes.

We have two objectives in this study: to demonstrate the utility of two summary anthropometric measures for quantifying craniofacial variation and to explore some of their potential uses by physicians and clinical morphologists in general. The Craniofacial Variability Index (CVI) is a summary anthropometric measure of facial "harmony." The mean z-score, based on craniofacial anthropometry, is a measure of overall facial size. Both add an objective component to the assessment of individual facial variation and allow us to place the individual along a scale of continuous variation with predetermined limits of "normality" based on a reference or control series. Our results suggest that these summary measures coincide well with clinical assessments of abnormality in 278 individuals representing five distinct syndromes (Brachmann-de Lange, Prader-Willi, Rubinstein-Taybi, Smith-Magenis, and Sotos), each of which has an associated craniofacial component. Although craniofacial variation is continuous and the normal and syndromic populations overlap to varying degrees, the syndromic cases can be characterized in a variety of ways by using CVI as a measure of facial harmony and Mean-Z as an indicator of overall facial size. Thus, these two-objective measures offer a novel and efficient means of assessing craniofacial variation, whether they are used as tools in the clinical evaluation of subjects or as a means of exploring the nature of craniofacial variation within or between syndromes.

Adolescent↗
PubMed1996

Nutritional status and mortality of highland children in Nepal: impact of sociocultural factors.

This study investigates the nutritional status of native children in the highlands of Nepal (1,700-3,000 m) and explores the relationship between child mortality and surviving children's nutritional status. A random sample of 145 households from 11 villages in the Koshi Hill Zone in east Nepal was surveyed, and the nutritional status of the 438 children < 14 years of age living in these households was assessed by means of anthropometry. We found a severe growth retardation in the Nepalese children compared to lowland reference groups as well as to highland children from the Andes. Child mortality and altitude are not significantly different between higher (Brahman and Chetri) and lower (Baisya and Sudra) caste households. A lower caste status and higher altitude of the household is associated with a significantly better nutritional status in offspring. In multiple regression analyses, improved nutritional status in children is significantly associated with lower caste (P = 0.001), higher altitude (P = 0.009), and less crowding (P = 0.001) but not with sibling mortality (P = 0.11). We thus conclude that nutritional status of children in households in the highlands of Nepal is associated with the household's socioeconomic status and altitude but not with mortality among siblings.

Adolescent↗
PubMed1998

Immunology and growth faltering of Anga children, Papua New Guinea: preliminary work.

Nutrition-infection interactions among poor children of the less-developed world influence growth and development. However, the relative importance of each is difficult to determine, because the relationship is mediated by immunological status. In this analysis, relationships between immunological measures and anthropometry were sought among 41 Anga, Papua New Guinea children aged 0-7 years. These had elevated serum total leucocyte and leucocyte subset counts relative to western reference values. Although there was no correlation between anthropometric nutritional status and total leucocytes and leucocyte subsets for this group, the small group (n=8) with very high total leucocyte count (greater than 15,000/mm2) had significantly lower mean Z score of stature for age (-3.78), and weight for stature (-1.35) than those with leucocyte counts lower than this cut-off (weight for stature Z score: -0.59; stature for age Z score: -2.68, respectively. Low stature-for-age Z score was associated with lower total lymphocyte count and increasing age, against a background of elevated lymphocyte levels relative to western reference values among the older children; low weight-for-stature Z score was associated with lower neutrophil count, against a background of normal neutrophil levels across all age groups. The pattern of weight and stature growth seen in the Anga may reflect extended nutritional deficits which result in stunting of a degree to which the most growth-compromised children die, leaving those above a threshold associated with high mortality alive. Thus, the anthropometric and immunological characteristics of the older children in this small sample may reflect the biology of survival under severe ecological conditions, where poor linear growth and elevated leucocyte status relative to normative values are characteristics of survivorship.

Age Factors↗
PubMed1998

A comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, Connecticut.

This study compared food insecurity, nutritional status (as measured through anthropometry and dietary intake), and food preparation patterns of low-income Puerto Rican female out-of-treatment drug users with that of low-income Puerto Rican women who reported no drug use. A convenience sample of 41 drug users was compared with 41 age-matched non-drug-users from inner-city Hartford, Connecticut. A culturally appropriate food frequency questionnaire was administered and anthropometric measurements were taken. The findings suggest a high degree of poverty among all study participants, but in particular among drug users. Drug users were more likely than the controls to be food insecure (P < 0.05) and to be exposed to increasingly severe food sufficiency problems. The daily frequency of consumption of vegetables was lower (P = 0.03) for drug users than non-drug-users. Conversely, the frequency of consumption for sweets/desserts was significantly higher for drug users than the controls (P = 0.0001). Drug users, who were classified as food insecure were less likely to consume vegetables (P = 0.004) and fish (P = 0.03) than were controls who were food insecure. When comparing drug users with controls, the former group reported consuming fewer meals during a usual week than the latter group (P < 0.0001). Drug users were more likely to fry foods (P = 0.02) while the controls were more likely to bake (P = 0.005), boil (P = 0.02), and steam (P = 0.002) foods. All anthropometric measurements, except for height, were significantly lower for drug users. The results show that drug users generally maintain poorer nutritional status than non-drug-users. Nutrition interventions as part of drug treatment are needed.

Adolescent↗
PubMed1999

Daily energy expenditure across the course of lactation among urban Bangladeshi women.

Measures of energy intake of lactating women in developing countries show that intakes are often lower than those recommended by international bodies, while fat-mass losses are often substantially less than the 3-4 kg used in the calculations of recommendations, suggesting that physiological adaptation must be commonplace among such women. The cost of lactation may be met by reduction in energy expenditure, including reduced physical activity, as well as by mobilization of bodily soft tissue. However, daily energy expenditure of lactating women has been shown to increase across the course of lactation among women in a rural population in the Philippines and an urban population in India, with a decline in body weight across the course of lactation in both studies. In the present study, total daily energy expenditure and anthropometric body composition were measured longitudinally in 68 mothers from a poor urban area of Dhaka, Bangladesh, at 0, 1, 2, 4, and 8 months of lactation, to determine whether the increasing energy expenditure across lactation observed elsewhere also occurs in Bangladeshi women. In addition, the extent to which an extended period of lactation was accompanied by weight and body fat change in these women was determined. Energy expenditure by heart-rate monitoring and activity report, and body composition from anthropometry was carried out four times across the 8-month period of lactation. A small decline in body fat mass and a significant increase in total energy expenditure across this period were observed, confirming similar observations elsewhere in the developing world.

Adult↗
PubMed1987

Body composition changes in marrow transplant recipients receiving total parenteral nutrition.

Nine patients with acute lymphocytic leukemia in remission, aged 12-35 years, undergoing allogeneic bone marrow transplantation (BMT) were studied for changes in body fluid balance and body composition. Body composition and fluids were assessed the first 4 weeks following BMT, using isotope dilution and anthropometry. Oral and parenteral nutrient intakes were recorded daily. Tracer dilution techniques were used to assess body fluid volumes and estimate body cell, lean body, and body fat masses. Body cell mass was lost (mean -1.62 kg, P less than 0.05) without significant changes in body fat or lean body masses. There was an expansion of the extracellular fluid compartment (mean +0.8 l, P less than 0.05) and a loss in the intracellular fluid compartment (mean -1.3 l, P less than 0.05) with little change in total body water volume. Changes in body weight correlated poorly with body cell mass or fluid volume changes. Change in arm muscle area correlated well with changes in body cell mass (r = 0.61, P less than 0.05) and lean body mass (r = 0.68, P less than 0.05), while that of arm fat area did not reflect its isotope dilution-derived counterpart. Instead, the change in arm fat area was related to shifts in fluid compartments. Prealbumin decreased significantly (mean -9.3 mg/dl, P less than 0.05), while albumin decreased slightly (mean -0.1 mg/dl), and both were related to changes in body cell mass. Nitrogen balance was negative throughout the study and the overall mean was related to the change in body cell mass (r = 0.60, P less than 0.05). Calorie and protein intakes were not associated with the changes in body composition, implying other causal factors.

Adolescent↗
PubMedDate not supplied

Commercial porters of eastern Nepal: health status, physical work capacity, and energy expenditure.

The purpose of the study was to compare full-time hill porters in eastern Nepal with part-time casual porters engaged primarily in subsistence farming. The 50 porters selected for this study in Kenja (elevation 1,664 m) were young adult males of Tibeto-Nepali origin. Following standardized interviews, anthropometry, and routine physical examinations, the porters were tested in a field laboratory for physiological parameters associated with aerobic performance. Exercise testing, using a step test and indirect calorimetry, included a submaximal assessment of economy and a maximal-effort graded exercise test. Energy expenditure was measured in the field during actual tumpline load carriage. No statistically significant differences were found between full-time and part-time porters with respect to age, anthropometric characteristics, health, nutritional status, or aerobic power. Mean VO2 peak was 2.38 +/- 0.27 L/min (47.1 +/- 5.3 ml/kg/min). Load-carrying economy did not differ significantly between porter groups. The relationship between VO2 and load was linear over the range of 10-30 kg with a slope of 9 +/- 4 ml O2/min per kg of load. During the field test of actual work performance, porters expended, on average, 348 +/- 68 kcal/hr in carrying loads on the level and 408 +/- 60 kcal/hr in carrying loads uphill. Most porters stopped every 2 min, on average, to rest their loads briefly on T-headed resting sticks (tokmas). The technique of self-paced, intermittent exercise together with the modest increase in energy demands for carrying increasingly heavier loads allows these individuals to regulate work intensity and carry extremely heavy loads without creating persistent medical problems.

Adult↗
PubMedDate not supplied

Allometric scaling of strength in an independently living population age 55-86 years.

Most physiological functions vary allometrically with body size; however, few investigators have examined the relationship between strength and body size with allometric scaling. Thus, we hypothesized that allometric analysis would reveal that both the amount and quality of muscle are significant determinants of strength in the elderly. Allometric analyses were used to determine the influence of limb cross-sectional area (CSA), physical activity, demispan (distance between index-middle finger web and the sternal notch), leg length, and sex on grip and plantar flexor strength in men (n = 188) and women (n = 205) age 55-86 years. Physical activity was measured using a self-reporting questionnaire (Taylor et al. [1978] J Chron Dis 31:741-755). Forearm and leg CSA was estimated from anthropometry. There was an age-related decline in grip strength, independent of forearm CSA, demispan, and sex, equal to approximately 12% per decade, whereas plantar flexor strength adjusted for leg CSA, physical activity, and sex was reduced at a rate of approximately 15% per decade. The allometric models explained 71.4% (r = 0.845) and 38.8% (r = 0.623) of the variance in grip and plantar flexor strength, respectively. Model parameters were identified using multiple linear regression (P < 0.05). Thus, grip strength = forearm CSA(0.435). demispan(0.161). exp(3.905 - 0.012 age + 0.413 sex) and plantar flexor strength = leg CSA(0.223). physical activity (0.115). exp(5.867 - 0.015 age + 0.366 sex). These findings indicate that age-related reductions in muscle CSA do not fully account for strength declines with age. Physical activity is also important and partially explains these reductions.

Activities of Daily Living↗
PubMedDate not supplied

Physical activity at 9-12 months and fatness at 2 years of age.

Previous research has shown that physical activity in early infancy does not predict later fatness, whereas in preschool children, such a relationship is found. The objective of this study was to investigate whether total energy expenditure (TEE) and behavior in late infancy are related to subcutaneous and total fatness in early childhood. Twenty-six infants were studied at 9-12 months and followed up at 2 years of age. Anthropometry, body composition, TEE, and behavior were measured in late infancy; skinfold thicknesses and total body fat were measured at 2 years of age. Infant TEE adjusted for fat-free mass was not related to later fatness. Infant behavior was related to later subcutaneous fatness, but not to total body fatness. Lower levels of infant activity were associated with greater skinfold thicknesses in childhood. Thus, by late infancy, physical activity level is related to subsequent skinfold thickness. Particular aspects of infant behavior appear to be more important than the sum of energy expended on activity. However, the relationship did not extend to total body fat.

Adipose Tissue↗
PubMedDate not supplied

Methodological agreement between two-compartment body-composition methods in children.

Increases in childhood obesity have emphasized the importance of accurate and accessible body composition assessment, especially in monitoring prevention and treatment efforts. Previous pediatric studies, comparing measures from air-displacement plethysmography (ADP) to dual-energy X-ray absorptiometry (DXA) and anthropometry (ANTH, skinfold measures), were performed in small numbers of children or in children across large age and body-size ranges. The objectives of this study were: 1) to compare body fat percentage (%BF), fat mass (FM), and fat-free mass (FFM) from ADP with DXA and ANTH, to determine the agreement between techniques; 2) to identify factors that influence agreement or lack of agreement; and 3) to determine if the agreement is constant over a range of body fatness. Healthy children (n = 125), 7-10 years old, participating in a longitudinal pediatric bone health study, were evaluated. Body composition was assessed by ADP, DXA, and ANTH to determine %BF, FM, and FFM. ADP underestimated %BF compared to DXA and ANTH by 5.0% and 1.4%, respectively. Agreement between techniques was influenced by body fatness, height, age, and gender (all P < 0.05). Relatively good agreement was observed between ADP and both DXA and ANTH for FM and FFM. In conclusion, the underestimation of %BF by ADP compared to DXA may be of a magnitude that is clinically significant, especially when using %BF in children to confirm a diagnosis of obesity. Further development of body-composition techniques for young children need to account for variability in age, gender, and level of fatness.

Absorptiometry, Photon↗
PubMed2003

ABase-a tool for the rapid assessment of anthropometric measurements on handheld computers.

Anthropometry is widely recognized as an important method in the evaluation of dysmorphic children. Nevertheless, it has never gained widespread clinical use. We believe that this has mainly practical reasons: appropriate growth charts are not readily available at the bedside or in clinic and taking multiple measurements and plotting them into corresponding growth charts is a time-consuming task. Here we describe a computer program that overcomes both problems: ABase compares entered anthropometric measurements to a database of age- and sex-matched reference values, calculates the centile rank and displays the result either as text or as a digitized growth chart. The program runs on small handheld computers that can easily be carried around in a shirt pocket.

Anthropometry↗
PubMed1984

The Diabetes Alert study: growth, fatness, and fat patterning, adolescence through adulthood in Mexican Americans.

Diabetes Alert is a multidisciplinary genetic and epidemiological study of Type II (non insulin-dependent) diabetes in Texas Mexican Americans. We report the anthropometry of 1,155 individuals 10 to 70 or more years with particular reference to overweight, fatness, and anatomical fat patterning in the sample. Children ages 10-18 of both sexes are growing at the 50th percentile of the reference data (U.S. Health and Nutrition Examination Survey-1) for height, Wt/Ht2, and triceps and subscapular skinfolds. Adults are well below median height but well above median Wt/Ht2 and skinfolds. Prevalence of obesity (Wt/Ht2 greater than or equal to 30) among adults is typically 30% or higher by age 30. Diabetics compared to age/sex-matched non diabetics have shorter sitting heights, have more upper body fat (subscapular skinfold), have less lower body fat (lateral calf skinfold), and were heavier at maximum weight and at age 18. The ratio of lower to upper body fat distribution decreases over the life cycle, being highest at adolescence and lowest at ages 40-50 in both sexes. Our results show a precipitous weight gain after maturity in the sample and an association of diabetes with differences in anatomical fat patterning. The age-related changes in fat patterning need to be explained in terms of their ecological and genetic influences.

Adipose Tissue↗
PubMed1986

Gene flow and variation in stature and craniofacial dimensions among indigenous populations of southern Mexico, Guatemala, and Honduras.

Populations with histories of outbreeding tend to be taller even in the face of seemingly unchanged health and nutritional circumstances, while inbreeding generally results in a negative correlation between body dimensions and level of inbreeding. Populations that have experienced a positive secular trend in stature and maturation typically have histories of higher outbreeding rates in combination with improved nutritional, health, and economic conditions, suggesting a genetic-environment interaction. In general, Middle American Indians have not experienced a secular trend in stature, nor a substantial increase in their standard of living, but they have experienced varying degrees of admixture with Spanish and African populations since the Spanish Conquest. The relationship between estimated gene flow and variation in several anthropometric dimensions is thus considered in indigenous Mesoamerican populations. Available data on height, sitting height, craniofacial dimensions, and admixture rate of Indian populations from southern Mexico, Guatemala, and Honduras were assembled from the literature. The population mean data on 3,371 adults from 23 populations for males and 18 for females were analyzed by regression with anthropometry as the dependent variable, and log10 of admixture as the independent variable. Admixture was less than or equal to 28.9% in this study and is suggestive of a primarily traditional Indian cultural and economic base. The results suggest that populations with higher admixture tend to be taller, and that the increase in stature is due to greater subischial length in both sexes. A decrease in nasion-menton height, and an increase in nasal breadth, nasal height, and the nasal index is suggested for the dimensions of the craniofacial complex.(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry↗
PubMed1978

Assessment of the nutritional state of patients with an intestinal fistula.

The arm muscle area, derived fat-free mass, urinary excretion of 3-methylhistidine and creatinine were measured serially in a group of patients with an intestinal fistula receiving prolonged nutritional support. While the two anthropometric tests appeared reasonable indicators of changes in muscle mass in these patients, the marked intra-individual variability in excretion of 3-methylhistidine and creatinine created problems in interpretation. It is suggested that more use be made of serial anthropometry in district general hospitals as an alternative, simple, measure of nutritional status.

Adolescent↗
PubMed2005

Relation of neonatal iron status to individual variability in neonatal temperament.

The relation between indices of neonatal iron status and individual differences in neonatal temperament were investigated in a sample of 148 low-income Peruvian women and their newborn infants. Using cord blood, at birth we obtained measures of neonatal ferritin, serum iron, and hemoglobin. While neonates were still in the hospital, their behavior during a structured anthropometry examination was videotaped and subsequently coded on four temperament dimensions: activity level, negative emotionality, alertness, and soothability. The same dimensions were coded using a videotape obtained during a subsequent visit to the neonates' homes. Results indicated that lower levels of neonatal hemoglobin and serum iron were related to higher levels of negative emotionality and to lower levels of alertness and soothability. A similar pattern was found for ferritin, but only for females. For the most part, relations between neonatal iron measures and neonatal temperament were linear, operating across the full range of iron values. Our pattern of iron-temperament results could not be attributed to variation in family demographics, low birth weight, gestational age, maternal dietary intake, or markers of neonatal illness and maternal diabetes. Our findings are consistent with prior research with older infants relating iron deficiency to temperament. These results support the importance of increased research on the early functional-behavioral consequences of individual differences in iron status as well as on the mechanisms that underlie such consequences.

Affect↗
PubMed1997

Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients.

The clinical relevance of malnutrition and hypermetabolism in end-stage liver disease, as well as their effects on survival after liver transplantation (LTx), are largely unknown. This study investigates the prognostic value of nutritional and metabolic parameters obtained before LTx for survival after LTx. One hundred fifty patients with end-stage liver disease undergoing LTx were assessed prospectively and followed for a mean period of 46 +/- 16 months after LTx. All patients were randomized into a study group and a validation group, each comprising 75 patients. Body composition analysis (24-hour urinary creatinine excretion, anthropometry, bioelectrical impedance analysis), deviation of measured from predicted resting energy expenditure (deltaREE), year of transplantation, and several variables known to be of prognostic relevance in patients with liver disease undergoing conservative treatment were analyzed. Kaplan-Meier and log rank analysis showed that hypermetabolic patients (deltaREE > +20%) and patients with a body cell mass (BCM) < 35% of body weight tended to have reduced survival after LTx. A risk profile on the basis of deltaREE and BCM identified patients with high risk (5-year survival rate, 54%) and low risk (5-year survival rate, 88%; P < .01). The predictive power of this risk profile was independent of the presence of ascites and clinical edema, and its validity was confirmed in the validation group (P < .01). The Child-Pugh score was not of prognostic value. We conclude that a poor nutritional state, as well as hypermetabolism, adversely affects survival after LTx. These potentially treatable presurgical factors deserve close attention in interventional studies.

Adult↗
PubMed2004

Case-control study of anthropometric measures and prostate cancer risk.

A population-based case-control study of 988 stage T2 or greater prostate cancer cases and 1063 controls was conducted in Alberta from November 1997 to December 2000 to examine the influence of anthropometric risk factors on the risk of prostate cancer using several different measures. An in-person interview was conducted, and all anthropometric measurements were taken using standardized methods. Respondents also recalled their body weight at each decade from age 20 to the referent year. Several anthropometric variables were derived, and unconditional logistic regression analyses were performed. The multivariable odds ratios, when comparing the highest to the lowest quartile were: for body mass index, OR = 1.12 (95% CI 0.85-1.47); for waist-hip ratio, OR = 1.07 (0.83-1.38); for height, OR = 0.78 (0.60-1.02); for weight, OR = 0.91 (0.70-1.18); for weight gain since age 20, OR = 0.91 (0.70-1.19); and for difference between minimum and maximum adult weight, OR = 0.89 (0.69-1.16). Our study provides evidence for no association between any measures of anthropometry including several derived measures of changes in weight over lifetime and prostate cancer risk.

Adult↗