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Adolescent anthropometry analysis questions

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Amelia Reese Masterson

Research Advisor, Nutrition & Food Security

Normal user

15 Jul 2015, 19:10

I am seeking to analyze data collected among adolescent girls 13-19 in Zimbabwe for undernutrition. I plan to follow WHO guidelines and do the following:

- for acute undernutrition/thinness (BMI-for-age <5th centile of NHANES 1 reference population)
- for chronic undernutrition/stunting (height-for-age <3rd centile of NHANES 1 reference population)
- adjust based on median age of reaching menarche (using average difference between survey and reference population)

I have a few questions regarding this analysis:

1. Are these still the correct guidelines for adolescent anthropometry? http://www.unsystem.org/scn/archives/adolescents/ch04.htm#TopOfPage

2. Should I use the NHANES 1 population as the reference population even though I am looking at nutritional status in Zimbabwean girls 13-19?

3. Does anyone have SPSS code for this? (all I can find is SAS but I no longer have access to SAS)

4. For pregnant adolescent girls, we did not use MUAC as there is no established MUAC cutoff for adolescents. Instead, can I adjust anthropometry data for month of pregnancy? Would appreciate advice!

***Information on adolescent anthropometry is limited - many thanks for any advice!***

Wisdom

Normal user

16 Jul 2015, 08:49

Hi Amelia, thanks for your questions l can try to share with you some of the adolescents analysis done by the Nutrition and NCD dept of the MOHCC maybe you can get some ideas. Perhaps contact me on vadubewg@gmail.com

Bradley A. Woodruff

Self-employed

Technical expert

16 Jul 2015, 13:01

Dear Ms. Masterson: I would definitely ignore the recommendations for adolescent anthropometry you cite in your question. That publication (Physical Status: The Use and Interpretation of Anthropometry - Report of a WHO Expert Committee) is quite old. Using the cut-off of the fifth centile and American adolescents as the reference has resulted in rather large overestimation of the prevalence of acute malnutrition in several nutrition surveys of adolescents. For an overall discussion of the difficulties with anthropometric assessment of nutritional status in adolescents, see Anthropometric assessment of nutritional status in adolescent populations in humanitarian emergencies. European Journal of Clinical Nutrition (2002) 56, 1108–1118. As an alternative, albeit an imperfect one, I would recommend using the relatively new anthropometric tables for children and adolescents 5-19 years of age published by WHO (see http://www.who.int/growthref/en/). Using this reference, global and severe undernutrition are defined as below -2 and -3 z-scores, respectively, as in children less than 5 years of age. This reference is also based on NHANES data from American adolescents, so it may also overestimate the prevalence of undernutrition. The adjustment for different average age of menarche between your population and the reference is unproven, but it can't hurt. I am not so sure adjusting the BMI for pregnancy stage is valid, but I am ignorant of any empirical evidence of its accuracy. I hope this helps. Please let me know if I can help in any way.

Charulatha Banerjee

Terre des hommes Foundation

Normal user

18 Jul 2015, 06:15

Dear all,

I have been following this discussion closely. and I would like to ask a related question additionally. We would like to measure nutritional status of married adolescent girls (ages 14-18- sometimes even 13) at regular intervals and keeping in mind the very high chances of them getting pregnant very early also try to improve nutritional status so that atleast in one aspect they are better prepared. Our interventions will not include any supplementary food distribution but will focus on working on improving dietary diversity and addressing food restrictions and taboos as we have seen that in communities where there is food security these 2 factors are the most damaging. We are planning to measure MUAC every quarter till she gets pregnant and once pregnant if necessary based on MUAC cut off of 210 she is enrolled in a Supplementary feedng programme.

My question - From the previous discussions, link mentioned below

http://www.en-net.org.uk/question/215.aspx

I concluded from the extensive communication and other links and articles that are mentioned that MUAC will suffice and we will not have to worry about weight and height for BMI or to look at Wasting indices. Can experts confirm if I am concluding right keeping in mind the programme described above? This will help me in furthering my project design as I am on it just now. Many thanks

Bradley A. Woodruff

Self-employed

Technical expert

18 Jul 2015, 13:37

Dear Dr. Banerjee:
I am not familiar with any standard recommendations for monitoring anthropometric indicators in pregnant women in less-developed countries. I would recommend also measuring height at the first visit and weight at each follow-up visit because weight gain during pregnancy is an excellent anthropometric indicator of nutritional status during pregnancy. Of course, in order to measure weight gain, you need a pre-pregnancy weight; thus the need to measure weight at follow-up visits. During pregnancy, you can use published tables showing target weight gain by the woman's height and week of gestation, at least in the second and third trimester (see Gueri et al. Anthropometric assessment of nutritional status in pregnant women: a reference table of weight-for-height by week of pregnancy. Am J Clin Nutr 1982;35:609-616).

I hope this is helpful.

Amelia Reese Masterson

Research Advisor, Nutrition & Food Security

Normal user

20 Jul 2015, 22:29

Dear Dr. Woodruff,

Thank you very much for your thorough and most useful response. I am now using the WHO macro to run my analysis in spss. Greatly appreciated. I do have one follow up question. Is there someone at WHO I can contact to help de-bug a code? I'd like to speak with someone who created or understands the spss code. When I calculate BMI-for-age zscores and height-for-age zscores, about 10% of my observations are counted as missing (for not apparent reason). I'd appreciate any direction you have. So far, "who_anthro@who.int" has not responded.

Bradley A. Woodruff

Self-employed

Technical expert

21 Jul 2015, 00:09

Dear Ms. Masterson:

Thank you for your reply. I do not know anyone in WHO who might help you with the SPSS syntax. In fact, I could not find any syntax on the WHO website to be used to analyze children 5-19. However, our little consulting group has a crack SPSS programmer. If you send me the syntax, I can ask him to take a look at it. I would also be interested in the URL where you found this syntax. Please communicate with me further at bradleyawoodruff@gmail.com.

Regards,
Woody

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