Anthropometric Measurements to Predict NICU Admission for Infants of Diabetic Mothers

Aim: Can NICU admission of IDM be predicted by anthropometric measurements like birth weight, lenght, head circumference (HC), mid upper arm circumference (MUAC) or triceps skin fold thickness (TSFT). Method: Eighty-six-term IDMs were analyzed prospectively. MUAC, HC and TSFT were measured within 48 hours of life. Prenatal-natal-postnatal problems; NICU admission; maternal characteristics, HbA1c were recorded. Results: Mean birth weight, gestational age were 3453.3±582.4g and 38.0±0.97weeks. 63.9% of IDMs was admitted to NICU. 56.3% hospitalized due respiratory problems; 32,7 % required endotracheal intubation. Mean MUAC, TSFT, HC and MUAC/HC ratio were 11.2±1.1 cm, 7.1±2.2 mm, 35.0±1.8 cm and 0.32±0.03 cm respectively for all. Although there was no significant relation between NICU admission and MUAC (p=0.071), TSFT and MUAC/HC were significantly higher in babies admitted to NICU (p=0.006 for TSFT, p<0.001 for MUAC/HC). HC was significantly low in babies followed in NICU (P<0.001). With increment of TSFT, MUAC/HC and HbA1c, NICU admission increases positively, but HC affects NICU admission negatively (OR for TSFT:1.6, OR for MUAC/HC: 2.1, OR for HbA1c: OR for HC:0,3). Mechanic ventilation requirement is affected positively by TSFT (p=0.008, OR:1.5) and affected negatively by HC (p=0.004, OR:0.6). Conclusion: This preliminary study showed; TSFT, HC and MUAC/HC ratio are helpful criterias to predict NICU admission risk for IDMs and might be helpful for risk assesment in limited settings. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 72-78

Circulating irisin levels in preadolescents and adolescents born preterm

Introduction. Prematurity is associated with increased cardiometabolic risk later in life. The adipomyokine irisin has been acknowledged as a modulator of energy metabolism and insulin sensitivity. The aim of this study was to investigate circulating levels of irisin and their relation to anthropometric measurements and cardiometabolic phenotype in a population of preterm-born children vs. full-term-born peers. Methods. A total of 160 children (87 born preterm aged 8.1-14.8 years and 73 born full-term of similar age and gender distribution) were studied. Arterial blood pressure, anthropometry, body composition assessments with dual energy X-ray absorptiometry (DXA) and skin fold measurements were performed. Blood biochemistry and circulating levels of irisin, insulin, cortisol, leptin, and adiponectin were also determined. Results. The preterm group had higher diastolic blood pressure, triceps skin fold, subscapular skin fold (SSF) and abdominal skin fold measurements and more central adiposity than the full-term group. Irisin was significantly lower (p=0.002), whereas leptin was higher (p=0.03), in the preterm than the full-term group. Irisin correlated positively with gestational age (r=0.19, p=0.01), birthweight (r=0.23, p=0.003) and high-density lipoprotein cholesterol (r=0.20, p=0.01), and negatively with SSSF (r=-0.25 p=0.003) and chronological age (r=-0.21, p=0.008). Conclusion. Lower levels of irisin and a slightly unhealthy adiposity and cardiometabolic pattern were detected in preterm-born children in comparison to their full-term-born peers. Whether low irisin levels in preadolescents and adolescents born prematurely could be of prognostic value for the development of cardiometabolic sequelae later in life remains to be further studied.

Effects of Insulin on Gestational Pima Indian Heritage Females

Diabetes and obesity reach epidemic proportions all over the world, while the effects of insulin resistance and its consequences are gaining prominence. The article derives the effects of insulin on gestational Pima Indian heritage females with minimum 21 years old. It is identified herein that mean insulin level for gestational women (GW) is positively linked with glucose level (P=0.0055), while it is negatively linked with age (P=0.0095). Mean insulin level for GW is independent of pregnancies (P=0.1866) and diabetes pedigree function (DPF) (P=0.5321), while it is partially positively linked with their joint interaction effect Pregnancies*DPF (P=0.0864). It is positively linked with blood pressure (BP) (P<0.0001) and triceps skin-fold thickness (TST) (P<0.0001), while it is negatively linked with the joint interaction effects BP*TST (P<0.0001) and DPF*TST (P<0.0001). In addition, mean insulin level is negatively linked with body mass index (BMI) (P=0.0001), while it is positively partially linked with the interaction effect BMI*DPF (P=0.1312). Variance of insulin level is positively linked with pregnancies (P=0.0184) and age (P=0.0027), while it is negatively linked with their joint interaction effect Pregnancies*Age (P=0.0418). Also variance of insulin level is partially negatively linked with BMI (P=0.0738) and glucose level (P=0.1439), while it is partially positively linked with their joint interaction effect BMI*Glucose (P=0.1472). Further, variance of insulin level is negatively linked with DPF (P=0.0309). It is concluded that for GW, insulin level increases with the increase of glucose level, BP, TST, and the interaction effects Pregnancies*DPF & BMI*DPF, and it decreases with the increase age, BMI, and the interaction effects BP*TST & DPF*TST. GW should be careful on her glucose level, BMI, BP & TST.

Which Anthropometric Measurement is better for Predicting Survival of Patients with Cancer Cachexia?

No relevant studies have yet been conducted to explore which measurement can best predict the survival time of patients with cancer cachexia. This study aimed to identify an anthropometric measurement that could predict the 1-year survival of patients with cancer cachexia. We conducted a nested case-control study using data from a multicenter clinical investigation of cancer from 2013 to 2020. Cachexia was defined using the Fearon criteria. A total of 262 patients who survived less than 1 year and 262 patients who survived more than 1 year were included in this study. Six candidate variables were selected based on clinical experience and previous studies. Five variables; body mass index, mid-arm circumference, mid-arm muscle circumference, calf circumference, and triceps skin fold (TSF), were selected for inclusion in the multivariable model. In the conditional logistic regression analysis, TSF (p=0.014) was identified as a significant independent protective factor. A similar result was observed in all patients with cancer cachexia (n=3084). In addition, a significantly stronger positive association between TSF and the 1-year survival of patients with cancer cachexia was observed in participants aged >65 years (OR: 0.94; 95% CI: 0.89, 0.99) than in those aged ≤65 years (OR: 0.96; 95% CI: 0.93, 0.99; P-interaction =0.013) and in participants with no chronic disease (OR: 0.92; 95% CI: 0.87, 0.97) than in those with chronic disease (OR: 0.97; 95% CI: 0.94,1.00; P-interaction =0.049). According to this study, TSF might be a good anthropometric measurement for predicting 1-year survival in patients with cancer cachexia.

The Impacts of Body Mass Index on Gestational Diabetes Pima Indian Heritage Women

Body mass index (BMI) acts as a casual factor for developing many diseases such as cardiovascular, breast cancer, heart, diabetes etc. The article presents the impacts of BMI on gestational diabetes Pima Indian heritage women with at least 21 years old. It is established here that mean BMI is larger for gestational diabetes mellitus (GDM) women (P=0.0007) than normal. Mean BMI is directly linked with triceps skin fold thickness (TSFT) (P<0.0001), and it is not related with age (P=0.5185), while it is inversely linked with their joint interaction effect TSFT*Age (P=0.0023). In addition, mean BMI is partially inversely linked with insulin (P=0.1813), and it is partially directly linked with diabetes pedigree function (PDF) (P=0.1601). Variance of BMI is larger for normal women (P<0.0001) than GDM women. It is inversely linked with glucose (P<0.0001), and it is not associated with the number of pregnancies (NOP) (P=0.5494), while it is directly linked with their joint interaction effect Glucose*NOP (P=0.0434). Mean and variance of BMI show many complex impacts on GDM women. Gestational women must care on BMI along with TSFT and glucose levels.

Nutritional Profile of Patients with Acquired Immunodefience Syndrome

Objective: To evaluate the nutritional status of patients living with the human immunodeficiency virus and making use of antiretroviral medication. Methods: This is an observational cross-sectional analytical study that was conducted from May to July 2018. The nutritional status was determined through the evaluation of anthropometric data. The anthropometric measurements collected were: body mass index, brachial circumference, triceps skin fold and waist circumference. Results: We evaluated 120 patients in regular use of antiretroviral therapy. According to the body mass index, most individuals (41.2%) presented eutrophy, followed by overweight (35.7%). Regarding waist circumference, about 30% of patients presented a much increased risk for cardiovascular diseases. It was also observed that 47.5% of the patients presented eutrophy through the arm circumference parameter. Regarding the anthropometric parameter, triceps skin fold, it was observed that 29.9% of the patients presented severe malnutrition, followed by obesity (24.2%). Conclusion: It is known that even individuals undergoing antiretroviral therapy, aiming at slowing the progression of the disease, may present a possible involuntary weight loss during treatment. When related, the parameters of arm circumference, triceps skin fold, and waist circumference characterize the clinical signs of lipodystrophic syndrome, defined as abnormal redistribution of body fat. It is concluded that constant nutritional monitoring of patients in regular use of antiretroviral therapy drugs is necessary in order to prevent possible complications in the nutritional status of patients living with the human immunodeficiency virus.

Study of percutaneous endoscopic gastrostomy compared to nasogastric tube feeding in patients requiring prolong enteral nutritional support

Background: The aims and objectives of this article were to compare the advantages, disadvantages associated with percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tube and also to compare complications, to measure the outcomes in terms of hospital stay, mortality and improvement in nutritional status.Methods: In this prospective and interventional study 25 patients were selected in each group on an alternate basis. Study was conducted on cases of traumatic brain injury and cerebrovascular accident patients admitted in Department of General Surgery, IGGMC for a period of November 2013- November 2015 with a need to provide prolonged enteral nutritional support. Each patient was assessed by a dietician and received a standard enteral feeding according to their body weight. The main outcome was measures at 4 weeks were complications (tube dislodgement, aspiration pneumonia, tube blockade and peristomal infections) and nutritional status.Results: The anthropometric parameters (mid arm circumference, biceps skin fold thickness and triceps skin fold thickness) and serum albumin showed a rise in PEG group at 4 weeks when compared to baseline (0 week) whereas they showed a decline in NG group at follow up (4 weeks). The NG group has got higher mortality 4 (17%) when compared to PEG group 2 (7%) due to aspiration pneumonia. Hence, PEG is better tolerated with lesser complications better nutritional support as assessed by the anthropometric parameters at 4 weeks.Conclusions: We conclude that whenever feasible percutaneous endoscopic gastrostomy (PEG) feeding is a choice over nasogastric (NG) feeding in patients requiring long term enteral support.

Correlation of body mass index with biceps and triceps skin fold thickness

Background: Body mass index (BMI) and skin fold thickness are independently established methods of nutritional assessment. Present study tries to find out correlation between them.Methods: A cross sectional study was conducted in private medical college among 2nd year MBBS students. Total 24 students were sampled by purposive sampling method. After obtaining permission from Institutional Ethics committee and written informed consent from participants, study information was gathered using semi structured proforma. Anthropometric measurements were taken using standard techniques and equipments. Data was analysed using Microsoft Excel and Prism version 5.0 and appropriate tests were used considering normality of data.Results: Out of 24 study participants 14 were males and 10 were females. Mean weight was 59.29±12.59 kg, mean height was 164.77±10.28 cm, mean BMI was 21.68±3.18 kg/m2. Mean biceps skin fold thickness was 7.20±2.68 mm and mean triceps skin fold thickness was 10.75±3.33mm. Of all the participants 4 (16.67%) were having underweight BMI, 15 (62.50%) were having normal BMI, 5 (20.83%) were pre-obese. BMI correlated significantly with triceps skin fold thickness Spearman’s r=0.53, p=0.006 as compared to biceps skin fold thickness Spearman’s r=0.36, p=0.07 in complete sample. Among males BMI correlated significantly with triceps skin fold thickness Spearman’s r=0.64, p=0.01 as compared to biceps skin fold thickness.Conclusions: BMI correlates significantly with triceps skin fold thickness as compared to biceps skin fold thickness in general. Significant correlation between BMI and triceps skin fold thickness was found with males as compared to females.

A study of pulmonary function abnormalities in obese individuals

Background: Previous studies suggest that obese individuals are prone to pulmonary function abnormalities. The aim of this study was to evaluate pulmonary function tests in obese individuals and to relate pulmonary abnormalities if any found to lipid abnormalities and to the extent and duration of obesity.Methods: This prospective study was done on 40 obese patients attending to Dr. D. Y. Patil Hospital, Mumbai with complaints of pulmonary functions during the period from January to December 2012. Pulmonary function test was done with the help of Jaegers pneumoscreen. The percentage of body fat was determined by using triceps skin fold thickness technique by using Vernier callipers. Fasting serum samples was collected to analyses cholesterol and triglycerides.Results: Female preponderance was seen in the study (57.5%). Forced expiratory volume, forced vital capacity, maximum mid expiratory flow rate was significantly reduced and the ratio of forced expiratory volume in one second to forced vital capacity was significantly increased in individuals who had abnormal pulmonary function. Decrease in pulmonary function was noted with increased levels of cholesterol and triglyceride but the correlation was not significant.Conclusions: Obese individuals although asymptomatic have significant lung function abnormality in the form of restrictive as well as obstructive pattern. Hence, reduction in the body weight may help in reversal of the pulmonary function indices.