Anthropometric measures are simple and accurate paediatric weight-prediction proxies in resource-poor settings with a high HIV prevalence

Abstract

The development of nomograms using these equations is warranted to allow for rapid and accurate weight prediction from these simple anthropometric measures in HIV-endemic, resource-constrained settings.

Mid-upper arm circumference (MUAC): new applications for an old measure

“…Whitfield et al also estimated body weight using a range of alternative equations which have been used or recommended, most of which are based on samples from high-income countries: errors in estimation of weight were far higher than with the newly developed MUAC approach, and typically unacceptably high. The MUAC and ulnar and tibial length measures made in the study by Whitfield et al 2 all had high precision (low inter-observer error) when made by the trained observers in the study, as expected 1. In summary, MUAC appears to be a promising option for the estimation of body weight where this cannot be measured or cannot be measured accurately—this could improve the accuracy of drug dosage, as well as making weight-based measures of nutritional status (eg, body mass index (BMI) for age) possible in some resource-poor settings.…”

“…The paper by Whitfield et al 2 notes that accurate measurement of body weight is often not possible in resource-poor settings, and this is important clinically because it substantially increases the risk of inaccurate drug dosage (where dosage is dependent on body weight). Whitfield et al 2 describe a study which suggests that MUAC, when combined with other anthropometric measures, could be a useful and accurate way of estimating body weight in children.…”

“…A few caveats are worth considering. First, as noted by the authors, prediction equations have to be converted to simpler calculation-free methods if they are to be used accurately and widely in clinical practice, since even apparently simple calculations to assess growth or nutritional status can produce large errors when used clinically3: the authors provide nomograms for this purpose 2. Second, generalisability of study findings is important.…”

“…Second, generalisability of study findings is important. Prediction equations of the kind developed by Whitfield et al 2 are notoriously population-specific, and external cross-validation in different populations would be important, along with evidence that the nomograms provided were practical and accurate, and inter-observer agreement high. Finally, when body weight cannot be measured then a proxy is clearly essential, but the issue of knowing when body weight measurement is inaccurate (eg, when scales are available but inaccurate) and when MUAC might be preferable, is more complicated than it might seem.…”

Development and validation of a method to estimate body weight in critically ill children using length and mid-arm circumference measurements: The PAWPER XL-MAC system

“…Maximum objectivity can best be achieved with the use of a simple, easy-to-perform anthropometric measurement such as mid-arm circumference (MAC), since MAC has been shown to have a strong association with body weight, as well as body habitus, in children and adolescents. [9,[16][17][18] An additional issue is that, depending on the drugs to be used, there are situations where estimations of both total body weight (TBW) and ideal body weight (IBW) may be required to optimise drug administration. Obese children, in particular, could be at risk of toxicity or reduced therapeutic effect if drug doses are not corrected for body composition.…”