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Novel segmental proxy measures for estimating weight and height in healthy school children aged 11–18 years
Abstracts / Clinical Nutrition ESPEN 10 (2015) e174ee212
OC76. NOVEL SEGMENTAL PROXY MEASURES FOR ESTIMATING WEIGHT AND HEIGHT IN HEALTHY SCHOOL CHILDREN AGED 11e18 YEARS
e211
OC77. AN EVALUATION OF THE ADAPTED MALNUTRITION UNIVERSAL SCREENING TOOL (MUST) CURRENTLY EMPLOYED WITHIN HOSPICE CARE SETTING AT DOROTHY HOUSE HOSPICE IN WILTSHIRE
A. Carey, H. McCarthy, J. Gill, A. Thompson, H. McNulty. Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK
A. Czerwinska. RGN, Dorothy House Hospice, Wiltshire BA15 2LE, UK
Weight and height measurements are fundamental in the monitoring of normal growth and development, identification of growth and endocrine disorders, examining disease impact, calculation and provision of nutrition support, calculating drug dosage, assessing fluid balance and choosing appropriate clinical and resuscitation equipment. Proxy measures for weight and height, such as mid upper arm circumference, arm span and knee height, have been suggested for use in clinical situations where weight and height cannot be easily measured1-5. The aim of this study was to identify valid proxy measures that can accurately predict weight and height in healthy school children. Participants, aged 11-18 years, were recruited from post primary schools throughout the island of Ireland. All participants with written parental consent were measured in minimal clothing by two researchers. Measurements recorded included weight, height, mid upper arm circumference, waist circumference, lower leg length, knee height, foot length, upper arm length and arm span. The strength of correlation between weight and height and their potential proxy measures were examined. Strong correlation was observed between weight and mid upper arm circumference (R2¼0.713). Correlation coefficients between height and segmental proxy measures were as follows: upper arm length (R2¼0.355), lower leg length (R2¼0.712), knee height (R2¼0.705), arm span (R2¼0.653) and foot length (R2¼0.605). Prediction equations for weight and height based on the strongest predictive proxy measures were determined.
In October 2012 an adapted version of MUST was introduced in Dorothy House Hospice to identify and support Palliative care patients with nutritional advice and appropriate care plans (Nutrition and Hydration Policy, 2013). This project aimed to evaluate MUST in a hospice setting and address the current lack of evaluation regarding the use of the Malnutrition Universal Screening Tool (MUST) within a hospice environment (Help the Hospices, 2009). In addition it also captured and explored the concerns voiced by the registered nurses who use the MUST in everyday practice. The ethics around this project was considered by The Clinical Governance Committee and the approval was obtained. Questionnaires were sent to all nurses in the hospice who use MUST. Open and close questions were used in this survey in order to explore nurses’ views regarding value of the MUST. Questionnaires were distributed to 47 nurses, 30 (64%) were returned. Semi structured interviews clarified unclear responses. 63% of all respondents felt that the MUST was not useful in the hospice environment. Moreover 53% indicated that MUST was not appropriate for palliative care patients. Whereas 27% respondents stated that MUST is useful and 23% nurses were happy to use it in their practice. Research in hospitals suggests a reluctance to use MUST due to negative impacts on oncological patients (Hopkinson and Corner, 2006). Moreover Green and Watson (2005) observed that nutritional screening tools require more work around validity and reliability in order to ensure suitability and accuracy. Furthermore (Savage & Scott, 2005; Raja et al., 2008) pointed out that the nurses
Table 1 Prediction equations for weight and height estimation using MUAC, WC, AS, KH and FL (OC76). Gender
Dependent variable
Independent variable
Equation
SEE
R2
Male
Weight Height
Female
Weight Height
MUAC AS KH FL MUAC AS KH FL
-23.638 + 2.382 (MUAC) + 1.272 (Age*) 34.343 + 0.561 (AS) + 2.726 (Age) 23.529 + 2.135 (KH) + 2.273 (Age) 19.790 + 4.819 (FL) + 2.121 (Age) -39.698 + 3.127 (MUAC) + 1.346 (Age) 47.448 + 0.639 (AS) + 0.745 (Age) 34.740 + 2.164 (KH) + 1.393 (Age) 25.650 + 4.182 (FL) + 2.547 (Age)
7.380 5.199 4.633 5.619 4.940 4.447 4.370 4.544
0.591 0.667 0.736 0.614 0.817 0.683 0.693 0.668
SEE, Standard Error of the Mean; MUAC, Mid Upper Arm Circumference; LLL, Lower Leg Length; KH, Knee Height; UAL, Upper Arm Length; FL, Foot Length; AS, Arm Span Child’s actual age in decimal years The results of this current study support the potential use of mid upper arm circumference as a proxy measure for weight while knee height may provide a practical predictive proxy measure for height in children. The regression equations reported here could potentially be used in a number of clinical and dietetic settings to facilitate the estimation of weight and height in children for whom these measures are not easily attainable. 1 Stallings et al., (1995) 2 Stevenson et al., (1995) 3 Kanchan et al. (2008) 4 Mazicioglu et al., (2009) 5 Yabanci et al., (2010)
clinical judgment is more accurate and sensitive in assessing patients nutritional status than using a screening tool. This case study is limited due to small sample and local use only. However the data shows that future study should be undertaken in order to explore and identify sensitive and accurate nutrition screening tool for palliative care patients. Also nurses who are using the MUST in their practice should be empowered to use their clinical judgement before using a screening tool. References; Green, S. M. and Watson, R. (2005) Nutritional screening and assessment tools for use by nurses: literature review. Journal of Advanced Nursing. Vol 50(1): 69-83 Help the Hospices. Food and Nutrition Group (2009) Professional consensus statement of nutritional care in palliative care patients. Available at: http://www.helpthehospices.org.uk/our-service/
OC76. NOVEL SEGMENTAL PROXY MEASURES FOR ESTIMATING WEIGHT AND HEIGHT IN HEALTHY SCHOOL CHILDREN AGED 11e18 YEARS
e211
OC77. AN EVALUATION OF THE ADAPTED MALNUTRITION UNIVERSAL SCREENING TOOL (MUST) CURRENTLY EMPLOYED WITHIN HOSPICE CARE SETTING AT DOROTHY HOUSE HOSPICE IN WILTSHIRE
A. Carey, H. McCarthy, J. Gill, A. Thompson, H. McNulty. Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, BT52 1SA, UK
A. Czerwinska. RGN, Dorothy House Hospice, Wiltshire BA15 2LE, UK
Weight and height measurements are fundamental in the monitoring of normal growth and development, identification of growth and endocrine disorders, examining disease impact, calculation and provision of nutrition support, calculating drug dosage, assessing fluid balance and choosing appropriate clinical and resuscitation equipment. Proxy measures for weight and height, such as mid upper arm circumference, arm span and knee height, have been suggested for use in clinical situations where weight and height cannot be easily measured1-5. The aim of this study was to identify valid proxy measures that can accurately predict weight and height in healthy school children. Participants, aged 11-18 years, were recruited from post primary schools throughout the island of Ireland. All participants with written parental consent were measured in minimal clothing by two researchers. Measurements recorded included weight, height, mid upper arm circumference, waist circumference, lower leg length, knee height, foot length, upper arm length and arm span. The strength of correlation between weight and height and their potential proxy measures were examined. Strong correlation was observed between weight and mid upper arm circumference (R2¼0.713). Correlation coefficients between height and segmental proxy measures were as follows: upper arm length (R2¼0.355), lower leg length (R2¼0.712), knee height (R2¼0.705), arm span (R2¼0.653) and foot length (R2¼0.605). Prediction equations for weight and height based on the strongest predictive proxy measures were determined.
In October 2012 an adapted version of MUST was introduced in Dorothy House Hospice to identify and support Palliative care patients with nutritional advice and appropriate care plans (Nutrition and Hydration Policy, 2013). This project aimed to evaluate MUST in a hospice setting and address the current lack of evaluation regarding the use of the Malnutrition Universal Screening Tool (MUST) within a hospice environment (Help the Hospices, 2009). In addition it also captured and explored the concerns voiced by the registered nurses who use the MUST in everyday practice. The ethics around this project was considered by The Clinical Governance Committee and the approval was obtained. Questionnaires were sent to all nurses in the hospice who use MUST. Open and close questions were used in this survey in order to explore nurses’ views regarding value of the MUST. Questionnaires were distributed to 47 nurses, 30 (64%) were returned. Semi structured interviews clarified unclear responses. 63% of all respondents felt that the MUST was not useful in the hospice environment. Moreover 53% indicated that MUST was not appropriate for palliative care patients. Whereas 27% respondents stated that MUST is useful and 23% nurses were happy to use it in their practice. Research in hospitals suggests a reluctance to use MUST due to negative impacts on oncological patients (Hopkinson and Corner, 2006). Moreover Green and Watson (2005) observed that nutritional screening tools require more work around validity and reliability in order to ensure suitability and accuracy. Furthermore (Savage & Scott, 2005; Raja et al., 2008) pointed out that the nurses
Table 1 Prediction equations for weight and height estimation using MUAC, WC, AS, KH and FL (OC76). Gender
Dependent variable
Independent variable
Equation
SEE
R2
Male
Weight Height
Female
Weight Height
MUAC AS KH FL MUAC AS KH FL
-23.638 + 2.382 (MUAC) + 1.272 (Age*) 34.343 + 0.561 (AS) + 2.726 (Age) 23.529 + 2.135 (KH) + 2.273 (Age) 19.790 + 4.819 (FL) + 2.121 (Age) -39.698 + 3.127 (MUAC) + 1.346 (Age) 47.448 + 0.639 (AS) + 0.745 (Age) 34.740 + 2.164 (KH) + 1.393 (Age) 25.650 + 4.182 (FL) + 2.547 (Age)
7.380 5.199 4.633 5.619 4.940 4.447 4.370 4.544
0.591 0.667 0.736 0.614 0.817 0.683 0.693 0.668
SEE, Standard Error of the Mean; MUAC, Mid Upper Arm Circumference; LLL, Lower Leg Length; KH, Knee Height; UAL, Upper Arm Length; FL, Foot Length; AS, Arm Span Child’s actual age in decimal years The results of this current study support the potential use of mid upper arm circumference as a proxy measure for weight while knee height may provide a practical predictive proxy measure for height in children. The regression equations reported here could potentially be used in a number of clinical and dietetic settings to facilitate the estimation of weight and height in children for whom these measures are not easily attainable. 1 Stallings et al., (1995) 2 Stevenson et al., (1995) 3 Kanchan et al. (2008) 4 Mazicioglu et al., (2009) 5 Yabanci et al., (2010)
clinical judgment is more accurate and sensitive in assessing patients nutritional status than using a screening tool. This case study is limited due to small sample and local use only. However the data shows that future study should be undertaken in order to explore and identify sensitive and accurate nutrition screening tool for palliative care patients. Also nurses who are using the MUST in their practice should be empowered to use their clinical judgement before using a screening tool. References; Green, S. M. and Watson, R. (2005) Nutritional screening and assessment tools for use by nurses: literature review. Journal of Advanced Nursing. Vol 50(1): 69-83 Help the Hospices. Food and Nutrition Group (2009) Professional consensus statement of nutritional care in palliative care patients. Available at: http://www.helpthehospices.org.uk/our-service/