Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review

Escaldelai, Fernanda Martins Dias; Silva Filho, Luiz Vicente Ribeiro Ferreira da; Neri, Lenycia de Cassya Lopes; Bergamaschi, Denise Pimentel

doi:10.1590/1984-0462/2023/41/2021333

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Brasil

Revista Paulista de Pediatria

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Brasil

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Sumário

Original Article • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021333 copy

Quality of anthropometric data measured in children and adolescents with cystic fibrosis: a scoping review

Qualidade dos dados antropométricos aferidos em crianças e adolescentes com fibrose cística: uma revisão de escopo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study aimed to identify methodological aspects involved in determining anthropometric measurements among studies assessing the nutritional status of individuals with cystic fibrosis (CF).

Methods:

A search of the literature was performed on MEDLINE via Pubmed, Embase, and Web of Science databases. The population comprised children and adolescents with CF. Observational studies and clinical trials using anthropometric and body composition measures and indices determined by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance assessment (BIA) were included. Use of a standardized procedure for data collection was defined when details on the instruments and their calibration were given, the measuring procedures were described, and when it was clear measures had been determined by a trained team, or the use of an anthropometric reference manual was cited. Data extracted were expressed as absolute and relative frequencies.

Results:

A total of 32 articles were included, and a total of 233 measures or indices were observed. The most frequently used measures were body mass index (kg/m²; 35%), weight (kg; 33%), and height (cm; 33%). Among the 28 studies that used anthropometric measures, 21 (75%) provided a complete or partial description of the measurement instruments used, 3 (11%) reported information on equipment calibration, 10 (36%) indicated the measurement procedures employed by assessors, and 2 (7%) stated a trained team had carried out the measurements.

Conclusions:

The poor description of measuring procedures precluded a meaningful evaluation of data quality. Scientific debate on this theme can help raise awareness of the need to ensure quality in collecting and fully presenting data.

Keywords:
Adolescent; Body composition; Body mass index; Cystic fibrosis; Child

Author and year	Study type*	Country	Sample size
Bizzarri et al., 201⁵¹51. Jensen NS, Camargo TF, Bergamaschi DP. Índice de massa corpórea e perímetro da cintura são bons indicadores para classificação do estado nutricional de crianças. Ciênc Saúde Colet. 2016;21:1175-80. https://doi.org/10.1590/1413-81232015214.138712015 https://doi.org/10.1590/1413-81232015214... 1	2	Italy	CF and CFRD group: 17. Control group CF, normal GTT: 52
Bruzzese et al., 2018¹²12. Bruzzese E, Raia V, Ruberto E, Scotto R, Giannattasio A, Bruzzese D, et al. Lack of efficacy of Lactobacillus GG in reducing pulmonary exacerbations and hospital admissions in children with cystic fibrosis: a randomised placebo controlled trial. J Cyst Fibros. 2018;17:375-82. https://doi.org/10.1016/j.jcf.2017.10.014 https://doi.org/10.1016/j.jcf.2017.10.01...	3	Italy	Lactobacillus rhamnosus GG group: 41 Placebo group: 40
Calella et al., 2018¹³13. Calella P, Valerio G, Thomas M, McCabe H, Taylor J, Brodlie M, et al. Association between body composition and pulmonary function in children and young people with cystic fibrosis. Nutrition. 2018;48:73-6. https://doi.org/10.1016/j.nut.2017.10.026 https://doi.org/10.1016/j.nut.2017.10.02...	1	The United Kingdom	69
Dentini et al., 2017¹⁴14. Dentini P, Marson FA, Bonadia LC, Bertuzzo CS, Ribeiro AF, Levy CE, et al. Burkholderia cepacia complex in cystic fibrosis in a Brazilian reference center. Med Microbiol Immunol. 2017;206:447-61. https://doi.org/10.1007/s00430-017-0521-2 https://doi.org/10.1007/s00430-017-0521-...	1	Brazil	Group A (BCC): 50. Group B (non-BCC): 134
Doulgeraki et al., 2017¹⁵15. Doulgeraki A, Petrocheilou A, Petrocheilou G, Chrousos G, Doudounakis SE, Kaditis AG. Body composition and lung function in children with cystic fibrosis and meconium ileus. Eur J Pediatr. 2017;176:737-43. https://doi.org/10.1007/s00431-017-2906-z https://doi.org/10.1007/s00431-017-2906-...	1	Greece	HMI: 19. Without HMI: 82
El Attar et al., 2017¹⁶16. El Attar MM, Azab NM, Hamed DH, Tawfik AS. Growth assessment in Egyptian children with cystic fibrosis: a single center study. Egyptian Paediatric Association Gazette. 2017;65:21-4. https://doi.org/10.1016/j.epag.2017.01.001 https://doi.org/10.1016/j.epag.2017.01.0...	1	Egypt	50
Engelen and Deutz, 2014¹⁷17. Engelen MP, Com G, Deutz NE. Increased whole body hydroxyproline production as assessed by a new stable isotope technique is associated with hip and spine bone mineral loss in cystic fibrosis. Clin Nutr. 2014;33:1117-21. https://doi.org/10.1016/j.clnu.2013.12.008 https://doi.org/10.1016/j.clnu.2013.12.0...	1	The United States	CF group: 15. Control group: 17
González-Jiménez et al., 2017¹⁸18. González-Jiménez D, Muñoz-Codoceo R, Garriga-García M, Molina-Arias M, Álvarez-Beltrán M, García-Romero R, et al. Excess weight in patients with cystic fibrosis: is it always beneficial? Nutr Hosp. 2017;34:578-83. https://doi.org/10.20960/nh.620 https://doi.org/10.20960/nh.620...	1	Spain	Pancreatic sufficiency: 371. Exocrine pancreatic insufficiency: 80
Goss et al., 2015¹⁹19. Goss CH, MacNeill SJ, Quinton HB, Marshall BC, Elbert A, Knapp EA, et al. Children and young adults with CF in the USA have better lung function compared with the UK. Thorax. 2015;70:229-36. https://doi.org/10.1136/thoraxjnl-2014-205718 https://doi.org/10.1136/thoraxjnl-2014-2...	1	The United States and United Kingdom	13,777; 3,968
Goss et al., 2018²⁰20. Goss CH, Sykes J, Stanojevic S, Marshall B, Petren K, Ostrenga J, et al. Comparison of nutrition and lung function outcomes in patients with cystic fibrosis living in Canada and the United States. Am J Respir Crit Care Med. 2018;197:768-75. https://doi.org/10.1164/rccm.201707-1541OC https://doi.org/10.1164/rccm.201707-1541...	2	Canada and the United States	5,149; 37,772
Groleau et al., 2014²¹21. Groleau V, Schall JI, Dougherty KA, Latham NE, Maqbool A, Mascarenhas MR, et al. Effect of a dietary intervention on growth and energy expenditure in children with cystic fibrosis. J Cyst Fibros. 2014;13:572-8. https://doi.org/10.1016/j.jcf.2014.01.009 https://doi.org/10.1016/j.jcf.2014.01.00...	3	The United States	LXS group: 27. Placebo group: 36
Haack and Garbi-Novaes, 2014²²22. Haack A, Garbi-Novaes MR. Cystic fibrosis patients assisted by a program nutrition therapy: assessment of the use of supplements in patients colonized and non colonized by P. aeruginosa. Rev Invest Clin. 2014;66:136-43. PMID: 24960323	1	Brazil	Without deficit: 34. With deficit: 13
Hauschild et al., 2016²³23. Hauschild DB, Barbosa E, Moreira EA, Ludwig Neto N, Platt VB, Piacentini Filho E, et al. Nutrition status parameters and hydration status by bioelectrical impedance vector analysis were associated with lung function impairment in children and adolescents with cystic fibrosis. Nutr Clin Pract. 2016;31:378-86. https://doi.org/10.1177/0884533615627157 https://doi.org/10.1177/0884533615627157...	1	Brazil	CF group: 46. Group without CF: 24
Hauschild et al., 2018²⁴24. Hauschild DB, Rosa AF, Ventura JC, Barbosa E, Moreira EA, Ludwig Neto N, et al. Association of nutritional status with lung function and morbidity in children and adolescents with cystic fibrosis: a 36-month cohort study. Rev Paul Pediatr. 2018;36:31-8. https://doi.org/10.1590/1984-0462/;2018;36;1;00006 https://doi.org/10.1590/1984-0462/;2018;...	2	Brazil	38
Hortencio et al., 2015²⁵25. Hortencio TD, Nogueira RJ, Marson FA, Hessel G, Ribeiro JD, Ribeiro AF. Factors impacting the growth and nutritional status of cystic fibrosis patients younger than 10 years of age who did not undergo neonatal screening. Rev Paul Pediatr. 2015;33:3-11. https://doi.org/10.1016/j.rpped.2014.11.004 https://doi.org/10.1016/j.rpped.2014.11....	2	Brazil	52
Isa et al., 2016²⁶26. Isa HM, Al-Ali LF, Mohamed AM. Growth assessment and risk factors of malnutrition in children with cystic fibrosis. Saudi Med J. 2016;37:293-8. https://doi.org/10.15537/smj.2016.3.13476 https://doi.org/10.15537/smj.2016.3.1347...	1	Bahrain	47
Kelly et al., 2016²⁷27. Kelly A, Schall J, Stallings VA, Zemel BS. Trabecular and cortical bone deficits are present in children and adolescents with cystic fibrosis. Bone. 2016;90:7-14. https://doi.org/10.1016/j.bone.2016.04.030 https://doi.org/10.1016/j.bone.2016.04.0...	1	The United States	CF group: 97. Control group: 199
Ledder et al., 2015²⁸28. Ledder O, Oliver MR, Heine RG, Graham J, Volders E, Robinson PJ. Clinical audit results in earlier nutritional intervention in malnourished children with cystic fibrosis with improved outcome. J Paediatr Child Health. 2015;51:988-93. https://doi.org/10.1111/jpc.12888 https://doi.org/10.1111/jpc.12888...	2	Australia	59
Okuro et al., 2017²⁹29. Okuro RT, Ribeiro MA, Ribeiro JD, Minsky RC, Schivinski CI. Alternative indexes to estimate the functional capacity from the 6-minute walk test in children and adolescents with cystic fibrosis. Respir Care. 2017;62:324-32. https://doi.org/10.4187/respcare.04625 https://doi.org/10.4187/respcare.04625...	1	Brazil	CF group: 55. Control group: 185
Ong et al., 2017³⁰30. Ong T, Schechter M, Yang J, Peng L, Emerson J, Gibson RL, et al. Socioeconomic status, smoke exposure, and health outcomes in young children with cystic fibrosis. Pediatrics. 2017;139:e20162730. https://doi.org/10.1542/peds.2016-2730 https://doi.org/10.1542/peds.2016-2730...	2	The United States	1,375
Papalexopoulou et al.,2018 ³¹31. Papalexopoulou N, Dassios TG, Lunt A, Bartlett F, Perrin F, Bossley CJ, et al. Nutritional status and pulmonary outcome in children and young people with cystic fibrosis. Respir Med. 2018;142:60-5. https://doi.org/10.1016/j.rmed.2018.07.016 https://doi.org/10.1016/j.rmed.2018.07.0...	1	The United Kingdom	CF group in study 1: 18. Study 2: 29
Sands et al., 2015³²32. Sands D, Umławska W, Zielińska A. A cross-sectional study of growth, nutritional status and body proportions in children and adolescents at a medical center specializing in the treatment of cystic fibrosis in Poland. Arch Med Sci. 2015;11:155-63. https://doi.org/10.5114/aoms.2015.49207 https://doi.org/10.5114/aoms.2015.49207...	1	Poland	89
Sheikh et al., 2014³³33. Sheikh S, Zemel BS, Stallings VA, Rubenstein RC, Kelly A. Body composition and pulmonary function in cystic fibrosis. Front Pediatr. 2014;15;2:33. https://doi.org/10.3389/fped.2014.00033 https://doi.org/10.3389/fped.2014.00033...	1	The United States	CF group: 208. Control group: 390
Welsh et al., 2014³⁴34. Welsh L, Robertson CF, Ranganathan SC. Increased rate of lung function decline in Australian adolescents with cystic fibrosis. Pediatr Pulmonol. 2014;49:873-7. https://doi.org/10.1002/ppul.22946 https://doi.org/10.1002/ppul.22946...	2	Australia	98
Woestenenk et al., 2017³⁵35. Woestenenk JW, Gulmans VA, van der Ent CK, Houwen RH. Height assessment in the Dutch-origin pediatric cystic fibrosis population. Nutr Clin Pract. 2017;32:130-2. https://doi.org/10.1177/0884533616639109 https://doi.org/10.1177/0884533616639109...	1	Holland	474

Author and year of publication	Study type*	Country	Sample size
Barbosa et al., 2020³⁶36. Barbosa RR, Liberato FM, Coelho PF, Vidal PR, Carvalho RB, Donadio MV. Sleep-disordered breathing and markers of morbidity in children and adolescents with cystic fibrosis. Pediatr Pulmonol. 2020;55:1974-83. https://doi.org/10.1002/ppul.24780 https://doi.org/10.1002/ppul.24780...	1	Brazil	31
Campos et al., 2020³⁷37. Campos NE, Heinzmann-Filho JP, Becker NA, Schiwe D, Gheller MF, Almeida IS, et al. Evaluation of the exercise intensity generated by active video gaming in patients with cystic fibrosis and healthy individuals. J Cyst Fibros. 2020;19:434-41. https://doi.org/10.1016/j.jcf.2020.01.001 https://doi.org/10.1016/j.jcf.2020.01.00...	1	Brazil	CF group: 30. Control group (healthy individuals): 25
Hak et al., 2019³⁸38. Hak SF, Arets HG, van der Ent CK, van der Kamp HJ. Rapid early increase in BMI is associated with impaired longitudinal growth in children with cystic fibrosis. Pediatr Pulmonol. 2019;54:1209-15. https://doi.org/10.1002/ppul.24343 https://doi.org/10.1002/ppul.24343...	2	Holland	57
Owen et al., 2021³⁹39. Owen E, Williams JE, Davies G, Wallis C, Grant RL, Fewtrell MS. Growth, body composition, and lung function in prepubertal children with cystic fibrosis diagnosed by newborn screening. Nutr Clin Pract. 2021;36:1240-46. https://doi.org/10.1002/ncp.10604 https://doi.org/10.1002/ncp.10604...	1	The United Kingdom	37
Phong et al., 2020⁴⁰40. Phong RY, Taylor SL, Robinson BA, Jhawar S, Nandalike K. Utility of mid-upper arm circumference in diagnosing malnutrition in children with cystic fibrosis. Nutr Clin Pract. 2020;35:1094-100. https://doi.org/10.1002/ncp.10593 https://doi.org/10.1002/ncp.10593...	1	The United States	49
Poulimeneas et al., 2020⁴¹41. Poulimeneas D, Grammatikopoulou MG, Petrocheilou A, Kaditis AG, Vassilakou T. Triage for malnutrition risk among pediatric and adolescent outpatients with cystic fibrosis, using a disease-specific tool. Children (Basel). 2020;7:269. https://doi.org/10.3390/children7120269 https://doi.org/10.3390/children7120269...	1	Greece	76
Sainath et al., 2019⁴²42. Sainath NN, Schall J, Bertolaso C, McAnlis C, Stallings VA. Italian and North American dietary intake after ivacaftor treatment for Cystic Fibrosis Gating Mutations. J Cyst Fibros. 2019;18:135-43. https://doi.org/10.1016/j.jcf.2018.06.004 https://doi.org/10.1016/j.jcf.2018.06.00...	2	The United States, Canada, and Italy	22

Method	n (%)	n (%)
Anthropometry	165 (71)
Measurements
Weight		28 (33)
Height		28 (33)
Others		29 (34)
Total		85 (100)
Indices or equations
Body mass index		28 (35)
Height for age		9 (11)
Body mass index for age		7 (9)
Target height		6 (8)
Weight for age		5 (6)
Upper arm muscle area		4 (5)
Upper arm fat area		3 (4)
Others (chest index, height velocity, hip to shoulder width index, % ideal body weight, puberty status, ratio of leg or trunk length to height, the sum of the three skinfold thickness, weight for height)		18 (22)
Total		80 (100)
Body composition	6,8 (29)
Dual-energy X-ray absorptiometry
Lean mass measurements		14 (25)
Lean mass index		10 (18)
Fat mass measurements		10 (18)
Fat mass index		10 (18)
Bone mineral (density and content)		11 (20)
Total		55 (100)
Bioimpedance
Fat free mass; fat mass		7 (54)
Resistance/height; reactance/height; resistance index		3 (23)
Hydration status; phase angle		3 (23)
Total		13 (100)
TOTAL	233 (100)

Measurements	Total	Details of instruments		Use of calibrated instruments		Details of measuring procedures		Training given
Measurements	n	n	%	n	%	n	%	n	%
Abdominal skinfold thickness	1	1	100	0	-	1	100	1	100
Birth weight	2	1	50	0	-	0	-	0	-
Height	28	22	79	0	-	10	36	2	7
Hip width	1	1	100	0	-	1	100	1	100
Leg length	1	0	-	0	-	1	100	1	100
Mid-upper arm circumference	6	4	67	0	-	3	50	1	17
Parental height	7	3	43	0	-	0	-	0	-
Sagittal chest depth	1	1	100	0	-	1	100	1	100
Shoulder width	1	1	100	0	-	1	100	1	100
Subscapular skinfold thickness	2	2	100	0	-	1	50	1	50
Transverse chest width	1	1	100	0	-	1	100	1	100
Triceps skinfold thickness	5	4	80	0	-	2	40	1	20
Trunk length	1	0	-	0	-	1	100	1	100
Weight	28	22	79	3	11	9	32	2	7
Total	85	63		3		32		14

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[1] *Corresponding author. E-mail: fernandamartins@usp.br (F. M. D. Escaldelai)