|Assessment of Nutritional Status in Emergency-Affected Populations - Adolescents (UNSSCN, 2000, 24 p.)|
|Possible solutions for the future|
When assessing adolescents, additional data from the same population should be collected. Such data could include the prevalence of undernutrition in young children, the prevalence of undernutrition in adults, rates of morbidity and mortality, and information on food security, food distribution, and alternate sources of food. If a survey of adolescents indicates substantial undernutrition, but data on young children, adults, and other population groups do not demonstrate undernutrition or elevated morbidity or mortality, it is very important to look critically at the adolescent data. It is unlikely that adolescents are the only population group with substantial undernutrition.
Unless anthropometric measures are valid, i.e., they truly measure nutrition and health, they may not be useful at all. Other measures, such as strength or other functional outcomes, may better reflect an individual's risk of nutrition-related morbidity or mortality. Experience in screening adults for admission to therapeutic feeding programmes has demonstrated that three clinical signs (apparent dehydration, oedema, and inability to stand) predict mortality better than BMI 59, 63. Such an approach, although as yet untested in adolescents, may be able to distinguish adolescents in need of therapeutic feeding from those who could benefit from a less intensive feeding program. However, clinical signs may not be useful for measuring the overall prevalence of lesser degrees of undernutrition in a population because persons with less severe undernutrition may not be so markedly impaired nor exhibit such a distinctive clinical picture.
Measures of muscle function, such as grip strength, shuttle run, or maximum jump height, may be able to detect moderate degrees of wasting. One author proposes that muscle performance may actually be affected earlier in the course of undernutrition than body composition 81. In one study among surgical patients, hand grip was associated with MUAC, and those patients with hand grip less than 85% of normal did much poorer postoperatively 82. In a second study, muscle strength, as measured by grip strength, endurance run, shuttle run, distance throw, and standing long jump, was greater in normally-nourished children 4-6.5 years of age than undernourished children 83. However, in this study, muscle strength was correlated with stature, and after removing the effect of this variable, well-nourished and poorly-nourished children no longer differed in muscle strength. A third study that directly stimulated the ulnar nerve and measured isometric muscle contractions did not find a difference between undernourished and normally nourished adults 84. Clearly, such measures are not ready to be used in the field. Much more work needs to be done to determine whether appropriate measures of muscle function exist, to describe a reference population and cut-off points, and to determine the sensitivity and specificity of proposed methods to detect moderate and severe undernutrition.