Future research needs

Certain questions need to be answered before definite recommendations can be made regarding the best method of assessing nutritional status in adolescents.

Anthropometric index - the association of various indices, such as weight-for-height, BMI, and Rohrer Index, with age and height should be further explored in adolescents. Such exploration should include analysis of existing data from past surveys that measured weight, height, MUAC, and age of adolescents. Re-analyses using data from populations with a variety of health conditions and various degrees of undernutrition could be undertaken. In addition to investigating the association between anthropometric indices and age and height, future analyses of survey data could include estimates of the error induced in the estimated prevalence of undernutrition by various degrees of uncertainty about age. The index chosen should be the least dependent on age in order to minimize the effect of using inaccurate ages.

Defining functional cut-offs - longitudinal studies are required to determine whether adolescents falling below specific cut-off points for weight-for-height, BMI, and Rohrer Index have elevated morbidity or mortality, poor pregnancy outcome, suppressed growth, or decreased work ability or physical performance measures. These studies should be conducted in a variety of situations among adolescents with different levels of undernutrition.

Practicality of measurements and calculations - the practicality of obtaining various measures should be explored in field situations. Survey organizers should assess the ease of training survey workers in measuring MUAC, weight, and height, as well as assessing inter-observer variability when measuring adolescents.

Markers of pubertal development - the accuracy of self-reported Tanner stage for breast and genital development among female and male adolescents needs to be tested in a variety of populations. For example, adolescents' self-assessment upon viewing drawings or photographs of different Tanner stages could be compared to findings of physical examinations. Studies could also explore the use of other markers of sexual development, such as the extent of axillary hair. Moreover, the ages at which various landmarks of sexual development are achieved should be described in many different populations, both normally-nourished and undernourished, in order to determine which markers can be used for adjusting for different developmental ages between survey and reference populations.

Adjusting for differences in body shape - surveys should explore the utility of adjusting anthropometric indices for differences in body shape by using the Cormic Index or other indicators of body shape in distinct populations.

Vulnerability - more nutrition surveys should include assessments of the nutritional status of different age groups to determine the relative vulnerability of young children, adolescents, women of child-bearing age, elderly, and other population subgroups in different types of humanitarian emergencies.

Use of anthropometry at all - other measures, such as strength or other functional outcomes, may better reflect an individual's risk of nutrition-related morbidity or mortality and should be explored as indicators of adolescent nutritional status.