title: Adjustments for weighing clothed babies at high altitude or in cold climates.
abstract: Public health nutritionists rely on anthropometry for nutritional assessment, program planning, and evaluation. Children are usually heavily clothed at high altitudes and in cold climates. Failing to adjust for clothing weight could underestimate malnutrition prevalence. The objective of this paper is to validate an adjustment process for estimating clothing weight and quantify potential misclassification error. In March and September 2009, 293 and 272 children under 2 years of age, respectively, were measured for weight and length in 14 highlands communities in Ecuador. Weight-for-age z-scores (WAZ) and weight-for-height z-scores (WHZ) were compared using clothing-unadjusted weights and two types of clothing-adjusted weights: individual clothing-weights and population-mean clothing-weights. Modelling showed up to 24% of children's nutritional status and degree of malnutrition were misclassified for WAZ, and 13% for WHZ, when clothing was not taken into account in this cold climate. Compared with the more time-intensive individual clothing-weight adjustment, the population-mean clothing-weight adjustments had high specificity and sensitivity for WAZ. In cold climates, adjusting for population mean clothing weight provides a better estimate of the prevalence of malnutrition to inform appropriate program decisions for addressing underweight. An individual clothing weight adjustment may also be essential to classify a specific child's nutritional status when acute malnutrition is a concern.
authors.affiliation: a Micronutrient Initiative , Ottawa , Canada.|b Centre for Indigenous Peoples' Nutrition and Environment (CINE) , McGill University , Montreal , Canada.|c School of Dietetics and Human Nutrition , McGill University , Montreal , Canada.
authors.forename: Marion L
authors.initials: ML
authors.lastname: Roche
authors.affiliation: d Division of Clinical Epidemiology , Research Institute of the McGill University Health , Montreal , Canada.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gyorkos
authors.affiliation: e World Vision Ecuador , Quito , Ecuador.
authors.forename: Julieta
authors.initials: J
authors.lastname: Sarsoza
authors.affiliation: b Centre for Indigenous Peoples' Nutrition and Environment (CINE) , McGill University , Montreal , Canada.|c School of Dietetics and Human Nutrition , McGill University , Montreal , Canada.
authors.forename: Harriet V
authors.initials: HV
authors.lastname: Kuhnlein
mesh_terms: D000531:Altitude; D000886:Anthropometry; D001835:Body Weight / Q000502:physiology*; D002675:Child, Preschool; D003081:Cold Climate; D004484:Ecuador; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014894:Weights and Measures / Q000592:standards*
keywords: anthropometry; children; climate; clothing; malnutrition