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Are We Ready to Measure Child Nutritional Status with Lasers?

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Are We Ready to Measure Child Nutritional Status with Lasers? SUPPLEMENT Perspective: Are We Ready to Measure Child Nutritional Status with Lasers? Joel Conkle1 and Reynaldo Martorell1,2 1Nutrition and Health Sciences Program, Laney Graduate School, and 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA ABSTRACT The continued use of basic, manual anthropometric tools (e.g., boards and tapes) leaves anthropometry susceptible to human error. A potential solution, 3-dimensional (3D) imaging systems for anthropometry, has been around since the 1950s. In the 1980s, 3D imaging technology advanced from photographs to the use of lasers for body digitization; and by the 2000s, the falling price of 3D scanners made commercial application feasible. The garment sector quickly adopted imaging technology for surveys because of the need for numerous measurements and large sample sizes. In the health sector, 3D imaging for anthropometry was not widely adopted; its use was limited to research and specialized purposes. The different cost and logistical requirements for measurement in the garment and health sectors help to explain why the technology was adopted in one sector and not the other. Despite reductions, the price of 3D imaging systems remained a barrier to the use of 3D imaging for regular nutritional assessment in the health sector. Additional barriers in the health sector were that imaging systems required dedicated space and were not designed for capturing measurements in young children. In recent years, the development of light-coding technology may have removed these barriers, and a handheld imaging system was developed specifically for young children. There are not yet recommendations to replace manual equipment with 3D imaging for nutritional assessment, and there is a need for more research on low-cost, handheld imaging systems—particularly research that evaluates the ability of 3D imaging to improve the quality of anthropometric data and indicators. Adv Nutr 2019;10:S10–S16. Keywords: anthropometry, body composition, child growth, development, nutritional assessment, nutritional surveillance Introduction centuries, and although interpretation of anthropometry Anthropometry, or the measurement of the human body, changed dramatically over the centuries—with measure- is an ancient practice. Texts from Ayurvedic and tradi- ments applied to health and well-being, productivity, fight- tional Chinese Medicine show that human beings have ing ability, fortune-telling, and eugenics—methods and attributed meaning to variation in human surface mor- tools for anthropometry have changed little since the phology for thousands of years (1, 2). Anthropometric 1800s (2, 3). Today’s anthropometric tools are rudimen- methods were standardized in science in the 18th and 19th tary. We rely on wooden boards, tapes, and calipers, which are some of the same basic tools found in bc Published in a supplement to Advances in Nutrition. Presented at the International Union of China (2). Nutritional Sciences (IUNS) 21st International Congress of Nutrition (ICN) held in Buenos Aires, Three-dimensional (3D) imaging is the norm for anthro- Argentina, October 15–20, 2017. The International Union of Nutritional Sciences (IUNS) thanks pometry used in garment design and ergonomics, but in the Mead Johnson Nutrition and Herbalife Nutrition for generously providing grants to support the publication and distribution of the present supplement from the 21st International Union of health sector the use of 3D imaging is limited to research Nutritional Sciences. The contents of this supplement are solely the responsibility of the and specialized purposes. We set out to determine why 3D authors and do not necessarily represent official views of the IUNS. The supplement imaging for anthropometry was used regularly in one sector coordinators were Angel Gil and Alfredo Martinez. The supplement coordinators had no conflicts of interest to disclose. andnottheother.Alongtheway,weidentifiedkeybarriers Author disclosures: JC and RM, no conflicts of interest. The funding sources had no role indata to the use of 3D imaging for regular nutritional assessment analyses, data interpretation, or report writing. in the health sector and found that recent technological Publication costs for this supplement were defrayed in part by the payment of page charges. This publication must therefore be hereby marked “advertisement”in accordance with 18 USC developments could be removing these barriers, making section 1734 solely to indicate this fact. The opinions expressed in this publication are those of it more feasible to use 3D imaging for regular nutritional the authors and are not attributable to the sponsors or the publisher, Editor, or Editorial Board assessment, including for growth monitoring of young of Advances in Nutrition. Address correspondence to JC (e-mail: [email protected]). children. S10 © 2019 American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Adv Nutr 2019;10:S10–S16; doi: https://doi.org/10.1093/advances/nmy053. Why Is the Use of Manual Tools for Surface Translations, Inc., had extensive experience in Anthropometry a Problem? measuring mobile subjects with 3D imaging, having spent 7 y New technology, such as DXA (4), improved the mea- developing and testing 3D scanners to estimate the weight of surement of body composition but did little to improve livestock on the basis of surface morphology. The company’s anthropometry. The lack of advancement in anthropometric experience in measuring moving subjects caught the eye of methods is problematic. First, current equipment, especially global nutrition experts because of the potential application length/height boards, places a burden on anthropometrists to hard-to-measure children. The Bill and Melinda Gates and young children. In some settings, anthropometrists must Foundation brought together the company, which had carry bulky and heavy boards, and length measurements no experience working with humans, with our research push a large percentage of young children into a crying fit. team—a team with experience in anthropometry, including Second, for routine nutritional assessment, we still rely on a experience in developing the 2006 WHO Child Growth few basic measurements because many body measurements Standards (16), but with no experience in 3D imaging—into with known or potential diagnostic value are too difficult to a partnership to develop and test a 3D imaging system for measurewithmanualanthropometryandbecausethecost child anthropometry (17–19). and complexity of laboratory techniques make laboratory measurement unsuitable for routine assessment. The third Historical Perspective: From Photographs to and most important reason that the lack of advancement is Lasers problematicisthatcurrenttoolsaresusceptibletohuman As early as 1952, methods were developed to use a pair of error (5), and when manual tools such as measuring tapes facial photographs to create a rough, 3D representation of and length boards are used outside of a research setting— ahumanface(20). The use of 2-dimensional photographs when stringent training and quality control are not in place— for 3D reconstruction was extremely labor intensive, but the result is often poor-quality measurement, especially in processing was eventually automated (21). One of the earliest young children. uses of automated processing of 3D photogrammetry for High-quality manual anthropometry is labor intensive anthropometry was to assess the nutritional status of Amer- and is only possible with well-trained, diligent anthro- ican astronauts; the researcher used a Cray supercomputer pometrists. It is no surprise that poor-quality anthropom- and software from the US Air Force that was designed for etry was documented extensively in health facilities and aerial mapping (M Golden, University of Aberdeen, personal surveys in both developed and developing countries, with communication, 2017) (22). circumferences and lengths showing the worst reliability and In the 1980s, 3D imaging for anthropometry took a accuracy (6–14). Measurement error is particularly common technological leap, advancing from photographs to body in children aged <3 y because many children in this age digitization with lasers via “range imaging,” which is a group will not stay still for measurement and may actively blankettermcoveringvariousmethodsthatprojectlightonto resist measurement, especially when asked to lie down on a thepersonbeingmeasuredandusetriangulationtoconstruct length board. The result of human error is that anthropomet- a3Dsurfacemap(21, 23). Range imaging was applied to ric data quality varies among countries and among surveys anthropometry in the United States in 1986 (24); and around in the same country, making it difficult to meaningfully thesametimeintheUnitedKingdomanotherrangeimaging compare countries, analyze trends over time, or target public system was developed through a collaboration between a health interventions. At the individual level, poor-quality university and the garment manufacturing industry (25); anthropometry limits our ability to monitor growth and leads industry would eventually bring 3D imaging to practical to misclassification of nutritional status during screening. anthropometry applications. The usefulness of anthropometry
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