Table 1

Important technologies for POC assessment of undernutrition

TechnologyTRLCost (approx.)Information providedMode of deploymentInterpretation of resultsSuitability for LMICs (1–5)Development required
Capsule systems
 Wireless capsule endoscopy9$$$Villous morphology (indirect)IHManual interpretation by specialist, automated image analysis feasible2
 Tethered capsule OCT8$$$Villous morphology (direct)IH/POCManual interpretation by specialist (training required), automated analysis feasible3POC validation
 Sampling/biopsy capsules5$$$Microbiota, biomarker quantification, metabolic profiling, villous morphology (via histopathology)IH
(sample freezing and shipping required)
Laboratory analysis required (eg, pathology, MS, etc)2Validation of location specific sampling
Optical spectroscopy
 Transcutaneous fluorescence spectroscopy5$PermeabilityPOCAutomated, on-sensor analysis5Deployable device development, human validation
 Raman spectroscopy4$$Translocation, microbiota, breath sample analysisPOCAutomated analysis feasible (algorithm development required)3Sample preparation techniques, device development
Portable sequencing
 MinION7$$Microbiota/microbiome, biomarker quantification, metabolic profilingPOCOn-site (POC) analysis using laptop3Sample preparation techniques, POC validation
 SmidgION6$$Microbiota/microbiome, biomarker quantification, metabolic profilingPOCOn-site (POC) analysis using laptop or smartphone4Sample preparation techniques, POC validation
Breath tests
 Untargeted9$$Microbiota, biomarker quantification, metabolic profilingPOC
(sample storage and shipping required)
Laboratory analysis required3Validation of biomarkers and sample stability, sample storage technology
 Targeted8$$Microbiota, biomarker quantification, metabolic profilingPOCLaboratory analysis required5Devices for POC analysis, identification and validation of biomarkers
Immune function
 Smartphone-based ELISA/LFIA6$Inflammatory biomarker quantification, immune function (indirect)POCAutomated, on-sensor analysis5Validation for EE biomarkers, device/system optimisation
Miniaturised metabolomics
 Paper strip metabolomics8$Biomarker quantification, metabolic profilingPOC
(sample shipping required)
Laboratory analysis required4Validation of biomarker/metabolite stability
 Portable mass spectrometry3$$Biomarker quantification, metabolic profilingPOCAutomated, on-site analysis feasible (significant development required)4Device/system development
  • The most promising technologies discussed in this article are highlighted here. They are compared against one another in terms of their TRL, cost, the information that they provide, their mode of deployment, the way in which results are interpreted, their suitability for use in LMICs and the further development required. TRL is ranked on a scale of 1–9 (9 represents a mature, commercially available technology; 1 represents an initial concept). Mode of deployment is classed as either IH or POC, with POC referring to use in primary care settings, rural health facilities or domestic environments. Where necessary, the need to freeze and/or ship samples for analysis is also noted. As costs vary according to location and as some technologies have not yet reached market status, costs are provided on a relative scale only (ie, $, $$ or $$$). The suitability for LMICs is rated on a coarse scale of 1–5, with 1 indicating low suitability and 5 indicating high suitability. Scores were generated via qualitative assessment based on a range of factors (including cost, ease of use, need for sample shipping, need for expert analysis, invasiveness, etc).

  • IH, in-hospital; LFIA, lateral flow immunoassay; LMICs, low-income and middle-income countries; MS, mass spectrometry; OCT, optical coherence tomography; POC, point-of-care; TRL, technological readiness level.