1
|
Zamberlan P, Mazzoni BP, Bonfim MAC, Vieira RR, Tumas R, Delgado AF. Body composition in pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S84-S102. [PMID: 37721465 DOI: 10.1002/ncp.11061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/26/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023] Open
Abstract
Undernutrition is highly prevalent in children who are critically ill and is associated with increased morbidity and mortality, including a higher risk of infection due to transitory immunological disorders, inadequate wound healing, reduced gut function, longer dependency on mechanical ventilation, and longer hospital stays compared with eutrophic children who are critically ill. Nutrition care studies have proposed that early interventions targeting nutrition assessment can prevent or minimize the complications of undernutrition. Stress promotes an acute inflammatory response mediated by cytokines, resulting in increased basal metabolism and nitrogen excretion and leading to muscle loss and changes in body composition. Therefore, the inclusion of body composition assessment is important in the evaluation of these patients because, in addition to the nutrition aspect, body composition seems to predict clinical prognosis. Several techniques can be used to assess body composition, such as arm measurements, calf circumference, grip strength, bioelectrical impedance analysis, and imaging examinations, including computed tomography and dual-energy x-ray absorptiometry. This review of available evidence suggests that arm measurements seem to be well-established in assessing body composition in children who are critically ill, and that bioelectrical impedance analysis with phase angle, handgrip strength, calf circumference and ultrasound seem to be promising in this evaluation. However, further robust studies based on scientific evidence are necessary.
Collapse
Affiliation(s)
- Patrícia Zamberlan
- Instituto da Criança e do Adolescente/Division of Nutrition, Support Team, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Beatriz P Mazzoni
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Maria A C Bonfim
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rafaela R Vieira
- Instituto da Criança e do Adolescente/Division of Nutrition, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Rosana Tumas
- Instituto da Criança e do Adolescente/Nutrology Unit, Universidade de São Paulo Hospital das Clínicas, São Paulo, Brazil
| | - Artur F Delgado
- Department of Pediatrics - Medical School, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Misirlioglu M, Yildizdas D, Ekinci F, Ozgur Horoz O, Tumgor G, Yontem A, Talay MN, Kangin M, Tufan E, Kesici S, Yener N, Kinik Kaya HE, Havan M, Tunc A, Akçay N, Sevketoglu E, Durak F, Ozel Dogruoz A, Ozcan S, Perk O, Duyu M, Boyraz M, Uysal Yazici M, Ozturk Z, Çeleğen M, Bukulmez A, Kacmaz E, Cagri Dinleyici E, Dursun O, Koker A, Bayraktar S, Talip Petmezci M, Nabaliyeva A, Agin H, Hepduman P, Akkuzu E, Kendirli T, Ozen H, Topal S, Ödek Ç, Ozkale M, Ozkale Y, Atay G, Erdoğan S, Konca C, Yapici G, Arslan G, Besci T, Yilmaz R, Gumus M, Oto A, Dalkiran T, Mercan M, Çoban Y, Ipek S, Gungor S, Arslankoylu AE, Alakaya M, Sari F, Yucel A, Yazar A. Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey. Front Pediatr 2023; 11:1179721. [PMID: 37601138 PMCID: PMC10436004 DOI: 10.3389/fped.2023.1179721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Malnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies. Material and Method In this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined. Results Of the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024). Conclusion Timely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.
Collapse
Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Mehmet Nur Talay
- Department of Pediatrics, Health Sciences University, Gazi Yasargil Training and Research Hospital, Diyarbakir, Türkiye
| | - Murat Kangin
- Department of Pediatric Intensive Care, Faculty of Medicine, Medipol University, Istanbul, Türkiye
| | - Erennur Tufan
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Selman Kesici
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Nazik Yener
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Hatice Elif Kinik Kaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Ali Tunc
- Department of Pediatrics, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Nihal Akçay
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Esra Sevketoglu
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Fatih Durak
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Aysenur Ozel Dogruoz
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Serhan Ozcan
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Oktay Perk
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Merve Boyraz
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Zeynelabidin Ozturk
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Mehmet Çeleğen
- Department of Pediatric Intensive Care, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Aysegul Bukulmez
- Department of Pediatric Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Ebru Kacmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Oguz Dursun
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Alper Koker
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Suleyman Bayraktar
- Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Türkiye
| | - Mey Talip Petmezci
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Aygul Nabaliyeva
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Hasan Agin
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Pinar Hepduman
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Emine Akkuzu
- Department of Pediatric Intensive Care, Isparta City Hospital, Isparta, Türkiye
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Hasan Ozen
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Regional Training and Research Hospital, ErzurumTürkiye
| | - Çağlar Ödek
- Department of Pediatric Intensive Care, Faculty of Medicine, Uludag University, Bursa, Türkiye
| | - Murat Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Yasemin Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Gürkan Atay
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Seher Erdoğan
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Capan Konca
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Guler Yapici
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Tolga Besci
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Resul Yilmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Meltem Gumus
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Arzu Oto
- Department of Pediatric Intensive Care, University of Health Sciences Bursa High Specialization Hospital, Bursa, Türkiye
| | - Tahir Dalkiran
- Department of Pediatric Intensive Care, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Mehmet Mercan
- Department of Pediatrics, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Faculty of Medicine, Mugla University, Mugla, Türkiye
| | - Sevcan Ipek
- Department of Pediatric Intensive Care, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Sukru Gungor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Ali Ertug Arslankoylu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ferhat Sari
- Department of Pediatric Intensive Care, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Aylin Yucel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
| | - Abdullah Yazar
- Department of Pediatric Intensive Care, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
| |
Collapse
|
4
|
Zhu PH, Mhango SN, Vinnakota A, Mansour M, Coss-Bu JA. Effects of COVID-19 Pandemic on Nutritional Status, Feeding Practices, and Access to Food Among Infants and Children in Lower and Middle-Income Countries: a Narrative Review. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:197-206. [PMID: 36249489 PMCID: PMC9549037 DOI: 10.1007/s40475-022-00271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review The COVID-19 pandemic has affected children across the planet and the consequences on their health, nutritional status, and social structure have been more pronounced in low- and middle-income countries (LMICs). This review will focus on the effects of the COVID-19 pandemic on infant growth and feeding practices and access to food and obesity prevalence among children in LMICs. An electronic search was performed on MEDLINE and Embase to identify relevant articles in the English language. Recent Findings A higher prevalence of infections by the SARS-CoV-2 virus and a lower mortality rate were found in children in LMICs compared to western countries. In 2020, 22% and 52% of the wasting and deaths in children under 5 years of age in LMICS came from the sub-Saharan Africa region, respectively. Despite the decrease in stunting from 40% in 1990 to 24.2% in 2019, the prevalence remains above 30% in LMICs. Regarding breastfeeding practices in LMICs, many organizations recommend breastfeeding for infants and children born to infected mothers with SARS-CoV-2. This pandemic has resulted in higher food insecurity and disruption to access to health care and nutrition-related programs from schools; this situation has been more detrimental for younger children from LMICs. Summary Given the devastating effects of the COVID-19 pandemic on the nutritional status, higher food insecurity, and lack of access to health care for infants and children in LMICs, efforts from government, world organizations, and non-for-profit institutions should be implemented to ameliorate the effects of this pandemic.
Collapse
Affiliation(s)
- Paola Hong Zhu
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Susan Nita Mhango
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Anirudh Vinnakota
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Marwa Mansour
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Jorge A. Coss-Bu
- Division of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA ,Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| |
Collapse
|
5
|
Ventura JC, Silveira TT, Bechard L, McKeever L, Mehta NM, Moreno YMF. Nutritional screening tool for critically ill children: a systematic review. Nutr Rev 2021; 80:1392-1418. [PMID: 34679168 DOI: 10.1093/nutrit/nuab075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Nutritional screening tools (NSTs) are used to identify patients who are at risk of nutritional status (NS) deterioration and associated clinical outcomes. Several NSTs have been developed for hospitalized children; however, none of these were specifically developed for Pediatric Intensive Care Unit (PICU) patients. OBJECTIVE A systematic review of studies describing the development, application, and validation of NSTs in hospitalized children was conducted to critically appraise their role in PICU patients. DATA SOURCES PubMed, Embase, Web of Science, Scopus, SciELO, LILACS, and Google Scholar were searched from inception to December 11, 2020. DATA EXTRACTION The review included 103 studies that applied NSTs at hospital admission. The NST characteristics collected included the aims, clinical setting, variables, and outcomes. The suitability of the NSTs in PICU patients was assessed based on a list of variables deemed relevant for this population. DATA ANALYSIS From 19 NSTs identified, 13 aimed to predict NS deterioration. Five NSTs were applied in PICU patients, but none was validated for this population. NSTs did not include clinical, NS, laboratory, or dietary variables that were deemed relevant for the PICU population. CONCLUSION None of the available NSTs were found to be suitable for critically ill children, so a new NST should be developed for this population. AQ6. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020167898.
Collapse
Affiliation(s)
- Julia C Ventura
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Taís T Silveira
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Lori Bechard
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Liam McKeever
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Nilesh M Mehta
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Yara M F Moreno
- Julia C. Ventura, Taís T. Silveira, and Yara M. F. Moreno are with the Graduate Program in Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil. L. Bechard and N. M. Mehta are with the Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA. L. McKeever is with the Perelman School of Medicine, at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. N. M. Mehta is with the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Yara M. F. Moreno is with the Department of Nutrition, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| |
Collapse
|