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Teshome MS, Verbecque E, Mingels S, Granitzer M, Abessa TG, Bruckers L, Belachew T, Rameckers E. Investigating the Effects of Dietary Supplementation and High-Intensity Motor Learning on Nutritional Status, Body Composition, and Muscle Strength in Children with Moderate Thinness in Southwest Ethiopia: A Cluster-Randomized Controlled Trial. Nutrients 2024; 16:3118. [PMID: 39339716 PMCID: PMC11435431 DOI: 10.3390/nu16183118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND In Ethiopia, moderate thinness (MT) is a persistent issue among children. Yet, evidence on the effects of dietary supplementation and motor skills training in these children is limited. OBJECTIVE This study aimed to assess the effect of Ready-to-Use Supplementary Food (RUSF), whether or not combined with high-intensity motor learning (HiML), on weight, height, body composition, and muscle strength in children 5-7 years old with MT living in Jimma Town, Ethiopia. METHODS A cluster-randomized controlled trial was carried out among 69 children (aged 5-7) with MT assigned to receive RUSF (n = 23), RUSF + HiML (n = 25), or no intervention (control group, n = 21). A multivariable Generalized Estimating Equations model was used and the level of significance was set at alpha < 0.05. RESULTS At baseline, there were no significant differences in the outcome measurements between the RUSF, RUSF + HiML, and control groups. However, after 12 weeks of intervention, there were significant mean differences in differences (DIDs) between the RUSF group and the control arm, with DIDs of 1.50 kg for weight (p < 0.001), 20.63 newton (N) for elbow flexor (p < 0.001), 11.00 N for quadriceps (p = 0.023), 18.95 N for gastrocnemius sup flexor of the leg (p < 0.001), and 1.03 kg for fat-free mass (p = 0.022). Similarly, the mean difference in differences was higher in the RUSF + HiML group by 1.62 kg for weight (p < 0.001), 2.80 kg for grip strength (p < 0.001), 15.93 for elbow flexor (p < 0.001), 16.73 for quadriceps (p < 0.001), 9.75 for gastrocnemius sup flexor of the leg (p = 0.005), and 2.20 kg for fat-free mass (p < 0.001) compared the control arm. CONCLUSION RUSF alone was effective, but combining it with HiML had a synergistic effect. Compared to the control group, the RUSF and RUSF + HiML interventions improved the body composition, height, weight, and muscle strength of the studied moderately thin children. The findings of this study suggest the potential that treating moderately thin children with RUSF and combining it with HiML has for reducing the negative effects of malnutrition in Ethiopia. Future research should explore these interventions in a larger community-based study. This trial has been registered at the Pan African Clinical Trials Registry (PACTR) under trial number PACTR202305718679999.
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Affiliation(s)
- Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma 378, Ethiopia
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
| | - Evi Verbecque
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
| | - Sarah Mingels
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven University, 3000 Leuven, Belgium
| | - Marita Granitzer
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
| | - Teklu Gemechu Abessa
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
- Department of Special Needs and Inclusive Education, Jimma University, Jimma 378, Ethiopia
| | - Liesbeth Bruckers
- I-BioStat, Data Science Institute, Hasselt University, 3590 Hasselt, Belgium
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma 378, Ethiopia
| | - Eugene Rameckers
- Rehabilitation Research Centre (REVAL), Rehabilitation Sciences and Physiotherapy, Hasselt University, Wetenschapspark 7, 3590 Diepenbeek, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, 6200 Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, 6281 Hoensbroek, The Netherlands
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Jimenez EY, Lamers-Johnson E, Long JM, Woodcock L, Bliss C, Steiber AL. Predictive Validity of the Academy of Nutrition and Dietetics/American Society for Parental Nutrition Indicators to Diagnose Malnutrition and the Screening Tool for Risk on Nutritional Status and Growth among Hospitalized Children Relative to Medical Outcomes. J Pediatr 2024; 276:114288. [PMID: 39233117 DOI: 10.1016/j.jpeds.2024.114288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/06/2024]
Abstract
OBJECTIVE To evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. STUDY DESIGN A prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. RESULTS Three hundred and forty-five children were enrolled in the cohort (n = 188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department visits and hospital readmissions, hospital length of stay (LOS), or health care resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more emergency department visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio 1.65, 95% CI: 1.09, 2.49, P = .018; high risk - incidence rate ratio 1.64, 95% CI: 1.05, 2.56, P = .028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, P = .023) for children at high risk compared with children at low risk after adjusting for patient characteristics. CONCLUSIONS Malnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL; Epidemiology Concentration, College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Erin Lamers-Johnson
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.
| | - Julie M Long
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Lindsay Woodcock
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Courtney Bliss
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Alison L Steiber
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
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Orkin S, Hitchcock K, Phillips J, Romantic E, Trauth A, Wessel J, Mouzaki M. Infant versus noninfant formulas and cow's milk: Transition based on age or weight? JPGN REPORTS 2024; 5:353-356. [PMID: 39149193 PMCID: PMC11322026 DOI: 10.1002/jpr3.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/07/2024] [Accepted: 03/29/2024] [Indexed: 08/17/2024]
Abstract
Infant formulas are meant to be used until 1 year of age, at which point children are transitioned to non-infant formulas or cow's milk, depending on their remaining dietary intake. Noninfant formulas and cow's milk are appropriate for children who have an average weight at that 1-year mark (9-9.5 kg); however, can contribute significant protein and/or electrolytes to children who are underweight for age, particularly if they still rely heavily on formula feeding for their caloric intake. In this short communication, we present several cases of patients who received excessive amounts of nutrients for age following the formula transition at the 1-year mark. We also provide recommendations for clinicians to consider when faced with underweight infants who are meant to be transitioning off infant formulas.
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Affiliation(s)
- Sarah Orkin
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kathryn Hitchcock
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jennifer Phillips
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Emily Romantic
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Amiee Trauth
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jacqueline Wessel
- Division of Nutrition TherapyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Marialena Mouzaki
- Division of Gastroenterology, Hepatology and Nutrition, Department of PediatricsCincinnati Children's Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOhioUSA
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Létourneau J, Bélanger V, Marchand V, Boctor DL, Rashid M, Avinashi V, Groleau V, Spahis S, Levy E, Marcil V. Post-discharge complications and hospital readmissions are associated with nutritional risk and malnutrition status in a cohort of Canadian pediatric patients. BMC Pediatr 2024; 24:469. [PMID: 39044205 PMCID: PMC11265476 DOI: 10.1186/s12887-024-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND This study constitutes a secondary analysis of a prospective cohort aiming to evaluate the potential correlation between nutritional risk and status at admission with the occurrence of post-discharge complications and hospital readmissions in children receiving care at high resource Centres. METHODS Data was collected from 5 Canadian tertiary pediatric Centers between 2012 and 2016. Nutritional risk and status were evaluated at hospital admission with validated tools (STRONGkids and Subjective Global Nutrition Assessment [SGNA]) and anthropometric measurements. Thirty days after discharge, occurrence of post-discharge complications and hospital readmission were documented. RESULTS A total of 360 participants were included in the study (median age, 6.1 years; median length of stay, 5 days). Following discharge, 24.1% experienced complications and 19.5% were readmitted to the hospital. The odds of experiencing complications were nearly tripled for participants with a high nutritional risk compared to a low risk (OR = 2.85; 95% CI [1.08-7.54]; P = 0.035) and those whose caregivers reported having a poor compared to a good appetite (OR = 2.96; 95% CI [1.59-5.50]; P < 0.001). According to SGNA, patients identified as malnourished had significantly higher odds of complications (OR, 1.92; 95% CI, 1.15-3.20; P = 0.013) and hospital readmission (OR, 1.95; 95% CI, 1.12-3.39; P = 0.017) than to those well-nourished. CONCLUSIONS This study showed that complications and readmission post-discharge are common, and these are more likely to occur in malnourished children compared to their well-nourished counterparts. Enhancing nutritional care during admission, at discharge and in the community may be an area for future outcome optimization.
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Affiliation(s)
- Joëlle Létourneau
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Véronique Bélanger
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marchand
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Dana L Boctor
- Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mohsin Rashid
- IWK Health Center, Dalhousie University, Halifax, NS, Canada
| | - Vishal Avinashi
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Véronique Groleau
- Department of Pediatrics, Université de Montréal, CHU Sainte-Justine, Montreal, QC, Canada
| | - Schohraya Spahis
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Emile Levy
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada
| | - Valérie Marcil
- Department of Nutrition, Université de Montréal, Research Center CHU Sainte-Justine, 3175 Ch de la Côte-Sainte-Catherine, Room 4.17.006, Montreal, QC, H3T 1C5, Canada.
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Shahnaz T, Fawole AO, Adeyanju AA, Onuh JO. Food Proteins as Functional Ingredients in the Management of Chronic Diseases: A Concise Review. Nutrients 2024; 16:2323. [PMID: 39064766 PMCID: PMC11279393 DOI: 10.3390/nu16142323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Chronic diseases have emerged as a formidable global health concern, with their prevalence steadily rising over the years. Several approaches to addressing these concerns include the use of medications, which are often expensive, contain synthetic chemical substances, and have reported adverse effects. The use of foods, especially proteins, as an alternative approach to addressing chronic health concerns by treating and managing chronic diseases is increasing. This review evaluates the intriguing role of food proteins in mitigating chronic diseases and improving our understanding of the therapeutic potential of different protein types, including those derived from legumes, nuts, and seeds, dairy, fish, and numerous other sources. They have been reported to offer promising avenues for managing chronic diseases, including cardiovascular diseases, diabetes, chronic inflammation, weight management, bone health, glycemic control, muscle preservation, and many other health benefits. Although the exact mechanisms for these actions are still not properly elucidated, it is, however, understood that food proteins exert these health-beneficial effects by their unique nutritional and bioactive profiles, especially their bioactive peptides and amino acids. Practical applications are also discussed, including dietary interventions that are tailored towards incorporating protein-rich foods and the development of functional foods for disease prevention and management. Food proteins are a promising approach to combating chronic diseases that can turn around public health practices.
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Affiliation(s)
- Thaniyath Shahnaz
- Department of Food and Nutritional Sciences, Tuskegee University, 1200 W. Montgomery Rd, Tuskegee, AL 36088, USA;
| | | | - Adeyemi A. Adeyanju
- Department of Food Science and Microbiology, Landmark University, PMB 1001, Omu-Aran 251103, Nigeria;
| | - John O. Onuh
- Department of Food and Nutritional Sciences, Tuskegee University, 1200 W. Montgomery Rd, Tuskegee, AL 36088, USA;
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Murphy JD, Symons HJ, Cooke KR. Nutritional Support Best Practices in Pediatric Blood and Marrow Transplant Patients: An Integrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:637. [PMID: 38929217 PMCID: PMC11202119 DOI: 10.3390/children11060637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024]
Abstract
Nutrition is vital to the long-term survival of children undergoing blood and marrow transplantation (BMT), but there is no standardization on how to optimize the nutritional status of these patients. A literature search was performed to evaluate nutritional support approaches currently in practice for pediatric patients who are undergoing BMT. CINAHL, Embase, and Cochrane databases were searched for peer-reviewed articles evaluating nutritional interventions for BMT recipients aged 20 or younger. Nine articles published between 2019 and 2023 were found and reviewed. The nutritional support varied between enteral nutrition, parenteral nutrition, a combination of both, and prophylactic feeding tube placement. The post-transplant outcomes identified as associated with alterations in nutritional regimens included length of stay, date of platelet engraftment, incidence of acute graft-versus-host disease, infection rate, and overall survival. The use of any amount of enteral nutrition compared to parenteral alone was beneficial. Complications during BMT can potentially be decreased via prioritizing enteral nutrition over parenteral. The paucity of literature on this topic highlights an unmet need in the field. Future research should focus on ways to optimize the nutritional support of transplant recipients, including increasing the likelihood of enteral feeding tube placement and utilization.
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Affiliation(s)
- Jessica D. Murphy
- School of Nursing, Johns Hopkins University, Baltimore, MD 21287, USA;
| | - Heather J. Symons
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
| | - Kenneth R. Cooke
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA;
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Zhang L, Wang L, Long J, Yin Y, Patil S. Nutritional and Body Composition Changes in Paediatric β-Thalassemia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Retrospective Study Using Bioelectrical Impedance Analysis. J Multidiscip Healthc 2024; 17:2203-2214. [PMID: 38751668 PMCID: PMC11094366 DOI: 10.2147/jmdh.s463796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This retrospective study evaluated nutritional status and body composition changes in paediatric β-thalassemia (β-TM) patients before and after hematopoietic stem cell transplantation (HSCT), using bioelectrical impedance analysis (BIA), and explored their relationship with HSCT outcomes. Methods A cohort of 40 paediatric β-TM patients undergoing allogeneic HSCT was assessed for their nutritional status, anthropometric parameters, including body mass index (BMI), weight, and height, and body composition parameters pre-and post-HSCT, focusing on BIA measurements, including intracellular water (ICW), extracellular water (ECW), fat mass (FAT), fat-free mass (FFM), Skeletal Muscle Mass (SMM), soft Lean Mass (SLM), percent body fat (PBF), Body Cell Mass (BCM), Phase angle (PA) and muscle balance pre- and post-HSCT. Post-HSCT clinical outcomes, including acute graft-vs-host disease (aGVHD), engraftment time, oral mucositis (OM), sinusoidal obstruction syndrome (SOS), and diarrhoea in relation to nutrition status after HSCT were analysed. Results After HSCT, 28.21% experienced diminished nutritional status, with 71.43% of those who were wasting before HSCT showing diminished nutritional status, significantly higher than the normal group (18.75%, P = 0.012). Anthropometric changes included significant weight reduction (87.5%, 22.15 ± 7.46 vs 20.74 ± 6.57, P < 0.001) and BMI decrease (90%, 15.19 ± 1.70 vs 14.05 ± 1.48, P < 0.001). Body composition parameters, which are FFM, SMM, SLM, ICW, ECW, BCM, and PA (18.26 ± 5.71 vs 17.27 ± 5.19, 8.68 ± 3.30 vs 7.93 ± 3.02, 17.11 ± 5.28 vs 16.06 ± 4.84, 8.19 ± 2.54 vs 7.62 ± 2.31, 5.15 ± 1.58 vs 4.94 ± 1.47, 11.74 ± 3.63 vs 10.92 ± 3.32, 4.42 ± 0.50 vs 3.90 ± 0.57, respectively, P < 0.001) analysis revealed significant decreases. No significant differences in clinical outcomes were observed based on nutritional status. Conclusion Paediatric β-TM patients undergoing HSCT exhibit significant changes in nutrition status and body composition, emphasizing the need for focused attention on malnourished children who are more prone to diminished nutritional status. Comprehensive BIA aids in understanding the impact, urging consideration for extended follow-up and larger cohorts in future research.
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Affiliation(s)
- Luyang Zhang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Li Wang
- Department of Clinical Nutrition, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Jiewen Long
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Yan Yin
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, 518000, People’s Republic of China
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Lee S, Marshall J, Clarke M, Smith C. 'They don't know what to do with our children': Experiences and views on feeding and swallowing from parents of children who use long-term ventilation. J Child Health Care 2024:13674935241242824. [PMID: 38590229 DOI: 10.1177/13674935241242824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Increasing use of paediatric long-term ventilation (LTV) has been reported around the world over the last two decades and it is anticipated that use of this medical intervention will continue to grow. Research has shown that children who use LTV have risk factors for feeding and swallowing difficulties which result in long-term reliance on non-oral feeding methods. This Patient and Public Involvement (PPI) activity explored experiences of parents of children with LTV on their children's feeding and swallowing journeys. Individual and group interviews with seven parents were conducted. Interview data was then analysed using content analysis. Families discussed a range of themes including impacts on their family, facilitators and barriers to feeding and swallowing journeys, speech and language therapy (SLT) support, their family's healthcare journey in relation to quality of life and future directions for research. This study highlighted potential key areas to explore when identifying ways to improve SLT care and research in feeding and swallowing for children who use LTV.
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Affiliation(s)
- Sabrena Lee
- Evelina London Childrens Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, University College London, London, UK
- Faculty of Brain Sciences, University College London, London, UK
| | - Jeanne Marshall
- Queensland Childrens Hospital, Childrens Health Queensland Hospital and Health Service, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia
| | | | - Christina Smith
- Faculty of Brain Sciences, University College London, London, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, Scotland
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Pike NA, Avedissian T, Halnon NH, Lewis AB, Kumar R. Low pre-albumin but not thiamine predicts cognitive deficits in adolescents post-Fontan and healthy controls. Cardiol Young 2024; 34:803-808. [PMID: 37850442 DOI: 10.1017/s1047951123003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Low pre-albumin, body mass index, and thiamine levels have been associated with poor nutritional status and cognitive/memory deficits in adult heart failure patients. However, the relationship of these nutritional/dietary intake biomarkers to cognition has not been assessed in adolescents post-Fontan procedure and healthy controls. METHODS This is a cross-sectional study. Adolescents (14-21 years of age) post-Fontan completion were recruited from paediatric cardiology clinics and controls from the community. The Montreal Cognitive Assessment was administered (normal ≥ 26), and blood draw (thiamine [normal 70-110 nmol/L] and pre-albumin levels [adolescent normal 23-45 mg/dL]) and the Thiamine Food Frequency Questionnaire were completed by all participants. RESULTS Seventy subjects, 40 post-Fontan (mean age 16 ± 1.6, female 51%, Hispanic 44%, hypoplastic left heart syndrome 26%) and 30 controls (mean age 16.8 ± 1.9, female 52%, Hispanic 66%), were participated. Post-Fontan group had lower median total cognitive scores (23 versus 29, p < 0.001), pre-albumin levels (23 versus 27, p = 0.013), and body mass index (20 versus 24, p = 0.027) than controls. Post-Fontan group had higher thiamine levels than controls (127 versus 103, p = 0.033). Lower pre-albumin levels (< 23) and underweight body mass index were associated with abnormal total cognitive scores (p = 0.030). Low pre-albumin level (p = .038) was an independent predictor of worse cognition. CONCLUSION Lower pre-albumin was an independent predictor for worse cognition in adolescents post-Fontan. Lower pre-albumin levels may reflect chronic liver changes or protein-losing enteropathy seen in Fontan physiology. These findings highlight the possibility for nutrition-induced cognitive changes.
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Affiliation(s)
- Nancy A Pike
- University of California Los Angeles, School of Nursing, Los Angeles, CA, USA
- Department of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tamar Avedissian
- American University of Beirut, Hariri School of Nursing, Beirut, Lebanon
| | - Nancy H Halnon
- Department of Pediatric Cardiology, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Alan B Lewis
- Department of Pediatric Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Departments of Anesthesiology and Radiological Sciences, University of California, Los Angeles, CA, USA
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Squires JE, Raghu VK, Mazariegos GV. Optimizing the pediatric transplant candidate. Curr Opin Organ Transplant 2024; 29:43-49. [PMID: 37823752 DOI: 10.1097/mot.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE OF REVIEW Advances in pediatric transplant parallel those in adult populations; however, there remain critical unique considerations and differences that require specialized knowledge and a specific skill set to optimize care afforded to the pediatric transplant candidate. We introduce general themes regarding optimization of the transplant candidate that are unique to children. RECENT FINDINGS The pathologies leading to pediatric organ transplant candidacy differ from adults and a precise understanding of the physiologies and natural histories of such diseases is critical for optimized care. Regardless of etiology, comorbidities including malnutrition, sarcopenia, and developmental delay are seen and often require disease and organ specific approaches to management. Additionally, an understanding of the concepts of developmental immunology and their relevance to transplant is critical. SUMMARY When looking to optimize pretransplant care, awareness of the pediatric-specific challenges by the transplant community in addition to organ- and age-specific management strategies enable the best outcomes for children awaiting solid organ transplantation.
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Affiliation(s)
- James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh
| | - Vikram K Raghu
- Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh
| | - George V Mazariegos
- Thomas E. Starzl Transplantation Institute, Hillman Center for Pediatric Transplantation, Department of Transplant Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zhong J, Martins DS, Piper HG. Standardizing vitamin D supplementation to minimize deficiency in children with intestinal failure. Nutr Clin Pract 2024; 39:177-183. [PMID: 38030590 DOI: 10.1002/ncp.11094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/17/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is present in 40%-70% of children with intestinal failure (IF), yet there are no published guidelines for repleting and maintaining vitamin D levels in this population. The purpose of this study is to evaluate the efficacy of a standardized vitamin D algorithm in reducing the incidence of deficiency. METHODS A retrospective chart review was performed in children with IF who had at least one serum vitamin D (25-hydroxyvitamin D3 ) measurement. Vitamin D levels were compared prealgorithm (2014-2016) and during active-algorithm use (2018-2020). Vitamin D levels were classified as severe deficiency (<12.5 nmol per L), mild deficiency (12.5-39 nmol/L), insufficiency (40-74 nmol/L), optimal (75-224 nmol/L), or toxicity (>225 nmol/L). Descriptive and comparative statistics were calculated using a linear mixed-effects model, with P < 0.05 considered significant. RESULTS Twenty-eight children with IF were enrolled, which included 157 vitamin D measurements (58 in the prealgorithm group and 98 in the active-algorithm group). Algorithm compliance was 4% in the prealgorithm group and 61% in the active-algorithm group. Active-algorithm patients had improved vitamin D levels in all categories compared with those of prealgorithm patients (mild deficiency: 8% vs 9%; insufficiency: 41% vs 72%; optimal: 50% vs 19%). Algorithm use was found to have a statistically significant effect on serum vitamin D levels (β = 21.58; 95% confidence interval, 14.11-29.05; P < 0.005). CONCLUSIONS Children with IF are at high risk for vitamin D deficiency. Use of a standardized vitamin D supplementation algorithm was associated with increased serum vitamin D levels.
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Affiliation(s)
- Jade Zhong
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Debby S Martins
- Complex Feeding and Nutrition Service, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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12
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Robyn S, Veronica N, Stephen B, Joanne P. Undernutrition in young children with congenital heart disease undergoing cardiac surgery in a low-income environment. BMC Pediatr 2024; 24:73. [PMID: 38262979 PMCID: PMC10804775 DOI: 10.1186/s12887-023-04508-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Malnutrition (undernutrition) in children with congenital disease (CHD) is a notable concern, with preoperative and persistent growth failure post-cardiac surgery contributing to poorer outcomes. Poor growth in children with CHD in low-income environments is exacerbated by feeding difficulties, poverty, delayed diagnosis, and late corrective surgery. This study describes and compares the growth of young children with CHD undergoing cardiac surgery in central South Africa from before to 6-months after cardiac surgery. METHODS Children 30 months and younger, with their mothers, were included in this prospective observational descriptive study. Weight- height-, and head circumference-for-age z-scores were used to identify children who were underweight, stunted and microcephalic. Z-scores for growth indices were compared from baseline to 3-months and 6-months post-cardiac surgery. Changes in growth over time were calculated using a 95% confidence interval on the difference between means. Linear regression was used to determine the association between growth and development, health-related quality of life and parenting stress respectively. RESULTS Forty mother-child pairs were included at baseline. Most children (n = 30) had moderate disease severity, with eight children having cyanotic defects. A quarter of the children had Down syndrome (DS). Twenty-eight children underwent corrective cardiac surgery at a median age of 7.4 months. Most children (n = 27) were underweight before cardiac surgery [mean z-score - 2.5 (±1.5)], and many (n = 18) were stunted [mean z-score - 2.2 (±2.5)]. A quarter (n = 10) of the children had feeding difficulties. By 6-months post-cardiac surgery there were significant improvements in weight (p = 0.04) and head circumference (p = 0.02), but complete catch-up growth had not yet occurred. Malnutrition (undernutrition) was strongly associated (p = 0.04) with poorer motor development [Mean Bayley-III motor score 79.5 (±17.5)] before cardiac surgery. Growth in children with cyanotic and acyanotic defects, and those with and without DS were comparable. CONCLUSION Malnutrition (undernutrition) is common in children with CHD in central South Africa, a low-income environment, both before and after cardiac surgery, and is associated with poor motor development before cardiac surgery. A diagnosis of CHD warrants regular growth monitoring and assessment of feeding ability. Early referral for nutritional support and speech therapy will improve growth outcomes.
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Affiliation(s)
- Smith Robyn
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- School of Health and Rehabilitation Sciences, University of the Free State, Bloemfontein, South Africa.
| | - Ntsiea Veronica
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Brown Stephen
- Department of Pediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
| | - Potterton Joanne
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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13
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Daidone C, Carper S. Differential Diagnosis and Interdisciplinary Workup of a Pediatric Patient With an Unknown Immune Condition: Chronic Respiratory Distress Secondary to Viral Illness and Developmental Consequences. Cureus 2024; 16:e53109. [PMID: 38414706 PMCID: PMC10898650 DOI: 10.7759/cureus.53109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
We present a case of a three-year-old African American male, born at term, who initially presented with bronchiolitis at six months and has since experienced recurrent episodes of respiratory distress and hospitalizations. The patient also has severe eczema, developmental delays, and recurrent viral illnesses. Despite thorough evaluations from various specialists, such as pulmonology, allergy, and gastroenterology, the underlying cause remained elusive. The differential diagnosis for this case is as follows: severe persistent asthma with a possible link to genetic mutations such as CDHR3, hyper-IgE syndrome, atypical presentation of Wiskott-Aldrich syndrome, and severe gastroesophageal reflux disease (GERD) with aspiration pneumonitis. This patient's chronic condition has contributed to several developmental consequences, including failure to gain weight and possible hypoxic encephalopathy, leading to delays in cognitive and motor milestones and speech delays. Aggressive medical management, especially long-term systemic steroids, raises concerns about future complications. Through this case, we highlight the importance of thorough workups and an interdisciplinary approach to diagnosing and managing an unknown immune condition, as well as consistent pediatric primary care follow-up to assess development and coordinate necessary support. Here, we aim to address a gap in research on the unique presentations of pediatric respiratory distress symptoms by formulating a comprehensive differential diagnosis and exploring the various ways that chronic respiratory illness can contribute to developmental deficits such as speech and cognitive delays in pediatric patients. This study calls for further research into genetic contributions to asthma, diverse presentations of GERD, prevention of viral illnesses, alternative treatments minimizing steroid use, and an understanding of the impact of chronic respiratory distress on cognitive and language development in children. Thorough workups and interdisciplinary approaches are essential for effective diagnosis and management.
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Affiliation(s)
- Camryn Daidone
- Research, Edward Via College of Osteopathic Medicine, Shreveport, USA
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14
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Calcaterra V, Mannarino S, Garella V, Rossi V, Biganzoli EM, Zuccotti G. Cardiovascular Risk in Pediatrics: A Dynamic Process during the First 1000 Days of Life. Pediatr Rep 2023; 15:636-659. [PMID: 37987283 PMCID: PMC10661305 DOI: 10.3390/pediatric15040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
The early childhood period, encompassing prenatal and early stages, assumes a pivotal role in shaping cardiovascular risk factors. We conducted a narrative review, presenting a non-systematic summation and analysis of the available literature, focusing on cardiovascular risk from prenatal development to the first 1000 days of life. Elements such as maternal health, genetic predisposition, inadequate fetal nutrition, and rapid postnatal growth contribute to this risk. Specifically, maternal obesity and antibiotic use during pregnancy can influence transgenerational risk factors. Conditions at birth, such as fetal growth restriction and low birth weight, set the stage for potential cardiovascular challenges. To consider cardiovascular risk in early childhood as a dynamic process is useful when adopting a personalized prevention for future healthcare and providing recommendations for management throughout their journey from infancy to early adulthood. A comprehensive approach is paramount in addressing early childhood cardiovascular risks. By targeting critical periods and implementing preventive strategies, healthcare professionals and policymakers can pave the way for improved cardiovascular outcomes. Investing in children's health during their early years holds the key to alleviating the burden of cardiovascular diseases for future generations.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Vittoria Garella
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, University Hospital, University of Milan, 20157 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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15
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Novina N, Ritonga MA, Yusuf AS. Gonadotropin Levels and Underlying Diseases in Adolescent With Secondary Amenorrhea. Int J Womens Health 2023; 15:1397-1404. [PMID: 37701180 PMCID: PMC10493105 DOI: 10.2147/ijwh.s412482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose To provide characteristics and hormonal profiles of secondary amenorrhea cases in adolescent patients treated at Hasan Sadikin General Hospital in Bandung. Patients and Methods The study was retrospective in nature and involved the analysis of medical records from 2017 to 2022 for 44 adolescent patients aged 10-18 who had secondary amenorrhea. Results There were 44 adolescents included in this study after excluded 69 adults from 113 secondary amenorrhea cases. The majority of patients were 14-17 years old (38.63%), in senior high school (45.45%), had started menarche at 11 years old (45.45%), had normal nutritional status (65.91%), and had normal stature (65.91%). The underlying diseases found in most patients were systemic lupus erythematosus (SLE) and tuberculosis. Among the patients, 29 had FSH, LH, and estradiol levels measured. The results of hormonal assays showed a wide range of abnormal serum levels, with normal to low concentrations of FSH and low levels of LH and estradiol. The median (interquartile range) results for FSH, LH, and estradiol were 4.57 (0.64, 90.65), 1.635 (0.06, 55.76), and 24.3 (0.2, 154.71), respectively. Positive significant correlation between FSH and LH (p < 0.01) was found in children with secondary amenorrhea. Conclusion Hormonal assay for FSH, LH, and Estradiol showed a wide range of abnormal serum level. Normal to low concentration levels of FSH and low LH and estradiol. The majority of secondary amenorrhea patients are associated with autoimmune disease and infection.
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Affiliation(s)
- Novina Novina
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Mulyanusa Amarullah Ritonga
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran / Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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16
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Acar-Tek N, Ağagündüz D, Şahin TÖ, Baygut H, Uzunlar EA, Zakkour HK, Karaçallı A. Validation of predictive equations for resting energy expenditure in children and adolescents with different body mass indexes. Nutr J 2023; 22:39. [PMID: 37559059 PMCID: PMC10413768 DOI: 10.1186/s12937-023-00868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Accurate estimation of resting energy expenditure (REE) in children and adolescents is important to establish estimated energy requirements. The objective of this study was to assess the validity of existing equations in literature and a newly developed equation in estimating REE in children and adolescents. METHODS 275 participants (148 boys, 127 girls) aged 6-18 years included in the study were classified as normal-weighted, overweight, obese based on BMI z-scores for age according to WHO-2007 growth curves for 5-19 years of age. REEs were measured using an indirect calorimeter, with various equations, and a newly established equation [REE = 505.412+(24.383*FFM);Adjusted R2 = 0.649] were compared with REE measured using Bland-Altman and further validation parameters. RESULTS When the predicted REEs were compared with the measured REEs, the highest prediction accuracy was achieved using the new Eq. (64.8%) and IOM (63.8%) for normal-weight participants, Müller FFM and new Eq. (59.6%) for overweight participants and Lazzer (44.9%) for obese participants. In normal and overweight participants, lowest root mean squared error (RMSE) values were acquired from Schmelzle's equation (respectively 136.2;159.9 kcal/d), and the highest values were found in Kim's Eq. (315.2; 295.2 kcal/d respectively). RMSE value of the new equation was 174.7 kcal/d for normal-weight children and adolescents, and 201.9 kcal/d for overweight ones. In obese participants, the lowest RMSE value was obtained from Schmelzle's Eq. (305.4 kcal/d) and the new Eq. (317.4 kcal/d), while the highest value was obtained from IOM Eq. (439.9 kcal/d). RMSE was higher in obese groups compared to the other BMI groups. CONCLUSION Indirect-calorimeter is the most suitable method for REE measurement in especially obese children and adolescents. The new equation and Schmelzle's equation appear to be most accurate equations for normal and overweight children and adolescents.
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Affiliation(s)
- Nilüfer Acar-Tek
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Duygu Ağagündüz
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey.
| | - Teslime Özge Şahin
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Hatice Baygut
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Süleyman Demirel University, Isparta, Turkey
| | - Elif Adanur Uzunlar
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Karadeniz Technical University, Trabzon, Turkey
| | - Hazal Küçükkaraca Zakkour
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayşegül Karaçallı
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Tokat Gaziosmanpaşa University, Tokat, Turkey
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Souza ACD, Silva DGD, Jezuíno JDS, Ferreira ARO, Ribeiro MVG, Vidigal CB, Moura KF, Erthal RP, Mathias PCDF, Fernandes GSA, Palma-Rigo K, Ceravolo GS. Protein restriction during peripubertal period impairs endothelial aortic function in adult male Wistar rats. J Dev Orig Health Dis 2023; 14:451-458. [PMID: 37198976 DOI: 10.1017/s2040174423000119] [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: 05/19/2023]
Abstract
Protein restriction during early phases of body development, such as intrauterine life can favor the development of vascular disorders. However, it is not known if peripubertal protein restriction can favor vascular dysfunction in adulthood. The present study aimed to evaluated whether a protein restriction diet during peripubertal period favors endothelial dysfunction in adulthood. Male Wistar rats from postnatal day (PND) 30 until 60 received a diet with either 23% protein (CTR group) or with 4% protein (LP group). At PND 120, the thoracic aorta reactivity to phenylephrine, acetylcholine, and sodium nitroprusside was evaluated in the presence or absence of: endothelium, indomethacin, apocynin and tempol. The maximum response (Rmax) and pD2 (-log of the concentration of the drug that causes 50% of the Rmax) were calculated. The lipid peroxidation and catalase activity were also evaluated in the aorta. The data were analyzed by ANOVA (one or two-ways and Tukey's) or independent t-test; the results were expressed as mean ± S.E.M., p < 0.05. The Rmax to phenylephrine in aortic rings with endothelium were increased in LP rats when compared with the Rmax in CTR rats. Apocynin and tempol reduced Rmax to phenylephrine in LP aortic rings but not in CTR. The aortic response to the vasodilators was similar between the groups. Aortic catalase activity was lower and lipid peroxidation was greater in LP compared to CTR rats. Therefore, protein restriction during the peripubertal period causes endothelial dysfunction in adulthood through a mechanism related to oxidative stress.
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Affiliation(s)
- Amanda Cristina de Souza
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Deborah Gomes da Silva
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | - Juliana da Silva Jezuíno
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Anna Rebeka Oliveira Ferreira
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
| | - Maiara Vanusa Guedes Ribeiro
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
| | - Camila Borecki Vidigal
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Kawane Fabricio Moura
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
| | - Rafaela Pires Erthal
- Department of General Biology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | | | - Glaura Scantamburlo Alves Fernandes
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
- Department of General Biology, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
| | - Kesia Palma-Rigo
- Department of Cell Biology and Genetics, Center of Biological Sciences, State University of Maringa, Maringa, Brazil
- Adventist College of Parana, Ivatuba, Brazil
| | - Graziela Scalianti Ceravolo
- Department of Physiological Sciences, Center of Biological Sciences, State University of Londrina, Londrina, Brazil
- Graduation Program of Physiological Sciences, Department of Physiological Sciences, State University of Londrina, Londrina, Brazil
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18
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Russel WA, Perry J, Bonzani C, Dontino A, Mekonnen Z, Ay A, Taye B. Feature selection and association rule learning identify risk factors of malnutrition among Ethiopian schoolchildren. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1150619. [PMID: 38455884 PMCID: PMC10910994 DOI: 10.3389/fepid.2023.1150619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/20/2023] [Indexed: 03/09/2024]
Abstract
Introduction Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors. Methods This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets. Results Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods. Discussion Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children.
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Affiliation(s)
- William A. Russel
- Department of Biology, Colgate University, Hamilton, NY, United States
| | - Jim Perry
- Department of Computer Science, Colgate University, Hamilton, NY, United States
| | - Claire Bonzani
- Department of Mathematics, Colgate University, Hamilton, NY, United States
| | - Amanda Dontino
- Department of Biology, Colgate University, Hamilton, NY, United States
| | - Zeleke Mekonnen
- Institute of Health, School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Ahmet Ay
- Department of Biology, Colgate University, Hamilton, NY, United States
- Department of Mathematics, Colgate University, Hamilton, NY, United States
| | - Bineyam Taye
- Department of Biology, Colgate University, Hamilton, NY, United States
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Centeno-Malfaz F, Moráis-López A, Caro-Barri A, Peña-Quintana L, Gil-Villanueva N, Redecillas-Ferreiro S, Marcos-Alonso S, Ros-Arnal I, Tejero MÁ, Sánchez CS, Leis R. Nutrition in congenital heart disease: consensus document. An Pediatr (Barc) 2023; 98:373-383. [PMID: 37137772 DOI: 10.1016/j.anpede.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION The prevalence of malnutrition among infants with congenital heart disease (CHD) is high. Early nutritional assessment and intervention contribute significantly to its treatment and improve outcomes. Our objective was to develop a consensus document for the nutritional assessment and management of infants with CHD. MATERIAL AND METHODS We employed a modified Delphi technique. Based on the literature and clinical experience, a scientific committee prepared a list of statements that addressed the referral to paediatric nutrition units (PNUs), assessment, and nutritional management of infants with CHD. Specialists in paediatric cardiology and paediatric gastroenterology and nutrition evaluated the questionnaire in 2 rounds. RESULTS Thirty-two specialists participated. After two evaluation rounds, a consensus was reached for 150 out of 185 items (81%). Cardiac pathologies associated with a low and high nutritional risk and associated cardiac or extracardiac factors that carry a high nutritional risk were identified. The committee developed recommendations for assessment and follow-up by nutrition units and for the calculation of nutritional requirements, the type of nutrition and the route of administration. Particular attention was devoted to the need for intensive nutrition therapy in the preoperative period, the follow-up by the PNU during the postoperative period of patients who required preoperative nutritional care, and reassessment by the cardiologist in the case nutrition goals are not achieved. CONCLUSIONS These recommendations can be helpful for the early detection and referral of vulnerable patients, their evaluation and nutritional management and improving the prognosis of their CHD.
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Affiliation(s)
- Fernando Centeno-Malfaz
- Servicio de Pediatría Hospital Universitario Río Hortega, Servicio Pediatría Hospital Recoletas Campogrande, Valladolid, Spain
| | - Ana Moráis-López
- Unidad de Nutrición Infantil y Enfermedades Metabólicas, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Caro-Barri
- Instituto Pediátrico del Corazón, Servicio de Pediatría, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Peña-Quintana
- Sección Gastroenterología, Hepatología y Nutrición Pediátrica, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas, Las Palmas de Gran Canaria, Spain
| | - Nuria Gil-Villanueva
- Cardiología Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Susana Redecillas-Ferreiro
- Unidad de Gastroenterología y Soporte Nutricional Pediátrico, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Sonia Marcos-Alonso
- Unidad de Cardiología Infantil, Servicio de Pediatría, Hospital Materno Infantil de A Coruña, A Coruña, Spain
| | - Ignacio Ros-Arnal
- Unidad de Gastroenterología y Nutrición Pediátrica, Hospital Miguel Servet, Zaragoza, Spain
| | - María Ángeles Tejero
- Cardiología Pediátrica, Unidad de Gestión Clínica (UGC) de Pediatría, Hospital Regional Universitario Reina Sofía, Córdoba, Spain
| | - César Sánchez Sánchez
- Servicio de Digestivo, Hepatología y Nutrición Infantil, Hospital Materno Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rosaura Leis
- Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
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Mousikou M, Kyriakou A, Skordis N. Stress and Growth in Children and Adolescents. Horm Res Paediatr 2023; 96:25-33. [PMID: 34814153 DOI: 10.1159/000521074] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/19/2021] [Indexed: 11/19/2022] Open
Abstract
The infantile, childhood, and adolescent periods of growth and development also represent times of increased vulnerability to stressors. Growth velocity in each period is dependent on the interplay of genetic, environmental, dietary, socioeconomic, developmental, behavioral, nutritional, metabolic, biochemical, and hormonal factors. A stressor may impact growth directly through modulation of the growth hormone axis or indirectly through other factors. The adaptive response to stressors culminates in behavioral, physiological, and biochemical responses which together support survival and conservation of energy. The immediate response involves activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The time-limited stress response is at once antigrowth, antireproductive, and catabolic with no lasting adverse consequences. However, chronic activation of the stress system and hypercortisolism have consequential negative impacts on growth, thyroid function, reproduction-puberty, and metabolism. High cortisol suppresses growth hormone-insulin-like growth factor 1, hypothalamic-pituitary-gonadal, and thyroid axes and has been reported to be responsible for an increase in visceral adiposity, a decrease in lean mass, suppression of osteoblastic activity with risk of osteoporosis, and induction of insulin resistance. Early-life adversities, emotional or physical, have been associated with long-term negative physical and mental health outcomes. Existing models of chronic stress corroborate that early-life adversities can affect growth and have consequences in other aspects of well-being throughout the lifespan. Targeted interventions to reduce stress during infancy, childhood, and adolescence can have far-reaching benefits to long-term health as well as attaining adequate growth. In this review, we describe the neuroendocrinology of the stress response, the factors influencing growth, and the impact of chronic stress on growth during critical periods of infancy, childhood, and puberty with particular reference to growth, thyroid, and gonadal axis.
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Affiliation(s)
- Maria Mousikou
- Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
| | - Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.,School of Medicine, University of Nicosia, Nicosia, Cyprus
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21
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Centeno-Malfaz F, Moráis-López A, Caro-Barri A, Peña-Quintana L, Gil-Villanueva N, Redecillas-Ferreiro S, Marcos-Alonso S, Ros-Arnal I, Ángeles Tejero M, Sánchez Sánchez C, Leis R. La nutrición en las cardiopatías congénitas: Documento de consenso. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Mignot M, Huguet H, Cambonie G, Guillaumont S, Vincenti M, Blanc J, Ovaert C, Picot MC, Karsenty C, Amedro P, Kollen L, Gavotto A. Risk factors for early occurrence of malnutrition in infants with severe congenital heart disease. Eur J Pediatr 2023; 182:1261-1269. [PMID: 36633658 DOI: 10.1007/s00431-023-04812-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
To identify the risk factors of early occurrence of malnutrition in infants with severe congenital heart disease (CHD) during their first year of life. Retrospective longitudinal multicenter study carried out from January 2014 to December 2020 in two tertiary care CHD centers. Four CHD hemodynamic groups were identified. Malnutrition was defined by a Waterlow score under 80% and/or underweight under -2 standard deviations. A total of 216 infants with a severe CHD, e.g., requiring cardiac surgery, cardiac catheterization, or hospitalization for heart failure during their first year of life, were included in the study. Malnutrition was observed among 43% of the cohort, with the highest prevalence in infants with increased pulmonary blood flow (71%) compared to the other hemodynamic groups (p < 0.001). In multivariate analysis, low birthweight (OR 0.62, 95% CI 0.44-0.89, p = 0.009), CHD with increased pulmonary blood flow (OR 4.80, 95% CI 1.42-16.20, p = 0.08), heart failure (OR 9.26, 95% CI 4.04-21.25, p < 0.001), and the number of hospitalizations (OR 1.35, 95% CI 1.08 l-1.69, p = 0.009) during the first year of life were associated with malnutrition (AUC 0.85, 95% CI 0.79-0.90). Conclusions: In infants with a severe CHD, early occurrence of malnutrition during the first year of life affected a high proportion of subjects. CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations were risk factors for malnutrition. Further studies are required to identify optimal nutritional support in this population. What is Known: • Malnutrition is a known morbidity and mortality factor in children with severe congenital heart disease. What is New: • Early occurrence of malnutrition during the first year of life in infant severe congenital heart disease (CHD) was high (43%). • CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations during the first year of life were risk factors for malnutrition.
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Affiliation(s)
- Margot Mignot
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France
- Pathogenesis and Control of Chronic Infection, INSERM, UMR 1058, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
- Pediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Marie Vincenti
- Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, Montpellier University Hospital, Montpellier, France
| | - Julie Blanc
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, Timone Children Hospital, Aix-Marseille University, Marseille, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, Montpellier University Hospital, Montpellier, France
- Epidemiology and Biostatistics, Clinical Investigation Centre, INSERM, University of Montpellier, Montpellier, France
| | - Clement Karsenty
- Pediatric Cardiology Unit, Children Hospital, Toulouse Hospital, Toulouse, France
- Institut Des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, INSERM U1048, I2MC, Toulouse, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Pessac, France
| | - Laura Kollen
- Department of Pediatric Gastroenterology, Montpellier University Hospital, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Giraud, Montpellier, 34295, France.
- PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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Lelii M, Senatore L, Paglialonga F, Consolo S, Montini G, Rocchi A, Marchisio P, Patria MF. Respiratory complications and sleep disorders in children with chronic kidney disease: A correlation often underestimated. Paediatr Respir Rev 2023; 45:16-22. [PMID: 35534343 DOI: 10.1016/j.prrv.2021.12.003] [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: 10/07/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022]
Abstract
Chronic Kidney Disease (CKD) is characterized by a progressive and irreversible loss of kidney function which gradually leads to end-stage kidney disease (ESKD). Virtually all the organs are damaged by the toxicity of uremic compounds. The lungs may be affected and the impaired pulmonary function may be the direct result of fluid retention and metabolic, endocrine and cardiovascular alterations, as well as systemic activation of the inflammation. An increased prevalence in sleep disorders (SD) is also reported in patients with CKD, leading to a further negative impact on overall health and quality of life. While these complex relationships are well documented in the adult population, these aspects remain relatively little investigated in children. The aim of this review is to provide a brief overview of the pathophysiology between lung and kidney and to summarize how CKD may affect respiratory function and sleep in children.
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Affiliation(s)
- M Lelii
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
| | - L Senatore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy
| | - F Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - S Consolo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy.
| | - G Montini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Nephrology, Dialysis and Transplant Unit, Via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - A Rocchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, via della Commenda 9, 20122 Milan, Italy.
| | - P Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - M F Patria
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, via della Commenda 9, 20122 Milan, Italy.
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24
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[Validation of the instrument "Infant Malnutrition and Feeding Checklist for Congenital Heart Disease", a tool to identify risk of malnutrition and feeding difficulties in infants with congenital heart disease]. NUTR HOSP 2023; 40:303-311. [PMID: 36880736 DOI: 10.20960/nh.04388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION currently, various tools have been designed to timely detect the risk of malnutrition in hospitalized children. In those with a diagnosis of congenital heart disease (CHD), there is only one tool developed in Canada: Infant Malnutrition and Feeding Checklist for Congenital Heart Disease (IMFC:CHD), which was designed in English. OBJECTIVE to evaluate the validity and reliability of the Spanish adaptation of the IMFC:CHD tool in infants with CHD. METHODS cross-sectional validation study carried out in two stages. The first, of translation and cross-cultural adaptation of the tool, and the second, of validation of the new translated tool, where evidence of reliability and validity were obtained. RESULTS in the first stage, the tool was translated and adapted to the Spanish language; for the second stage, 24 infants diagnosed with CHD were included. The concurrent criterion validity between the screening tool and the anthropometric evaluation was evaluated, obtaining a substantial agreement (κ = 0.660, 95 % CI: 0.36-0.95) and for the predictive criterion validity, which was compared with the days of hospital stay, moderate agreement was obtained (κ = 0.489, 95 % CI: 0.1-0.8). The reliability of the tool was evaluated through external consistency, measuring the inter-observer agreement, obtaining a substantial agreement (κ = 0.789, 95 % CI: 0.5-0.9), and the reproducibility of the tool showed an almost perfect agreement (κ = 1, CI 95 %: 0.9-1.0). CONCLUSIONS the IMFC:CHD tool showed adequate validity and reliability, and could be considered as a useful resource for the identification of severe malnutrition.
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25
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Costa MDCN, Cardim LL, Moore CA, de Jesus EDS, Carvalho-Sauer R, Barreto ML, Rodrigues LC, Smeeth L, Schuler-Faccini L, Brickley EB, Oliveira WK, Carmo EH, Pescarini JM, Andrade RFS, Rodrigues MMS, Veiga RV, Costa LC, França GVA, Teixeira MG, Paixão ES. Causes of death in children with congenital Zika syndrome in Brazil, 2015 to 2018: A nationwide record linkage study. PLoS Med 2023; 20:e1004181. [PMID: 36827251 PMCID: PMC9956022 DOI: 10.1371/journal.pmed.1004181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/23/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Children with congenital Zika syndrome (CZS) have severe damage to the peripheral and central nervous system (CNS), greatly increasing the risk of death. However, there is no information on the sequence of the underlying, intermediate, immediate, and contributing causes of deaths among these children. The aims of this study are describe the sequence of events leading to death of children with CZS up to 36 months of age and their probability of dying from a given cause, 2015 to 2018. METHODS AND FINDINGS In a population-based study, we linked administrative data on live births, deaths, and cases of children with CZS from the SINASC (Live Birth Information System), the SIM (Mortality Information System), and the RESP (Public Health Event Records), respectively. Confirmed and probable cases of CZS were those that met the criteria established by the Brazilian Ministry of Health. The information on causes of death was collected from death certificates (DCs) using the World Health Organization (WHO) DC template. We estimated proportional mortality (PM%) among children with CZS and among children with non-Zika CNS congenital anomalies (CA) by 36 months of age and proportional mortality ratio by cause (PMRc). A total of 403 children with confirmed and probable CZS who died up to 36 months of age were included in the study; 81.9% were younger than 12 months of age. Multiple congenital malformations not classified elsewhere, and septicemia unspecified, with 18 (PM = 4.5%) and 17 (PM = 4.2%) deaths, respectively, were the most attested underlying causes of death. Unspecified septicemia (29 deaths and PM = 11.2%) and newborn respiratory failure (40 deaths and PM = 12.1%) were, respectively, the predominant intermediate and immediate causes of death. Fetuses and newborns affected by the mother's infectious and parasitic diseases, unspecified cerebral palsy, and unspecified severe protein-caloric malnutrition were the underlying causes with the greatest probability of death in children with CZS (PMRc from 10.0 to 17.0) when compared to the group born with non-Zika CNS anomalies. Among the intermediate and immediate causes of death, pneumonitis due to food or vomiting and unspecified seizures (PMRc = 9.5, each) and unspecified bronchopneumonia (PMRc = 5.0) were notable. As contributing causes, fetus and newborn affected by the mother's infectious and parasitic diseases (PMRc = 7.3), unspecified cerebral palsy, and newborn seizures (PMRc = 4.5, each) were more likely to lead to death in children with CZS than in the comparison group. The main limitations of this study were the use of a secondary database without additional clinical information and potential misclassification of cases and controls. CONCLUSION The sequence of causes and circumstances involved in the deaths of the children with CZS highlights the greater vulnerability of these children to infectious and respiratory conditions compared to children with abnormalities of the CNS not related to Zika.
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Affiliation(s)
- Maria da Conceição N. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Luciana Lobato Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Cynthia A. Moore
- Goldbelt Professional Services, LLC, Chesapeake, Virginia, United States of America
| | - Eliene dos Santos de Jesus
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- Municipal Health Department, Department of Health Information, Salvador, Bahia, Brazil
| | - Rita Carvalho-Sauer
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
- East Regional Health Center, State Health Secretariat of Bahia, Santo Antonio de Jesus, Bahia, Brazil
| | - Mauricio L. Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Laura C. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lavínia Schuler-Faccini
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Wanderson K. Oliveira
- Technical Directorate of Education and Research, Ministry of Defense Hospital das Armed Forces, Brasília, Distrito Federal, Brazil
| | - Eduardo Hage Carmo
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Julia Moreira Pescarini
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Roberto F. S. Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Physics Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Moreno M. S. Rodrigues
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Rafael V. Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Larissa C. Costa
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Giovanny V. A. França
- Secretariat of Health Surveillance, Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - Maria Gloria Teixeira
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Enny S. Paixão
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Belyaeva IA, Bombardirova EP, Prihodko EA, Kruglyakov AY, Mikheeva AA, Larina AR. Clinical Phenotypes of Malnutrition in Young Children: Differential Nutritional Correction. CURRENT PEDIATRICS 2023. [DOI: 10.15690/vsp.v21i6.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.
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Affiliation(s)
- I. A. Belyaeva
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University; Morozovskaya Children’s City Hospital
| | - E. P. Bombardirova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - A. A. Mikheeva
- Research Institute for Healthcare Organization and Medical Management
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Diaz GA, Giugliani R, Guffon N, Jones SA, Mengel E, Scarpa M, Witters P, Yarramaneni A, Li J, Armstrong NM, Kim Y, Ortemann-Renon C, Kumar M. Long-term safety and clinical outcomes of olipudase alfa enzyme replacement therapy in pediatric patients with acid sphingomyelinase deficiency: two-year results. Orphanet J Rare Dis 2022; 17:437. [PMID: 36517856 PMCID: PMC9749157 DOI: 10.1186/s13023-022-02587-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Olipudase alfa is a recombinant human acid sphingomyelinase (ASM) enzyme replacement therapy (ERT) for non-central-nervous-system manifestations of acid sphingomyelinase deficiency (ASMD). We report 2-year cumulative safety and efficacy data after olipudase alfa treatment in 20 children (four adolescents [12-17 year], nine children [6-11 year], and seven infants/early child [1-5 year]) with baseline splenomegaly and growth deficits who completed the 1-year ASCEND-Peds clinical trial (NCT02292654) and who continue to receive olipudase alfa in a long-term study (NCT02004704). Efficacy endpoints include spleen and liver volumes, diffusing capacity of the lung for carbon monoxide (DLCO), high-resolution computed tomography (HRCT) lung imaging, lipid profiles, liver function tests, and height Z-scores. RESULTS All 20 former ASCEND-Peds patients completed at least 2 years of olipudase alfa treatment. No patient discontinued and no new safety issue arose during the second year of treatment; 99% of adverse events were mild or moderate. During year 2, one patient had two treatment-related serious events of hypersensitivity that resolved. Mean reductions from baseline in spleen and liver volumes were 61% and 49%, respectively (p < 0.0001) and mean percent-predicted-DLCO increased by 46.6% (p < 0.0001) in nine patients who performed the test at baseline. Lipid profiles and elevated liver transaminase levels that improved or normalized by 1 year remained stable. Mean height Z-scores improved in all age groups (mean change from baseline 1.17, P < 0.0001). CONCLUSION Olipudase alfa was generally well-tolerated during 2 years of treatment. Improvements in clinically relevant disease endpoints observed during the first year of treatment were maintained or augmented in the second year. Trial registration NCT02004704 registered 26 Nov 2013, https://clinicaltrials.gov/ct2/show/record/NCT02004704 .
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Affiliation(s)
- George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Roberto Giugliani
- Medical Genetics Service HCPA, Department of Genetics UFRGS, DASA and Casa dos Raros, Porto Alegre, Brazil
| | - Nathalie Guffon
- Reference Centre of Inherited Metabolic Disease in Femme Mère Enfant Hospital, Hospices Civils of Lyon, Lyon, France
| | - Simon A Jones
- Manchester University National Health Service Trust, St Mary's Hospital, Manchester, UK
| | - Eugen Mengel
- Institute of Clinical Science for Lysosomal Storage Disorders, SphinCS GmbH, Mainz, Germany
| | | | | | | | - Jing Li
- Sanofi, Bridgewater, NJ, USA
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Rupp Hanzen Andrades G, Abud Drumond Costa C, Crestani F, Tedesco Tonial C, Fiori H, Santos IS, Celiny Ramos Garcia P. Association of nutritional status with clinical outcomes of critically ill pediatric patients with complex chronic conditions. Clin Nutr 2022; 41:2786-2791. [PMID: 36379176 DOI: 10.1016/j.clnu.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS There is a high prevalence of children with complex chronic conditions (CCCs) in pediatric intensive care units (PICUs). However, information on the nutritional status (NS) of this specific population is limited. This study aimed to evaluate the NS of critically ill pediatric patients with CCCs and to relate it to clinical outcomes. METHODS A retrospective cohort study of children admitted to a PICU over a 4-year period. We classified NS according to body mass index-for-age (BMI/A) and height-for-age (H/A) z-scores, using the World Health Organization (WHO) growth curves as a reference. We recorded the presence of CCC according to the definition proposed by Feudtner et al. Severity on admission was measured using the Pediatric Index of Mortality 2 (PIM2). We assessed the following outcomes: mortality, multiple organ dysfunction syndrome during PICU stay, and PICU length of stay (LOS). RESULTS We included 1753 children in the study. Presence of CCC accounted for 49.8% (873) of the sample. Among children with CCCs, 61.7% (539) had appropriate weight, 19.8% (173) were underweight, and 18.4% (161) were overweight. H/A was considered inadequate in 32.2% (281) of patients with CCCs, a higher rate than in those without CCCs (25.3%; 132) (p < 0.001). Regarding outcomes, underweight children had more organ dysfunctions and prolonged LOS. The association only remained for prolonged LOS when adjusting for confounders. Although underweight children had a higher PIM2-predicted risk of mortality, there was no significant difference in actual mortality between the three NS groups (p = 0.200). CONCLUSIONS The rates of nutritional inadequacies in patients with CCCs were high. Underweight was independently associated with prolonged LOS in children with CCC.
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Affiliation(s)
- Gabriela Rupp Hanzen Andrades
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
| | - Caroline Abud Drumond Costa
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
| | - Francielly Crestani
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
| | - Cristian Tedesco Tonial
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
| | - Humberto Fiori
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
| | - Ina S Santos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, 3(o) Andar, Pelotas, 96020-220 - RS, Brazil.
| | - Pedro Celiny Ramos Garcia
- Post Graduate Program in Pediatrics and Child Health of PUCRS - Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil; Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, 90619-900 - RS, Brazil.
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29
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Dal Ben S, Gaudino R, Cavarzere P, Volpi S, Antoniazzi F, Boner A, Piacentini G. Age at menarche in girls with cystic fibrosis and asthma. Minerva Endocrinol (Torino) 2022; 47:479-481. [PMID: 35195379 DOI: 10.23736/s2724-6507.21.03451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sarah Dal Ben
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy -
| | - Rossella Gaudino
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Sonia Volpi
- Center of Cystic Fibrosis, University Hospital of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Attilio Boner
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Division of Pediatrics, University of Verona, Verona, Italy
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Prasadajudio M, Devaera Y, Noormanto N, Kuswiyanto RB, Sudarmanto B, Andriastuti M, Lanang Sidiartha IG, Sitorus NL, Basrowi RW. Disease-Related Malnutrition in Pediatric Patients with Chronic Disease: A Developing Country Perspective. Curr Dev Nutr 2022. [DOI: 10.1016/j.cdnut.2022.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Namubiru T, Mbabazi N, Namirembe T, Lugobe HM, Musiime V. Thinness among children aged 5–17 years living in Nakivale refugee settlement, South Western Uganda: a cross-sectional study. BMC Nutr 2022; 8:132. [PMCID: PMC9662126 DOI: 10.1186/s40795-022-00632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Hunger and malnutrition are rampant among refugees and displaced populations, many of whom are infants and children. We sought to determine the prevalence and factors associated with thinness among children aged 5–17 years living in Nakivale refugee settlement, Isingiro district, southwestern Uganda.
Methods
This was a cross sectional study that enrolled 420 children aged 5 to 17 years. The World Health Organization cluster sampling was used to select 30 villages from which 14 households were selected by consecutive sampling and participants were then chosen per household by simple random sampling. Data were collected on the participant socio-demographic, family, dietary, medical, hygiene and refugee status factors. Thinness was defined as having a z-score < -2 standard deviations of Body Mass Index-for-age from the median WHO growth standards. The prevalence of thinness was determined by ascertaining the total number of children with thinness over the total number of children studied. Multivariable logistic regression model was used to determine the factors independently associated with thinness with p < 0.05 level of significance.
Results
A total of 420 children aged 5–17 years were enrolled into the study. The median age (IQR) was 8.6 (6.8–11.8) and majority 248 (59.1%) were female. The prevalence of thinness was 5.5% (95% CI: 3.7-8.1%). The factors independently associated with thinness were; living with a chronic disease (aOR 6.47, 95%CI; 1.63–24.64, p = 0.008), use of water from natural sources (aOR 3.32, 95%CI; 1.27–8.71, p = 0.015), and duration of stay in the settlement of less or equal to 10 years (aOR 3.19, 95%CI; 1.15–8.83, p = 0.025).
Conclusion
Five in every 100 children aged 5–17 years in Nakivale refugee settlement have thinness. Thinness was more likely among children who are living with a chronic disease, used water from natural sources and those whose families had stayed shorter in the settlement. Our findings suggest that children with chronic disease should receive extra food supplementation and have routine growth monitoring as part of their chronic care. The study reiterates a need to have clean and safe water supply and close nutrition assessment and monitoring, especially for newly registered refugee children.
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Vitamin D Repletion and AA/EPA Intake in Children with Type 1 Diabetes: Influences on Metabolic Status. Nutrients 2022; 14:nu14214603. [PMID: 36364863 PMCID: PMC9655859 DOI: 10.3390/nu14214603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Our study aimed to show a relationship between metabolic control, vitamin D status (25OHD), and arachidonic acid (AA)/eicosapentaenoic acid (EPA) ratio in children with type 1 diabetes (T1D). The secondary aim was to evaluate dietary intake and the presence of ketoacidosis (DKA) at the onset of T1D. Methods: A cohort of 40 children with T1D was recruited, mean age 9.7 years (7.1; 13), with onset of T1D in the last 5 years: some at onset (n: 20, group A) and others after 18.0 ± 5 months (n: 20; group B). Twenty healthy children were compared as control subjects (CS). Dietary intakes were assessed through a diary food frequency questionnaire. Moreover, dried blood spots were used to test AA/EPA ratio by gas chromatography. Results: T1D children had a lower percentage of sugar intake (p < 0.02) than CS. Furthermore, group B introduced a greater amount of AA with the diet (g/day; p < 0.05) than CS (p < 0.01) and group A (p < 0.01). Children with an AA/EPA ratio ≤ 22.5 (1st quartile) required a lower insulin demand and had higher 25OHD levels than those who were in the higher quartiles (p < 0.05). Subjects with DKA (9/40) had levels of 25OHD (p < 0.05) and C-peptide (p < 0.05) lower than those without DKA. Moreover, analyzing the food questionnaire in group A, subjects with DKA showed a lower intake of proteins, sugars, fiber (g/day; p< 0.05), vitamin D, EPA, and DHA (g/day; p < 0.01) compared to subjects without DKA. Non-linear associations between vitamin D intake (p < 0.0001; r2:0.580) and linear between EPA intake and C-peptide (p < 0.05; r: 0.375) were found in all subjects. Conclusions: The study shows a relationship between vitamin D status, AA/EPA ratio, and metabolic state, probably due to their inflammatory and immune mechanisms. A different bromatological composition of the diet could impact the severity of the onset.
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Flores-Calderón J, Cisneros-Garza LE, Chávez-Barrera JA, Vázquez-Frias R, Reynoso-Zarzosa FA, Martínez-Bejarano DL, Consuelo-Sánchez A, Reyes-Apodaca M, Zárate-Mondragón FE, Sánchez-Soto MP, Alcántara-García RI, González-Ortiz B, Ledesma-Ramírez S, Espinosa-Saavedra D, Cura-Esquivel IA, Macías-Flores J, Hinojosa-Lezama JM, Hernández-Chávez E, Zárate-Guerrero JR, Gómez-Navarro G, Bilbao-Chávez LP, Sosa-Arce M, Flores-Fong LE, Lona-Reyes JC, Estrada-Arce EV, Aguila-Cano R. Consensus on the management of complications of cirrhosis of the liver in pediatrics. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2022; 87:462-485. [PMID: 35810090 DOI: 10.1016/j.rgmxen.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/08/2022] [Indexed: 12/07/2022]
Abstract
The Asociación Mexicana de Hepatología A.C. carried out the Consensus on the Management of Complications of Cirrhosis of the Liver in Pediatrics to provide physicians with useful information for treating said complications. A group of pediatric gastroenterologists and experts in nutrition, nephrology, and infectious diseases participated and reviewed the medical literature. The Delphi method was applied to obtain the level of agreement on the statements that were formulated. The statements were sent to the participants to be analyzed and voted upon, after which they were discussed in virtual sessions, and the final versions were produced. The aim of the consensus results was to issue indications for the management of pediatric patients with liver cirrhosis, to prevent or control complications.
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Affiliation(s)
- J Flores-Calderón
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico.
| | | | - J A Chávez-Barrera
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | | | | | | | | | | | | | - M P Sánchez-Soto
- Hospital de Especialidades del Niño y la mujer de Querétaro Dr. Felipe Núñez Lara, Querétaro, Mexico
| | | | - B González-Ortiz
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | - S Ledesma-Ramírez
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | - D Espinosa-Saavedra
- UMAE Hospital de Pediatría, CMN XXI Dr. Silvestre Frenk Freund IMSS, Cd, México, Mexico
| | | | - J Macías-Flores
- Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico
| | | | - E Hernández-Chávez
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - J R Zárate-Guerrero
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - G Gómez-Navarro
- UMAE Hospital de Pediatría Centro Médico de Occidente, IMSS, Guadalajara, Mexico
| | - L P Bilbao-Chávez
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | - M Sosa-Arce
- UMAE Hospital General CMN La Raza, Dr. Gaudencio González Garza IMSS, Cd, México, Mexico
| | - L E Flores-Fong
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - J C Lona-Reyes
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - E V Estrada-Arce
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
| | - R Aguila-Cano
- Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Guadalajara, Mexico
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John-Joy Owolade A. Malnutrition: An underlying health condition faced in sub Saharan Africa: Challenges and recommendations. Ann Med Surg (Lond) 2022; 82:104769. [PMID: 36249309 PMCID: PMC9562605 DOI: 10.1016/j.amsu.2022.104769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022] Open
Abstract
In Sub-Saharan Africa, the morbidity and mortality rate from malnutrition is increasing more than in any place in the world. Malnutrition has been a public health challenge in Sub-Saharan Africa that has not received enough attention. This commentary discussed the causes, effects and the need to prioritize the prevention and control of Malnutrition in Africa, together with practical recommendations. Several factors contribute to the high prevalence of malnutrition in sub-Saharan Africa. Some are poverty, overpopulation, unsuccessful small-scale agriculture, low educational status, climate change, corruption, wars and conflicts, fluctuation of food prices, etc. Conversely, the effects of malnutrition on individuals have resulted in the development of illnesses and chronic health issues. Hence, there is a need to reach out to malnourished individuals, encourage the government, investors, and non-governmental organizations (NGOs) to take action, educate health staff to detect and react to early indicators of malnutrition, enhance agricultural product output, manage and preserve the environment, and use technology to its full potential. All of these suggestions will significantly impact the incidence of malnutrition in Sub-Saharan Africa.
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Association of Maternal Erythrocyte PUFA during Pregnancy with Offspring Allergy in the Chinese Population. Nutrients 2022; 14:nu14112312. [PMID: 35684115 PMCID: PMC9182582 DOI: 10.3390/nu14112312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 12/10/2022] Open
Abstract
Findings on prenatal polyunsaturated fatty acids (PUFA) and offspring allergies have been inconsistent, and the majority of studies have focused on Western populations. This study aimed to investigate the associations between maternal erythrocyte PUFA and offspring allergies in the first 2 years in the Chinese population. We included 573 mother–infant pairs from a birth cohort. Based on the outpatient medical records, we identified the diagnosis and time of offspring allergic disease onset. We measured erythrocyte fatty acids by gas chromatography. Associations were examined using Cox regression. We found that higher maternal total PUFA levels (HR = 0.80; 95% CI: 0.68, 0.94), especially of arachidonic acid (AA) (HR = 0.79; 95% CI: 0.65, 0.97) and n-3 PUFA (HR = 0.77; 95% CI: 0.62, 0.97), were associated with reduced risk of offspring allergies. Similar results were found for eczema. Compared with children without a maternal allergy history, the associations of total PUFA (p = 0.028) and n-6 PUFA (p = 0.013) with offspring allergies were stronger in those with a maternal allergy history. Maternal erythrocyte total PUFA, especially AA, and n-3 PUFA were inversely associated with offspring allergies within 2 years of age. There was a significant interaction between maternal allergy history and maternal PUFA in offspring allergies.
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Perenc L, Guzik A, Podgórska-Bednarz J, Drużbicki M. Somatic Development Disorders in Children and Adolescents Affected by Syndromes and Diseases Associated with Neurodysfunction and Hydrocephalus Treated/Untreated Surgically. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095712. [PMID: 35565107 PMCID: PMC9105737 DOI: 10.3390/ijerph19095712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Background: This study was conducted to evaluate the co-occurrence of hydrocephalus treated/untreated surgically and congenital nervous system disorders or neurological syndromes with symptoms visible since childhood, and with somatic development disorders, based on significant data obtained during admission to a neurological rehabilitation unit for children and adolescents. Methods: The study applied a retrospective analysis of data collected during hospitalization of 327 children and adolescents, aged 4−18 years, all presenting congenital disorders of the nervous system and/or neurological syndromes associated with at least one neurodysfunction that existed from early childhood. To allow the identification of individuals with somatic development disorders in the group of children and adolescents with hydrocephalus treated/untreated surgically, the adopted criteria considered the z-score values for body height, body weight, head circumference, body mass index, and head circumference index. Results: Treated/untreated hydrocephalus was observed in the study group at the rates of 8% and 0.9%, respectively. Among 239 patients with cerebral palsy, 9 (3.8%) had surgically treated hydrocephalus, 17 (70.8%) of 24 patients with neural tube defects also had hydrocephalus treated with surgery, and 3 (12.5%) of 24 patients with neural tube defects had untreated hydrocephalus. This medical condition was a more frequent comorbidity in subjects with neural tube defects compared with those with cerebral palsy (p < 0.001). Subjects with untreated hydrocephalus most frequently presented macrocephaly (p < 0.001), including absolute macrocephaly (p = 0.001), and with tall stature (p = 0.007). Excessive body mass co-occurred more frequently with surgically untreated hydrocephalus, but the relationship was not statistically significant (p = 0.098). Conclusions: Surgically treated hydrocephalus occurred in patients with cerebral palsy and neural tube defects, and untreated hydrocephalus was present only in patients with neural tube defects. Untreated hydrocephalus negatively changed the course of individual development in the studied group of children, in contrast to surgically treated hydrocephalus.
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Molani Gol R, Kheirouri S, Alizadeh M. Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:65-83. [PMID: 35000681 DOI: 10.1016/j.jneb.2021.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed to present an overview of the association between dietary diversity (DDiv) and growth outcomes (stunting, wasting, and underweight) in children aged < 5 years. DESIGN This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. SETTING AND PARTICIPANTS PubMed, Scopus, Embase, Cochrane library, and Google Scholar databases were searched up to February, 2021, using relevant keywords as follows: "Dietary diversity or diet diversity or food diversity or diet variety or dietary variety or food variety," "under-nutrition or stunting or wasting or underweight or nutritional status," and "children or infants." Original articles published in English were eligible for this review. Newcastle-Ottawa scales and the Cochrane Collaboration's tool were used to assess the quality and risk of bias of the articles. MAIN OUTCOME MEASURES, ANALYSIS, AND RESULTS Totally, 81 articles (70 cross-sectional, 4 longitudinal cohort, 5 case-control, and 2 randomized controlled trials) were included in this review. Of the studies, 45 focused on infants and 36 on children aged < 5 years. The reviewed articles had good quality and low risk of bias (scores > 6). In infants, low DDiv was associated with stunting, wasting, and being underweight (79%, 57%, and 68% of the studies, respectively). Among children aged < 5 years, the association was observed in 75%, 56%, and 57% of the studies, respectively, for stunting, wasting, and underweight. CONCLUSIONS AND IMPLICATIONS The findings indicate a possible association between low DDiv of infants and children aged < 5 years with stunting. However, this association remained uncertain with wasting and being underweight.
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Affiliation(s)
- Roghayeh Molani Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Yanagisawa S, Swannimitr A, Singhala K, Rujkorakarn D, Aryamuang S, Hashimoto H, Sakamoto M. Needs assessment of caregivers of children with disabilities in resource-limited settings. J Rural Med 2022; 17:143-150. [PMID: 35847758 PMCID: PMC9263948 DOI: 10.2185/jrm.2021-062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022] Open
Abstract
Objective: This study aimed to identify and classify the needs of caregivers
of children with disabilities living in resource-limited settings and develop a framework
for need assessment. Participants and Methods: This study was conducted in the Maha Sarakham
Province, Thailand, with 15 caregivers caring for children with disabilities recruited
from hospitals, the Association for the Disabled, and primary health centers.
Semi-structured interviews were conducted in local dialects, recorded, transcribed,
converted into standard Thai, and then into English for thematic analysis. Meaning units
corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically
organized into subcategories by comparing similarities and differences among the extracted
codes. The subcategories were further grouped and abstracted into categories, and then
domains of caregivers’ needs were formed. Results: Nineteen categories were identified across five domains of
caregivers’ needs: health and medical, welfare, educational, social, and informational.
Although basic medical treatment was covered, specific support, such as referral to a
specialist, rehabilitation, or psychological support, was limited. Financial support and
relief from the care burden are the main welfare needs. Educational needs were identified
to provide knowledge to children and to offer respite to their caregivers. Social needs
revealed ethical problems that arose because of strong rural community ties, making it
difficult to maintain privacy. Informational needs were intertwined with the other four
domains. In rural areas, where parents of children with disabilities migrate to cities to
find work, the special needs of grandparents who were primary caregivers of the children
needed to be addressed. Conclusion: This study provides a conceptual framework for comprehensive
needs assessment and policy development for caregivers of children with disabilities
living in resource-limited settings.
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Affiliation(s)
| | | | | | | | | | - Hidemi Hashimoto
- Faculty of Nursing, Doshisha Women’s College of Liberal Arts, Japan
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Burden of Malnutrition among Children and Adolescents with Cerebral Palsy in Arabic-Speaking Countries: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13093199. [PMID: 34579076 PMCID: PMC8468429 DOI: 10.3390/nu13093199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/03/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We aimed to estimate the burden and underlying risk factors of malnutrition among children and adolescents with cerebral palsy in Arabic-speaking countries. METHODS OVID Medline, OVID Embase, CINAHL via EBSCO, Cochrane Library, and SCOPUS databases were searched up to 3 July 2021. Publications were reviewed to identify relevant papers following pre-defined inclusion/exclusion criteria. Two reviewers independently assessed the studies for inclusion. Data extraction was independently completed by two reviewers. Descriptive and pooled analysis has been reported. RESULTS From a total of 79 records screened, nine full-text articles were assessed for eligibility, of which seven studies met the inclusion criteria. Study characteristics, anthropometric measurements used, and nutritional outcome reported varied between the studies. The included studies contained data of total 400 participants aged 1-18 years. Overall, (mean: 71.46%, 95% confidence interval: 55.52-85.04) of children with cerebral palsy had at least one form of malnutrition. Severe gross motor function limitation, feeding difficulties, cognitive impairment and inadequate energy intake were the commonly reported underlying risk factors for malnutrition among children with cerebral palsy. CONCLUSIONS The burden of malnutrition is high among children with cerebral palsy in Arabic-speaking countries. More research is needed for better understanding of this public health issue in these countries.
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Incidence of and risk factors for short stature in children with chronic kidney disease: results from the KNOW-Ped CKD. Pediatr Nephrol 2021; 36:2857-2864. [PMID: 33786659 DOI: 10.1007/s00467-021-05054-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preserving optimal growth has long been a significant concern for children with chronic kidney disease (CKD). We aimed to examine the incidence of and risk factors for short stature in Asian pediatric patients with CKD. METHODS We analyzed growth status by height, weight, and body mass index (BMI) standard deviation scores (SDSs) for 432 participants in the KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease. RESULTS The median height, weight, and BMI SDSs were - 0.94 (interquartile range (IQR) - 1.95 to 0.05), - 0.58 (IQR - 1.46 to 0.48), and - 0.26 (IQR - 1.13 to 0.61), respectively. A high prevalence of short stature (101 of 432 patients, 23.4%) and underweight (61 of 432 patients, 14.1%) was observed. In multivariable logistic regression analysis, CKD stages 4 and 5 (adjusted odds ratio (aOR) 2.700, p = 0.001), onset before age 2 (aOR 2.928, p < 0.0001), underweight (aOR 2.353, p = 0.013), premature birth (aOR 3.484, p < 0.0001), LBW (aOR 3.496, p = 0.001), and low household income (aOR 1.935, p = 0.030) were independent risk factors associated with short stature in children with CKD. CONCLUSIONS Children with CKD in Korea were shorter and had lower body weight and BMI than the general population. Short stature in children with CKD was most independently associated with low birth weight, followed by premature birth, onset before age 2, CKD stages 4 and 5, underweight, and low household income. Among these, underweight is the only modifiable factor. Therefore, we suggest children with CKD should be carefully monitored for weight, nutritional status, and body composition to achieve optimal growth.
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Singh MP, Rai SN, Dubey SK, Pandey AT, Tabassum N, Chaturvedi VK, Singh NB. Biomolecules of mushroom: a recipe of human wellness. Crit Rev Biotechnol 2021; 42:913-930. [PMID: 34412526 DOI: 10.1080/07388551.2021.1964431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Indian system of medicine - Ayurveda says "When diet is wrong, medicine is of no use. When diet is correct, medicine is of no use". In this context, mushroom constitutes one of the major resources for nutraceuticals. Biomolecules of mushrooms have attracted the attention of researchers around the globe due to their proven healthy attributes. They have a plenitude of health-giving properties and these range from immunomodulatory, antiviral, antibacterial, antifungal, antioxidant, anti-inflammatory, antitumor, anticancer, anti-HIV, antidiabetic, anticholesterolic to antiarthritic activities.Mushrooms contain both primary and secondary metabolites. The primary metabolites provide energy while the secondary metabolite exhibits medicinal properties. Hence, the mushroom can be a recipe for human wellness and will play a significant role in fighting COVID-19 pandemics and other infectious diseases.The key findings suggested in this paper refer to the exploration of health and the healing traits of biomolecules of mushrooms. This article reviews the current status of the medicinal attributes of mushrooms and their biomolecules in different diseases such as cardiovascular, diabetes, reproductive diseases, cancer, and neurodegenerative diseases. The global malnutrition-related morbidity and mortality among children under five and lactating women presents a frightening picture and also a black spot on the human face. Malnutrition is responsible for more ill-health than any other cause. Mushrooms as a rich source of bioactive compounds can be claimed as "Best from the Waste" since they grow on the most abundant organic wastes of the Earth, the lignocellulosic substrate, and 'Best of the Rest' because they are excellent nutraceutical resources.
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Affiliation(s)
| | | | | | | | - Nazish Tabassum
- Centre of Biotechnology, University of Allahabad, Prayagraj, India
| | | | - Narsingh Bahadur Singh
- Department of Chemistry and Biochemistry, University of Maryland, Baltimore County (UMBC), Baltimore, MD, USA.,Department of Computer Science and Electrical Engineering, University of Maryland, Baltimore County (UMBC), Baltimore, MD, USA
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Leiskau C, Samuel S, Pfister ED, Junge N, Beneke J, Stupak J, Richter N, Vondran F, Schrem H, Baumann U. Low-dose steroids do make a difference: Independent risk factors for impaired linear growth after pediatric liver transplantation. Pediatr Transplant 2021; 25:e13989. [PMID: 33689189 DOI: 10.1111/petr.13989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 01/31/2023]
Abstract
Growth failure persists after pediatric liver transplantation and impairs pediatric development and quality of life. Steroid dose minimization attempts to prevent growth impairment, yet long-term assessment in pediatric liver recipients is lacking. We identified risk factors for impaired linear growth after pediatric liver transplantation, with a special focus on low-dose steroid therapy. This is a single-center retrospective analysis of height development in pediatric liver recipients up to 5 years after transplantation. Risk factors for impaired linear growth (height Z-scores≤-2) at transplantation, after two (n = 347) and five years (n = 210) were identified by univariate and multivariate logistic regression. At transplantation, growth retardation was found in 52.2%, predominantly younger children. Height Z-scores improved from -2.23 to -1.40 (SE 0.11; 95%CI 0.74-1.16; p < .001) two years and -1.19 (SE 0.07;0.08-0.34; p = .017) five years post-transplant. Multivariate analysis showed previous growth impairment (OR=1.484; 95%-CI=1.107-1.988; p = .004), graft loss (49.006;2.232-1076; p = .006), and prolonged cold ischemic time (1.034;1.007-1.061; p = .011) as main long-term risk factors; steroid use was a significant predictor of 2-year but not 5-year growth impairment. In univariate analysis, impaired growth after 2 and 5 years was associated with continuous low-dose (2.5 mg/m2 BSA) steroid therapy (OR=3.323;1.578-6.996; p < .001/OR=8.352;1.089-64.07; p = .006)and graft loss (OR=2.513;1.395-4.525; p = .003/OR=3.378;1.815-7.576; p < .001). Furthermore, indication and era of transplantation affected growth. Our results show significant catch-up growth after pediatric liver transplantation, yet growth failure strongly affects particularly young liver recipients. The main influenceable long-term risk factor is pre-existing growth failure, emphasizing the importance of early aggressive nutritional therapy. Moreover, low-dose steroid therapy might impair growth and should therefore be critically questioned in long-term immunosuppression.
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Affiliation(s)
- Christoph Leiskau
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Saskia Samuel
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of Internal Medicine, Military Hospital Hamburg, Germany
| | - Eva-Doreen Pfister
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Norman Junge
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Jan Beneke
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Julia Stupak
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - Florian Vondran
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany
| | - Harald Schrem
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany.,Department of General, Visceral and Transplant Surgery, Hannover Medical School, Germany.,Division of Transplant Surgery, Department of Surgery, Medical University Graz, Austria
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
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43
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Saengnipanthkul S, Chongviriyaphan N, Densupsoontorn N, Apiraksakorn A, Chaiyarit J, Kunnangja S, Wongpratoom S, Papakhee S, Det-Amnatkul W, Monwiratkul J, Saengpanit P, Limthongthang P, Panthongviriyakul C. Hospital-acquired malnutrition in paediatric patients: a multicentre trial focusing on prevalence, risk factors, and impact on clinical outcomes. Eur J Pediatr 2021; 180:1761-1767. [PMID: 33492441 DOI: 10.1007/s00431-021-03957-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
Alteration of nutrient metabolism during hospital stay may cause a deterioration in patients' nutritional status. The aim of this study was to determine the prevalence and possible risk factors for nutritional deterioration in hospitalized children. A multicentre prospective study was conducted among the patients aged 1 month to 18 years in tertiary-care hospitals, between December 2018 and May 2019. Demographic data, illness, and nutritional assessment on the first and the last day of admission were collected. There were 623 patients enrolled in this study with the median age of 4.3 years. Two thirds of the patients had at least one underlying disease. Eighty-eight percent of the patients were admitted with mild medical conditions including a scheduled cycle of chemotherapy or immunosuppressive drugs, minor infection, and non-invasive procedures. The prevalence of nutritional deterioration (reduction in body mass index ≥ 0.25 Z-score) was 24% and was associated with a significantly higher rate of nosocomial infection (24% vs. 11%, p < 0.001) compared to patients without hospital-acquired malnutrition. Risk factors included moderate to severe medical conditions (AOR 1.90, 95% CI 1.09-3.31, p = 0.024), pneumonia (AOR 1.85, 95% CI 1.05-3.28, p = 0.034), seizure (AOR 2.82, 95% CI 1.28-6.19, p = 0.01), and surgery (AOR 2.98, 95% CI 1.60-5.56, p = 0.001). Nutritional management showed a significant reduction in the incidence of hospital-acquired malnutrition and a trend towards a 60% decrease in infectious complications in patients with moderate to severe medical conditions.Conclusions: Approximately one fourth of paediatric patients developed malnutrition during hospitalization. Nutritional screening, assessment, and treatment should be implemented to improve the outcomes of hospitalized paediatric patients. What is Known: • Malnutrition at admission has a negative impact on outcomes of patients, including prolonged hospitalization, increased costs of care, and a higher rate of nosocomial infection. What is New: • Hospital-acquired malnutrition can occur regardless of prior nutritional status and is predominantly related to illness severity. • Malnourished patients with nutritional intervention experience an improvement in their nutritional status as well as a lower risk of developing hospital morbidity during hospitalization.
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Affiliation(s)
- Suchaorn Saengnipanthkul
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand. .,Pediatric Nutrition Association of Thailand, PedNAT, Bangkok, Thailand.
| | - Nalinee Chongviriyaphan
- Pediatric Nutrition Association of Thailand, PedNAT, Bangkok, Thailand.,Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narumon Densupsoontorn
- Pediatric Nutrition Association of Thailand, PedNAT, Bangkok, Thailand.,Division of Nutrition, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Jitjira Chaiyarit
- Clinical Epidemiology Unit, Khon Kaen University, Khon Kaen, Thailand
| | - Supawan Kunnangja
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasiwimol Wongpratoom
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Supawan Papakhee
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand
| | | | - Jittima Monwiratkul
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Puthita Saengpanit
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Charnchai Panthongviriyakul
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Srinagarind Hospital, Khon Kaen University, Khon Kaen, 40002, Thailand.,Pediatric Nutrition Association of Thailand, PedNAT, Bangkok, Thailand
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44
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Boussetta A, Laamouri R, Jellouli M, Naija O, Gargah T. Efficacy of Growth Hormone Treatment in Children With Chronic Kidney Disease: Tunisian Experience. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Gaudino R, Dal Ben S, Cavarzere P, Volpi S, Piona C, Boner A, Antoniazzi F, Piacentini G. Delayed age at menarche in chronic respiratory diseases. Eur J Clin Invest 2021; 51:e13461. [PMID: 33247946 DOI: 10.1111/eci.13461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/18/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Age at menarche (AAM) is an important indicator of physiological development in women, and delayed AAM has been associated with chronic illnesses. We investigated predictive factors at diagnosis that influence AAM in adolescents with chronic respiratory diseases. STUDY DESIGN AAM was assessed in 1207 northern Italian female aged 11-24 (1062 healthy, 98 with asthma and 47 with cystic fibrosis [CF]). AAM was defined by recall and status quo methods. We studied anthropometric data, metabolic status, diagnosis parameters, presence of irregular menses. Clinical data of subjects with chronic respiratory illness were compared with that of healthy adolescents. RESULTS Mean AAM for healthy adolescents was 12.49 ± 1.2 years. Mother's AAM was positively associated with that of their daughters (P < .001). BMI was negatively correlated with AAM (P < .001). 69% of healthy adolescents referred regular menses. AAM in the different groups was 12.79 ± 3.0 years for patients with asthma (P < .05 vs healthy) and 13.24 ± 1.44 years for adolescents with CF (P < .0001 vs healthy). In the asthmatic group, 57% of the patients referred regular menses, and no significant differences were found between AAM and control of the disease (ACT test). In the CF group, no correlation was found between the type of CFTR mutation or FEV1% and AAM. 53% of the patients with CF referred regular menses. CONCLUSIONS AAM in patients with CF and asthma was significantly higher than in healthy adolescents, and menses abnormalities were observed in the last two groups. Inflammation influences the reproductive function in chronic respiratory disease.
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Affiliation(s)
- Rossella Gaudino
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Sarah Dal Ben
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Sonia Volpi
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Claudia Piona
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Attilio Boner
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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46
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Perenc L, Guzik A, Podgórska-Bednarz J, Drużbicki M. Microsomic and macrosomic body structure in children and adolescents affected by syndromes or diseases associated with neurodysfunction. Sci Rep 2021; 11:6349. [PMID: 33737592 PMCID: PMC7973426 DOI: 10.1038/s41598-021-85587-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
In Poland the issue of microsomic body structure (micro-SBS) and macrosomic body structure (macro-SBS) has so far been overlooked. Up until now only a small amount of data have been published, most often as an overview of the problem. The current study was designed to investigate the co-occurrence of microsomic/macrosomic body structure (micro/macro-SBS) and congenital nervous system disorders or neurological syndromes with symptoms visible from infancy, based on essential data acquired during admission procedures at a neurological rehabilitation ward for children and adolescents. The study applied a retrospective analysis of data collected during hospitalization of 327 children and adolescents, aged 4-18 years who had been affected since infancy by congenital disorders of the nervous system and/or neurological syndromes associated with a minimum of one neurodysfunction. To identify subjects with microsomic or macrosomic body structure in the group of children and adolescents, the adopted criteria took into account z-score values for body height (z-score Ht), body weight (z-score Wt), head circumference (z-score HC), BMI (z-score BMI) and head circumference index (z-score HCI). The rates of micro/macro-SBS in the study group amounted to 7.3% and 0.6%, respectively. The findings show a more frequent co-occurrence of, as well as statistically significant correlations between, micro/macro-SBS and type of spasticity (cerebral palsy) (p = 0.024) as well as hydrocephalus not treated surgically (p < 0.001). Macro-SBS was found to more frequently co-occur with hemiplegia and hydrocephalus not treated surgically.
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Affiliation(s)
- Lidia Perenc
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Agnieszka Guzik
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland.
| | - Justyna Podgórska-Bednarz
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Mariusz Drużbicki
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
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Silverman AH, Erato G, Goday P. The relationship between chronic paediatric feeding disorders and caregiver stress. J Child Health Care 2021; 25:69-80. [PMID: 32048866 DOI: 10.1177/1367493520905381] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Paediatric feeding disorders (PFDs) are common. Earlier studies have shown an association between PFD and caregiver stress, but these studies have been hampered by insufficient power. This study reports stress for caregivers of children diagnosed with PFD. These caregivers were then compared to community norms of the Parental Stress Index-Short Form. Caregivers also completed the Mealtime Behaviour Questionnaire, Child Behaviour Checklist and Child Development Inventory. Linear regression and hierarchical regression analyses assessed the relationship among the variables. Caregivers of 840 children with PFD responded. Negative child behaviours and lower child developmental function predicted higher levels of total parenting stress, parental distress, parent-child dysfunctional interaction and caregiver perceptions of their child as difficult. Higher rates of child internalizing and externalizing problems and child mealtime aggression were associated with parent perceptions of their child as difficult and contributed to total parental stress. Parents of older children reported higher levels of stress, whereas parents of younger children were more likely to be defensive responders. Overall, parents of children with PFD have more caregiver-related stress. These caregivers may benefit from consultations with mental health professionals to provide the most appropriate care to affected families.
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Affiliation(s)
- Alan H Silverman
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gina Erato
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Praveen Goday
- Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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48
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Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective. Neuroimage 2021; 231:117828. [PMID: 33549754 DOI: 10.1016/j.neuroimage.2021.117828] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 02/08/2023] Open
Abstract
Approximately one in five children worldwide suffers from childhood malnutrition and its complications, including increased susceptibility to inflammation and infectious diseases. Due to improved early interventions, most of these children now survive early malnutrition, even in low-resource settings (LRS). However, many continue to exhibit neurodevelopmental deficits, including low IQ, poor school performance, and behavioral problems over their lifetimes. Most studies have relied on neuropsychological tests, school performance, and mental health and behavioral measures. Few studies, in contrast, have assessed brain structure and function, and to date, these have mainly relied on low-cost techniques, including electroencephalography (EEG) and evoked potentials (ERP). The use of more advanced methods of neuroimaging, including magnetic resonance imaging (MRI) and functional near-infrared spectroscopy (fNIRS), has been limited by cost factors and lack of availability of these technologies in developing countries, where malnutrition is nearly ubiquitous. This report summarizes the current state of knowledge and evidence gaps regarding childhood malnutrition and the study of its impact on neurodevelopment. It may help to inform the development of new strategies to improve the identification, classification, and treatment of neurodevelopmental disabilities in underserved populations at the highest risk for childhood malnutrition.
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49
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Cardiovascular Risk Factors in Patients With Congenital Heart Disease. Can J Cardiol 2020; 36:1458-1466. [DOI: 10.1016/j.cjca.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/26/2022] Open
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