1
|
Impact of the HAS 2019 French guidelines on the frequency of hospital undernutrition in children. Arch Pediatr 2023; 30:36-41. [PMID: 36473753 DOI: 10.1016/j.arcped.2022.11.009] [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: 02/11/2022] [Revised: 07/25/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
In 2019, the French National Authority for Health (Haute Autorité de Santé, HAS) published guidelines on the diagnosis of undernutrition. The present article focuses on the impact of switching from the 2012 guidelines of the Nutrition Committee of the French Paediatric Society (CNSFP) to the HAS guidelines on the frequency of hospital undernutrition in children. We selected for the period 2010-2019 from the ePINUT database: (1) all children aged more than 2 years with (2) clinically confirmed nutritional status in (3) French sites. The frequency of undernutrition was 15.4% vs. 28.8% using the CNSFP and HAS criteria, respectively (p < 0.01; n = 6304). When compared to non-malnourished children regardless of the criteria used, malnourished children: (1) stayed longer in hospital (CNSFP: 9.0 ± 11.8 vs. 6.5 ± 8.7 days, p < 0.01; HAS: 7.8 ± 10.1 vs. 6.4 ± 8.4 days, p < 0.01), (2) gained more weight during hospitalization (% of weight at admission) (CNSFP: +1.4 ± 4.1 vs. -0.3 ± 3.5%, p < 0.01; HAS: +2.3 ± 4.7 vs. -0.1 ± 3.4%, p < 0.01), and (3) received nutritional support more frequently during hospitalization (CNSFP: 20% vs. 5%, p < 0.01; HAS: 13% vs. 4%, p < 0.01). Switching to the HAS guidelines resulted in an almost twofold higher frequency of undernutrition in hospitalized children. Initiation of nutritional care remained low considering the nutritional status. The present study warrants interventional studies to determine which children may benefit more from nutritional therapy to improve their outcome.
Collapse
|
2
|
De Rosso S, Riera-Navarro C, Ducrot P, Schwartz C, Nicklaus S. Counseling parents about child feeding: a qualitative evaluation of French doctors and health/childcare professionals' experiences and perception of a brochure containing new recommendations. BMC Public Health 2022; 22:2303. [PMID: 36482341 PMCID: PMC9733000 DOI: 10.1186/s12889-022-14778-2] [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: 12/28/2021] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Parents are crucial in establishing their children's eating habits, and doctors and health/childcare professionals (HCCPs) can provide meaningful and trusted guidance on feeding, especially in the 0-3-year-old period. With the upcoming release of the official brochure containing the new child feeding recommendations in France, this study aims to: (1) assess professionals' practices and perceptions regarding their communication with parents on child feeding and (2) evaluate their perception of the draft of the new brochure. METHODS A 15-page draft brochure (without pictures) containing updated child feeding recommendations for children 0-3 years old was developed by Santé publique France (the French public health agency). Online semi-structured interviews were conducted with professionals (n = 21), including 13 pediatricians and general practitioners (doctors) and eight healthcare or childcare professionals (HCCPs) two weeks after they were provided with this draft brochure to read. The interview guide was developed and piloted with other professionals (n = 3) prior to these interviews. Interview data were transcribed verbatim and analyzed thematically using an inductive approach. RESULTS While doctors and HCCPs mostly communicate orally with parents, both acknowledged that the brochure might be a helpful supplement, especially for HCCPs to legitimize their advice to parents. For doctors, giving the brochure to parents may help provide systematic advice and save time during consultations. Professionals serving parents of lower socioeconomic status would prefer a supplement with less text and more illustrations. In general, the messages were perceived to be easily understandable but providing detachable cards to distribute according to the child's age would facilitate information dissemination and might be more useful to parents. Professionals reported that lack of training, the circulation of contradictory information, and language barriers were common challenges. CONCLUSION French professionals welcomed the new official brochure as a means to spread updated child feeding recommendations. However, this brochure could be modified and specific tools developed to better adapt to professionals' needs of communication with parents and to facilitate the relay of information. Providing updated and consistent information to parents should be considered a priority for public health stakeholders toward increased adherence to new recommendations.
Collapse
Affiliation(s)
- Sofia De Rosso
- grid.507621.7Centre des Sciences du Goût et de l’Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Camille Riera-Navarro
- grid.507621.7Centre des Sciences du Goût et de l’Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Pauline Ducrot
- grid.493975.50000 0004 5948 8741Santé publique France, French national public health agency, F-94415 Saint- Maurice, France
| | - Camille Schwartz
- grid.507621.7Centre des Sciences du Goût et de l’Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Sophie Nicklaus
- grid.507621.7Centre des Sciences du Goût et de l’Alimentation, CNRS, INRAE, Institut Agro, Université Bourgogne Franche-Comté, F-21000 Dijon, France
| |
Collapse
|
3
|
Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical Nutrition and Human Rights. An International Position Paper. Nutr Clin Pract 2021; 36:534-544. [PMID: 34013590 DOI: 10.1002/ncp.10667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
Collapse
Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogotá, Colombia
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, Louisiana, USA
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, Tours, France
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| |
Collapse
|
4
|
Cardenas D, Correia MITD, Ochoa JB, Hardy G, Rodriguez-Ventimilla D, Bermúdez CE, Papapietro K, Hankard R, Briend A, Ungpinitpong W, Zakka KM, Pounds T, Cuerda C, Barazzoni R. Clinical nutrition and human rights. An international position paper. Clin Nutr 2021; 40:4029-4036. [PMID: 34023070 DOI: 10.1016/j.clnu.2021.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/02/2023]
Abstract
The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.
Collapse
Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, El Bosque University, Bogotá, Colombia.
| | | | - Juan B Ochoa
- Department of Surgery, Ochsner Medical Center-New Orleans, New Orleans, LA, USA.
| | - Gil Hardy
- Ipanema Research Trust, Auckland, New Zealand.
| | | | - Charles E Bermúdez
- Surgery and Nutrition Department, Clínica La Colina and Clínica Del Country, Bogota, Colombia.
| | - Karin Papapietro
- Nutrition Unit, Hospital Clínico de La Universidad de Chile, Santiago, Chile.
| | - Régis Hankard
- Nutrition Mobile Unit, CHU Tours, Université de Tours, European Institute for History and Culture of Food, University of Tours, France.
| | - André Briend
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark and Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | | | - Katerina Mary Zakka
- Department of Internal Medicine, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Teresa Pounds
- Department of Pharmacy, Wellstar Atlanta Medical Center, Atlanta, GA, USA.
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
| |
Collapse
|
5
|
Intrauterine growth restriction: Clinical consequences on health and disease at adulthood. Reprod Toxicol 2021; 99:168-176. [DOI: 10.1016/j.reprotox.2020.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
|
6
|
|
7
|
Chouraqui JP, Tavoularis G, Turck D, Ferry C, Feillet F. Mineral and vitamin intake of infants and young children: the Nutri-Bébé 2013 survey. Eur J Nutr 2019; 59:2463-2480. [PMID: 31555975 DOI: 10.1007/s00394-019-02093-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/11/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE Minerals and vitamins are essential for optimal growth and development, particularly during the first years of life. Therefore, regularly evaluating their intake makes sense. For this purpose, we report the data from the Nutri-Bébé 2013 survey in comparison with the European Food Safety Authority Adequate Intake (AI), or Average Requirement, (AR) according to age. METHODS This observational, nationally representative, cross-sectional survey was conducted in 1035 non-breastfed French children aged 0.5-35 months. Dietary intake was recorded using a food diary on three non-consecutive days, framed by two face-to-face interviews. RESULTS The intake of zinc, magnesium and water-soluble vitamins most of the time met the recommendations. From the first weeks of life, sodium intake exceeded the AI, with a maximum median intake of 1137 mg/day after the age of 30 months. However, it has decreased since 2005. Calcium median intake often exceeded the AI or AR, reaching a maximum of 780 mg/day between 18 and 23 months. Median vitamin A intake always exceeded the AI or AR but exceeded the recommended upper limit in only a few cases. After 2 years, median iron intake was clearly below the AR, i.e. lower than 6.0 mg/day. Dietary vitamin D intake was below the AI, thereby justifying adequate supplementation. Vitamin E intake was below the AI in 50-75% of toddlers. CONCLUSION This survey highlights excessive sodium intake as well as a shortfall of iron, vitamin D, and vitamin E intakes. The potential consequences of these discrepancies with respect to health outcomes remain to be assessed.
Collapse
Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Medical and Surgical Department of Paediatrics, Centre Hospitalier Universitaire Vaudois, 21 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Gabriel Tavoularis
- CREDOC (Centre de Recherche pour l'Etude et l'Observation des Conditions de Vie), 142 rue du Chevaleret, 75013, Paris, France
| | - Dominique Turck
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lille University Jeanne de Flandre Children's Hospital and Faculty of Medicine, University of Lille, INSERM U995, 59037, Lille, France
| | | | | |
Collapse
|
8
|
Chouraqui JP, Delmas B, Le Bris M, Bellaiche M, Jung C, Hanh T. Physicians advice, parental practice and adherence to doctor's advice: an original survey on infant feeding. BMC Pediatr 2019; 19:313. [PMID: 31484507 PMCID: PMC6724317 DOI: 10.1186/s12887-019-1697-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/27/2019] [Indexed: 12/27/2022] Open
Abstract
Abstract Background: Despite several years of guidance on infant feeding, there has been only a slight change in consumer compliance. Therefore, this study aimed to analyse parents feeding practices, explore physicians’ advice about infant feeding and subsequent parent’s adherence to advice. Methods A multicentric cross-sectional qualitative and descriptive self-report online study was conducted in volunteers to participate in the study. Results Fifty-four physicians (paediatricians and general practitioners) and 600 parents of infants were recruited. Of the infants, 20.2% presented at inclusion with at least one type of functional gastrointestinal disorder. The breastfeeding prevalence was quite low (37.3%). The main initial deviance from guidelines said they observed in infant feeding was the early use of cow’s milk. More than two-thirds of infants older than 8 months were drinking cow’s milk. The introduction of solid foods was globally in line with recommendations. Most physicians gave advice about the different aspects of infant feeding but were seeking more information, as did the parents. A discrepancy between the physicians’ statements and the parents’ perceptions was observed. However the majority (95.4%) of parents reported that they followed totally or partially the advice received, especially by abandoning subsequently the use of cow’s milk in favour of a formula. The main reason for not adhering to the advice was that they did not consider it suitable for their infant and they preferred to rely on their feelings or recommendations from familiars. Conclusions This survey provides good insights into parents’ infant feeding practices together with the advice given by their doctor. The gap between practices and current guidelines is notable only for breast-feeding and use of formula. Despite several guidelines professionals and parents seek nutrition information. It highlights the need to deliver consistent, relevant, and less confusing messages about infant feeding. Electronic supplementary material The online version of this article (10.1186/s12887-019-1697-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Division of Pediatrics, Woman, Mother and Child Department, Centre Hospitalier Universitaire Vaudois (CHUV), 21 rue du Bugnon, 1011, Lausanne, Switzerland.
| | - Bérénice Delmas
- Nestlé, Département Médical et Nutrition Infantile, 7 Boulevard Pierre Carle, BP 900, Noisiel, France
| | - Marine Le Bris
- Nestlé, Département Médical et Nutrition Infantile, 7 Boulevard Pierre Carle, BP 900, Noisiel, France
| | - Marc Bellaiche
- Service de Gastroentérologie, Mucoviscidose et Nutrition Pédiatriques, Hôpital Robert Debré, 48 Boulevard Serurier, 75935, Paris, France
| | - Camille Jung
- Centre de Recherche Clinique, CHI Creteil, 40 Avenue de Verdun, 94000, Creteil, France
| | - Thierry Hanh
- Nestlé, Département Médical et Nutrition Infantile, 7 Boulevard Pierre Carle, BP 900, Noisiel, France
| |
Collapse
|
9
|
Chouraqui JP, Tavoularis G, Simeoni U, Ferry C, Turck D. Food, water, energy, and macronutrient intake of non-breastfed infants and young children (0–3 years). Eur J Nutr 2019; 59:67-80. [DOI: 10.1007/s00394-018-1883-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 12/13/2018] [Indexed: 01/02/2023]
|
10
|
Darmaun D, Lapillonne A, Simeoni U, Picaud JC, Rozé JC, Saliba E, Bocquet A, Chouraqui JP, Dupont C, Feillet F, Frelut ML, Girardet JP, Turck D, Briend A. Parenteral nutrition for preterm infants: Issues and strategy. Arch Pediatr 2018; 25:286-294. [PMID: 29656825 DOI: 10.1016/j.arcped.2018.02.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/26/2018] [Accepted: 02/18/2018] [Indexed: 01/13/2023]
Abstract
Due to transient gut immaturity, most very preterm infants receive parenteral nutrition (PN) in the first few weeks of life. Yet providing enough protein and energy to sustain optimal growth in such infants remains a challenge. Extrauterine growth restriction is frequently observed in very preterm infants at the time of discharge from hospital, and has been found to be associated with later impaired neurodevelopment. A few recent randomized trials suggest that intensified PN can improve early growth; whether or not such early PN improves long-term neurological outcome is still unclear. Several other questions regarding what is optimal PN for very preterm infants remain unanswered. Amino acid mixtures designed for infants contain large amounts of branched-chain amino acids and taurine, but there is no consensus on the need for some nonessential amino acids such as glutamine, arginine, and cysteine. Whether excess growth in the first few weeks of life, at a time when very preterm infants receive PN, has an imprinting effect, increasing the risk of metabolic or vascular disease at adulthood continues to be debated. Even though uncertainty remains regarding the long-term effect of early PN, it appears reasonable to propose intensified initial PN. The aim of the current position paper is to review the evidence supporting such a strategy with regards to the early phase of nutrition, which is mainly covered by parenteral nutrition. More randomized trials are, however, needed to further support this type of approach and to demonstrate that this strategy improves short- and long-term outcome.
Collapse
Affiliation(s)
- D Darmaun
- Université Nantes-Atlantique, 44300 Nantes, France.
| | | | - U Simeoni
- Université de Lausanne, CHUV, 1011 Lausanne, Suisse
| | - J-C Picaud
- Université Claude-Bernard-Lyon 1, 69008 Lyon, France
| | - J-C Rozé
- Université Nantes-Atlantique, 44300 Nantes, France
| | - E Saliba
- Université François-Rabelais, 37000 Tours, France
| | - A Bocquet
- Université de Franche-Comté, 25000 Besançon, France
| | | | - C Dupont
- Université Paris Descartes, 75006 Paris, France
| | - F Feillet
- Université de Lorraine, 54000 Nancy, France
| | - M-L Frelut
- Université Paris-Sud, CHU de Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - J-P Girardet
- Université Pierre et Marie Curie-Paris 6, 75005 Paris, France
| | - D Turck
- Université Lille 2, LIRIC-Inserm U995, 59037 Lille, France
| | - A Briend
- Institut de recherche pour le développement, 13572 Marseille, France
| | | |
Collapse
|
11
|
Schwartz C, Vandenberghe-Descamps M, Sulmont-Rossé C, Tournier C, Feron G. Behavioral and physiological determinants of food choice and consumption at sensitive periods of the life span, a focus on infants and elderly. INNOV FOOD SCI EMERG 2018. [DOI: 10.1016/j.ifset.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
12
|
The French national survey on food consumption of children under 3 years of age – Nutri-Bébé 2013: design, methodology, population sampling and feeding practices. Public Health Nutr 2017; 21:502-514. [DOI: 10.1017/s1368980017002518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
To update the data on food consumption and practices in children under 3 years of age in metropolitan France.
Design
The Nutri-Bébé 2013 cross-sectional study selected a random sample, according to the quota sampling method. After giving their informed consent, parents had to record the food consumption during three non-consecutive days framed by two face-to-face interviews, using for quantitative information different portion size measurement aids.
Results
One thousand one hundred and eighty-four children were enrolled. Mothers’ mean age was 30·8 (sd 5·4) years; 38 % were primiparous; 89 % lived with a partner; 60 % had an occupation. Of the infants younger than 4 months, 31 % were breast-fed. One thousand and thirty-five children consumed infant formula followed by growing-up milk in 63 % of them; solid foods were introduced at a mean age of 5·4 (sd 2·13) months. From 8 months onwards, 25 % of children consumed the same foods as their parents on a more or less regular basis; 29 % ate in front of a screen, with a daily average screen time of 43·0 (sd 40·4) min.
Conclusions
This robust survey highlights the low prevalence and duration of breast-feeding in France and shows a modest improvement since the previous survey of 2005 in the observance of recommendations concerning other feeding practices. The frequent consumption of adult foods and the screen time are of concern.
Collapse
|