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Pavan Kumar ST, Sangma SN, Devi CB, Lahiri B, Kencharaddi HG, Vastrad J. Evaluating food security and nutritional pathways of rural farm families: Empirical evidence from northeast India. EVALUATION AND PROGRAM PLANNING 2024; 107:102478. [PMID: 39226733 DOI: 10.1016/j.evalprogplan.2024.102478] [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: 02/06/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/05/2024]
Abstract
The study aimed to ascertain a relationship between agricultural status, socioeconomic factors, and nutrition of farm families. The study was conducted in selected villages in the West Garo Hills district of Meghalaya, using Stratified Random Sampling (St. RS). Using pretested interview schedules, we collected primary data from respondents in 2020 and 2021, focusing on socioeconomic variables, body mass index, and income from agriculture and related sectors. The data was analysed using correlation analyses and separate combined regression estimates for each year and month were obtained. Results from the study indicate that agricultural income significantly influenced nutritional status (p < 0.05) and household income growth was also found significant. The region's agricultural production of cereals, pulses, and vegetables was insufficient, as was the production of meat and meat products, milk, and milk products. Hence, expenditure towards purchasing the above food groups from the market was found to be significant (p < 0.05). Therefore, the markets near the mainland especially in the hilly region play a crucial role in the nutritional pathway of rural farm families.
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Affiliation(s)
- S T Pavan Kumar
- College of Community Science, Central Agricultural University (Imphal), Tura, Meghalaya, India.
| | - Silkame N Sangma
- College of Community Science, Central Agricultural University (Imphal), Tura, Meghalaya, India
| | - Ch Basanti Devi
- College of Community Science, Central Agricultural University (Imphal), Tura, Meghalaya, India
| | - Biswajit Lahiri
- College of Fisheries, Central Agricultural University (Imphal), Lembucherra, Tripura, India
| | - H G Kencharaddi
- College of Community Science, Central Agricultural University (Imphal), Tura, Meghalaya, India
| | - Jyoti Vastrad
- College of Community Science, Central Agricultural University (Imphal), Tura, Meghalaya, India
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Alqahtani S, Aldubayan K, Alshehri S, Almuhareb G, Mahnashi A. The Validity of the Original and the Saudi-Modified Screening Tools for the Assessment of Malnutrition in Pediatrics: A Cross-Sectional Study. Diagnostics (Basel) 2024; 14:2256. [PMID: 39451579 PMCID: PMC11505708 DOI: 10.3390/diagnostics14202256] [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: 09/27/2024] [Revised: 10/04/2024] [Accepted: 10/08/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Screening for malnutrition among hospitalized children is essential, and the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) is a validated tool for this purpose. The study aimed to modify STAMP for a Saudi context and assess the sensitivity and specificity of both the original and modified tools. Method: A cross-sectional study was conducted among 307 hospitalized children, where both the original and Saudi-modified STAMP were applied. Anthropometric measurements were also recorded, and statistical analysis using SPSS and validity parameters was used to assess the tools' validity. Results: The Saudi-modified STAMP identified a higher percentage of children at high risk of malnutrition compared to the original STAMP (91.6% vs. 62.9%). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement of the Saudi-modified STAMP compared to the original were 94.3%, 13.2%, 64.8%, 57.7%, 0.654, and 0.089, respectively. Conclusions: The Saudi-modified STAMP showed excellent sensitivity and varied negative predictive value, indicating its potential effectiveness in screening for the risk of malnutrition among hospitalized children compared to the original STAMP.
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Affiliation(s)
- Sheikha Alqahtani
- Department of Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia (A.M.)
- Department of Dietetics, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Khalid Aldubayan
- Department of Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia (A.M.)
| | - Saleh Alshehri
- Department of Emergency, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia;
| | - Ghada Almuhareb
- Department of Dietetics, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
| | - Amal Mahnashi
- Department of Community Health Sciences, Collage of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia (A.M.)
- Department of Clinical Nutrition, Riyadh Third Health Cluster, Riyadh 13717, Saudi Arabia
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Merlino Barr S, Hand RK, Fenton TR, Groh-Wargo S. Role of the neonatal registered dietitian nutritionist in Canada: A description of staffing and a comparison to practices in the United States. Nutr Clin Pract 2024; 39:1212-1226. [PMID: 39010702 DOI: 10.1002/ncp.11182] [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: 01/09/2024] [Revised: 04/15/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team. Ideal RDN staffing levels are unknown. Current staffing levels of neonatal RDNs in Canadian NICUs have not been recently reported. The objective of this study was to describe neonatal RDN staffing and responsibilities in Canada and contrast these findings with those of neonatal RDNs in the United States. METHODS An online cross-sectional neonatal RDN survey was performed in the Fall of 2021 to collect hospital-level and individual-RDN-level data. Descriptive statistics were performed to summarize Canadian neonatal RDN staffing levels and responsibilities and compared with US findings. RESULTS Canadian RDNs reported a median staffing ratio of 25.3 NICU beds per RDN full-time equivalent, with neonatal RDNs reporting a desired 31% increase in staffing. The majority of Canadian NICUs (n = 20/24) reported having a dedicated space to prepare infant feeds away from bedside. Canadian neonatal RDNs reported wanting to expand their responsibilities in research, administration, and education. Canadian neonatal RDNs reported a higher rate of order writing privileges as compared with that of US neonatal RDNs. CONCLUSION Canadian neonatal RDNs reported a desired increase in their staffing levels. Neonatal RDNs have the potential to expand their professional role but require additional staffing, dedicated time, and compensation to support this. Further research determining the optimal neonatal RDN staffing ratio to maximize patient outcomes is required.
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Affiliation(s)
| | - Rosa K Hand
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tanis R Fenton
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sharon Groh-Wargo
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
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Gliwińska A, Badeńska M, Dworak M, Świętochowska E, Badeński A, Bjanid O, Trembecka-Dubel E, Morawiec-Knysak A, Szczepańska M. Assessment of brain-derived neurotrophic factor and irisin concentration in children with chronic kidney disease: a pilot study. BMC Nephrol 2024; 25:318. [PMID: 39334009 PMCID: PMC11430335 DOI: 10.1186/s12882-024-03767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Patients suffering from chronic kidney disease (CKD) are particularly placed at risk of multiorgan complications. One of them is malnutrition, which adds up to a higher mortality factor among them. This study was designed to determine the usefulness of brain-derived neurotrophic factor (BDNF) and irisin assays in the assessment of CKD development. The study group included 28 children with CKD at stages 2-5 treated conservatively. The outcome of our study revealed decreased serum BDNF and irisin levels in CKD patients, whereas urine concentrations were increased for BDNF and decreased for irisin, comparing to healthy controls. There was a positive correlation between anthropometric measures and urine BDNF concentration, as well as anthropometric measures and both serum and urine irisin levels in the study group, however no dependence of the tested markers on the stage of CKD was observed. In recent years, a role of myokines was described as vital for maintaining metabolic homeostasis therefore we suspect a potential role of these multifaceted markers in detecting malnutrition in CKD children.
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Affiliation(s)
- Aleksandra Gliwińska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland.
| | - Marta Badeńska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
| | - Marta Dworak
- Department of Pediatric Nephrology with Dialysis Division for Children, Independent Public Clinical Hospital No. 1, Zabrze, 41-800, Silesia, Poland
| | - Elżbieta Świętochowska
- Department of Medical and Molecular Biology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
| | - Andrzej Badeński
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
| | - Omar Bjanid
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
| | - Elżbieta Trembecka-Dubel
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
| | - Aurelia Morawiec-Knysak
- Department of Pediatric Nephrology with Dialysis Division for Children, Independent Public Clinical Hospital No. 1, Zabrze, 41-800, Silesia, Poland
| | - Maria Szczepańska
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, 40-055, Silesia, Poland
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Becker P, Abdel-Rahman S, Nemet D, Marino LV, Noritz G, Fisberg M, Beretich K. Measurement of mid-upper arm circumference to screen for childhood malnutrition: General applicability and use in special populations. Nutr Clin Pract 2024. [PMID: 39292197 DOI: 10.1002/ncp.11208] [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: 01/10/2024] [Revised: 07/19/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024] Open
Abstract
Since the development of consensus-recommended indicators for pediatric malnutrition in 2014, screening and diagnosis of pediatric malnutrition have improved, but the indicators are not always used; malnutrition continues to be underdiagnosed in some community and healthcare settings. In particular, mid-upper arm circumference (MUAC) is underused as a screening indicator for pediatric malnutrition, despite its unique advantages and usefulness in several clinical situations. In December 2022, a scientific roundtable was held to bring together several experts in pediatric malnutrition. One of the goals of the scientific roundtable was to discuss the clinical use of anthropometric measures as screening tools for pediatric malnutrition status, with a focus on the use of MUAC. This article arose from that event and is intended as an educational tool to aid clinicians in implementing MUAC measurements. In addition to describing the use of MUAC as a screening tool, the article discusses several clinical situations in which MUAC is especially useful. Additionally, the article reviews practical aspects of measuring and interpreting MUAC values, provides links to additional educational resources, and briefly reviews areas in which further research is needed regarding the use of MUAC for screening of nutrition status in children.
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Affiliation(s)
- Patricia Becker
- Neonatal Intensive Care Unit/Nutrition Clinic, Dayton's Children's Hospital, Dayton, Ohio, USA
| | | | - Dan Nemet
- Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Luise V Marino
- University Hospital Southampton, NHS Foundation Trust, and Faculty of Medicine and Health Sciences, University of Southampton, Southampton, UK
| | - Garey Noritz
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Mauro Fisberg
- CENDA-Instituto PENSI-Sabará Children's Hospital Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kaitlan Beretich
- Medical Affairs & Research, Abbott Nutrition, Dallas-Fort Worth, Texas, USA
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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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Qiu H, Zhang H, Zhang J, Kuo F, Huysentruyt K, Smith C, Bhutada AM, Xiao N, Xu K. International consensus on early rehabilitation and nutritional management for infants at high risk of neurological impairments. Pediatr Investig 2024; 8:159-170. [PMID: 39347521 PMCID: PMC11427905 DOI: 10.1002/ped4.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/16/2024] [Indexed: 10/01/2024] Open
Affiliation(s)
- Huiying Qiu
- Department of RehabilitationGuangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangdongChina
| | - Huayan Zhang
- Division of NeonatologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of NeonatologyGuangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangdongChina
| | - Jingbo Zhang
- Department of RehabilitationGuangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangdongChina
| | - Fengyi Kuo
- Semel Institute for Neuroscience and Human BehaviorUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of RehabilitationLIH HealthcareBeijingChina
| | - Koen Huysentruyt
- Brussels Centre for Intestinal Rehabilitation in ChildrenVrije Universiteit BrusselBrusselsBelgium
| | - Christopher Smith
- Department of Nutrition and DieteticsRoyal Alexandra Children's HospitalBrightonUK
| | - Ankita M. Bhutada
- Asante Three Rivers Medical Centre (Inpatient & Outpatient), Asante Health SystemOregonUSA
- Department of Speech Pathology and AudiologyUniversity of South AlabamaMobileAlabamaUSA
| | - Nong Xiao
- Department of RehabilitationChongqing Medical University Affiliated Children's HospitalChongqingChina
| | - Kaishou Xu
- Department of RehabilitationGuangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangdongChina
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Zhou H, Qiu H, Wang X, Zhao J, Zhang J, Zhang Y, Peng T, Yang X, Cheng Y, Hou Q, Yang W, Huang X, Qiu S, Ma L, Zheng Y, Tang H, He L, Xu K. Nutritional status and neurodevelopmental levels in infants at high risk of cerebral palsy. Pediatr Investig 2024; 8:184-192. [PMID: 39347528 PMCID: PMC11428172 DOI: 10.1002/ped4.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/28/2024] [Indexed: 10/01/2024] Open
Abstract
Importance Nutrition is associated with neurodevelopment. Infants at high risk of cerebral palsy (CP) usually suffer from undernutrition, yet the relationship between nutritional status and neurodevelopmental levels is unclear. Objective To describe the nutritional status characteristics of infants at high risk of CP, and to explore the relationship between neurodevelopmental levels and nutritional status. Methods This single-center cross-sectional study enrolled infants at high risk of CP, with corrected age from 0 days to 12 months. Weight and height were measured and calculated into z-scores, which were used to classify the nutritional status based on the World Health Organization growth charts and American Society for Parenteral and Enteral Nutrition standards. The Bayley Scales of Infant and Toddler Development were used to evaluate the developmental levels of gross motor, fine motor, cognition, receptive communication, and expressive communication. Results A total of 479 infants at high risk of CP were recruited, with 43.4% classified as undernutrition. Compared to those with normal neurodevelopment, the odds of moderate and severe undernutrition were about 1.8 and 3.9 times higher in gross motor delay, 2.2 and 3.1 times higher in fine motor delay, 2.5 and 9.4 times higher in cognition delay, 2.2 and 3.9 times higher in receptive communication delay, and 3.0 and 5.6 times higher in expressive communication delay. There were significant positive correlations between nutritional status and neurodevelopmental levels (P < 0.001). Interpretation Undernutrition and neurodevelopmental delays are prevalent among infants at high risk of CP. Worse nutritional status was correlated with lower neurodevelopmental levels.
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Affiliation(s)
- Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Huiying Qiu
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Xiaoyue Wang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Jingyi Zhao
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of Sport Rehabilitation Shanghai University of Sport Shanghai China
| | - Jingbo Zhang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Yuan Zhang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of Sport Rehabilitation Shanghai University of Sport Shanghai China
| | - Tingting Peng
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Xubo Yang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Yahui Cheng
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Qingfen Hou
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of Sports and Health Guangzhou Sport University Guangdong China
| | - Wen Yang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- School of Nursing Guangdong Pharmaceutical University Guangdong China
| | - Xiaoyin Huang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Shaihong Qiu
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Liying Ma
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Yuai Zheng
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children Medical Center Guangzhou Medical University Guangdong China
- Department of rehabilitation Guangdong Provincial Clinical Research Center for Child Health Guangdong China
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Gehl B, Feinn R, Haines K, Hussain N, Lainwala S. Growth at 2 years corrected age in preterm infants discharged on two different breast milk enhancements: An observational study. J Pediatr Gastroenterol Nutr 2024. [PMID: 39166799 DOI: 10.1002/jpn3.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/24/2024] [Accepted: 07/19/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVE Breast milk (BM) enhancement is often used to meet the nutritional needs of preterm infants after hospital discharge to achieve optimal growth. This study compared growth at 18-28 months corrected age (CA) among very preterm (VP) and very low birth weight (VLBW) infants discharged from the neonatal intensive care units (NICUs) on two BM enhancements. METHODS We conducted a retrospective chart review study of infants born between January 1, 2013 and December 31, 2017, with gestational age < 32 weeks or birthweight < 1500 g, discharged from the NICU on BM enhancements; fortification of BM with infant formula additives (BM-F) or unfortified BM supplemented with bottle feeds of infant formula (BM-S). BM enhancements were nonrandomized and determined by the medical team. A linear mixed model regression analysis with propensity score matching was used to estimate the adjusted associations between the nutrition plan at discharge and growth outcomes at 18-28 months CA follow-up. RESULTS Two hundred and fifty-one VLBW/VP infants were included. Compared with BM-S, infants discharged on BM-F were more likely to continue receiving BM at 8-12 months CA, and had lower head circumference, weight-for-length z scores, and higher incidence of moderate malnutrition (p ≤ 0.01). After adjusting for confounders, discharge on BM-F was associated with a lower incidence of overweight/obesity at 18-28 months CA (odds interval: 0.45; confidence interval: 0.21-0.96; p = 0.04). CONCLUSIONS This retrospective study suggests that VLBW/VP infants discharged on BM-F received BM longer, had lower growth parameter and were less likely to be overweight/obese at 18-28 months CA. Further studies are needed to evaluate the role of postdischarge nutrition on preterm born children's growth, metabolic disease, and neurodevelopmental outcomes.
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Affiliation(s)
- Brigitta Gehl
- Department of Pediatrics, New York Presbyterian-Columbia University, New York, New York, USA
| | - Richard Feinn
- Department of Medical Sciences, Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Kathleen Haines
- Department of Clinical Nutrition Services, Connecticut Children's, Hartford, Connecticut, USA
| | - Naveed Hussain
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
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10
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Blaess M, Eliot K. A Framework for RDN and SLP Collaboration: A Missing Piece in Autism Spectrum Disorder Treatment. J Acad Nutr Diet 2024; 124:939-946. [PMID: 38615995 DOI: 10.1016/j.jand.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Martha Blaess
- Department of Nutrition and Dietetics, Department of Speech, Language, and Hearing Sciences, Saint Louis University, Saint Louis, MO.
| | - Kathrin Eliot
- Department of Nutritional Sciences, The University of Oklahoma Health Sciences, Oklahoma City, OK
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11
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Jimenez EY, Lamers-Johnson E, Long JM, Mordarski BA, Ma X, Steiber A. Completion of a Nutrition-Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study. Nutr Clin Pract 2024; 39:888-902. [PMID: 38372592 DOI: 10.1002/ncp.11137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. METHODS Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RESULTS RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. CONCLUSION RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Beth A Mordarski
- Lifelong Learning and Engagement, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Alison Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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12
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Zhu S, Mohd Yusoff D, Yusoff H, Cheng KY, Feng X, Chen H. Knowledge, attitude, and practice regarding malnutrition amongst patients with chronic kidney disease in China: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:233. [PMID: 39297097 PMCID: PMC11410278 DOI: 10.4103/jehp.jehp_1378_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 09/21/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) can be complicated by malnutrition, which has adverse implications on patients' health outcomes and quality of life. CKD patients from different sociocultural contexts may have varying perceptions of knowledge, attitudes, and practices of malnutrition. However, information on the perception of malnutrition in patients with CKD is limited. This study aimed to explore and describe the knowledge, attitude, and practice of patients with CKD disease regarding malnutrition. MATERIALS AND METHODS A qualitative-descriptive design was used. Thirteen participants were selected through a purposive sampling technique among malnourished CKD patients from a hospital in Xi'an Provincial Hospital of Traditional Chinese Medicine between November 2022 and January 2023. Data were collected through face-to-face semistructured interviews until data saturation. All participants were informed about the study. Data obtained were analyzed by content analysis. RESULTS Three main categories and seven subcategories were extracted from the data analysis: 1) knowledge (basic knowledge acquisition and understanding, knowledge misconceptions, and confusion, nutrition knowledge, and culture collision); 2) attitude (negative attitudes and adverse situations, positive attitude and self-awareness); 3) practice (disadvantageous and passive practice, favorable practice). CONCLUSION This study provided insight into the knowledge, attitude, and practice of malnutrition in patients with CKD. Our findings can serve as important baseline data for the development of future interventions that can help reduce the risk of malnutrition, slow disease progression, and improve the quality of life in patients with CKD.
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Affiliation(s)
- Shengrui Zhu
- Nursing Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Dariah Mohd Yusoff
- Nursing Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Hafzan Yusoff
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Kueh Yee Cheng
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Xiujuan Feng
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Hongfang Chen
- Human Resources Office, Xi'an Provincial Hospital of Traditional Chinese Medicine, Xi'an, China
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Ow MYL, Tran NT, Berde Y, Nguyen TS, Tran VK, Jablonka MJ, Baggs GE, Huynh DTT. Oral nutritional supplementation with dietary counseling improves linear catch-up growth and health outcomes in children with or at risk of undernutrition: a randomized controlled trial. Front Nutr 2024; 11:1341963. [PMID: 39050140 PMCID: PMC11266289 DOI: 10.3389/fnut.2024.1341963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Childhood undernutrition is associated with increased morbidity, mortality and a high socio-economic burden. Methods Supporting Pediatric GRowth and Health OUTcomes (SPROUT) is a randomized, controlled trial evaluating the effects of an oral nutritional supplement (ONS) with dietary counseling (DC; n = 164) compared to a DC-only group who continued consuming their habitual milk (n = 166; NCT05239208). Children aged 24-60 months who were at risk or with undernutrition, as defined by weight-for-age [WAZ] < -1 and height-for-age [HAZ] < -1 according to the WHO Growth Standards, and who also met the criterion of weight-for-height [WHZ] < 0, were enrolled in Vietnam. Results ONS + DC had a larger WAZ increase at day 120 (primary endpoint) vs. DC (least squares mean, LSM (SE): 0.30 (0.02) vs. 0.13 (0.02); p < 0.001), and larger improvements in all weight, BMI and weight-for-height indices at day 30 and 120 (all p < 0.01). Height gain was larger in ONS + DC in all indices, including height-for-age difference [HAD; cm: 0.56 (0.07) vs. 0.10 (0.07); p < 0.001], at day 120. ONS + DC had larger arm muscle but not arm fat indices, higher parent-rated appetite, physical activity and energy levels, longer night sleep, fewer and shorter awakenings, and better sleep quality than DC. Conclusion Adding ONS to DC, compared to DC-alone, improves growth in weight and height, linear catch-up growth, and health outcomes in children with or at risk of undernutrition.
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Affiliation(s)
- Mandy Y. L. Ow
- Abbott Nutrition R&D Asia Pacific-Center, Abbott Laboratories, Singapore, Singapore
| | - Nga Thuy Tran
- Department of Micronutrients, National Institute of Nutrition, Hanoi, Vietnam
| | - Yatin Berde
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd., Mumbai, India
| | - Tu Song Nguyen
- Department of General Planning, National Institute of Nutrition, Hanoi, Vietnam
| | - Van Khanh Tran
- Department of Micronutrients, National Institute of Nutrition, Hanoi, Vietnam
| | | | | | - Dieu T. T. Huynh
- Abbott Nutrition R&D Asia Pacific-Center, Abbott Laboratories, Singapore, Singapore
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Aviles T, Giangiordano A, Evelyn D, Liu C, Dorfman L, Kaul A. Factors influencing gastrostomy tube feeding duration and nutrition outcomes in pediatric patients with Down syndrome: A descriptive cohort study. JPEN J Parenter Enteral Nutr 2024; 48:605-613. [PMID: 38715451 DOI: 10.1002/jpen.2637] [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: 06/01/2023] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Feeding difficulty is widely recognized in patients with Down syndrome, and many patients require gastrostomy tube (G-tube) placement for nutrition. No reliable factors have been identified to predict the expected duration of G-tube feeds in patients with Down syndrome. This descriptive cohort study aimed to determine the factors affecting the duration of G-tube feeds. We also investigated change in body mass index (BMI) from G-tube placement to discontinuation. METHODS Medical records of patients with Down syndrome seen by a pediatric gastroenterologist at a tertiary care center between September 1986 and December 2021 were reviewed. Data collection included demographics, anthropometrics, comorbidities, and feeding route. Comparison was performed between patients who discontinued G-tube feeds and those who did not. RESULTS Two hundred twenty patients (45% female) were included. The median age at G-tube placement was 5 months (interquartile range [IQR]: 0.2-1.3 years). There were 113 (51%) patients who discontinued G-tube feeds, after a median duration of 31.6 months (IQR: 15.6-55.7 months). Tracheostomy was the only covariant associated with a longer duration of G-tube feeds (158 months vs 53 months; P = 0.002). Neither age at G-tube placement nor any comorbidities were associated with BMI status at discontinuation of G-tube. CONCLUSION In our cohort of patients with Down syndrome, age at placement of G-tube did not impact the duration of G-tube feeds. Most patients who had a G-tube placed were likely to require enteral feeds for at least 1 year. Those who had a tracheostomy needed their G-tube for a longer time.
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Affiliation(s)
- Thomas Aviles
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Abby Giangiordano
- Department of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Danielle Evelyn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Lev Dorfman
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ajay Kaul
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Prezelski K, Villarreal Acha D, Ngo TVC, Wilson C, Thrasher V, Trevino K, Van't Slot C, Hallac RR, Seaward JR, Kane AA. A Dedicated Multidisciplinary Growth and Feeding Clinic for Infants with Cleft Lip and/or Palate Demonstrates Need for Intervention. Cleft Palate Craniofac J 2024:10556656241258687. [PMID: 38860332 DOI: 10.1177/10556656241258687] [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: 06/12/2024] Open
Abstract
OBJECTIVE A Growth and Feeding Clinic (GFC) focused on early intervention around feeding routines in patients with cleft lip and/or palate (CL/P) was implemented. DESIGN This study assessed the effect of preoperative feeding interventions provided by the GFC. SETTING Tertiary academic center. METHODS This study evaluated patients with CL/P who were cared for by the GFC and a control group of patients with CL/P. Weight-for-age (WFA) Z-score of less than -2.00 was used as a cutoff to classify patients who were underweight during the preoperative period. MAIN OUTCOME MEASURE The number of underweight patients who were able to reach normal weight by the time of their cleft lip repair was used as the primary outcome measure. RESULTS Within both the GFC and control groups, 25% of patients with CL/P were underweight as determined by WFA Z-score. GFC patients who were underweight received more clinic visits (P < .001) and GFC interventions (P < .001) compared to GFC patients who were normal weight. At the time of cleft lip surgery, 64.1% of GFC underweight patients were normal weight compared to 31.8% of control group underweight patients (P = .0187). CONCLUSION This study showed that multidisciplinary care provided by the GFC was able to target preoperative nutritional interventions to the highest-risk patients, resulting in double the percentage of patients who were of normal weight at the time of their cleft lip repair. These results provide objective proof supporting the assertion that multidisciplinary team care of the infant with cleft leads to measurable improvement in outcomes.
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Affiliation(s)
- Kayla Prezelski
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Daniel Villarreal Acha
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tuong-Vi Cindy Ngo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caitlin Wilson
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Vania Thrasher
- Department of Clinical Nutrition, Children's Health, Dallas, TX, USA
| | - Kandi Trevino
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Cortney Van't Slot
- Department of Speech-Language Pathology, Children's Health, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Analytical Imaging and Modeling Center, Children's Health, Dallas, TX, USA
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16
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Mansour M, Knebusch N, Daughtry J, Fogarty TP, Lam FW, Orellana RA, Lai YC, Erklauer J, Coss-Bu JA. Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses (CNIs)?-A Quaternary Hospital Experience. CHILDREN (BASEL, SWITZERLAND) 2024; 11:711. [PMID: 38929290 PMCID: PMC11202205 DOI: 10.3390/children11060711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
The literature on the nutritional needs and outcomes of critically ill children is scarce, especially on those with critical neurological illnesses (CNIs). Current evidence shows a lower mortality in patients who achieve two-thirds of their nutritional needs during the first week of pediatric intensive care unit (PICU) admission. We hypothesized that achieving 60% of the recommended dietary intake during the first week of a PICU stay is not feasible in patients with CNI. We designed an observational retrospective cohort study where we included all index admissions to the PICU in our institution of children (1 month to 18 years) with CNI from January 2018 to June 2021. We collected patient demographics, anthropometric measures, and caloric and protein intake (enteral and parenteral) information during the first week of PICU admission. Goal adequacy for calories and protein was defined as [(intake/recommended) × 100] ≥ 60%. A total of 1112 patients were included in the nutrition assessment, 12% of whom were underweight (weight for age z score < -2). Of this group, 180 met the criteria for nutrition support evaluation. On the third day of admission, 50% of the patients < 2 years achieved caloric and protein goal adequacy, compared to 25% of patients > 2 years, with p-values of 0.0003 and 0.0004, respectively. Among the underweight patients, 60% achieved both caloric and protein goal adequacy by day 3 vs. 30% of non-underweight patients with p-values of 0.0006 and 0.002, respectively. The results show that achieving 60% of the recommended dietary intake by days 5 and 7 of admission was feasible in more than half of the patients in this cohort. Additionally, children who were evaluated by a clinical dietician during the first 48 h of PICU admission reached higher nutrition adequacy.
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Affiliation(s)
- Marwa Mansour
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Nicole Knebusch
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Jennifer Daughtry
- Department of Clinical Nutrition Services, Texas Children’s Hospital, Houston, TX 77030, USA
| | - Thomas P. Fogarty
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Fong Wilson Lam
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Renan A. Orellana
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Yi-Chen Lai
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
| | - Jennifer Erklauer
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jorge A. Coss-Bu
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX 77030, USA; (M.M.)
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17
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Rompca A, McCallister A, Cruse W, Webber EC, Vanderpool C. Education and documentation strategies to improve malnutrition diagnosis in hospitalized children: A quality improvement project. Nutr Clin Pract 2024; 39:696-701. [PMID: 37817534 DOI: 10.1002/ncp.11080] [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: 06/08/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) published malnutrition guidelines in 2014. In 2015, our institution implemented a quality improvement project focused on malnutrition identification with the goal to improve the diagnosis of malnutrition in hospitalized children. METHODS Our project included three approaches: education, nutrition assessment, and documentation initiatives. Education initiatives focused on physicians at all levels of training. Nutrition screening was completed on all patients admitted to our institution. Registered dietitians (RDs) conducted nutrition assessments and identified and documented malnutrition based on AND/ASPEN guidelines. Documentation initiatives included development of automatic text and template changes to allow import of RD-assigned malnutrition diagnosis into physician documentation. We met with members of our clinical documentation integrity team regularly to review the results of these initiatives starting in 2016. RESULTS The total diagnosed cases of malnutrition increased from 208 cases in 2016 at the start of our monitoring to >800 cases per year in 2020-2022. Unspecified (no severity assigned) protein calorie malnutrition as a percentage of total malnutrition diagnoses decreased from 36.9% in 2016 to <10% since 2018. Children with severe malnutrition have remained the largest portion of children with a malnutrition diagnosis, with >40% of children with malnutrition diagnosed with severe malnutrition. CONCLUSION Our education and documentation initiatives have led to both improved diagnosis of malnutrition and accurate identification and documentation of malnutrition severity. These initiatives could be utilized to improve malnutrition diagnosis and documentation at other institutions caring for hospitalized children.
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Affiliation(s)
- Annemarie Rompca
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Anne McCallister
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Wendy Cruse
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Emily C Webber
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
- Division of Pediatric Hospital Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Charles Vanderpool
- Division of Pediatric Gastroenterology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
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18
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Lara-Pompa NE, Macdonald S, Fawbert K, Shaw V, Wells JC, Fewtrell M, Hill S. Measuring body composition in pediatric patients with complex diagnoses: Acceptability, practicality, and validation of different techniques. Nutr Clin Pract 2024; 39:673-684. [PMID: 38142311 DOI: 10.1002/ncp.11098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/17/2023] [Accepted: 11/05/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Body composition could help identify malnutrition in pediatric patients, but there is uncertainty over which techniques are most suitable and prevailing opinion that measurements are difficult to obtain in practice. This study examined the acceptability, practicality, reliability, and validity of different anthropometric and body composition measurements in patients with complex diagnoses in a tertiary pediatric hospital. METHODS A total of 152 children aged 5-18 years had weight, height, body mass index (BMI), mid-upper arm circumference (MUAC), 4-site skinfold thicknesses (SFT), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA) assessed on admission and discharge. Acceptability was assessed in a continuous scale, practicality with number/percentage of successful measurements, reliability with intraclass correlation coefficients and coefficients of repeatability, and validity between "simpler" techniques and DXA with Bland-Altman analysis of agreement and Cohen kappa. RESULTS Techniques were overall acceptable. Measurements were successful in >50%, with patient refusal uncommon. Coefficients of repeatability were good (0.3 cm MUAC and height, 0.2 kg weight, and 1.0 mm SFTs). All techniques significantly overestimated DXA fat mass, but BMI and triceps SFT better identified abnormal fat mass (κ = 0.46 and 0.49). BIA fat-free mass was not significantly different from DXA, with substantial agreement between techniques (κ = 0.65). CONCLUSION Body composition by a range of techniques is acceptable, practical, and reliable in a diverse group of children with complex diagnoses. BIA seems a good alternative to DXA for assessing fat-free mass, triceps SFT, and BMI for fat mass but should be used with care as it could overestimate total fat mass in individuals.
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Affiliation(s)
- Nara E Lara-Pompa
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
- Clinical Nutrition, Hospital Infantil Teletón de Oncología, Santiago de Querétaro, México
| | - Sarah Macdonald
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Katherine Fawbert
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Vanessa Shaw
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, UCL Great Ormond St Institute of Child Health, London, UK
| | - Susan Hill
- Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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19
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Bellini SG, Johnson J, McDonald CM, Culhane S, Snell Y, Eggett D. Developing a nutrition screening tool for children with cystic fibrosis ages 0 to 2 years: Children with cystic fibrosis nutrition screening tool. J Cyst Fibros 2024; 23:532-537. [PMID: 37926667 DOI: 10.1016/j.jcf.2023.10.013] [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: 05/26/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND For children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. METHODS A retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. RESULTS The nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. CONCLUSION The nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed.
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Affiliation(s)
- Sarah Gunnell Bellini
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, S219 ESC, Provo, UT 84602, United States.
| | - Jessica Johnson
- Nutrition, Dietetics, and Food Science Department, Brigham Young University, S219 ESC, Provo, UT 84602, United States; Intermountain Medical Center, 5121 S Cottonwood St, Murray, UT 84107, United States
| | - Catherine M McDonald
- Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, United States
| | - Suzanne Culhane
- Texas Children's Hospital, 6621 Fannin St, M/C2-3521, Houston, TX 77030, United States
| | - Yungjing Snell
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, United States
| | - Dennis Eggett
- Department of Statistics, Brigham Young University, 2152 WVB, Provo, UT 84602, United States
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20
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Lisanti AJ, Vittner DJ, Peterson J, Van Bergen AH, Miller TA, Gordon EE, Negrin KA, Desai H, Willette S, Jones MB, Caprarola SD, Jones AJ, Helman SM, Smith J, Anton CM, Bear LM, Malik L, Russell SK, Mieczkowski DJ, Hamilton BO, McCoy M, Feldman Y, Steltzer M, Savoca ML, Spatz DL, Butler SC. Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2023; 33:2521-2538. [PMID: 36994672 PMCID: PMC10544686 DOI: 10.1017/s1047951123000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
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Affiliation(s)
- Amy J. Lisanti
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University Fairfield, CT, USA, Connecticut Children’s, Hartford, CT, USA
| | | | - Andrew H. Van Bergen
- Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Thomas A. Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Erin E. Gordon
- DO, Inpatient Cardiac Neurodevelopment Program, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karli A Negrin
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Hema Desai
- Rehabilitation Services, CHOC Children’s Hospital, Orange, CA, USA
| | - Suzie Willette
- Department of Speech-Language Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Melissa B Jones
- Cardiac Critical Care, Children’s National Hospital, Washington DC USA
| | - Sherrill D. Caprarola
- Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Anna J. Jones
- Office of Advanced Practice Providers, UT Southwestern Medical Center, Dallas, TX, USA, Heart Center, Children’s Health, Dallas, TX, USA
| | - Stephanie M. Helman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jodi Smith
- Parent Representative, The Mended Hearts, Inc., Program Director, Richmond, VA, USA
| | - Corinne M. Anton
- Department of Psychology and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA, Department of Cardiology, Children’s Health, Dallas, Texas, USA
| | - Laurel M. Bear
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA
| | - Lauren Malik
- Department of Acute Care Therapy Services, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah K. Russell
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Dana J. Mieczkowski
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Bridy O. Hamilton
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Meghan McCoy
- Pediatric and Congenital Heart Center, Duke University Hospital, Durham, NC, USA
| | - Yvette Feldman
- Nursing & Patient Care Center of Excellence, St. Luke’s Health System, Boise, ID, USA
| | - Michelle Steltzer
- Single Ventricle Center of Excellence, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Melanie L Savoca
- Department of Clinical Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane L. Spatz
- Department of Family & Community Health, University of Pennsylvania School of Nursing, The Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha C. Butler
- Department of Psychiatry (Psychology), Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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21
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Klein LJ, Abdullahi SU, Gambo S, Stallings VA, Acra S, Rodeghier M, DeBaun MR. Risk factors in underweight older children with sickle cell anemia: a comparison of low- to high-income countries. Blood Adv 2023; 7:6923-6930. [PMID: 37756514 PMCID: PMC10685159 DOI: 10.1182/bloodadvances.2023009711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/25/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Previously, we demonstrated that older children with sickle cell anemia (SCA) living in Nigeria are at increased risk of death if they are underweight (weight-for-age z score < -1). We now conducted a cross-sectional study in low- and high-income settings to determine the risk factors for being underweight a in children aged 5 to 12 years with SCA. The children from low- and high-income settings were eligible participants for the Primary Prevention of Stroke in Children with Sickle Cell Disease in Nigeria (SPRING; N = 928) and the Silent Cerebral Infarct (SIT, North America/Europe; N = 1093) trials, respectively. The median age in the SPRING and SIT cohorts was 8.1 and 8.5 years, respectively (P < .001). A total of 87.9% (n = 816) of participants in the SPRING trial (low-income) met the study criteria for being underweight (weight-for-age z score < -1), and 22.7% (n = 211) for severely underweight (weight-for-age z score < -3), significantly higher than the SIT (high-income) cohort at 25.7% underweight (n = 281) and 0.7% severely underweight (n = 8; P < .001 for both comparisons). In the combined cohort, older age (odds ratio [OR], 1.24; P < .001) and lower hemoglobin level (OR, 0.67; P < .001) were associated with being underweight. Age and hemoglobin level remained statistically significant in separate models for the SPRING and SIT cohorts. Older age and lower hemoglobin levels in children aged 5 to 12 years with SCA are associated with being underweight in low- and high-income settings.
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Affiliation(s)
- Lauren Jane Klein
- D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
| | - Shehu Umar Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | - Michael R. DeBaun
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
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22
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Drayton AK, Knight RM, Shepard H, Andersen AS, Shriver D. Looking Beyond the Growth Curve: A Retrospective Study on Nutrient Deficient Diets in Children with Severe Food Selectivity. JPGN REPORTS 2023; 4:e365. [PMID: 38034439 PMCID: PMC10684205 DOI: 10.1097/pg9.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/22/2023] [Indexed: 12/02/2023]
Abstract
Severe food selectivity places children at risk for nutrient deficiencies and long-term medical complications, if unaddressed. However, poor nutrition in highly selective eaters is often overlooked when considering other behavioral or medical concerns. Additionally, studies regarding food selectivity are sparse and limited to children with developmental delays. This study further investigates the nutritional deficiencies and growth characteristics of children with severe food selectivity to assist pediatricians in the earlier identification of patients for nutrition screening. A retrospective chart review was completed for 13 patients admitted to a pediatric feeding program solely for table-textured food selectivity. Nutrition and anthropometric data from the medical record were analyzed. All patients were determined to be following an age-appropriate growth curve but had multiple micronutrient deficiencies. Additionally, 6 children were typically developing outside of the feeding context. Results suggest that children with food selectivity may require more intensive and earlier nutrition screening beyond their growth patterns.
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Affiliation(s)
- Amy K Drayton
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | - Rachel M Knight
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
| | - Heather Shepard
- Ambulatory Care Services Department of Clinical Nutrition, Harris Health System, Houston, TX
| | | | - Daniel Shriver
- From the Department of Pediatric Feeding Disorders, University of Nebraska Medical Center, Munroe-Meyer Institute, Omaha, NE
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23
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Gallagher H. Pediatric growth faltering: Evaluation and management in primary care. JAAPA 2023; 36:1-6. [PMID: 37884047 DOI: 10.1097/01.jaa.0000979524.39905.7f] [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: 10/28/2023]
Abstract
ABSTRACT Pediatric growth faltering (GF), previously known as failure to thrive and now also called pediatric malnutrition and weight faltering, is a common clinical finding in primary care. Most pediatric GF cases are caused by inadequate caloric intake, not organic disease states. Evaluation requires clinicians to obtain detailed nutritional, medical, psychosocial, and family histories; take accurate anthropometric measurements; and perform a careful physical examination. Evaluation findings should be analyzed to determine whether targeted diagnostic workup, specialty referral, or a trial of nutritional counseling is indicated. Management includes caregiver education about childhood nutrition and frequent monitoring of growth parameters. A multidisciplinary approach that includes nutritionist, developmental therapist, and other specialty team member involvement is desirable.
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Affiliation(s)
- Heather Gallagher
- Heather Gallagher is an associate professor at Massachusetts College of Pharmacy and Health Sciences in Manchester, N.H. The author has disclosed no potential conflicts of interest, financial or otherwise
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24
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Kim EJ, Cho A, Kim DH, Park HC, Yoon JY, Shon K, Kim E, Koo JR, Lee YK. Geriatric Nutritional Risk Index as a Prognostic Factor for Renal Progression in Patients with Type 2 Diabetes Mellitus. Nutrients 2023; 15:4636. [PMID: 37960289 PMCID: PMC10649929 DOI: 10.3390/nu15214636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to evaluate whether the geriatric nutritional risk index (GNRI) is associated with chronic kidney disease (CKD) progression in patients with type 2 diabetes mellitus (DM). In total, 1100 patients with type 2 DM with a follow-up duration > 1 year were included in this longitudinal study. The risk of CKD progression was assessed according to GNRI quartiles. Patients in the lowest GNRI quartile exhibited a significantly lower estimated glomerular filtration rate (eGFR), compared with those in quartile four. Moreover, these patients had poorer glycemic control and lower hemoglobin levels, body mass index, and albumin levels. Additionally, they exhibited a greater annual decline in eGFR. Multivariate logistic regression analysis showed that old age (>60 years), baseline eGFR, the presence of proteinuria, the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and low GNRI were significantly associated with CKD progression. GNRI may serve as a valuable predictive tool for identifying the risk of adverse renal outcomes in patients with type 2 DM. It may potentially serve as a more feasible measure for assessing the nutritional status of these patients, as well as for predicting their clinical outcomes.
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Affiliation(s)
- Eun Jung Kim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Graduate School of Kangwon National University, Kangwon 24341, Republic of Korea
| | - Ajin Cho
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Do Hyoung Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Hayne Cho Park
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Joo Yeon Yoon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Kyungjun Shon
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Eunji Kim
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si 18450, Republic of Korea; (E.J.K.); (J.-R.K.)
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
| | - Young-Ki Lee
- Hallym Kidney Research Institute, Hallym University, Seoul 07441, Republic of Korea; (A.C.); (D.H.K.); (J.Y.Y.); (K.S.); (E.K.)
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
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25
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Hilbrands J, Feuling MB, Szabo A, Teng BQ, Fabus N, Froh M, Heisler R, Lampone O, Smith A, Mikhailov TA, Goday PS. Nutrition Screening in the Pediatric Intensive Care Unit: Evaluation of an Electronic Medical Record-Based Tool. Nutrients 2023; 15:4591. [PMID: 37960244 PMCID: PMC10647546 DOI: 10.3390/nu15214591] [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: 07/24/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Hospitalized, critically ill children are at increased risk of developing malnutrition. While several pediatric nutrition screening tools exist, none have been validated in the pediatric intensive care units (PICU). The Children's Wisconsin Nutrition Screening Tool (CWNST) is a unique nutrition screening tool that includes the Pediatric Nutrition Screening Tool (PNST) and predictive elements from the electronic medical record and was found to be more sensitive than the PNST in acute care units. The aim of this study was to assess the performance of the tool in detecting possible malnutrition in critically ill children. The data analysis, including the results of the current nutrition screening, diagnosis, and nutrition status was performed on all patients admitted to PICUs at Children's Wisconsin in 2019. All 250 patients with ≥1 nutrition assessment by a dietitian were included. The screening elements that were predictive of malnutrition included parenteral nutrition, positive PNST, and BMI-for-age/weight-for-length z-score. The current screen had a sensitivity of 0.985, specificity of 0.06, positive predictive value (PPV) of 0.249, and negative predictive value of 0.929 compared to the PNST alone which had a sensitivity of 0.1, specificity of 0.981, PPV of 0.658, and NPV of 0.749. However, of the 250 included patients, 97.2% (243) had a positive nutrition screen. The CWNST can be easily applied through EMRs and predicts the nutrition risk in PICU patients but needs further improvement to improve specificity.
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Affiliation(s)
- Julia Hilbrands
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Mary Beth Feuling
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.S.)
| | - Bi Q. Teng
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI 53226, USA; (A.S.)
| | - Nicole Fabus
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Melissa Froh
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Rebecca Heisler
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Olivia Lampone
- Clinical Nutrition, Children’s Wisconsin, Milwaukee, WI 53226, USA; (J.H.); (M.B.F.); (N.F.)
| | - Amber Smith
- Nutrition Services, University of California San Francisco Health, San Francisco, CA 94143, USA
| | | | - Praveen S. Goday
- Pediatric Gastroenterology, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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26
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Abdullahi SU, Gambo S, Murtala HA, Kabir H, Shamsu KA, Gwarzo G, Acra S, Stallings VA, Rodeghier M, DeBaun MR, Klein LJ. Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria. Blood Adv 2023; 7:6024-6034. [PMID: 37428866 PMCID: PMC10582275 DOI: 10.1182/bloodadvances.2023010789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023] Open
Abstract
Children with sickle cell anemia (SCA) living in Nigeria are at an increased risk of malnutrition, which contributes to increased morbidity and mortality. However, evidence-based guidelines for managing malnutrition in children with SCA are lacking. To address this gap, we conducted a multicenter, randomized controlled feasibility trial to assess the feasibility and safety of treating children with SCA aged from 5 to 12 years and having uncomplicated severe acute malnutrition (body mass index z score of <-3.0). Children with SCA and uncomplicated severe acute malnutrition were randomly allocated to receive supplemental ready-to-use therapeutic food (RUTF) with or without moderate-dose hydroxyurea therapy (20 mg/kg per day). Over a 6-month enrollment period, 3190 children aged from 5 to 12 years with SCA were evaluated for eligibility, and 110 of 111 children who were eligible were enrolled. During the 12-week trial, no participants withdrew or missed visits. One participant died of unrelated causes. Adherence was high for hydroxyurea (94%, based on pill counts) and RUTF (100%, based on the number of empty sachets returned). No refeeding syndrome event or hydroxyurea-related myelosuppression occurred. At the end of the trial, the mean change in body mass index z score was 0.49 (standard deviation = 0.53), and 39% of participants improved their body mass index z score to ≥-3.0. Our findings demonstrate the feasibility, safety, and potential of outpatient treatment for uncomplicated severe acute malnutrition in children with SCA aged from 5 to 12 years in a low-resource setting. However, RUTF sharing with household and community members potentially confounded the response to malnutrition treatment. This trial was registered at clinicaltrials.gov as #NCT03634488.
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Affiliation(s)
- Shehu U. Abdullahi
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Safiya Gambo
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Hassan Adam Murtala
- Department of Pediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Halima Kabir
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Khadija A. Shamsu
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Garba Gwarzo
- Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sari Acra
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | | | - Michael R. DeBaun
- Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren J. Klein
- Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN
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27
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Hilbrands J, Feuling MB, Szabo A, Teng BQ, Burgess C, Clark B, Crouse J, Fortin H, Heisler B, Karls C, Lampone O, Matschull L, Seyfert M, Smith A, Goday PS. Evaluation of an electronic medical record-based Paediatric Nutrition Screening Tool. J Hum Nutr Diet 2023; 36:1912-1921. [PMID: 37138388 DOI: 10.1111/jhn.13177] [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: 09/21/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk. METHODS The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis. RESULTS One thousand five hundred seventy-five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD-identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI-for-age or weight-for-length z-score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population. CONCLUSION This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone.
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Affiliation(s)
- Julia Hilbrands
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Aniko Szabo
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bi Q Teng
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Chandler Burgess
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Brittani Clark
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Jennifer Crouse
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Heather Fortin
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Becky Heisler
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Catherine Karls
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Olivia Lampone
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Lauren Matschull
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Marissa Seyfert
- Clinical Nutrition, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Amber Smith
- Clinical Nutrition, University of California San Francisco Health, San Francisco, California, USA
| | - Praveen S Goday
- Nutrition and Feeding Programs, Nationwide Children's Hospital, Columbus, Ohio, USA
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28
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DiVito D, Wellik A, Burfield J, Peterson J, Flickinger J, Tindall A, Albanowski K, Vishnubhatt S, MacMullen L, Martin I, Muraresku C, McCormick E, George-Sankoh I, McCormack S, Goldstein A, Ganetzky R, Yudkoff M, Xiao R, Falk MJ, R Mascarenhas M, Zolkipli-Cunningham Z. Optimized Nutrition in Mitochondrial Disease Correlates to Improved Muscle Fatigue, Strength, and Quality of Life. Neurotherapeutics 2023; 20:1723-1745. [PMID: 37723406 PMCID: PMC10684455 DOI: 10.1007/s13311-023-01418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 09/20/2023] Open
Abstract
We sought to prospectively characterize the nutritional status of adults ≥ 19 years (n = 22, 27% males) and children (n = 38, 61% male) with genetically-confirmed primary mitochondrial disease (PMD) to guide development of precision nutritional support strategies to be tested in future clinical trials. We excluded subjects who were exclusively tube-fed. Daily caloric requirements were estimated using World Health Organization (WHO) equations to predict resting energy expenditure (REE) multiplied by an activity factor (AF) based on individual activity levels. We developed a Mitochondrial Disease Activity Factors (MOTIVATOR) score to encompass the impact of muscle fatigue typical of PMD on physical activity levels. PMD cohort daily diet intake was estimated to be 1,143 ± 104.1 kcal in adults (mean ± SEM, 76.2% of WHO-MOTIVATOR predicted requirement), and 1,114 ± 62.3 kcal in children (86.4% predicted). A total of 11/22 (50%) adults and 18/38 (47.4%) children with PMD consumed ≤ 75% predicted daily Kcal needs. Malnutrition was identified in 16/60 (26.7%) PMD subjects. Increased protein and fat intake correlated with improved muscle strength in those with insufficient daily Kcal intake (≤ 75% predicted); higher protein and fat intake correlated with decreased muscle fatigue; and higher protein, fat, and carbohydrate intake correlated with improved quality of life (QoL). These data demonstrate the frequent occurrence of malnutrition in PMD and emphasize the critical need to devise nutritional interventions to optimize clinical outcomes.
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Affiliation(s)
- Donna DiVito
- Clinical Nutrition Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amanda Wellik
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessica Burfield
- Clinical Nutrition Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - James Peterson
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jean Flickinger
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alyssa Tindall
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kimberly Albanowski
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shailee Vishnubhatt
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura MacMullen
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Isaac Martin
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colleen Muraresku
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth McCormick
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ibrahim George-Sankoh
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shana McCormack
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amy Goldstein
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rebecca Ganetzky
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marc Yudkoff
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rui Xiao
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marni J Falk
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maria R Mascarenhas
- Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Zarazuela Zolkipli-Cunningham
- Department of Pediatrics, Division of Human Genetics, Mitochondrial Medicine Frontier Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Neyer PJ, Kaboré B, Nakas CT, Hartmann B, Post A, Diallo S, Tinto H, Hammerer-Lercher A, Largiadèr CR, van der Ven AJ, Huber AR. Exploring the host factors affecting asymptomatic Plasmodium falciparum infection: insights from a rural Burkina Faso study. Malar J 2023; 22:252. [PMID: 37658365 PMCID: PMC10474782 DOI: 10.1186/s12936-023-04686-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Asymptomatic Plasmodium falciparum parasitaemia forms a reservoir for the transmission of malaria disease in West Africa. Certain haemoglobin variants are known to protect against severe malaria infection. However, data on the potential roles of haemoglobin variants and nongenetic factors in asymptomatic malaria infection is scarce and controversial. Therefore, this study investigated the associations of iron homeostasis, inflammation, nutrition, and haemoglobin mutations with parasitaemia in an asymptomatic cohort from a P. falciparum-endemic region during the high transmission season. METHODS A sub-study population of 688 asymptomatic individuals (predominantly children and adolescents under 15 years, n = 516) from rural Burkina Faso previously recruited by the NOVAC trial (NCT03176719) between June and October 2017 was analysed. Parasitaemia was quantified with conventional haemocytometry. The haemoglobin genotype was determined by reverse hybridization assays targeting a selection of 21 HBA and 22 HBB mutations. Demographics, inflammatory markers (interleukins 6 and 10, hepcidin), nutritional status (mid upper-arm circumference and body mass index), and anaemia (total haemoglobin, ferritin, soluble transferrin receptor) were assessed as potential predictors through logistic regression. RESULTS Malaria parasites were detected in 56% of subjects. Parasitaemia was associated most strongly with malnutrition. The effect size increased with malnutrition severity (OR = 6.26, CI95: 2.45-19.4, p < 0.001). Furthermore, statistically significant associations (p < 0.05) with age, cytokines, hepcidin and heterozygous haemoglobin S were observed. CONCLUSIONS According to these findings, asymptomatic parasitaemia is attenuated by haemoglobin S, but not by any of the other detected genotypes. Aside from evidence for slight iron imbalance, overall undernutrition was found to predict parasitaemia; thus, further investigations are required to elucidate causality and inform strategies for interventions.
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Affiliation(s)
- Peter J Neyer
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland.
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland.
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Bérenger Kaboré
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Christos T Nakas
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Laboratory of Biometry, Department of Agriculture Crop, Production and Rural Environment, University of Thessaly, Volos, Greece
| | - Britta Hartmann
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Annelies Post
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salou Diallo
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | - Halidou Tinto
- IRSS/Clinical Research Unit of Nanoro (CRUN), Nanoro, Burkina Faso
| | | | - Carlo R Largiadèr
- Graduate School for Cellular & Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andre J van der Ven
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andreas R Huber
- Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
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Gorrell S, Downey AE, Saunders E, Accurso EC, Buckalew S, Kreiter A, Grange DL, Garber AK. Parental self-efficacy: Longitudinal impact on clinical outcomes across levels of care in adolescent anorexia nervosa. Int J Eat Disord 2023; 56:1764-1771. [PMID: 37272755 PMCID: PMC10524863 DOI: 10.1002/eat.24007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Parental self-efficacy in the domain of weight restoration for adolescents with restrictive eating disorders is central to success in family-based interventions. We sought to characterize this parental self-efficacy during a brief hospitalization for medical stabilization and follow-up among patients with anorexia nervosa (AN) or atypical AN (AAN) enrolled in the StRONG clinical trial to understand the potential impact of inpatient treatment on caregiver empowerment. METHODS Patients were enrolled upon hospital admission and refed per protocol. We examined correlates of the Parents Versus Anorexia (PVA) scale, a measure of parental self-efficacy in the domain of weight restoration, at admission, discharge, 10-days, 1-month, and 3-months post-discharge. Multi-level models evaluated associations among PVA scores and change in %median BMI and Eating Disorder Examination-Questionnaire (EDE-Q) global scores over 3-months post-discharge. RESULTS Parents of N = 67 adolescents and young adults M(SD) age 15.79 (2.20) years and 85.00 (11.86) %median BMI participated. PVA scores did not change significantly during hospitalization (p = .053), which lasted on average 10.7 ± 4.5 days. PVA scores increased post-discharge (p = .009), with significant increase between discharge and 1-month post-discharge (p = .045). PVA scores were not associated with subsequent clinical outcomes. Rather, a main effect of time significantly predicted higher %median BMI and improved EDE-Q scores (p < .001). DISCUSSION The finding that parental self-efficacy did not deteriorate during the inpatient stay is promising given the medical necessity of hospitalization to ensure short-term safety in some cases and the importance of parental self-efficacy to support long-term recovery. PUBLIC SIGNIFICANCE Family-based treatment is the recommended treatment for young people with AN and AAN, serious psychiatric illnesses that may require inpatient medical stabilization. Prior evidence suggests that parental self-efficacy in the outpatient setting is a key component of treatment success. The current study suggests that parental self-efficacy and longer-term treatment outcomes are not undermined by a brief inpatient hospitalization.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Amanda E. Downey
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth Saunders
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sara Buckalew
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Andrea K. Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Hojati A, Alesaeidi S, Izadi S, Nikniaz A, Farhangi MA. MyKid'sNutrition mobile application trial: a randomized controlled trial to promote mothers' nutritional knowledge and nutritional status of preschool children with undernutrition-a study protocol. Trials 2023; 24:544. [PMID: 37596662 PMCID: PMC10439575 DOI: 10.1186/s13063-023-07503-w] [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: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Childhood malnutrition is a crucial public health issue in developing countries. Mothers' nutritional knowledge significantly affects children's nutritional status. It also appears that mothers with low health literacy are unable to adequately meet their children's nutritional needs because they do not clearly understand their children's nutrition and malnutrition status. METHODS This randomized controlled trial aims to describe the development and study protocol of the MyKid'sNutrition application, a smartphone-based intervention for mothers of preschool (2-6 years old) children. The application contains several contents on children's healthy eating, childhood underweight, children's loss of appetite, and child growth assessment. As part of the MyKid'sNutrition trial, a total of 116 participants will be randomized 1:1 either to (a) treatment as usual and MyKid'sNutrition or (b) treatment as usual alone. The results of this trial will be based on changes in growth indicators and mothers' nutritional knowledge, attitude, and practice within the groups and the differences between them. DISCUSSION Due to their widespread availability throughout society, smartphones can be used to deliver educational content on a large scale at a low cost. In addition, they can provide novel ways for patients to receive support. Hence, it is essential to conduct research studies on these types of interventions. MyKid'sNutrition application offers dietary solutions for such nutritional problems as underweight, loss of appetite, and malnutrition in children. Meanwhile, it provides detailed instructions on how to interact with the child. TRIAL REGISTRATION IRCT.ir IRCT20140907019082N11. Registered on February 19, 2022.
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Affiliation(s)
- Ali Hojati
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sogol Alesaeidi
- Department of Pediatric Medicine, Imam Hossein Hospital, Resident of Pediatric Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeideh Izadi
- Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Nikniaz
- Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Kim YS, Kim W, Na JH, Lee YM. Nutritional Intervention Through Ketogenic Diet in GLUT1 Deficiency Syndrome. Clin Nutr Res 2023; 12:169-176. [PMID: 37593212 PMCID: PMC10432162 DOI: 10.7762/cnr.2023.12.3.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023] Open
Abstract
Glucose transporter type 1 (GLUT1) deficiency syndrome (DS) is a metabolic brain disorder caused by a deficiency resulting from SLC2A1 gene mutation and is characterized by abnormal brain metabolism and associated metabolic encephalopathy. Reduced glucose supply to the brain leads to brain damage, resulting in delayed neurodevelopment in infancy and symptoms such as eye abnormalities, microcephaly, ataxia, and rigidity. Treatment options for GLUT1 DS include ketogenic diet (KD), pharmacotherapy, and rehabilitation therapy. Of these, KD is an essential and the most important treatment method as it promotes brain neurodevelopment by generating ketone bodies to produce energy. This case is a focused study on intensive KD nutritional intervention for an infant diagnosed with GLUT1 DS at Gangnam Severance Hospital from May 2022 to January 2023. During the initial hospitalization, nutritional intervention was performed to address poor intake via the use of concentrated formula and an attempt was made to introduce complementary feeding. After the second hospitalization and diagnosis of GLUT1 DS, positive effects on the infant's growth and development, nutritional status, and seizure control were achieved with minimal side effects by implementing KD nutritional intervention and adjusting the type and dosage of anticonvulsant medications. In conclusion, for patients with GLUT1 DS, it is important to implement a KD with an appropriate ratio of ketogenic to nonketogenic components to supply adequate energy. Furthermore, individualized and intensive nutritional management is necessary to improve growth, development, and nutritional status.
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Affiliation(s)
- Young-Sun Kim
- Department of Nutrition and Food Control, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Woojeong Kim
- Department of Nutrition and Food Control, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Ji-Hoon Na
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Young-Mock Lee
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
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Khlevner J, Naranjo K, Hoyer C, Carullo AS, Kerr KW, Marriage B. Healthcare Burden Associated with Malnutrition Diagnoses in Hospitalized Children with Critical Illnesses. Nutrients 2023; 15:3011. [PMID: 37447337 DOI: 10.3390/nu15133011] [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: 05/23/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Our primary study objectives were to (i) determine the proportion of children admitted to the Pediatric Intensive Care Unit (PICU) with malnutrition diagnoses, (ii) compare healthcare utilization by malnourished and non-malnourished PICU patients, and (iii) examine the impact of implementing malnutrition screening and coding practices at a major academic urban tertiary care medical center. Using patient records, we conducted a retrospective analysis of 4106 children admitted to the PICU for severe illnesses between 2011 and 2019. Patients were identified as malnourished if records showed an ICD-9 or ICD-10 code for malnutrition. We compared malnourished and non-malnourished patients by age, admitting diagnoses, number of comorbid conditions, and clinical outcomes (length of stay, hospital readmission). About 1 of every 5 PICU-admitted patients (783/4106) had a malnutrition diagnosis. Patients with malnutrition were younger (mean age 6.2 vs. 6.9 years, p < 0.01) and had more comorbid conditions (14.3 vs. 7.9, p < 0.01) than those without. Malnourished patients had longer hospital stays (26.1 vs. 10.0 days, p < 0.01) and higher 30-day readmission rates (10% vs. 7%, p = 0.03). Implementation of malnutrition screening and coding practices was associated with an increase in malnutrition diagnosis. In this study of children admitted to the PICU, malnourished patients had more comorbid diagnoses and used more healthcare resources (prolonged hospitalizations and higher 30-day readmission rates), leading to higher healthcare costs. Such findings underscore the need for policies, training, and programs emphasizing identification and treatment of malnutrition at hospitals caring for critically ill children.
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Affiliation(s)
- Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - Kelly Naranjo
- Department of Biology, New York University, New York, NY 10032, USA
| | - Christine Hoyer
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Angela S Carullo
- New York Presbyterian Morgan Stanley Children's Hospital, New York, NY 10032, USA
| | - Kirk W Kerr
- Abbott Laboratories, Columbus, OH 43023, USA
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Patel PV, Kao E, Stekol E, Heyman MB, Vu L, Verstraete SG. Evaluating the Relationship Between Nutrition and Post-colectomy Pouchitis in Pediatric Patients with Ulcerative Colitis. Dig Dis Sci 2023; 68:2188-2195. [PMID: 36807017 PMCID: PMC11017704 DOI: 10.1007/s10620-023-07872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Pouchitis is the most frequent complication following restorative proctocolectomy and ileal pouch anal anastomosis (RP-IPAA) in patients with Ulcerative colitis (UC). Pediatric data on nutritional status during RP-IPAA and in patients with pouchitis are limited. AIMS We aimed to delineate nutritional changes in children undergoing 2-stage and 3-stage surgeries and to evaluate the association between nutrition and the development of recurrent or chronic pouchitis. METHODS This single-center retrospective study involved 46 children with UC who underwent a RP-IPAA. Data were collected at each surgical stage and for up to 2-year post-ileostomy takedown. We used Wilcoxon matched-pairs signed-rank test to evaluate the differences in nutritional markers across surgical stages and logistic regression to identify the factors associated with recurrent or chronic pouchitis. RESULTS Twenty patients (43.5%) developed recurrent or chronic pouchitis. Children who underwent a 3-stage procedure had improvements in albumin, hematocrit, and body mass index (BMI)-for-age Z-scores (p < 0.01) between the first two stages. A positive trend in BMI-for-age Z-scores (p = 0.08) was identified in children with 2-stage procedures. All patients showed sustained nutritional improvement during the follow-up period. Among patients who underwent 3-stage surgeries, BMI worsened by 0.8 standard deviations (SDs) (p = 0.24) between the initial stages in those who developed recurrent or chronic pouchitis and improved by 1.1 SDs (p = 0.04) in those who did not. CONCLUSIONS Early improvement in BMI-for-age Z-scores following the initial stage was associated with lower rates of recurrent or chronic pouchitis. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Perseus V Patel
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA.
| | - Emily Kao
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Emily Stekol
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
| | - Lan Vu
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sofia G Verstraete
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, 550 16th Street, 4th Floor, Box 0136, San Francisco, CA, 94158, USA
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Clinical Features of Transient Growth Hormone Deficiency. ENDOCRINES 2023. [DOI: 10.3390/endocrines4010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Background: Most patients with idiopathic growth hormone deficiency (iGHD) in childhood have normal GH stimulation test results in adulthood. The present study aimed to investigate the characteristics and possible etiology of transient iGHD. Methods: Patients with childhood-onset iGHD who completed their GH treatment between March 2010 and March 2021 were retrospectively studied. Patients with a clear history of child abuse or constitutional delay of growth and puberty were excluded. Ten patients with a diagnosis of iGHD based on a decreased growth rate and growth hormone stimulation test findings at the time of onset were included. Retesting demonstrated that these patients had a normal GH level. Results: Five patients had insufficient weight gain (BMI SD score < −1.0 at the start of treatment or a decrease in BMI SD score > 1.0 from one year before treatment to the start of treatment). The other five patients had no remarkable clinical features. One patient had decreased height velocity at the same time as their sibling. Conclusion: Insufficient pre-treatment weight gain or a familial cluster of cases may be related to low GH peaks of GHST, leading to a diagnosis of transient GHD.
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Singh A, Midha V, Mahajan R, Verma S, Kakkar C, Grover J, Singh D, Kaur R, Masih A, Bansal N, Wall C, Sood A. Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn's Disease. Dig Dis Sci 2023; 68:580-595. [PMID: 36064826 DOI: 10.1007/s10620-022-07652-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with an increased risk of malnutrition and sarcopenia. AIMS To evaluate the nutritional status of patients with IBD and determine the threshold values of different parameters of nutritional assessment to identify malnutrition. METHODS This was a single-centre cross-sectional analysis of adult patients with IBD [ulcerative colitis (UC) and Crohn's disease (CD)] who underwent anthropometry [body mass index (BMI), mid upper arm circumference (MUAC) and triceps-fold thickness (TSF)], body composition analysis and assessment for sarcopenia [hand-grip strength and skeletal muscle index (SMI) at L3 vertebral level)]. Age- and gender-matched healthy adults served as controls. Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. RESULTS A total of 406 patients [336 (82.76%) UC and 70 (17.24%) CD; mean age 40.56 ± 13.67 years; 215 (52.95%) males] with IBD and 100 healthy controls (mean age 38.69 ± 10.90 years; 56 (56%) males) were enrolled. The mean BMI, MUAC, TSF thickness, fat and lean mass, hand-grip strength, and SMI at L3 vertebral level were lower in patients with IBD compared to controls. The prevalence of malnutrition was similar in UC and CD [24.40% (n = 82) and 28.57% (n = 20), respectively (p = 0.46)]. Thresholds for fat mass in females (15.8 kg) and visceral fat index in males (0.26) were both sensitive and specific to detect malnutrition. The cutoff values of MUAC and TSF thickness to identify malnutrition were 23.25 cm and 25.25 cm, and 16.50 mm and 8.50 mm, in females and males, respectively. CONCLUSION Malnutrition and sarcopenia were common in patients with IBD, with the prevalence being similar in patients with both UC and CD.
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Affiliation(s)
- Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Shruti Verma
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Chandan Kakkar
- Department of Radiology and Radiodiagnosis, Dayanand Medical College, Ludhiana, Punjab, India
| | - Jasmine Grover
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Dharmatma Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramandeep Kaur
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Abhishek Masih
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Namita Bansal
- Research and Development Centre, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Catherine Wall
- Department of Medicine and Department of Human Nutrition, University of Otago, Christchurch, New Zealand
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
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Aryafar M, Mahdavi M, Shahzadi H, Nasrollahzadeh J. Effect of feeding with standard or higher-density formulas on anthropometric measures in children with congenital heart defects after corrective surgery: a randomized clinical trial. Eur J Clin Nutr 2022; 76:1713-1718. [PMID: 35906331 DOI: 10.1038/s41430-022-01186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The aim of the present study was to assess the efficacy of feeding a higher-density formula (HDF) in infant with congenital heart disease (CHD). METHODS In a parallel randomized trial, infants (6 to 12 months) who underwent CHD corrective surgery received either a standard-density formula (SDF, 67 kcal /100 ml) or an HDF (90 kcal/100 ml) after discharge from the intensive care unit for 8 weeks. In addition to the formula, infants could receive breast milk or complementary food. Anthropometry, biochemistry, and formula intake were collected. RESULT Sixty-four infants completed the study (n = 32 in each group). All infants gained weight. The mean ± standard deviation (SD) of weight z score at baseline and week-8 were -2.38 ± 10.04 to -1.38 + 0.97 in the SDF group and -2.69 ± 1.19 to -0.89 ± 0.90 in the HDF group (between-group p = 0.0001). Both groups gained length, but showed a decline in length z-score which was significant in the SDF group but not significant in the HDF group. Mid-upper arm circumference and its z score improved in both groups, with more improvement in the HDF group. Serum albumin level was higher in the HDF than the SDF group at week-8, but no significant between-group differences were observed in hemoglobin, serum ferritin, or iron. Symptoms of gastrointestinal intolerance were not reported, but parents of 4 infants in the HDF group complained of their infants' constipation. CONCLUSION Feeding infants using a concentrated formula could increase infants' weight gain and growth, and improve the nutritional status after CHD surgery.
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Affiliation(s)
- Maryam Aryafar
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdavi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shahzadi
- Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Nasrollahzadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Academy of Nutrition and Dietetics: Revised 2022 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Pediatric Nutrition. J Acad Nutr Diet 2022; 122:2134-2149.e50. [DOI: 10.1016/j.jand.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/23/2022]
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Haque MA, Choudhury N, Ahmed SMT, Farzana FD, Ali M, Naz F, Raihan MJ, Rahman SS, Siddiqua TJ, Faruque ASG, Ahmed T. Does a child's mid-upper arm circumference-for-age z-score represent another nutritional indicator of childhood malnutrition status? MATERNAL & CHILD NUTRITION 2022; 18:e13404. [PMID: 35821653 PMCID: PMC9480943 DOI: 10.1111/mcn.13404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
Child wasting is defined as a weight-for-height/length z-score (WLZ/WHZ) < -2, and this indicator of nutritional status is used worldwide. However, a precise measurement is required for the assessment of a child's nutritional status, which may not always be possible due to expensive instruments, especially in poor resource settings. In some instances, mid-upper arm circumference-for-age z-score (MUACZ) is also being used for screening purposes, which is a simple and useful nutritional indicator. The objective of this paper is to identify the optimal cut-off point for the MUACZ to identify wasted children, and also to determine if the same factors are associated with MUACZ and wasting. Data were derived from the Suchana evaluation data. The optimal cut-off value was estimated via receiver operating characteristic (ROC) curve analysis using acute malnutrition as a gold standard with maximum sensitivity and specificity. Multiple logistic regression was used to assess the associated factors with the MUACZ. Using the gold standard indicator of nonwasting (WLZ ≥ -2), a positive outcome, the optimal cut-off point for the MUACZ was -1.27. The area under the ROC curve was 0.88, indicating that the model had a power of 88% to differentiate between the positive and negative classes. It implies that a child's MUACZ was correlated with WLZ, and a MUACZ below -1.27 appeared to accurately identify wasting among children aged 3-23 months. MUACZ < -1.27 might be another useful indicator of childhood wasting than a WLZ < -2.
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Affiliation(s)
| | - Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | | | | | - Mohammad Ali
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | - Farina Naz
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
| | | | | | | | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,bDhakaBangladesh
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Wang P, Jiang L, Soh KL, Ying Y, Liu Y, Huang X, Tan Y, Soh KG. Mini Nutritional Assessment for Adult Cancer Patients: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 75:61-72. [PMID: 35903897 DOI: 10.1080/01635581.2022.2104877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Early assessment of malnutrition in cancer patients is very important. The Mini Nutritional Assessment (MNA) is often used to assess malnutrition in adult cancer patients. However, the diagnostic values of MNA are controversial. We aimed to analyze the diagnostic values of MNA in assessing malnutrition in adult cancer patients. A systematic search was performed using Embase, Web of Science, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP). Studies comparing MNA with other tools or criteria in cancer patients were included. The quality of the included studies was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The pooled sensitivity, specificity, the area under the receiver-operating characteristic curve (AUC), and the diagnostic odds ratio (DOR) were calculated using Stata 17.0 and Meta-DiSc1.4. In addition, sensitivity, subgroup, meta-regression, and publication bias analyses were conducted. In total, 11 studies involving 1367 patients involving MNA were included. The pooled sensitivity, specificity, ROC, and DOR were 0.84 (95% CI: 0.81-0.87), 0.66 (95% CI: 0.63-0.69), 0.84 (95% CI: 0.81-0.87), and 16.11 (95% CI: 7.16-36.27), respectively. In the assessment of malnutrition in adult cancer patients, MNA has high sensitivity and moderate specificity.
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Affiliation(s)
- Pengpeng Wang
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia.,Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jiang
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
| | - Yanping Ying
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuanhang Liu
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Xueling Huang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yanmei Tan
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kim Geok Soh
- Department of Sport Studies, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
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The Effect of Different Nutritional Nursing Support on the Nutritional Status and Disease Recovery of Elderly Patients with Gastrointestinal Tumors during the Perioperative Period. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4977922. [PMID: 35813422 PMCID: PMC9259356 DOI: 10.1155/2022/4977922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/17/2022]
Abstract
Objective This study explored the effect of different nutritional nursing support on nutritional status, immune function, postoperative bowel motility, and complications in elderly patients with gastrointestinal tumors during the perioperative period. Methods 300 patients with gastrointestinal tumors treated in the Department of Gastroenterology and anorectal surgery of Hangzhou First People's Hospital Affiliated with the Medical College of Zhejiang University from February 2018 to March 2020 were selected as the research objects in this study. Patients were divided into the early enteral nutrition (EEN) and total parenteral nutrition (TPN) groups (150 cases in each group) according to the principle of odd and even admission numbers. The patients in the EEN and TPN groups were given enteral nutrition nursing support and parenteral nutrition nursing support, respectively. The nutritional status, immune function, postoperative bowel motility, and complication rate of the two groups were evaluated 7 days after the operation. Results The nutritional indexes decreased 3 days after the operation and gradually recovered 7 days after the operation in both groups with different nutritional nursing support. The Hb, TRF, PAB, and ALB indexes in the TPN group were significantly lower than those in the EEN group (P < 0.01). On the 7th day after the operation, the indexes of peripheral blood immunoglobulin (IgG, IgM, and IgA) were significantly lower than those in the TPN group, and T lymphocyte subsets (CD4, CD8, and CD4/CD8) demonstrated that the immunological indexes of patients in the EEN group were significantly higher than those in the TPN group (P < 0.01). In terms of intestinal peristalsis, the time of first exhaust and first defecation in the EEN group was significantly shorter than that in the TPN group (P < 0.01) during the perioperative period. Furthermore, both groups had different degrees of complications, while patients demonstrated a lower complication rate in the EEN group compared to those in the TPN group, suggesting a safer postoperative mode. The results of subgroup analysis showed that the nutritional indexes of the gastric cancer group 7 days after operation were significantly higher than those of the colorectal cancer group under EEN and TPN nutritional support modes. Conclusion Clinical results have suggested that enteral nutrition nursing support can improve the perioperative nutritional status of elderly patients with gastrointestinal tumors by enhancing the immune function and promoting intestinal peristalsis. Meanwhile, the postoperative EEN mode reduces the rate of complications and demonstrates higher safety. Therefore, it has a high clinical application value.
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South CA, Keown-Stoneman CDG, Birken CS, Malik VS, Zlotkin SH, Maguire JL. Underweight in the First 2 Years of Life and Growth in Later Childhood. JAMA Netw Open 2022; 5:e2224417. [PMID: 35904782 PMCID: PMC9338407 DOI: 10.1001/jamanetworkopen.2022.24417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Few studies have examined the association between underweight in the first 2 years and growth in later childhood in high-income countries. OBJECTIVE To evaluate the associations of underweight in the first 2 years of life with body mass index (calculated as weight in kilograms divided by height in meters squared) z score (zBMI), weight-for-age z score (WAZ), and height-for-age z score (HAZ) from ages 2 to 10 years. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted between February 2008 to September 2020 in The Applied Research Group for Kids! practice-based research network in Toronto, Canada. Participants included healthy children aged 0 to 10 years. Data were analyzed from October 2020 to December 2021. EXPOSURES Underweight (ie, zBMI less than -2, per the World Health Organization) in the first 2 years of life. MAIN OUTCOMES AND MEASURES The primary outcome was zBMI from ages 2 to 10 years. Linear mixed-effects models were used to account for multiple growth measures over time. RESULTS A total of 5803 children were included in the primary analysis. At baseline, the mean (SD) age was 4.07 (5.62) months, 2982 (52.2%) were boys, and 550 children (9.5%) were underweight. Underweight in the first 2 years was associated with lower zBMI (difference, -0.39 [95% CI, -0.48 to -0.31]) at 10 years and lower HAZ (difference, -0.24 [95% CI, -0.34 to -0.14]) at age 2 years. Stratified by sex, at age 10 years, girls and boys with underweight in the first 2 years both had lower zBMI (girls: difference, -0.47 [95% CI, -0.59 to -0.34]; boys: difference, -0.32 [95% CI, -0.44 to -0.20]). At age 10 years, children with underweight and a lower zBMI growth rate in the first 2 years had lower zBMI (difference, -0.64 [95% CI, -0.77 to -0.53) and HAZ (difference, -0.12 [-0.24 to -0.01]), while children with underweight and a higher zBMI growth rate in the first 2 years had similar zBMI (difference, -0.11 [95% CI, -0.22 to 0.001]) and higher HAZ (difference, 0.16 [95% CI, 0.05 to 0.27]) compared with children who did not have underweight in the first 2 years. CONCLUSIONS AND RELEVANCE In this prospective cohort study, children with underweight in the first 2 years of life had lower zBMI and HAZ in later childhood. These associations were attenuated among children with a higher growth rate in the first 2 years.
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Affiliation(s)
- Courtney A. South
- Department of Pediatrics, St Michael’s Hospital, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles D. G. Keown-Stoneman
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Catherine S. Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Stanley H. Zlotkin
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jonathon L. Maguire
- Department of Pediatrics, St Michael’s Hospital, Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
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Pre-operative nutritional status and its association with short-term post-operative outcomes in Iranian children with CHD. Cardiol Young 2022; 33:579-589. [PMID: 35695155 DOI: 10.1017/s1047951122001305] [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: 11/07/2022]
Abstract
BACKGROUND Nutritional assessment appears to be an essential component of the evaluation of children with CHD undergoing surgery because nutritional status may impact corrective surgery-associated morbidity. METHODS A prospective single-centre cohort study with children between 6 and 24 months of age. Patients who had genetic syndromes or those who were premature or low birthweight at birth were excluded. Pre-operative nutritional parameters included anthropometric measurements and serum concentrations of total protein, vitamin D, iron, and ferritin. Outcome measures included ICU length of stay, mechanical ventilation, vasoactive-inotropic score, and duration of inotropes. Linear regression analysis was performed to determine whether pre-operative variables were associated with outcomes. RESULTS Analysis was performed on 120 patients (median age of 8 months), of whom 67 were male. Prior to surgery, 50.8% of patients had reduced (z ≤ -2.0) weight-for-age z score, 23.3% had reduced length-for-age z score, and 59.2% had reduced mid-upper arm circumference z score. Pre-operative serum total protein levels were 59.36 ± 9.16 g/L. Multiple regression analysis showed that low serum protein was associated with longer ICU length of stay and length of mechanical ventilation, while mid-upper arm circumference z score ≤ -2 was associated with longer ICU length of stay and mechanical ventilation and inotropes duration. CONCLUSIONS Pre-operative assessment of nutritional status by performing anthropometric and biochemical measurements including mid-upper arm circumference z score and serum protein concentrations in children undergoing CHD surgery appears to be predictors of some post-operative short-term outcomes and could be used as a guide to highlight patients needing appropriate perioperative nutritional interventions.
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44
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Cao LL, Gaffney LK, Marcus C. Hypokalemia-Induced Rhabdomyolysis in a Child with Autism Affected by the COVID-19 Pandemic. J Dev Behav Pediatr 2022; 43:e356-e360. [PMID: 34740217 DOI: 10.1097/dbp.0000000000001035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/23/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Pediatric patients with autism spectrum disorder (ASD) often have coexisting feeding disorders. We hope to emphasize the significant implications that these feeding disorders can have on this patient population through a unique case of hypokalemia-induced rhabdomyolysis. METHOD We present a unique case of a 3-year-old boy with ASD and a longstanding history of food selectivity whose routine was disrupted during the COVID-19 pandemic resulting in avoidant/restrictive food intake disorder and severe undernutrition, who presented with profound hypokalemia and was subsequently found to have elevated muscle enzymes consistent with rhabdomyolysis despite only subtle complaints of difficulty walking. RESULTS The patient was treated with aggressive hydration, electrolyte therapy, and nasogastric tube feeds, which resulted in clinical and biochemical evidence of improvement. He was also reconnected to ASD-related care services that had lapsed during the COVID-19 pandemic. CONCLUSION This case exemplifies the adverse impact that feeding disorders can have on patients with ASD, particularly in the setting of stressors such as a global pandemic, and is also the first documented pediatric case of rhabdomyolysis secondary to hypokalemia from severe undernutrition. It demonstrates that physicians should have a low threshold to assess for clinical and laboratory evidence of rhabdomyolysis in patients with profound hypokalemia because symptoms of hypokalemia-induced rhabdomyolysis can often be subtle, which can delay diagnosis and thereby increase the risk for life-threatening complications from extensive muscle damage.
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Affiliation(s)
- Longyue L Cao
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; and
- Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Lukas K Gaffney
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; and
- Department of Pediatrics, Boston Medical Center, Boston, MA
| | - Carolyn Marcus
- Department of Pediatrics, Boston Children's Hospital, Boston, MA; and
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45
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Carter L, Hulst JM, Afzal N, Jeejeebhoy K, Brunet-Wood K. Update to the pediatric Subjective Global Nutritional Assessment (SGNA). Nutr Clin Pract 2022; 37:1448-1457. [PMID: 35594373 DOI: 10.1002/ncp.10859] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 04/02/2022] [Indexed: 11/12/2022] Open
Abstract
Lack of a standardized method of identifying and defining pediatric malnutrition has led to an inability to fully understand the prevalence of and impact that malnutrition has on pediatric patients and the healthcare system. The Subjective Global Nutritional Assessment (SGNA) is an assessment tool meant to determine presence and severity of malnutrition in pediatric populations. However, the anthropometric section of the tool contains some out-dated parameters. This has limited its clinical practicality. The aim of this paper is to propose updates to the anthropometrics section of the SGNA. A retrospective analysis of 153 SGNA's performed on children aged 1 month to 16 years was completed, comparing the original SGNA results to SGNA results incorporating updated anthropometric parameters for percentiles and ideal body weight. The category of length/height for age was updated to include z score cutoffs rather than percentiles, and ideal body weight was updated to z scores for weight for length or body mass index (BMI). Two serial growth questions were updated in wording only, to reflect z score trends. The results of the analysis showed these updates would have changed the rankings of eight patients (5%) for length/height for age, and 20 patients (13%) for ideal body weight to weight for length or BMI. Adjustments to these questions did not impact the overall SGNA rating. This study shows updates to the SGNA are not expected to have a significant impact on the validity of the tool and has the potential to improve its applicability to current day practice.
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Affiliation(s)
- Laura Carter
- Alberta Health Services, Nutrition Services, Edmonton, Alberta, Canada
| | - Jessie M Hulst
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics and Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Canadian Malnutrition Task Force, Edmonton, Alberta, Canada
| | - Nooran Afzal
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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46
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Development and Validation of a New Screening Tool with Non-Invasive Indicators for Assessment of Malnutrition Risk in Hospitalised Children. CHILDREN 2022; 9:children9050731. [PMID: 35626908 PMCID: PMC9140013 DOI: 10.3390/children9050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
There is no evidence of the most effective nutritional screening tool for hospitalized children. The present study aimed to develop a quick, simple, and valid screening tool for identifying malnutrition risk of hospital admission with non-invasive indicators. A cross-sectional study was conducted. Children`s nutritional baseline using a questionnaire, subjective malnutritional risk, and Subjective Global Nutritional Assessment were assessed on admission. Concurrent validity was assessed using American Society for Parenteral and Enteral Nutrition (ASPEN)and Academy of Nutrition and Dietetics assessment and Subjective Global Nutritional Assessment tool. A new screening tool Simple Pediatric Nutritional risk Screening tool (SPENS) was developed, and sensitivity, specificity and reliability were evaluated. A total of 180 children aged from 1 month to 18 years were included (142 in the development phase and 38 in the validation phase). SPENS consist of four variables and shows almost perfect agreement with subjective malnutritional risk assessment (κ = 0.837) with high sensitivity and specificity (93.3% and 91.3% respectively). Compared with Subjective Global Nutritional Assessment and ASPEN and Academy of Nutrition and Dietetics assessment, SPENS had sensitivity 92.9% and 86.7%, a specificity of 87.5% and 87.0%, and an overall agreement of 0.78 and 0.728, respectively. Due to the fast, simple, easy, and practical to use, screening the SPENS can be performed by nurses, physicians, and dieticians.
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47
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Lezo A, Diamanti A, Marinier EM, Tabbers M, Guz-Mark A, Gandullia P, Spagnuolo MI, Protheroe S, Peretti N, Merras-Salmio L, Hulst JM, Kolaček S, Ee LC, Lawrence J, Hind J, D’Antiga L, Verlato G, Pukite I, Di Leo G, Vanuytsel T, Doitchinova-Simeonova MK, Ellegard L, Masconale L, Maíz-Jiménez M, Cooper SC, Brillanti G, Nardi E, Sasdelli AS, Lal S, Pironi L. Chronic Intestinal Failure in Children: An International Multicenter Cross-Sectional Survey. Nutrients 2022; 14:nu14091889. [PMID: 35565856 PMCID: PMC9103944 DOI: 10.3390/nu14091889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The European Society for Clinical Nutrition and Metabolism database for chronic intestinal failure (CIF) was analyzed to investigate factors associated with nutritional status and the intravenous supplementation (IVS) dependency in children. Methods: Data collected: demographics, CIF mechanism, home parenteral nutrition program, z-scores of weight-for-age (WFA), length or height-for-age (LFA/HFA), and body mass index-for-age (BMI-FA). IVS dependency was calculated as the ratio of daily total IVS energy over estimated resting energy expenditure (%IVSE/REE). Results: Five hundred and fifty-eight patients were included, 57.2% of whom were male. CIF mechanisms at age 1−4 and 14−18 years, respectively: SBS 63.3%, 37.9%; dysmotility or mucosal disease: 36.7%, 62.1%. One-third had WFA and/or LFA/HFA z-scores < −2. One-third had %IVSE/REE > 125%. Multivariate analysis showed that mechanism of CIF was associated with WFA and/or LFA/HFA z-scores (negatively with mucosal disease) and %IVSE/REE (higher for dysmotility and lower in SBS with colon in continuity), while z-scores were negatively associated with %IVSE/REE. Conclusions: The main mechanism of CIF at young age was short bowel syndrome (SBS), whereas most patients facing adulthood had intestinal dysmotility or mucosal disease. One-third were underweight or stunted and had high IVS dependency. Considering that IVS dependency was associated with both CIF mechanisms and nutritional status, IVS dependency is suggested as a potential marker for CIF severity in children.
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Affiliation(s)
- Antonella Lezo
- Department of Clinical Nutrition, OIRM-S, Anna Hospital, Città della Salute e della Scienza, 10126 Turin, Italy;
| | | | - Evelyne M. Marinier
- Service des Maladies Digestives et Respiratoires de l’Enfant, Centre de Référence des Maladies Digestives Rares, Hôpital R Debré, 75019 Paris, France;
| | - Merit Tabbers
- Emma Children’s Hospital/Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy, IRCCS G, Gaslini Institute, 16147 Genoa, Italy;
| | - Maria I. Spagnuolo
- Section of Paediatrics, Department of Translational Medical Science, University of Naples Federico II, 80138 Naples, Italy;
| | - Sue Protheroe
- Department of Gastroenterology and Nutrition, Birmingham Children’s Hospital NHS Trust, Birmingham B4 6NH, UK;
| | - Noel Peretti
- Paediatric Hospital “Femme Mère Enfant de Lyon”, 69677 Lyon, France;
| | - Laura Merras-Salmio
- Pediatric Gastroenterology Unit, Helsinki University Hospital, Children’s Hospital Helsinki, 00290 Helsinki, Finland;
| | - Jessie M. Hulst
- Erasmus Medical Center, Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
| | - Sanja Kolaček
- Children’s Hospital Zagreb, Zagreb Medical University, 10000 Zagreb, Croatia;
| | - Looi C. Ee
- Queensland Children’s Hospital, Brisbane, QLD 4101, Australia;
| | | | - Jonathan Hind
- Paediatric Liver, GI and Nutrition Centre, King’s College Hospital, London SE5 9RS, UK;
| | - Lorenzo D’Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, “Papa Giovanni XXIII” Hospital, 24127 Bergamo, Italy;
| | - Giovanna Verlato
- Paediatric Nutrition Service-Neonatal Intensive Care Unit, University Hospital of Padova, 35128 Padova, Italy;
| | - Ieva Pukite
- University Children Hospital, LV-1004 Riga, Latvia;
| | - Grazia Di Leo
- Pediatric Department, University of Trieste, IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Tim Vanuytsel
- University Hospital Leuven, Leuven Intestinal Failure and Transplantation (LIFT), 3000 Leuven, Belgium;
| | | | - Lars Ellegard
- Sahlgrenska University Hospital, Institute of Medicine, Departement of Internal Medicine and Clinical Nutrition, University of Gothenburg, 41390 Gothenburg, Sweden;
| | | | - María Maíz-Jiménez
- Department of Endocrinology and Nutrition, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Sheldon C. Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Giorgia Brillanti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Anna S. Sasdelli
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford M6 8HD, UK;
| | - Loris Pironi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy;
- Clinical Nutrition and Metabolism Unit, Center for Chronic Intestinal Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bolohna, Italy;
- Correspondence:
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Malekiantaghi A, AsnaAshari K, Shabani-Mirzaee H, Vigeh M, Sadatinezhad M, Eftekhari K. Evaluation of the risk of malnutrition in hospitalized children by PYMS, STAMP, and STRONGkids tools and comparison with their anthropometric indices: a cross-sectional study. BMC Nutr 2022; 8:33. [PMID: 35449119 PMCID: PMC9027700 DOI: 10.1186/s40795-022-00525-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Malnutrition is a determining factor of pediatric mortality and morbidity, especially in low and middle-income countries. Hospitalized children are at a higher risk of malnutrition. Several malnutrition screening tools have been used, among which STAMP, PYMS, and STRONGkids are valid tools with high sensitivity and specificity. The aim of this study was to compare these screening tools to find the best ones in identifying the risk of malnutrition in hospitalized children. Methods This is a cross-sectional study performed on hospitalized children aged 1 to 16 years. The questionnaires of PYMS, STAMP, STRONGkids malnutrition risk assessment tools were filled. The weight for height and BMI for age Z-scores were calculated. The data were analyzed by SPSS. Sensitivity, specificity, positive predictive value, and negative predictive values of the risk scores based on weight for height and BMI for age Z-scores were calculated. Results Ninety-three patients with a mean age of 5.53 ± 3.9 years were included. The frequency of malnutrition was reported as 26% and 39% according to weight for height and BMI for age Z-scores, respectively. A significant relationship was found between PYMS and Weight for height Z-score (P-value < 0.001), and BMI for age Z-score (P-value < 0.001). Moreover, STRONGkids was found to be associated with weight for height Z-score (P-value: 0.017). Conclusion The PYMS is a practical and beneficial tool in early identifying the risk of severe malnutrition in hospitalized patients. It is a suitable method for patients in our settings. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00525-8.
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Affiliation(s)
- Armen Malekiantaghi
- Pediatric department, Pediatric Gastroenterology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kosar AsnaAshari
- Pediatric department, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabani-Mirzaee
- Pediatric department, Pediatric Endocrinology and Metabolism, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Vigeh
- Maternal-Fetal Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadatinezhad
- Pediatric department, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Eftekhari
- Pediatric department, Pediatric Gastroenterology and Hepatology Research Center, Bahrami Children Hospital, Tehran University of Medical Sciences, Kiaee Street, 1641744991, Tehran, Iran.
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49
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Lu Y, Nyunt MSZ, Gao Q, Gwee X, Chua DQ, Yap KB, Pan F, Ng TP. Malnutrition Risk and Kidney Function and Decline in Community-Dwelling Older Adults. J Ren Nutr 2022; 32:560-568. [PMID: 35300925 DOI: 10.1053/j.jrn.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/26/2021] [Accepted: 09/05/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The association of malnutrition with chronic kidney disease (CKD) is well established. However, there is a paucity of studies of the effect of malnutrition risk (MR) on kidney function decline among older persons who do not have end-stage or dialyzable CKD. This study aimed to examine the association between MR status and kidney function, and future risks of kidney function decline and CKD progression in community-dwelling older adults. DESIGN AND METHODS Nutrition Screening Initiative's DETERMINE Your Nutritional Health Checklist and estimated glomerular filtration rate (eGFR) were assessed at baseline among 5,122 participants free of end-stage renal failure or dialyzed CKD in the Singapore Longitudinal Aging Studies (SLAS-1 and SLAS-2). Follow-up eGFR was assessed in a subcohort of SLAS-2 participants without CKD (eGFR > 60 mL/min/1.73 m2) at baseline (N = 786) who were followed up at 3-5 years. RESULTS In baseline cross-sectional analyses adjusting for other risk factors, low, moderate, and high MR was significantly associated with decreasing eGFR coefficients of -1.5, -3.3, and -5.0 mL/min/1.73 m2 respectively, and increasing CKD odds ratios of 1.81, 2.18, and 3.11 respectively. In longitudinal analysis, low, moderate, and high MR was significantly associated with increased risk of eGFR (>25%) decline (odds ratio of 2.37, 3.34, and 2.18 respectively). CONCLUSIONS Among older adults without advanced kidney disease, MR is associated with poor kidney function and increased risk of kidney function decline and CKD. Preventive interventions to modify MR may help to reduce the deterioration of renal function in older people.
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Affiliation(s)
- Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ma Shwe Zin Nyunt
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xinyi Gwee
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Denise Ql Chua
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keng Bee Yap
- Department of Geriatric Medicine, Ng Teng Fong General Hospital, Singapore
| | - Fang Pan
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Tze Pin Ng
- Gerontology Research Programme, Department of Psychological Medicine, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Hobbie WL, Li Y, Carlson C, Goldfarb S, Laskin B, Denburg M, Goldmuntz E, Mostoufi-Moab S, Wilkes J, Smith K, Sacks N, Szalda D, Ginsberg JP. Late effects in survivors of high-risk neuroblastoma following stem cell transplant with and without total body irradiation. Pediatr Blood Cancer 2022; 69:e29537. [PMID: 34971017 DOI: 10.1002/pbc.29537] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neuroblastoma is the most common extracranial solid tumor in children. Those with high-risk disease are treated with multimodal therapy, including high-dose chemotherapy, stem cell transplant, radiation, and immunotherapy that have led to multiple long-term complications in survivors. In the late 1990s, consolidation therapy involved myeloablative conditioning including total body irradiation (TBI) with autologous stem cell rescue. Recognizing the significant long-term toxicities of exposure to TBI, more contemporary treatment protocols have removed this from conditioning regimens. This study examines an expanded cohort of 48 high-risk neuroblastoma patients to identify differences in the late effect profiles for those treated with TBI and those treated without TBI. PROCEDURE Data on the study cohort were collected from clinic charts, provider documentation in the electronic medical record of visits to survivorship clinic, including all subspecialists, and ancillary reports of laboratory and diagnostic tests done as part of risk-based screening at each visit. RESULTS All 48 survivors of BMT for high-risk neuroblastoma had numerous late effects of therapy, with 73% having between five and 10 late effects. TBI impacted some late effects significantly, including growth hormone deficiency (GHD), bone outcomes, and cataracts. CONCLUSION Although high-risk neuroblastoma survivors treated with TBI have significant late effects, those treated without TBI also continue to have significant morbidity related to high-dose chemotherapy and local radiation. A multidisciplinary care team assists in providing comprehensive care to those survivors who are at highest risk for significant late effects.
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Affiliation(s)
- Wendy L Hobbie
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yimei Li
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Claire Carlson
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel Goldfarb
- Division of Pulmonary and Sleep Medicine, Masonic Children's Hospital, Minneapolis, Minnesota, USA.,University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Benjamin Laskin
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michelle Denburg
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth Goldmuntz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Endocrinology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Wilkes
- Department of Pediatrics, Cancer and Blood Disorders Center, Seattle, Washington, USA.,University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Nancy Sacks
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dava Szalda
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill P Ginsberg
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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